湖北地区医务人群严重急性呼吸道综合征冠状病毒血清学调查分析

目的 确定医务人群中是否存在严重急性呼吸道综合征(SARS)冠状病毒(SARS-CoV)隐性或亚临床感染及健康带毒者。方法 以问卷调查方式抽样调查湖北地区有可能接触SARS—CoV的高危医务人群的流行病学状况；以酶联免疫吸附法测定血清SARS-CoV IgM、IgG；以一步法双重RT—PCR检测受试者喉漱液是否存在SARS-CoV。结果 接受调查的102名医务人员中，均曾在抗SARS一线工作过，9名曾到过SARS流行疫区，84名(82．3％)在2003年SARS流行期间，否认曾与确诊SARS患者有过接触；18名报告与确诊SARS患者有过接触，其中1名曾无防护接触过数天，但无任何不适，其他17名均为有防护接触，其中3名在接触后20天内曾有过感冒样不适。全部102名受调查者的血清SARS—CoV IgM、IgG以及喉漱液SARS-CoV检测均为阴性。结论 本次抽样调查未发现湖北地区医务人群中曾经有过SARS-CoV隐性或亚临床感染，也未发现有上呼吸道SARS—CoV健康带毒的情况。     

SARS: clinical features and diagnosis

Severe acute respiratory syndrome (SARS) is a highly infectious disease with a significant morbidity and case fatality. The major clinical features include persistent fever, chills/rigor, myalgia, malaise, dry cough, headache and dyspnoea. Less common symptoms include sputum production, sore throat, coryza, dizziness, nausea, vomiting and diarrhoea. Older subjects may present with decrease in general well-being, poor feeding, fall/fracture and delirium, without the typical febrile response. Common laboratory features include lymphopenia with depletion of CD4 and CD8 lymphocytes, thrombocytopenia, prolonged activated partial thromboplastin time, elevated D-Dimer, elevated alanine transminases, lactate dehydrogenase and creatinine kinase. The constellation of compatible clinical and laboratory findings, together with the rather characteristic radiological features especially on HRCT and the lack of clinical response to broad-spectrum antibiotics, should quickly arouse suspicion of SARS.
The positivity rates of urine, nasophargyngeal aspirate and stool specimen have been reported to be 42%, 68% and 97%, respectively, on day 14 of illness, whereas serology for confirmation may take 28 days to reach a detection rate above 90%. Recently, quantitative measurement of blood SARS CoV RNA with real-time RT-PCR technique has been developed with a detection rate of 80% as early as day 1 of hospital admission but the detection rates drop to 75% and 42% on day 7 and day 14, respectively.     

传染性非典型肺炎病例SARS冠状病毒特异性抗体检测及分析

目的　对福建省传染性非典型肺炎病例血清标本中SARS冠状病毒 (SARS -CoV)特异性抗体进行检测。方法　采用间接酶联免疫吸附试验 (ELISA)测定SARS临床诊断、疑似、医学观察病例以及其他非SARS患者和健康人群血清SARS -CoV特异性IgM、IgG抗体。 结果　 (1) 3例SARS临床诊断病例血清SARS -CoV特异性IgG抗体均为阳性 ,其中 2例IgM抗体阳性 ,2例恢复期血清比急性期血清IgG抗体呈≥ 4倍增长 ;(2 ) 1例疑似病例IgM和IgG抗体均为阳性 ,且恢复期血清比急性期血清IgG抗体呈 >4倍增长 ;(3) 11例医学观察病例IgM和IgG抗体均为阴性 ;(4 ) 5 0例非SARS患者和健康人群IgG抗体全部阴性。 结论　间接ELISA是传染性非典型肺炎实验室特异性检测方法 ,可对SARS临床诊断进行进一步的核实。     

Controlling SARS: a review on China's response compared with other SARS-affected countries

Objective  To summarise the major control measures implemented by severe acute respiratory syndrome (SARS)-affected countries and to compare distinctive features of the Chinese approach to other affected Asian countries and Canada.
Method  Literature review.
Results  The realisation in March 2003 that SARS was spreading led affected countries to introduce measures such as rapid dissemination of information, early case detection and isolation, tracing and quarantining of SARS contacts, traveller screening, raising public awareness of risk and institution of stricter infection control in health care settings. SARS became a notifiable disease in China in mid-April 2003, after which introduction of efficient nationwide control measures led to containment within 2 months. Countries differed in the timeliness of implementing control measures, the mode and extent to which these were enforced and in the resources available to do so.
Conclusion  SARS challenged the political and public health systems of all affected countries. It demanded rapid and decisive action to be taken, yet the comparison shows how difficult this was for an unknown new disease. Guangdong reacted rapidly but this pace was not continued by China for some time, which facilitated national and international spread. Once the Chinese government changed its policy, it developed an impressive control strategy involving the public which culminated in containment. The significance of timely information was perhaps the main lesson which the SARS epidemic taught.     

