SARS (SEVERE ACUTE RESPIRATORY SYNDROME)

Severe acute respiratory syndrome is a respiratory infection

caused by a virus. It is also known as SARS. SARS was first
reported in Asia in 2003. It spread worldwide over several
months before the outbreak ended. SARS is spread mainly by
close person to person contact. Frequently washing your
hands with soap and water might prevent infection. SARS
can be life threatening. This program helps you understand
SARS, including symptoms and causes. It also talks about the
diagnosis and treatment of this infection.
HISTORY: SARS virus was first reported in 2002 in Asia and
cases were reported until mid-year 2003. According to the
World Health Organization (WHO), as of July 2003, a total of
8,437 people worldwide become ill with SARS and 813 died
during the outbreak or epidemic.
DISCOVERY: World Health Organization (WHO) physician Dr.
Carlo Urbani identified SARS as a new disease in 2003. He
diagnosed it in a 48-year-old businessman who had traveled
from the Guangdong province of China, through Hong Kong,
to Hanoi, Vietnam.
SARS (severe acute respiratory syndrome) originated in
animals and made the leap from animal to human infection
somewhere in the Guangdong province of China in late 2002.
The condition was relatively contained for several months.
Phylogenetic analysis of these viruses indicated a high
probability that SARScoronavirus originated in bats and
spread to humans either directly or through animals held in
Chinese markets. The bats did not show any visible signs of
disease, but are the likely natural reservoir of SARS-like
coronaviruses.
SARS stands for Severe Acute Respiratory Syndrome. It is a
severe respiratory illness that is caused by a previously
unkown type of virus. The SARS virus is a type of virus known
as a coronavirus.
CHARACTERISITICS OF SARS:
Characteristics of SARS-Associated Coronovirus (SARS-CoV)
The SARS-associated coronavirus is physically a typical
coronavirus. Their shape – A core of genetic material
surrounded by a spherical protein shell, characterizes
Coronaviruses. The protein shell is covered with extruding
surface proteins that create a halo, or corona, when viewed

with electron micrography.

Stability and Resistance of the SARS-Associated Coronavirus:
Virus survival in stool and urine:
*Virus is stable in feces (and urine) at room temperature for
at least 1-2 days.
*Virus is more stable (up to 4 days) in stool from diarrhea
patients (which has higher pH than normal stool).
Disinfectants: Virus loses infectivity after exposure to
different commonly used disinfectants and fixatives.
Virus survival in cell-culture supernatant:
*Only minimal reduction in virus concentration after 21 days
at 4°C and -80°C.
*Reduction in virus concentration by one log only at stable
room temperature for 2 days. This would indicate that the
virus is more stable than the known human coronaviruses
under these conditions.
*Heat at 56°C kills the SARS coronavirus at around 10000
units per 15 min (quick reduction).
Fixatives (for use in laboratories only):
*SARS virus fixation (killing) on glass slides for
immunofluorescence assays in room temperature does not
kill virus efficiently unless the acetone is cooled down to -
20oC.
Characteristics of the Disease:
Incubation period:
*Generally 2-7 days, can be up to 10 days
Figure 1. Chest radiographs of index patient with severe
acute respiratory syndrome (SARS). a, day 5 of symptoms; b,

day 10; c, day 13; d, day 15.

SYMPTOMS: The hallmark symptoms are:
 Cough
 Difficulty breathing
 Fever greater than 100.4 degrees F (38.0 degrees C)
 Other breathing symptoms
The most common symptoms are:
 Chills and shaking
 Cough -- usually starts 2-3 days after other symptoms
 Fever
 Headache
 Muscle aches
Less common symptoms include:
 Cough that produces phlegm (sputum)
 Diarrhea
 Dizziness
 Nausea and vomiting
 Runny nose
 Sore throat
In some people, the lung symptoms get worse during the
second week of illness, even after the fever has stopped.
CAUSES:
SARS is caused by a type of coronavirus. Coronavirus is a
family of viruses. It includes the virus that causes the
common cold. Viruses from the coronavirus family were not
thought to be very dangerous to humans. SARS changed this.
Like most respiratory illnesses, SARS is spread through
droplets. The droplets enter the air when an infected person
coughs or sneezes. You can get SARS if the droplets land on
your mouth, nose or eyes. Close contact with an infected
person can put you at risk for SARS. Examples of close
contact are:
* Kissing or embracing.
*Sharing utensils for eating or drinking.
*Talking to someone within 3 feet.
*Touching.
The virus may also spread through contact with a surface or
object that has been contaminated. This happens if a person
touches the surface or object and then touches his or her
mouth, nose or eyes.
Diagnosis& Test Results:
Your health care provider may hear abnormal lung sounds
while listening to your chest with a stethoscope. In most
people with SARS, changes on a chest x-ray or chest CT show
pneumonia, which is typical with SARS.
Tests used to diagnose SARS might include:
 Chest X-Ray (CXR) or chest CT scan:
In most people with SARS, changes on CXR or chest CT show
pneumonia.
 Enzyme-linked immunosorbent assay (ELISA) test:
This test detects antibodies to SARS reliably, but only 21
days after the onset of symptoms.
 Immunofluorescence assay:
This test can detect antibodies 10 days after the onset of the
disease.
 Reverse transcription polymerase chain reaction (RT-PCR)
test:
SARS-CoV can be detected in clinical specimens such as
blood, stool and nasal secretions with the help of this test.
Antibody tests for SARS:
 Serologic testing also can be performed to detect SARS-CoV
antibodies produced after infection.
 Viral culture and direct isolation of the SARS virus:
For a viral culture, a small sample of tissue or fluid that may
be infected is placed in a container along with cells in which
the virus can grow. If the virus grows in the culture, it will
cause changes in the cells that can be seen under a
microscope.
 Serologic testing:
A serologic test is a laboratory method for detecting the
presence and/or level of antibodies to an infectious agent in
serum from a person.

Blood Clotting Tests

 Complete blood count (CBC):

White blood cell (neutrophils and lymphocytes) and platelet
counts are often low.
 All current tests have some limitations:
They may not be able to easily identify a SARS case during
the first week of the illness, when it is most important.
PREVENTION:
We can prevent SARS by following good hygiene habits:
*Cough or sneeze into a tissue and ask others to do the
same.
*Do not share drinking glasses and eating utensils.
* Wash your hands often with warm, soapy water.
*Use alcohol-based gel for hand washing when soap and
water are not available.
We should also avoid close contact with people who are sick
with SARS. SARS is spread easily through close contact. If we
cannot avoid close contact or we are caring for someone
with SARS, there are steps to take to prevent infection. We
should:
*Wear disposable gloves when in contact with body fluids.
*Wear a surgical mask that covers your mouth and nose
when in the same room as an infected person.
We should also:
*Wash bedding, clothing and utensils of an infected person
in hot, soapy water.
*Use a disinfectant on surfaces or objects that may have
become contaminated.
 *To keep your immune system healthy and ready to fight
infections like SARS:
* Avoid smoking.
*Eat healthy.
*Exercise.
*Do not drink alcohol in excess.
* Reduce stress.
*Sleep well.
SUMMARY:
Severe acute respiratory syndrome, or SARS, is a respiratory
infection caused by a virus. It was first reported in Asia in
2003. The infection spread worldwide over several months
before the outbreak ended. SARS is spread mainly by close
person to person contact. Frequently washing your hands
with soap and water might prevent infection. Other ways to
prevent infection are:
* Avoiding close contact with people who are sick.
* Not sharing drinking glasses and eating utensils.
*Eating healthy, exercising and sleeping well.
If you think you may have SARS, do not hesitate to get
medical care. SARS can be life threatening.