Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study
Identifieur interne : 006414 ( Main/Exploration ); précédent : 006413; suivant : 006415Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study
Auteurs : J. S. M. Peiris [Hong Kong] ; C. M. Chu [Hong Kong] ; V. C. C. Cheng [Hong Kong] ; K. S. Chan [Hong Kong] ; I. F. N. Hung [Hong Kong] ; L. L. M. Poon [Hong Kong] ; K. I. Law [Hong Kong] ; B. S. F. Tang [Hong Kong] ; T. Y. W. Hon [Hong Kong] ; C. S. Chan [Hong Kong] ; K. H. Chan [Hong Kong] ; J. S. C. Ng [Hong Kong] ; B. J. Zheng [Hong Kong] ; W. L. Ng [Hong Kong] ; R. W. M. Lai [Hong Kong] ; Y. Guan [Hong Kong] ; K. Y. Yuen [Hong Kong]Source :
- Lancet : (British edition) [ 0140-6736 ] ; 2003.
Descripteurs français
- KwdFr :
- Administration par voie orale, Adulte, Adulte d'âge moyen, Association amoxicilline-clavulanate de potassium (administration et posologie), Charge virale (), Complications de la grossesse et maladies infectieuses (), Complications de la grossesse et maladies infectieuses (diagnostic), Durée du séjour, Femelle, Flambées de maladies (), Grossesse, Humains, Mâle, Ofloxacine, Perfusions veineuses, Pharmacothérapie administrée en bolus, Poumon (imagerie diagnostique), Radiographie, Sujet âgé, Syndrome respiratoire aigu sévère (diagnostic), Syndrome respiratoire aigu sévère (traitement médicamenteux), Syndrome respiratoire aigu sévère (virologie), Syndrome respiratoire aigu sévère (épidémiologie), Taux de survie, Virus du SRAS (isolement et purification), Études de suivi, Évolution de la maladie.
- MESH :
- administration et posologie : Association amoxicilline-clavulanate de potassium.
- diagnostic : Complications de la grossesse et maladies infectieuses, Syndrome respiratoire aigu sévère.
- imagerie diagnostique : Poumon.
- isolement et purification : Virus du SRAS.
- traitement médicamenteux : Syndrome respiratoire aigu sévère.
- virologie : Syndrome respiratoire aigu sévère.
- épidémiologie : Syndrome respiratoire aigu sévère.
- Pascal (Inist)
- Administration par voie orale, Adulte, Adulte d'âge moyen, Charge virale, Complications de la grossesse et maladies infectieuses, Durée du séjour, Femelle, Flambées de maladies, Grossesse, Humains, Mâle, Ofloxacine, Perfusions veineuses, Pharmacothérapie administrée en bolus, Pneumopathie, Aigu, Radiographie, Sujet âgé, Syndrome, Homme, Epidémiologie, Chine, Evolution, Facteur risque, Pronostic, Diagnostic, Taux de survie, Études de suivi, Évolution de la maladie.
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Acute, Administration, Oral, Adult, Aged, Amoxicillin-Potassium Clavulanate Combination (administration & dosage), China, Diagnosis, Disease Outbreaks (statistics & numerical data), Disease Progression, Epidemiology, Evolution, Female, Follow-Up Studies, Human, Humans, Infusions, Intravenous, Length of Stay, Lung (diagnostic imaging), Male, Middle Aged, Ofloxacin, Pneumopathy, Pregnancy, Pregnancy Complications, Infectious (diagnosis), Pregnancy Complications, Infectious (therapy), Prognosis, Pulse Therapy, Drug, Radiography, Risk factor, SARS Virus (isolation & purification), Severe Acute Respiratory Syndrome (diagnosis), Severe Acute Respiratory Syndrome (drug therapy), Severe Acute Respiratory Syndrome (epidemiology), Severe Acute Respiratory Syndrome (virology), Survival Rate, Syndrome, Viral Load (statistics & numerical data).
- MESH :
- chemical , administration & dosage : Amoxicillin-Potassium Clavulanate Combination.
- diagnosis : Pregnancy Complications, Infectious, Severe Acute Respiratory Syndrome.
- diagnostic imaging : Lung.
- drug therapy : Severe Acute Respiratory Syndrome.
- epidemiology : Severe Acute Respiratory Syndrome.
- isolation & purification : SARS Virus.
- statistics & numerical data : Disease Outbreaks, Viral Load.
- therapy : Pregnancy Complications, Infectious.
- virology : Severe Acute Respiratory Syndrome.
- Administration, Oral, Adult, Aged, Disease Progression, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Length of Stay, Male, Middle Aged, Ofloxacin, Pregnancy, Pulse Therapy, Drug, Radiography, Survival Rate.
Abstract
Background 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-transcdptase (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.
