Fan Cheng Kuo, Yieh Kuo Ming, Peng Ming Yieh, Lin Jung Chung, Wang Ning Chi, Chang Feng Yee
Department of Internal Medicine, Tao-Yuan Armed Forces General Hospital, Tao-Yuan County, Taiwan.
J Microbiol Immunol Infect. 2006 Feb;39(1):45-53.
To characterize the clinical and laboratory features of severe acute respiratory syndrome (SARS) in the early stage and to compare them with those of patients initially suspected of having SARS who were later determined to have other febrile diseases.
Between March and June 2003, 122 patients with possible SARS were admitted to the isolation ward of Tri-Service General Hospital. SARS was diagnosed according to the modified World Health Organization case definition (May 1, 2003). Among them, 43 were classified as probable SARS cases and a SARS etiology was excluded in 32 patients.
Presenting symptoms on admission included fever (97.7% of probable cases, 84.4% of excluded cases), chills (39.5% vs 18.8%), cough with sputum production (16.3% vs 40.6%), dry cough (23.3% vs 9.4%), dyspnea (18.6% vs 9.4%), diarrhea (14.0% vs none), rhinorrhea (2.3% vs none), and myalgia (7.0% vs 6.6%). Common laboratory features included lymphopenia and elevated aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, C-reactive protein and creatine kinase values. Intubation and mechanical ventilation were required in 12 probable cases and 6 excluded cases. Five patients with probable SARS (11.6%) died. A scoring system which was developed to differentiate SARS patients from other febrile patients in the emergency room could differentiate probable cases from excluded cases with a sensitivity of 36.4% and a specificity of 70.6%.
The clinical presentation and laboratory features at the early stage do not allow differentiation of patients with SARS-CoV infection from other febrile patients. Thus, it is mandatory for all healthcare workers to strictly follow standard isolation precautions during an outbreak to minimize disease transmission.
描述严重急性呼吸综合征（SARS）早期的临床和实验室特征，并将其与最初疑似SARS但后来确诊为其他发热性疾病的患者的特征进行比较。
2003年3月至6月期间，122例可能患有SARS的患者被收治入三军总医院隔离病房。根据修改后的世界卫生组织病例定义（2003年5月1日）诊断SARS。其中，43例被归类为疑似SARS病例，32例患者排除了SARS病因。
入院时的症状包括发热（疑似病例的97.7%，排除病例的84.4%）、寒战（39.5%对18.8%）、咳痰咳嗽（16.3%对40.6%）、干咳（23.3%对9.4%）、呼吸困难（18.6%对9.4%）、腹泻（14.0%对无）、流涕（2.3%对无）和肌痛（7.0%对6.6%）。常见的实验室特征包括淋巴细胞减少以及天冬氨酸转氨酶、丙氨酸转氨酶、乳酸脱氢酶、C反应蛋白和肌酸激酶值升高。12例疑似病例和6例排除病例需要插管和机械通气。5例疑似SARS患者（11.6%）死亡。为在急诊室区分SARS患者与其他发热患者而开发的评分系统，区分疑似病例与排除病例的敏感性为36.4%，特异性为70.6%。
早期的临床表现和实验室特征无法区分SARS-CoV感染患者与其他发热患者。因此，在疫情暴发期间，所有医护人员必须严格遵循标准的隔离预防措施，以尽量减少疾病传播。
