Lesens O, Hustache-Mathieu L, Hansmann Y, Remy V, Hoen B, Christmann D
Service des maladies infectieuses et tropicales, Clinique médicale A, Hôpitaux Universitaires, Strasbourg.
Presse Med. 2003 Sep 13;32(29):1359-64.
In mid-June 2003, 8500 probable cases of Severe Acute respiratory Syndrome (SARS) responsible for 800 deaths in 29 countries were reported by the World Health Organization (WHO). In France, 5 probable cases of SARS were diagnosed until May 2003. We report the case of one of the 5 French cases, hospitalized successively in Besançon then in Strasbourg.
This 54 year-old man was infected during the Air France flight from Hanoi to Paris via Bangkok by the index case, who himself had been contaminated at the French hospital in Hanoi and who was hospitalized in a critical state in the Tourcoing hospital shortly after his arrival in France. The first clinical signs (fever and dry cough) appeared 4 days after contact with the index case. The chest X-ray showed a pulmonary consolidation 6 days after the first clinical symptoms. Blood test revealed deep lymphopenia and elevated LDH. The patient finally recovered with a treatment combining ribavirin and steroids.
The clinical symptoms of SARS are unspecific and its evolution may be misleading. The epidemiological context (contact with the index case) is a key point for the diagnosis. The management of such a patient requires the careful protection of contacts, the adequation between medical and paramedical staff and excess work and communication to the general public.
2003年6月中旬，世界卫生组织（WHO）报告称，在29个国家出现了8500例可能的严重急性呼吸综合征（SARS）病例，导致800人死亡。在法国，截至2003年5月共诊断出5例可能的SARS病例。我们报告其中1例法国病例，该患者先后在贝桑松和斯特拉斯堡住院。
这名54岁男子在乘坐法航从河内经曼谷飞往巴黎的航班途中，被首例病例感染，首例病例本人在河内的法国医院受到感染，抵达法国后不久在图尔宽医院重症住院。与首例病例接触4天后出现了最初的临床症状（发热和干咳）。首次临床症状出现6天后，胸部X光显示肺部有实变。血液检查显示淋巴细胞显著减少，乳酸脱氢酶升高。患者最终通过利巴韦林和类固醇联合治疗康复。
SARS的临床症状不具特异性，其病情发展可能会产生误导。流行病学背景（与首例病例接触）是诊断的关键。对这类患者的管理需要仔细保护接触者，医护人员与辅助医护人员之间要做好协调，应对额外工作，并向公众做好沟通。