SARS: prognosis, outcome and sequelae

Severe acute respiratory syndrome (SARS) is associated with considerable morbidity and mortality in the acute phase. Worldwide case fatality rate is 11% (range 7 to 27%) for the most severely affected regions. Several adverse prognostic factors have been identified, including advanced age, presence of comorbidity, higher lactose dehydrogenase levels and initial neutrophil count, but the impact of viral and other host factors on outcome is unknown. Published data on sequelae of SARS are limited. Clinical follow-up of patients who recovered from SARS has demonstrated radiological, functional and psychological abnormalities of varying degrees. In the early rehabilitation phase, many complained of limitations in physical function from general weakness and/or shortness of breath. In a small series of subjects who underwent CT scan of the chest, over half showed some patchy changes consistent with pulmonary fibrosis. Lung function testing at 6–8 weeks after hospital discharge showed mild or moderate restrictive pattern consistent with muscle weakness in 6–20% of subjects. Mild decrease in carbon monoxide diffusing capacity was detected in a minority of subjects. Preliminary evidence suggests that these lung function abnormalities will improve over time. Psychobehavioural problems of anxiety and/or depression were not uncommon in the early recovery phase, and improved over time in the majority of patients. Avascular necrosis of the hip has been reported as another complication. The long-term sequelae of SARS are still largely unknown. It is important to follow up these patients to detect and appropriately manage any persistent or emerging long-term sequelae in the physical, psychological and social domains.     

Overview: The history and pediatric perspectives of severe acute respiratory syndromes: Novel or just like SARS

Many respiratory viral infections such as influenza and measles result in severe acute respiratory symptoms and epidemics. In the spring of 2003, an epidemic of coronavirus pneumonia spread from Guangzhou to Hong Kong and subsequently to the rest of the world. The WHO coined the acronym SARS (severe acute respiratory syndrome) and subsequently the causative virus as SARS‐CoV. In the summer of 2012, epidemic of pneumonia occurred again in Saudi Arabia which was subsequently found to be caused by another novel coronavirus. WHO coined the term MERS (Middle East respiratory syndrome) to denote the Middle East origin of the novel virus (MERS‐CoV). In the winter of 2019, another outbreak of pneumonia occurred in Wuhan, China which rapidly spread globally. Yet another novel coronavirus was identified as the culprit and has been named SARS‐CoV‐2 due to its similarities with SARS‐CoV, and the disease as coronavirus disease‐2019. This overview aims to compare and contrast the similarities and differences of these three major episodes of coronavirus outbreak, and conclude that they are essentially the same viral respiratory syndromes caused by similar strains of coronavirus with different names. Coronaviruses have caused major epidemics and outbreaks worldwide in the last two decades. From an epidemiological perspective, they are remarkably similar in the mode of spread by droplets. Special focus is placed on the pediatric aspects, which carry less morbidity and mortality in all three entities.     

SARS: ventilatory and intensive care

Severe acute respiratory syndrome (SARS) is an emerging infection caused by a novel coronavirus. It is characterised by a highly infectious syndrome of fever and respiratory symptoms, and is usually associated with bilateral lung infiltrates. The clinical syndrome of SARS often progresses to varying degrees of respiratory failure, with about 20% of patients requiring intensive care. Despite concern about potential aerosol generation, non-invasive ventilation (NIV) has been reported to be efficacious in the treatment of SARS-related ARF without posing infection risks to health care workers (HCW). Spontaneous pneumomediastinum and pneumothorax in SARS is common. The incidence of NIV-associated barotrauma ranged from 6.6% to 15%. Patients who fail to tolerate NIV or fail NIV with progressive dyspnoea, tachypnoea and hypoxaemia should be intubated and mechanically ventilated. Mortality rates in intensive care units for SARS patients were high: 34–53% at 28 days, when some patients were still being ventilated. Strict adherence to infection control measures including isolation, use of appropriate personal protective equipment and negative pressure environment had been reported to eliminate cross-infection to HCW.     

