Highlights & Basics
- Severe acute respiratory syndrome (SARS) is an emerging infectious disease responsible for the first pandemic of the 21st century; there have been no reported cases since 2004.
- Infection control precautions are of paramount importance; transmission is usually caused by direct contact with infected individuals through respiratory droplets.
- Reverse-transcription polymerase chain reaction (RT-PCR) is the test of choice for confirming diagnosis.
- Treatment is mainly supportive; neither specific therapy nor a vaccine is available.
- Fatality rate is about 10% and death usually occurs due to severe respiratory failure.
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History & Exam
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Definition
Epidemiology
Etiology
Pathophysiology
Citations
Christian MD, Poutanen SM, Loutfy MR, et al. Severe acute respiratory syndrome. Clin Infect Dis. 2004;38:1420-1427.[Abstract][Full Text]
Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767-1772.[Abstract]
Mahony JB, Richardson S. Molecular diagnosis of severe acute respiratory syndrome: the state of the art. J Mol Diagn. 2005;7:551-559.[Abstract]
Peiris JS, Yuen KY, Osterhaus AD, et al. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431-2441.[Abstract]
Fowler RA, Lapinsky SE, Hallet D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367-373.[Abstract][Full Text]
1. Christian MD, Poutanen SM, Loutfy MR, et al. Severe acute respiratory syndrome. Clin Infect Dis. 2004;38:1420-1427.[Abstract][Full Text]
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11. Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767-1772.[Abstract]
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33. Grant PR, Garson JA, Teddar RS, et al. Detection of SARS coronavirus in plasma by real-time RT-PCR. N Engl J Med. 2003;349:2468-2469.[Abstract]
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36. Das D, Kammila S, Suresh MR. Development, characterization, and application of monoclonal antibodies against severe acute respiratory syndrome coronavirus nucleocapsid protein. Clin Vaccine Immunol. 2010;17:2033-2036.[Abstract][Full Text]
37. Peiris JS, Yuen KY, Osterhaus AD, et al. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431-2441.[Abstract]
38. Hon KL, Leung CW, Cheng WT, et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet. 2003;361:1701-1703.[Abstract]
39. Lau KK, Yu WC, Chu CM, et al. Possible central nervous system infection by SARS coronavirus. Emerg Infect Dis. 2004;10:342-344.[Abstract]
40. Fisher DA, Lim TK, Lim YT, et al. Atypical presentations of SARS. Lancet. 2003;361:1740.[Abstract]
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44. Wong SS, Yuen KY. The management of coronavirus infections with particular reference to SARS. J Antimicrob Chemother. 2008;62:437-441.[Abstract][Full Text]
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46. Centers for Disease Control and Prevention. Public health guidance for community-level preparedness and response to severe acute respiratory syndrome (SARS), version 2/3. Supplement D: community containment measures, including non-hospital isolation and quarantine. Jan 2004 [internet publication].[Full Text]
47. Donnelly CA, Ghani AC, Leung GM, et al. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361:1761-1766.[Abstract]
48. Wang YH, Lin AS, Chao TY, et al. A cluster of patients with severe acute respiratory syndrome in a chest ward in southern Taiwan. Intensive Care Med. 2004;30:1228-1231.[Abstract]
49. Fowler RA, Lapinsky SE, Hallet D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367-373.[Abstract][Full Text]
50. Lew TW, Kwek TK, Tai D, et al. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:374-80.[Abstract]
51. Esquinas AM, Egbert Pravinkumar S, Scala R, et al; International NIV Network. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review. Eur Respir Rev. 2014;23:427-438.[Abstract][Full Text]
52. Levy MM, Baylor MS, Bernard GR, et al. Clinical issues and research in respiratory failure from severe acute respiratory syndrome. Am J Respir Crit Care Med. 2005;171:518-26.[Abstract]
53. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67.[Abstract][Full Text]
54. Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004;59:252-256.[Abstract][Full Text]
55. Chen RC, Tang XP, Tan SY, et al. Treatment of severe acute respiratory syndrome with glucosteroids: the Guangzhou experience. Chest. 2006;129:1441-1452.[Abstract][Full Text]
56. Ho JC, Wu AY, Lam B, et al. Pentaglobin in steroid-resistant severe acute respiratory syndrome. Int J Tuberc Lung Dis. 2004;8:1173-1179.[Abstract]
57. Ströher U, DiCaro A, Li Y, et al. Severe acute respiratory syndrome-related coronavirus is inhibited by interferon- alpha. J Infect Dis. 2004;189:1164-1167.[Abstract][Full Text]
58. Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. 2006;3:e343.[Abstract][Full Text]
59. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al; Convalescent Plasma Study Group. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis. 2015;211:80-90.[Abstract][Full Text]
60. Maunder RG, Lancee WJ, Balderson KE, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis. 2006;12:1924-1932.[Abstract][Full Text]