Affiliations:
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Le document en format XML
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Zheng</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Ng, W L" sort="Ng, W L" uniqKey="Ng W" first="W. L." last="Ng">W. L. Ng</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Lai, R W M" sort="Lai, R W M" uniqKey="Lai R" first="R. W. M." last="Lai">R. W. M. Lai</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Guan, Y" sort="Guan, Y" uniqKey="Guan Y" first="Y." last="Guan">Y. Guan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Yuen, K Y" sort="Yuen, K Y" uniqKey="Yuen K" first="K. Y." last="Yuen">K. Y. 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S. M." last="Peiris">J. S. M. Peiris</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Chu, C M" sort="Chu, C M" uniqKey="Chu C" first="C. M." last="Chu">C. M. Chu</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Cheng, V C C" sort="Cheng, V C C" uniqKey="Cheng V" first="V. C. C." last="Cheng">V. C. C. Cheng</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Chan, K S" sort="Chan, K S" uniqKey="Chan K" first="K. S." last="Chan">K. S. Chan</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Hung, I F N" sort="Hung, I F N" uniqKey="Hung I" first="I. F. N." last="Hung">I. F. N. Hung</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Poon, L L M" sort="Poon, L L M" uniqKey="Poon L" first="L. L. M." last="Poon">L. L. M. Poon</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Law, K I" sort="Law, K I" uniqKey="Law K" first="K. I." last="Law">K. I. Law</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Tang, B S F" sort="Tang, B S F" uniqKey="Tang B" first="B. S. F." last="Tang">B. S. F. Tang</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Hon, T Y W" sort="Hon, T Y W" uniqKey="Hon T" first="T. Y. W." last="Hon">T. Y. W. Hon</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Chan, C S" sort="Chan, C S" uniqKey="Chan C" first="C. S." last="Chan">C. S. Chan</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Chan, K H" sort="Chan, K H" uniqKey="Chan K" first="K. H." last="Chan">K. H. Chan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Ng, J S C" sort="Ng, J S C" uniqKey="Ng J" first="J. S. C." last="Ng">J. S. C. Ng</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Zheng, B J" sort="Zheng, B J" uniqKey="Zheng B" first="B. J." last="Zheng">B. J. Zheng</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Ng, W L" sort="Ng, W L" uniqKey="Ng W" first="W. L." last="Ng">W. L. Ng</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Lai, R W M" sort="Lai, R W M" uniqKey="Lai R" first="R. W. M." last="Lai">R. W. M. Lai</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</s1><s3>HKG</s3><sZ>2 aut.</sZ><sZ>4 aut.</sZ><sZ>7 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>12 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Department of Medicine, Intensive Care, Radiology, and Pathology, United Christian Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Guan, Y" sort="Guan, Y" uniqKey="Guan Y" first="Y." last="Guan">Y. Guan</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author><author><name sortKey="Yuen, K Y" sort="Yuen, K Y" uniqKey="Yuen K" first="K. Y." last="Yuen">K. Y. Yuen</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</s1><s3>HKG</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>11 aut.</sZ><sZ>13 aut.</sZ><sZ>16 aut.</sZ><sZ>17 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Departments of Microbiology and Medicine, Queen Mary Hospital, University of Hong Kong, Special Administrative Region</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute</term><term>Administration, Oral</term><term>Adult</term><term>Aged</term><term>Amoxicillin-Potassium Clavulanate Combination (administration & dosage)</term><term>China</term><term>Diagnosis</term><term>Disease Outbreaks (statistics & numerical data)</term><term>Disease Progression</term><term>Epidemiology</term><term>Evolution</term><term>Female</term><term>Follow-Up Studies</term><term>Human</term><term>Humans</term><term>Infusions, Intravenous</term><term>Length of Stay</term><term>Lung (diagnostic imaging)</term><term>Male</term><term>Middle Aged</term><term>Ofloxacin</term><term>Pneumopathy</term><term>Pregnancy</term><term>Pregnancy Complications, Infectious (diagnosis)</term><term>Pregnancy Complications, Infectious (therapy)</term><term>Prognosis</term><term>Pulse Therapy, Drug</term><term>Radiography</term><term>Risk factor</term><term>SARS Virus (isolation & purification)</term><term>Severe Acute Respiratory Syndrome (diagnosis)</term><term>Severe Acute Respiratory Syndrome (drug therapy)</term><term>Severe Acute Respiratory Syndrome (epidemiology)</term><term>Severe Acute Respiratory Syndrome (virology)</term><term>Survival Rate</term><term>Syndrome</term><term>Viral Load (statistics & numerical data)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Administration par voie orale</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Association amoxicilline-clavulanate de potassium (administration et posologie)</term><term>Charge virale ()</term><term>Complications de la grossesse et maladies infectieuses ()</term><term>Complications de la grossesse et maladies infectieuses (diagnostic)</term><term>Durée du séjour</term><term>Femelle</term><term>Flambées de maladies ()</term><term>Grossesse</term><term>Humains</term><term>Mâle</term><term>Ofloxacine</term><term>Perfusions veineuses</term><term>Pharmacothérapie administrée en bolus</term><term>Poumon (imagerie diagnostique)</term><term>Radiographie</term><term>Sujet âgé</term><term>Syndrome respiratoire aigu sévère (diagnostic)</term><term>Syndrome respiratoire aigu sévère (traitement médicamenteux)</term><term>Syndrome respiratoire aigu sévère (virologie)</term><term>Syndrome respiratoire aigu sévère (épidémiologie)</term><term>Taux de survie</term><term>Virus du SRAS (isolement et purification)</term><term>Études de suivi</term><term>Évolution de la maladie</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Amoxicillin-Potassium Clavulanate Combination</term></keywords><keywords scheme="MESH" qualifier="administration et posologie" xml:lang="fr"><term>Association amoxicilline-clavulanate de potassium</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Pregnancy Complications, Infectious</term><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Complications de la grossesse et maladies infectieuses</term><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Lung</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Poumon</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>SARS Virus</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Virus du SRAS</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Disease Outbreaks</term><term>Viral Load</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>Severe Acute Respiratory Syndrome</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Syndrome respiratoire aigu sévère</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Administration, Oral</term><term>Adult</term><term>Aged</term><term>Disease Progression</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Infusions, Intravenous</term><term>Length of Stay</term><term>Male</term><term>Middle Aged</term><term>Ofloxacin</term><term>Pregnancy</term><term>Pulse Therapy, Drug</term><term>Radiography</term><term>Survival Rate</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Administration par voie orale</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Charge virale</term><term>Complications de la grossesse et maladies infectieuses</term><term>Durée du séjour</term><term>Femelle</term><term>Flambées de maladies</term><term>Grossesse</term><term>Humains</term><term>Mâle</term><term>Ofloxacine</term><term>Perfusions veineuses</term><term>Pharmacothérapie administrée en bolus</term><term>Pneumopathie</term><term>Aigu</term><term>Radiographie</term><term>Sujet âgé</term><term>Syndrome</term><term>Homme</term><term>Epidémiologie</term><term>Chine</term><term>Evolution</term><term>Facteur risque</term><term>Pronostic</term><term>Diagnostic</term><term>Taux de survie</term><term>Études de suivi</term><term>Évolution de la maladie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background 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-transcdptase (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.</div></front></TEI><affiliations><list><country><li>Hong Kong</li></country></list><tree><country name="Hong Kong"><noRegion><name sortKey="Peiris, J S M" sort="Peiris, J S M" uniqKey="Peiris J" first="J. S. M." last="Peiris">J. S. M. Peiris</name></noRegion><name sortKey="Chan, C S" sort="Chan, C S" uniqKey="Chan C" first="C. S." last="Chan">C. S. Chan</name><name sortKey="Chan, K H" sort="Chan, K H" uniqKey="Chan K" first="K. H." last="Chan">K. H. Chan</name><name sortKey="Chan, K S" sort="Chan, K S" uniqKey="Chan K" first="K. S." last="Chan">K. S. Chan</name><name sortKey="Cheng, V C C" sort="Cheng, V C C" uniqKey="Cheng V" first="V. C. C." last="Cheng">V. C. C. Cheng</name><name sortKey="Chu, C M" sort="Chu, C M" uniqKey="Chu C" first="C. M." last="Chu">C. M. Chu</name><name sortKey="Guan, Y" sort="Guan, Y" uniqKey="Guan Y" first="Y." last="Guan">Y. Guan</name><name sortKey="Hon, T Y W" sort="Hon, T Y W" uniqKey="Hon T" first="T. Y. W." last="Hon">T. Y. W. Hon</name><name sortKey="Hung, I F N" sort="Hung, I F N" uniqKey="Hung I" first="I. F. N." last="Hung">I. F. N. Hung</name><name sortKey="Lai, R W M" sort="Lai, R W M" uniqKey="Lai R" first="R. W. M." last="Lai">R. W. M. Lai</name><name sortKey="Law, K I" sort="Law, K I" uniqKey="Law K" first="K. I." last="Law">K. I. Law</name><name sortKey="Ng, J S C" sort="Ng, J S C" uniqKey="Ng J" first="J. S. C." last="Ng">J. S. C. Ng</name><name sortKey="Ng, W L" sort="Ng, W L" uniqKey="Ng W" first="W. L." last="Ng">W. L. Ng</name><name sortKey="Poon, L L M" sort="Poon, L L M" uniqKey="Poon L" first="L. L. M." last="Poon">L. L. M. Poon</name><name sortKey="Tang, B S F" sort="Tang, B S F" uniqKey="Tang B" first="B. S. F." last="Tang">B. S. F. Tang</name><name sortKey="Yuen, K Y" sort="Yuen, K Y" uniqKey="Yuen K" first="K. Y." last="Yuen">K. Y. Yuen</name><name sortKey="Zheng, B J" sort="Zheng, B J" uniqKey="Zheng B" first="B. J." last="Zheng">B. J. Zheng</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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