Longitudinal profile of antibodies against SARS-coronavirus in SARS patients and their clinical significance

BACKGROUND: Severe acute respiratory syndrome (SARS) is a newly discovered disease caused by a novel coronavirus. The present study studied the longitudinal profile of antibodies against SARS-coronavirus (SARS-CoV) in SARS patients and evaluated the clinical significance of these antibodies. METHODS: Two methods, ELISA and indirect immunofluorescent assay, were used for the detection of the anti-SARS-CoV IgG and IgM in 335 serial sera from 98 SARS patients. In 18 patients, serum antibody profiles were investigated and antibody neutralization tests were performed from 7 to 720 days after the onset of symptoms. RESULTS: The ratios of positive IgG/IgM by ELISA were 0/0, 45.4/39.4, 88.6/71.4, 96/88, 100/48.6, 100/30.9, 100/17.1, 100/0 per cent, respectively, on 1-7, 8-14, 15-21, 22-28, 29-60, 61-90, 91-180 and 181-720 days after the onset of symptoms. Antibodies were not detected within the first 7 days of illness, but IgG titre increased dramatically on day 15, reaching a peak on day 60, and remained high until day 180 from when it declined gradually until day 720. IgM was detected on day 15 and rapidly reached a peak, then declined gradually until it was undetectable on day 180. Neutralizing viral antibodies were demonstrated in the convalescence sera from SARS patients. CONCLUSION: The persistence of detectable IgG antibodies and neutralizing viral antibodies for up to 720 days suggest that SARS patients may be protected from recurrent SARS-CoV infection for up to 2 years.     

对严重急性呼吸综合征的再认识——胸部影像特点结合临床资料对早期诊断严重急性呼吸综合征的意义

目的:分析2004年在北京发生的严重急性呼吸综合征(SARS)早期胸部影像特点及相对应的临床表现,并对比2003年资料,探讨其早期的表现,为临床提供借鉴。方法:对2004年在北京地坛医院住院的7例SARS患者的临床、化验、胸片及高分辨CT(HRCT)资料进行回顾性分析。结果:6例均急性起病,体温>38℃,无上呼吸道卡他症状,发热第1周出现肺部局灶或多段分布的阴影,阴影常呈类圆型,多表现为磨玻璃影,其内可见小叶间隔增厚,部分表现肺实变影,病灶内可见支气管气像,无坏死或空洞病灶,无肺门及纵隔淋巴结肿大,无胸腔积液。发热的第2周,肺部阴影迅速扩大,或发展至对侧,出现呼吸困难,在出现肺部阴影进展时,给予糖皮质激素,阴影在2~3d内明显吸收,临床症状改善。病程早期,白细胞不增高,淋巴细胞和血小板偏低,血乳酸脱氢酶(LDH)在第2周明显增高,丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)在第2或第3周开始增高。结论:对于急性起病、发热、白细胞不高、胸部HRCT表现类圆型磨玻璃阴影伴小叶间隔增厚或肺实变、短期抗生素治疗无效的患者应提高警惕,注意排除SARS。     

SARS: epidemiology

Severe acute respiratory syndrome (SARS) originated in Southern China in November 2002, and was brought to Hong Kong in February 2003. From Hong Kong, the disease spread rapidly worldwide but mostly to Asian countries. At the end of the epidemic in June, the global cumulative total was 8422 cases with 916 deaths (case fatality rate of 11%). People of all ages were affected, but predominantly females. Health care workers were at high risk and accounted for one-fifth of all cases. Risk factors for death included old age and comorbid illnesses, especially diabetes. The disease is caused by a novel coronavirus and is transmitted by droplets or direct inoculation from contact with infected surfaces. Contaminated sewage was found to be responsible for the outbreak in a housing estate in Hong Kong affecting over 300 residents. The mean incubation period was 6.4 days (range 2–10). The duration between onset of symptoms and hospitalisation was from 3 to 5 days. The relatively prolonged incubation period allowed asymptomatic air travellers to spread the disease globally. The number of individuals infected by each case has been estimated to be 2.7. Effective control of nosocomial transmission included early detection of disease, strict isolation of patients, practice of droplet and contact precautions and compliance with the use of personal protective equipment. Effective control of disease spread in the community included tracing and quarantine of contacts. Development of a validated diagnostic test and an effective vaccine as well as elimination of possible animal reservoirs are measures needed to prevent another epidemic.     

Severe acute respiratory syndrome in children

Severe acute respiratory syndrome (SARS) is a newly described and highly contagious respiratory infection. Many adult patients will develop progressive hypoxia, and a large proportion will develop respiratory distress syndrome (RDS), possibly related to massive and uncontrolled activation of the immune system. The mortality has been reported to be quite high, especially in the elderly with comorbid conditions. The causative agent has been identified as a novel coronavirus, and children appear to acquire the infection by close-contact household exposure to an infected adult. However, the severity is much milder and the clinical progression much less aggressive in young children. The exact pathophysiology of SARS is still unclear, and the medical treatment of SARS remains controversial. The main treatment regime used in Hong Kong is a combination of ribavirin and steroid. To date, there have been no reported case fatalities in children with this disease. The success of reducing the burden of this infection in children will depend on proper isolation of infected adults early in the course of illness. Strict public health policy and quarantine measures are the key in controlling the infection in the community.     

160例SARS患者心脏变化的观察

目的　探讨 SARS感染后是否导致心肌受损。方法　入院第二日 ,监测血清酶 AST、AL T、L DH、CK、CKMB及 HBDH,并连续观察 ,拍胸片 ,记录症状 ,对部分患者于出院后 2周进行复查。结果　 16 0例患者中呼吸困难 6 3例 ,心悸 6 1例 ,肌肉痛 37例 ;112例有不同程度的心肌酶升高 ,谷丙转氨酶 (AL T) /谷草转氨酶 (AST) <1,普通型及重型分别为 3例 (3/ 10 8)和 31例 (31/ 5 3) ;X线检查心胸比例 >0 .6普通型及重型分别为 3例 (3/ 10 8)和 39例 (39/ 5 2 )。出院复查 5 1例患者 9例心肌酶异常 ,窦性心动过速 3例 ,其余正常。结论　 SARS病毒感染后可能会导致心肌一过性损害。     

SARS患者主要临床特征与年龄的相关性

目的　探讨SARS患者的主要临床特征与年龄的关系。方法　将 680例SARS患者按不同年龄段分为 6组 ,以主要临床症状和合并症为指标 ,对资料进行统计学处理。结果　SARS易感人群集中在青壮年人中 ,但呼吸困难、胸痛、胸闷、呼吸音改变等主要呼吸道症状或体征均随年龄改变呈增加的趋势 ,其中呼吸困难和胸闷随龄增加幅度大 ,60岁以上老年SARS患者与其他年龄组相比有显著性差异 (P <0 0 5) ;SARS患者合并症主要包括糖尿病、高血压、结核等 ,且合并症数量随增龄而增加。结论　SARS患者的主要临床症状和合并症表现为随年龄增加的趋势     

42例SARS患者出院后的近期健康状况分析

目的 研究SARS病人出院后的近期健康状况。方法 SARS病人出院后2周随诊．记录病史．完成相关辅助检查。结果 12例患者中乏力2l例(50．0％)．轻度憋气16例(38．1％)．低热11例(26．2％)，心悸8例(18．9％)．丙氨酸氨基转移酶(ALT)及乳酸脱氢酶(LDH)升高分别为12例(28．6％)和20例(47．6％)．X线检查肺部异常16例(37．8％)．42．9％的病例CD4仍低于正常。结论 SARS病人恢复期存在多种躯体症状和实验室指标异常，应予随访检查和干预。     

2004年中国首例社区获得性散发严重急性呼吸综合征的临床分析

目的　了解 2 0 0 4年我国首例社区获得性散发严重急性呼吸综合征 (SARS)病例的流行病学、临床、病原学检查特点及预后转归。方法　对患者流行病学及临床资料进行回顾性分析 ,并采用酶联免疫吸附试验 (ELISA)及免疫荧光试验检测SARS IgM /IgG抗体 ,荧光聚合酶链反应 (PCR)测定SARS CoVRNA。结果　患者 2 0 0 3年 12月 16日以发热起病 ,持续 8d ,有咳嗽、气促等症状 ,白细胞及T淋巴细胞计数降低 ,影像学检查示双肺密度增高影。起病前无流行病学依据 ,81名接触者均未出现发热等异常情况。 12月 2 7日被诊断为SARS疑似病例 ,2 0 0 4年 1月 5日确诊为SARS。经对症支持等综合治疗痊愈出院。对多份血清进行平行检测 ,SARS IgM阴转阳 ,滴度呈 4倍以上升高 ,SARS IgG在起病一周内出现 ,抗体滴度很快呈现 4倍以上升高。在咽拭子中检测出SARS CoVRNA。中和试验结果阳性。结论　该患者为 2 0 0 4年我国首例社区获得性散发SARS确诊病例 ,其无流行病学依据 ,临床表现不重 ,抗体出现早 ,病情恢复快。     