61. Pollock A, Campbell P, Cheyne J, et al. Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review. Cochrane Database Syst Rev. 2020 Nov 5;11:CD013779.[Abstract][Full Text]
62. Chen L, Liu P, Gao H, et al. Inhalation of nitric oxide in the treatment of severe acute respiratory syndrome: a rescue trial in Beijing. Clin Infect Dis. 2004;39:1531-1535.[Abstract]
63. Akerström S, Gunalan V, Keng CT, et al. Dual effect of nitric oxide on SARS-CoV replication: viral RNA production and palmitoylation of the S protein are affected. Virology. 2009 Dec 5;395(1):1-9.[Abstract][Full Text]
64. Liu X, Zhang M, He L, et al. Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS). Cochrane Database Syst Rev. 2012;(10):CD004882.[Abstract][Full Text]
65. Coughlin M, Lou G, Martinez O, et al. Generation and characterization of human monoclonal neutralizing antibodies with distinct binding and sequence features against SARS coronavirus using XenoMouse. Virology. 2007;361:93-102.[Abstract]
66. Chang Z, Babiuk LA, Hu J. Therapeutic and prophylactic potential of small interfering RNAs against severe acute respiratory syndrome: progress to date. BioDrugs. 2007;21:9-15.[Abstract]
67. Li SW, Wang CY, Jou YJ, et al. SARS coronavirus papain-like protease induces Egr-1-dependent up-regulation of TGF-beta1 via ROS/p38 MAPK/STAT3 pathway. Sci Rep. 2016 May 13;6:25754.[Abstract][Full Text]
68. Millet JK, Kien F, Cheung CY, et al. Ezrin interacts with the SARS coronavirus Spike protein and restrains infection at the entry stage. PLoS One. 2012;7(11):e49566.[Abstract][Full Text]
69. Barnard DL, Day CW, Bailey K, et al. Evaluation of immunomodulators, interferons and known in vitro SARS-coV inhibitors for inhibition of SARS-coV replication in BALB/c mice. Antivir Chem Chemother. 2006;17:275-284.[Abstract]
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71. Zhou N, Pan T, Zhang J, et al. Glycopeptide antibiotics potently inhibit cathepsin L in the late endosome/lysosome and block the entry of Ebola virus, Middle East respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus (SARS-CoV). J Biol Chem. 2016 Apr 22;291(17):9218-32.[Abstract][Full Text]
72. Balzarini J, Keyaerts E, Vijgen L, et al. Inhibition of feline (FIPV) and human (SARS) coronavirus by semisynthetic derivatives of glycopeptide antibiotics. Antiviral Res. 2006;72:20-33.[Abstract]
73. Tang F, Quan Y, Xin ZT, et al. Lack of peripheral memory B cell responses in recovered patients with severe acute respiratory syndrome: a six-year follow-up study. J Immunol. 2011;186:7264-7268.[Abstract]
74. Li J, Ulitzky L, Silberstein E, et al. Immunogenicity and protection efficacy of monomeric and trimeric recombinant SARS coronavirus spike protein subunit vaccine candidates. Viral Immunol. 2013;26:126-132.[Abstract][Full Text]
75. Chen WH, Du L, Chag SM, et al. Yeast-expressed recombinant protein of the receptor-binding domain in SARS-CoV spike protein with deglycosylated forms as a SARS vaccine candidate. Hum Vaccin Immunother. 2014;10:648-658.[Abstract]
76. Maxwell C, McGeer A, Tai KFY, Sermer M. No. 225-management guidelines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syndrome (SARS). J Obstet Gynaecol Can. 2017;39(8):e130-7.[Full Text]
77. The College of Physicians and Surgeons of Ontario. Infection prevention and control for clinical office practice. April 2015 [internet publication].[Full Text]
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80. Chan JW, Ng CK, Chan YH, et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax. 2003;58;686-689.[Abstract]
81. Wong RS, Wu A, To KF, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ. 2003;326:1358-1362.[Abstract][Full Text]
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83. Chiu WK, Cheung PC, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med. 2003;4:279-283.[Abstract]
84. Bitnun A, Allen U, Heurter H, et al. Children hospitalized with severe acute respiratory syndrome-related illness in Toronto. Pediatrics. 2003;112:e261.[Abstract][Full Text]
85. Tansey CM, Louie M, Loeb M, et al. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med. 2007;167:1312-1320.[Abstract][Full Text]
86. Moldofsky H, Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011;11:37.[Abstract][Full Text]
87. Xie L, Liu Y, Xiao Y, et al. Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge. Chest. 2005;127:2119-2124.[Abstract][Full Text]
88. Tsai LK, Hsieh ST, Chang YC. Neurological manifestations in severe acute respiratory syndrome. Acta Neurol Taiwan. 2005;14:113-119.[Abstract]
89. Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191:292-297.[Abstract]
90. Griffith JF, Antonio GE, Kumta SM, et al. Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids. Radiology. 2005;235:168-175.[Abstract]
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92. Lai TS, Yu WC. The lessons of SARS in Hong Kong. Clin Med. 2010;10:50-53.[Abstract]
93. Yen MY, Lin YE, Lee CH, et al. Taiwan's traffic control bundle and the elimination of nosocomial severe acute respiratory syndrome among healthcare workers. J Hosp Infect. 2011;77:332-337.[Abstract]
94. Naylor CD, Chantler C, Griffiths S. Learning from SARS in Hong Kong and Toronto. JAMA. 2004;291:2483-2487.[Abstract]
95. Smith JD, MacDougall CC, Johnstone J, et al. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMAJ. 2016;188:567-574.[Abstract][Full Text]
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