后"非典"时期"非典"的鉴别诊断

目前全国内地每日新增传染性非典型肺炎(SARS)临床诊断病例不足10例,已进入后“非典”时期。SARS属于呼吸道传染病之一,具有临床表现、肺部体征及胸部影像学不一致的特点。在没有SARS流行期间也存在“非典型肺炎”(AP),因此在后“非典”时期加深对SARS发病率及临床演变过程的认识,加强对具有相似临床表现特点的疾病如AP、流感病毒性肺炎、肺结核、肺真菌性肺炎等的鉴别诊断,做好同步化的信息资源共享及加强基层一线医疗人员对SARS与AP的认识与培训,对及时发现SARS患者并避免SARS的“过度诊断”是非常重要的。采用临床多专业专家联合会诊是SARS诊断与鉴别诊断的关键,也是对新出现的传染性疾病临床诊断治疗以及预防和隔离的一种有益尝试。

Differential diagnosis of severe acute respiratory syndrome (SARS) in "post-SARS" stage

The epidemic of severe acute respiratory syndrome (SARS) has now been brought under control and entered the so-called post-SARS stage, with only a very few new cases reported daily throughout China. As an infectious disease spreading through the respiratory tract, SARS is featured by the inconsistency between its clinical representations, physical signs of the lungs and chest imaging findings. It has been shown that atypical pneumonia (AP), with similar clinical features to SARS, has been identified in Guangzhou, China, long before the prevalence of SARS, a fact that urges further understanding of SARS in regard to its incidence and variable clinical courses, for its differential diagnosis with such diseases as AP, influenza-related pneumonia, pulmonary tuberculosis, fungal and cytomegalovirus pneumonia. Information sharing among the medical institutes and training of the first-line medical staff for their better understanding and awareness of SARS and AP is crucial in the clinical practice, to insure timely case identification and avoid "oversensitive" diagnosis. Consultation of particular cases involving experts from multiple medical science fields should be encouraged, which is also an effective measure against newly emerged infectious diseases.