MERS,SARS and other coronaviruses as causes of pneumonia

Human coronaviruses (HCoVs) have been considered to be relatively harmless respiratory pathogens in the past. However, after the outbreak of the severe acute respiratory syndrome (SARS) and emergence of the Middle East respiratory syndrome (MERS), HCoVs have received worldwide attention as important pathogens in respiratory tract infection. This review focuses on the epidemiology, pathogenesis and clinical characteristics among SARS‐coronaviruses (CoV), MERS‐CoV and other HCoV infections.     

Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected children: A retrospective study

Since the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, considerable attention has been paid on its epidemiology and clinical characteristics in children patients. However, it is also crucial for clinicians to summarize and investigate the co-infection of SARS-CoV-2 in children.We retrospectively reviewed the clinical manifestations, laboratory findings, and imaging characteristics of COVID-19 patients in co-infection group (CI, n = 27) and single infection group (SI, n = 54). Samples were tested for multiple pathogens.A high incidence (27/81, 33%) of co-infection in children with COVID-19 was revealed. The most frequent co-infected pathogen was mycoplasma pneumoniae (MP, 20/81, 25%), followed by virus (6/81, 7%), and bacteria (4/81, 5%). No significant difference in clinical characteristics, laboratory examinations, or hospital stay was observed between the patients with co-infections and those with monomicrobial, only lower in white blood cell counts (CI: 5.54 ± 0.36 vs SI: 7.38 ± 0.37, P = .002), neutrophil counts (CI: 2.20 ± 0.20 vs SI: 2.92 ± 0.23, P = .024) and lymphocyte counts (CI: 2.72 ± 0.024 vs SI: 3.87 ± 0.28, P = .006). Compared with the patients with monomicrobial, chest imaging of those with co-infections showed consolidation in more cases (CI: 29.6% vs SI: 11.1%, P = .038) and duration of positive in nucleic acid was shorter (CI: 6.69 ± 0.82 vs SI: 9.69 ± 0.74, P = .015).Co-infection was relatively common in children with COVID-19, almost 1/3 had co-infection, most commonly caused by MP. Co-infection did not cause a significant exacerbation in clinical manifestations.     

SARS: radiological features

Air-space disease is typical in severe acute respiratory syndrome (SARS) and may be indistinguishable from pneumonia of other causes. In the majority of patients, ground glass opacities on chest radiographs progress rapidly to focal, multifocal or diffuse consolidation. Unilateral involvement is common in the early acute phase, becoming bilateral at maximal lung involvement. Generally, radiographic opacities peak between 8 and 10 days after onset of illness, with radiographic scores reflecting temporal changes in clinical and laboratory parameters such as oxygen saturation (SaO₂) and liver transaminases. Pleural effusions, cavitating consolidation and mediastinal lymphadenopathy are not typical radiographic features. Pneumomediastinum and pneumothoraces are complications that are associated with extensive disease, with or without assisted ventilation.
The utility of high resolution computed tomography (HRCT) and CT scans lies in the confirmation of airspace opacities in cases with normal initial chest radiographs that have strong contact history and signs and symptoms highly suspicious of SARS during the outbreak, allowing early treatment and prompt isolation. The characteristic HRCT feature in the acute phase is ground-glass opacities with smooth interlobular septal thickening, sometimes with consolidation in a subpleural location, which progress rapidly to involve other areas of the lungs. Temporal lung changes documented on HRCT suggest that some residual opacities found may not be reversible.     

糖皮质激素在SARS、MERS治疗中的应用进展及对COVID-19治疗的启示

COVID-19是一种新发的急性呼吸道传染性疾病,其病原与严重急性呼吸综合征（severe acute respiratory syndrome, SARS）和中东呼吸综合征（Middle East respiratory syndrome, MERS）的病原同为冠状病毒,目前针对COVID-19的治疗尚缺乏有效的抗病毒药物。糖皮质激素广泛应用于危重症患者的救治,但其使用有可能带来各种不良反应,甚至危及患者生命,如何适时适量应用糖皮质激素一直是针对这类疾病治疗的争论焦点之一。本文对既往SARS、MERS等病毒性肺炎治疗中糖皮质激素使用情况进行综述,以期为COVID-19治疗提供借鉴。