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Article: Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective study

TitleClinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective study
Authors
Issue Date2003
PublisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lancet
Citation
Lancet, 2003, v. 361 n. 9371, p. 1767-1772 How to Cite?
AbstractBackground: We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). Methods: We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. Findings: Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. Interpretation: The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.
Persistent Identifierhttp://hdl.handle.net/10722/79193
ISSN
2015 Impact Factor: 44.002
2015 SCImago Journal Rankings: 14.638
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorPeiris, JSMen_HK
dc.contributor.authorChu, CMen_HK
dc.contributor.authorCheng, VCCen_HK
dc.contributor.authorChan, KSen_HK
dc.contributor.authorHung, IFNen_HK
dc.contributor.authorPoon, LLMen_HK
dc.contributor.authorLaw, KIen_HK
dc.contributor.authorTang, BSFen_HK
dc.contributor.authorHon, TYWen_HK
dc.contributor.authorChan, CSen_HK
dc.contributor.authorChan, KHen_HK
dc.contributor.authorNg, JSCen_HK
dc.contributor.authorZheng, BJen_HK
dc.contributor.authorNg, WLen_HK
dc.contributor.authorLai, RWMen_HK
dc.contributor.authorGuan, Yen_HK
dc.contributor.authorYuen, KYen_HK
dc.date.accessioned2010-09-06T07:51:43Z-
dc.date.available2010-09-06T07:51:43Z-
dc.date.issued2003en_HK
dc.identifier.citationLancet, 2003, v. 361 n. 9371, p. 1767-1772en_HK
dc.identifier.issn0140-6736en_HK
dc.identifier.urihttp://hdl.handle.net/10722/79193-
dc.description.abstractBackground: We investigated the temporal progression of the clinical, radiological, and virological changes in a community outbreak of severe acute respiratory syndrome (SARS). Methods: We followed up 75 patients for 3 weeks managed with a standard treatment protocol of ribavirin and corticosteroids, and assessed the pattern of clinical disease, viral load, risk factors for poor clinical outcome, and the usefulness of virological diagnostic methods. Findings: Fever and pneumonia initially improved but 64 (85%) patients developed recurrent fever after a mean of 8.9 (SD 3.1) days, 55 (73%) had watery diarrhoea after 7.5 (2.3) days, 60 (80%) had radiological worsening after 7.4 (2.2) days, and respiratory symptoms worsened in 34 (45%) after 8.6 (3.0) days. In 34 (45%) patients, improvement of initial pulmonary lesions was associated with appearance of new radiological lesions at other sites. Nine (12%) patients developed spontaneous pneumomediastinum and 15 (20%) developed acute respiratory distress syndrome (ARDS) in week 3. Quantitative reverse-transcriptase (RT) PCR of nasopharyngeal aspirates in 14 patients (four with ARDS) showed peak viral load at day 10, and at day 15 a load lower than at admission. Age and chronic hepatitis B virus infection treated with lamivudine were independent significant risk factors for progression to ARDS (p=0.001). SARS-associated coronavirus in faeces was seen on RT-PCR in 65 (97%) of 67 patients at day 14. The mean time to seroconversion was 20 days. Interpretation: The consistent clinical progression, shifting radiological infiltrates, and an inverted V viral-load profile suggest that worsening in week 2 is unrelated to uncontrolled viral replication but may be related to immunopathological damage.en_HK
dc.languageengen_HK
dc.publisherThe Lancet Publishing Group. The Journal's web site is located at http://www.elsevier.com/locate/lanceten_HK
dc.relation.ispartofLanceten_HK
dc.subject.meshAdministration, Oralen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAmoxicillin-Potassium Clavulanate Combination - administration & dosageen_HK
dc.subject.meshDisease Outbreaks - statistics & numerical dataen_HK
dc.subject.meshDisease Progressionen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshFollow-Up Studiesen_HK
dc.subject.meshHumansen_HK
dc.subject.meshInfusions, Intravenousen_HK
dc.subject.meshLength of Stayen_HK
dc.subject.meshLung - radiographyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshOfloxacinen_HK
dc.subject.meshPregnancyen_HK
dc.subject.meshPregnancy Complications, Infectious - diagnosis - therapyen_HK
dc.subject.meshPulse Therapy, Drugen_HK
dc.subject.meshSARS Virus - isolation & purificationen_HK
dc.subject.meshSevere Acute Respiratory Syndrome - diagnosis - drug therapy - epidemiology - virologyen_HK
dc.subject.meshSurvival Rateen_HK
dc.subject.meshViral Load - statistics & numerical dataen_HK
dc.titleClinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective studyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0140-6736&volume=361 &issue=9371&spage=1767&epage=72&date=2003&atitle=Clinical+progression+and+viral+load+in+a+community+outbreak+of+coronavirus-associated+SARS+pneumonia:+a+prospective+study.en_HK
dc.identifier.emailPeiris, JSM: malik@hkucc.hku.hken_HK
dc.identifier.emailHung, IFN: ivanhung@hkucc.hku.hken_HK
dc.identifier.emailPoon, LLM: llmpoon@hkucc.hku.hken_HK
dc.identifier.emailZheng, BJ: bzheng@hkucc.hku.hken_HK
dc.identifier.emailGuan, Y: yguan@hkucc.hku.hken_HK
dc.identifier.emailYuen, KY: kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityPeiris, JSM=rp00410en_HK
dc.identifier.authorityHung, IFN=rp00508en_HK
dc.identifier.authorityPoon, LLM=rp00484en_HK
dc.identifier.authorityZheng, BJ=rp00353en_HK
dc.identifier.authorityGuan, Y=rp00397en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S0140-6736(03)13412-5en_HK
dc.identifier.pmid12781535-
dc.identifier.scopuseid_2-s2.0-0038362701en_HK
dc.identifier.hkuros83159en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0038362701&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume361en_HK
dc.identifier.issue9371en_HK
dc.identifier.spage1767en_HK
dc.identifier.epage1772en_HK
dc.identifier.isiWOS:000183074800008-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.f10001013869-
dc.identifier.scopusauthoridPeiris, JSM=7005486823en_HK
dc.identifier.scopusauthoridChu, CM=7404345558en_HK
dc.identifier.scopusauthoridCheng, VCC=23670479400en_HK
dc.identifier.scopusauthoridChan, KS=7406031627en_HK
dc.identifier.scopusauthoridHung, IFN=7006103457en_HK
dc.identifier.scopusauthoridPoon, LLM=7005441747en_HK
dc.identifier.scopusauthoridLaw, KI=7202563012en_HK
dc.identifier.scopusauthoridTang, BSF=8908243000en_HK
dc.identifier.scopusauthoridHon, TYW=6603902566en_HK
dc.identifier.scopusauthoridChan, CS=8791643700en_HK
dc.identifier.scopusauthoridChan, KH=35338760600en_HK
dc.identifier.scopusauthoridNg, JSC=7202426193en_HK
dc.identifier.scopusauthoridZheng, BJ=7201780588en_HK
dc.identifier.scopusauthoridNg, WL=7401613401en_HK
dc.identifier.scopusauthoridLai, RWM=7201986840en_HK
dc.identifier.scopusauthoridGuan, Y=7202924055en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK

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