Thursday, March 11, 2010

Severe acute respiratory syndrome

Severe acute respiratory syndrome - Acute
Rahul Soman, M. Pharm


 


 

Definition  

A coronavirus (SARS-CoV) that causes an infectious, severe atypical pneumonia, newly emerged from mainland China in 2002. It may be the first example of a coronavirus that causes severe disease in humans . The vast majority of patients with severe acute respiratory syndrome (SARS) develop pneumonia and a fever after a clear history of exposure to a person with SARS.


 

Medical History  

* Adult, Geriatric (>65 years)

* Travel

* Occupational Exposure

* Chronic obstructive pulmonary disease

* Asthma [Asthma - Acute]

* Disorder of cardiovascular system

* Patient immunocompromised


 

Findings  

* Abnormal breath sounds

* Chest pain - Acute

* Dry cough

* Dyspnea - Acute

* Diarrhea, acute

* Fever with chills

* Headache

* Malaise

* Myalgia

* Sore throat symptom


 

Tests  


 

Hospitalized patients with community acquired pneumonia  

* Gram stain, sputum: Sputum Gram stain is indicated in some hospitalized patients, broadens initial empiric antibiotic coverage for less common etiologies, and validates sputum culture results .


 

Hospitalized patients with community acquired pneumonia  

* Microbial culture of sputum: Sputum culture may be indicated for hospitalized pneumonia patients if a good quality specimen can be obtained and optimal handling and processing is ensured .


 

Suspected and known community-acquired pneumonia  

* Pulse oximetry: An assessment of oxygenation by pulse oximetry is indicated for all patients with clinical features suggestive of pneumonia as part of the initial clinical evaluation .


 

Suspected or known community-acquired pneumonia  

* White blood cell count: A WBC count less than 4,000 cells/mm3 is an indicator of severe pneumonia and the need for more extensive initial diagnostic testing .


 

Hospitalized adults with community acquired pneumonia  

* Blood culture: Blood cultures may identify the presence of bacteremia, particularly in patients with severe community-acquired pneumonia .


 

Suspected pneumonia  

* Plain chest X-ray: The presence of alveolar infiltrates on chest x-ray, in combination with suggestive clinical features, establishes the diagnosis of pneumonia .


 

Suspected severe acute respiratory syndrome (SARS)  

* Lymphocyte count: Severe lymphopenia is one of the hallmark indicators of severe acute respiratory syndrome (SARS) .


 

Suspected severe acute respiratory syndrome (SARS)  

* PCR test for SARS: Confirmation of SARS requires RT-PCR for SARS-CoV from 2 different specimens from separate sources or 2 specimens from one source on 2 separate days .

* SARS-CoV antibody assay: Serum antibodies to SARS-CoV in a single specimen or a 4-fold or greater increase in titer between acute and convalescent serum will confirm SARS .


 

Suspected and known severe acute respiratory syndrome (SARS)  

* Platelet count: Thrombocytopenia is an incidental finding in patients with severe acute respiratory syndrome (SARS) .


 

Differential Diagnosis  

* Community acquired pneumonia - Acute

* Influenza

* Asthma - Acute

* Tuberculosis - Acute


 

Treatment  


 

Drug Therapy  


 

Treatment of severe acute respiratory syndrome (SARS)  


 

METHYLPREDNISOLONE  


 


 

Procedural Therapy  


 

Hypoxic, hospitalized patients with community acquired pneumonia  

* Oxygen therapy: The goal of supplemental oxygen is to maintain a PaO2 of 8 kPa or higher and an SaO2 of 92% or higher .


 

Selected patients with acute respiratory failure caused by severe community-acquired pneumonia  

* Noninvasive positive pressure ventilation: In certain patients, noninvasive positive pressure ventilation decreases the need for intubation and decreases length of ICU stay .


 

Hospitalized patients with severe acute respiratory syndrome (SARS)  

* Infection control procedure: The Centers for Disease Control and Prevention has recommended certain infection control precautions specific to SARS patients in addition to standard precautions .


 

 
 

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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence