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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