A.

  Based on the reading material provided regarding SARS:

1. Differentiate the following based on the clinical definition for SARS during an
outbreak: 5 points each)

A.  Suspect Case

A person is said to have a suspected case of SARS if he/she presents the following
symptoms after November 1, 2002. Fever of >38˚C and cough or breathing difficulty plus One or
more of the following exposure during 10 days prior to onset of symptoms
 Close contact with a person who is a suspect or probable case of SARS
 History of travel to an area with recent local transmission of SARS
 Residing in an area with recent local transmission of SARS

A person may also be classified as having a suspected case of SARS if he/she has an
unexplained acute respiratory illness resulting in death after November 1 2002 but on whom
autopsy was not performed and one or more of the following exposures during the 10 days prior
to onset of symptoms.
 Close contact with a person who is a suspect or probable case of SARS
 History of travel to an area with recent local transmission of SARS
 Residing in an area with recent local transmission of SARS

 B.  Probable Case

A person is classified as having a probable case of SARS if he/she is a suspect case
with any of the following:
 With radiographic evidence of infiltrates consistent with pneumonia or respiratory
distress syndrome on chest X-ray
 Is positive for SARS coronavirus by one or more assays.
 With autopsy findings consistent with the pathology of respiratory distress syndrome
without an identifiable cause.

2.  Give one condition where re-classification of case should be made. (2.5 points)
Re-classification of case is done when the case is initially classified as suspected or
probable but has an alternative diagnosis which is able to fully explain the illness of the patient,
classification should be discarded after carefully considering the possibility of co-infection.
3.   Give 2 differential diagnoses that can mimic the clinical manifestations of SARS
(signs and symptoms and diagnostic test results). and differentiate it from SARS
infection. (10 points)

Legionella presents as pneumonia with fever, diarrhea and weakness. Chest x-ray
finding shows interstitial infiltrates, multi-lobular infiltrates and pleural effusions similar to SARS
but in SARS it will later develop into ground glass opacificatios. Hyponatremia is also
experienced by both SARS and Legionella infected patients however in SARS it will be
accompanied by hypokalemia, elevated serum creatinine, lymphopenia, leukopenia and
thrombocytopenia. Legionella urinary antigen may be used to rule out the possibility of
Legionella infection.

Mycobacterium Tuberculosis would present as symptoms similar to SARS such as

prolonged coughing and pneumonia. Some patients also develop fever and enlargement of the
liver. These signs and symptoms are similar to both TB patient and SARS however in TB
patients they would present with significant weight loss, lymphadenitis and hemoptysis. The
chest x-ray findings for both disease are quite different as TB would present with cavitary
lesions with military pattern and hilar infiltrates only while SARS would present with interstitial
infiltrates. A tuberculin skin test may be used to screen for patients with TB and be used to rule
out a possibility of TB infection.