Severe acute respiratory syndrome: clinical features, diagnosis, and management

In November 2003, a new, life-threatening, respiratory illness named severe acute respiratory syndrome (SARS) arose from Guangdong Province in China. The illness spread across the globe, caused many major outbreaks, and had an overall mortality rate of 11%. The purpose of this review is primarily to review the clinical features, diagnosis, and management of SARS, but also to comment briefly on the epidemiology and pathogen.

SARS is caused by a novel coronavirus that primarily affects the lower respiratory tract. It starts with an influenza-like illness characterized by nonspecific, systemic symptoms. This is followed by the rapid development of a non-specific bronchopneumonia associated with lower tract respiratory symptoms, or gastrointestinal symptoms. Most patients recover after a week or 2, but some go on to develop acute respiratory distress syndrome. There is no proven treatment, although cocktails of broad-spectrum antibiotics, antiviral, and immunomodulatory therapy have been tried. Secondary spread can be prevented and outbreaks brought under control provided that staff wear personal protective equipment and pay close attention to good personal hygiene, and patients are isolated. The most urgent needs at present are to develop a vaccine, to develop rapid, inexpensive, accurate diagnostic tests that can give results early in the illness and within a few hours of sampling. Other needs are to investigate which therapies have the lowest adverse event/efficacy ratios.

Up-to-date knowledge of SARS should help in early detection, isolation of high-risk patients, to reduce mortality and morbidity, and to prevent a new global epidemic arising.