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The Spectrum of Severe Acute Respiratory Syndrome–Associated Coronavirus Infection

Timothy H. Rainer, MD; Paul K.S. Chan, MD; Margaret Ip, MRCP; Nelson Lee, MRCP; David S. Hui, MD; DeVilliers Smit, MBChB; Alan Wu, MBChB, MRCP; Anil T. Ahuja, FRCR; John S. Tam, PhD; Joseph J.Y. Sung, MD; and Peter Cameron, MD
[+] Article and Author Information

From The Chinese University of Hong Kong, Hong Kong.


Acknowledgments: The authors thank the staff of the Department of Accident and Emergency for their dedication during the SARS crisis and for diligently ensuring the highest possible level of data capture. They also thank their research nurse, Ms. Paulina Mak, for her tireless efforts that extended beyond her contractual commitments.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Timothy H. Rainer, MD, Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Rooms 107/113, Trauma and Emergency Centre, Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, NT, Hong Kong; e-mail, rainer1091@cuhk.edu.hk.

Current Author Addresses: Dr. Rainer: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Rooms 107/113, Trauma and Emergency Centre, Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, NT, Hong Kong.

Drs. Chan, Hui, Tam, Sung, and Cameron and Ms. Ip, Mr. Lee, Mr. Smit, Mr. Wu, and Mr. Ahuja: The Chinese University of Hong Kong, Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, NT, Hong Kong.

Author Contributions: Conception and design: T.H. Rainer, P.K.S. Chan, D. Smit, P. Cameron.

Analysis and interpretation of the data: T.H. Rainer, P.K.S. Chan, M. Ip, N. Lee, P. Cameron.

Drafting of the article: T.H. Rainer, M. Ip, N. Lee, D. Smit, A. Wu, A.T. Ahuja, J.J.Y. Sung, P. Cameron.

Critical revision of the article for important intellectual content: T.H. Rainer, N. Lee, D.S. Hui, D. Smit, A. Wu, A.T. Ahuja, J.S. Tam, J.J.Y. Sung, P. Cameron.

Final approval of the article: T.H. Rainer, M. Ip, N. Lee, D.S. Hui, D. Smit, A. Wu, A.T. Ahuja, J.S. Tam, J.J.Y. Sung, P. Cameron.

Provision of study materials or patients: T.H. Rainer, N. Lee, D. Smit, A.T. Ahuja, J.J.Y. Sung.

Statistical expertise: T.H. Rainer.

Administrative, technical, or logistic support: P.K.S. Chan, J.S. Tam.

Collection and assembly of data: T.H. Rainer, D. Smit.


Ann Intern Med. 2004;140(8):614-619. doi:10.7326/0003-4819-140-8-200404200-00008
Text Size: A A A

Background: Whether subclinical or atypical presentations of severe acute respiratory syndrome (SARS) occur and whether clinical judgment is accurate in detecting SARS are unknown.

Objectives: To describe the spectrum of SARS coronavirus infection in a large outbreak and to compare diagnoses based on clinical judgment with the SARS coronavirus test.

Design: Secondary analysis of prospectively collected clinical data and archived serum.

Setting: A SARS screening clinic of a university hospital in the New Territories of Hong Kong.

Patients: 1221 patients attending the clinic between 12 March 2003 and 12 May 2003.

Measurements: SARS coronavirus serology.

Results: 145 of 553 (26%) patients had serologic evidence of SARS coronavirus infection. Of 910 patients who were managed without hospitalization, only 6 had serologic evidence of SARS. Five of the six patients had normal chest radiographs, and four had symptoms such as myalgia, chills, coughing, and feeling feverish. With the SARS coronavirus serologic test as the gold standard, the clinical diagnosis of probable SARS at hospitalization had a sensitivity of 0.96 (95% CI, 0.91 to 0.98) and a specificity of 0.96 (CI, 0.92 to 0.97).

Limitations: Follow-up serologic samples were not obtained from almost half of the patients because they declined further testing. Some people living in the community who were infected but who had minor or no symptoms might not have visited the clinic.

Conclusions: There is little evidence of widespread subclinical or mild forms of SARS coronavirus infection. Clinical diagnoses during the outbreak were reasonable and resulted in appropriate triaging.

Figures

Grahic Jump Location
Figure.
Accuracy of clinical decisions at hospitalization or discharge from the clinic and at discharge from hospital.

SARS = severe acute respiratory syndrome.

Grahic Jump Location

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Summary for Patients

Do Some Patients with SARS Have Mild Disease?

The summary below is from the full report entitled “The Spectrum of Severe Acute Respiratory Syndrome–Associated Coronavirus Infection.” It is in the 20 April 2004 issue of Annals of Internal Medicine (volume 140, pages 614-619). The authors are T.H. Rainer, P.K.S. Chan, M. Ip, N. Lee, D.S. Hui, D. Smit, A. Wu, A.T. Ahuja, J.S. Tam, J.J.Y. Sung, and P. Cameron.

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