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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">SARS Bulletin from Hong Kong: 30 March—4 April 2003</title><author><name sortKey="Gorbach, Sherwood L" sort="Gorbach, Sherwood L" uniqKey="Gorbach S" first="Sherwood L." last="Gorbach">Sherwood L. Gorbach</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7110236</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110236</idno><idno type="RBID">PMC:7110236</idno><idno type="doi">10.1086/512444</idno><idno type="pmid">NONE</idno><date when="2003">2003</date><idno type="wicri:Area/Pmc/Corpus">000B61</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B61</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">SARS Bulletin from Hong Kong: 30 March—4 April 2003</title><author><name sortKey="Gorbach, Sherwood L" sort="Gorbach, Sherwood L" uniqKey="Gorbach S" first="Sherwood L." last="Gorbach">Sherwood L. Gorbach</name></author></analytic><series><title level="j">Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader></TEI><pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Clin. Infect. Dis</journal-id><journal-id journal-id-type="hwp">cid</journal-id><journal-id journal-id-type="publisher-id">cid</journal-id><journal-title-group><journal-title>Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America</journal-title></journal-title-group><issn pub-type="ppub">1058-4838</issn><issn pub-type="epub">1537-6591</issn><publisher><publisher-name>The University of Chicago Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7110236</article-id><article-id pub-id-type="doi">10.1086/512444</article-id><article-categories><subj-group subj-group-type="heading"><subject>SARS Bulletin from Hong Kong</subject></subj-group></article-categories><title-group><article-title>SARS Bulletin from Hong Kong: 30 March—4 April 2003</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Gorbach</surname><given-names>Sherwood L.</given-names></name><role>Section Editor</role></contrib></contrib-group><pub-date pub-type="ppub"><day>15</day><month>4</month><year>2003</year></pub-date><pub-date pub-type="epub" iso-8601-date="2003-04-15"><day>15</day><month>4</month><year>2003</year></pub-date><pub-date pub-type="pmc-release"><day>15</day><month>4</month><year>2003</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>36</volume><issue>8</issue><fpage>iii</fpage><lpage>iii</lpage><permissions><copyright-statement>© 2003 by the Infectious Diseases Society of America</copyright-statement><copyright-year>2003</copyright-year><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p></license></permissions><self-uri xlink:href="36-8-iii.pdf"></self-uri></article-meta></front><body><p><bold><italic>Introduction.</italic></bold> The authors of these bulletins are infectious diseases physicians on the front line in the epidemic of severe acute respiratory syndrome (SARS) in Hong Kong. They are affiliated with the Division of Infectious Disease, Department of Microbiology, at Queen Mary Hospital and the University of Hong Kong, and they are also caring for patients in the Pamela Youde Nethersole Eastern Hospital, Princess Margaret Hospital, and Kwong Wah Hospital. Their bulletins are being published in the News section of the electronic edition of <italic>Clinical Infectious Diseases</italic> within 1–2 days after receipt in our office; below is a condensation of the bulletins for 30 March–4 April 2003.—<italic>Sherwood Gorbach</italic></p><p><bold><italic>Bulletin.</italic></bold> At first, we were excited to hear of an outbreak of atypical pneumonia in Guangzhou (Guangdong Province, China) involving 305 patients, of which one-third were health care workers. When a similar outbreak occurred in Hong Kong, in late February 2003, we all rushed to collect clinical and microbiological data in an effort to find ways to help the patients. Everybody tried to cultivate this previously unknown pneumonic pathogen in the laboratory, but without success. After repeated failure to grow the organism in standard cell lines, such as Madin-Darby canine kidney cells and human embryonic lung fibroblast cells, we switched to other panels. We were amazed to start seeing a cytopathic effect in one of the embryonal animal cell lines inoculated with a lung tissue biopsy specimen obtained from a patient who had a history of contact with a visitor from Guangzhou. Both the index case patient and the contact case patient subsequently died of SARS.</p><p>We reported our finding to Dr. Klaus Stohr, World Health Organization (WHO) coordinator for the SARS program, after confirming that the virus was a coronavirus and that a specific antibody response against the infected cell line could be demonstrated in many SARS patients. After a heated debate, the strain was released, with coordination by the WHO, to the relevant research community. Each individual researcher requesting the strain signed a transfer agreement.</p><p>Still, we are as worried as is the panic-stricken general public. The number of patients with cases of SARS has increased to >400, one-quarter of whom are our colleagues. There is no place for complacency; we still do not understand this virus well, and no vaccine will be available in the near future. From the epidemiological point of view, we believe that the infection has been spreading from Guangzhou since January 2003. The condition seems to be under control in the hospital setting; there have not been many new cases of infection among health care workers since more-stringent infection control procedures were implemented.</p><p>We are starting to see a second wave of patients who have had no direct contact with the index case patients or health care workers. This is still a high-risk situation. Although we have no health care workers who are ill at our facility, our team has seen infected staff at other hospitals. On the basis of the experience in Guangzhou, we modified the treatment regimen used for adult respiratory distress syndrome and bronchitis obliterans with organized pneumonia, and we are using high-dose steroid therapy along with broad-spectrum antimicrobial coverage to treat patients with severe lung damage. The preliminary impression (unofficial data) is that conditions improved in ∼15% of patients and deteriorated in ∼15% of patients after high-dose steroid therapy.</p><p>The increasing number of cases of SARS in the community and among our colleagues added pressure to find the cause of the disease. People questioned whether we were capable of handling this disaster. Then researchers in Hong Kong announced that they had isolated a paramyxovirus from their cluster of patients. They described a gene-segment sequence that has 98% homology with the known sequence of human metapneumovirus and claimed that this is the cause of SARS.</p><p>However, human metapneumovirus is not known to cause such severe progressive pneumonia with concomitant thrombocytopenia, lymphopenia, and disturbed liver function at the time of presentation. We pressed on with our studies. We performed transmission electron microscopy on a cell pellet and then negative stain electron microscopy on ultra-centrifuged cell culture supernatant. Transmission electron microscopy revealed beautiful viral particles in clusters inside the endoplasmic reticulum of infected cells. Negative stain electron microscopy revealed pleomorphic viral particles with petal-like projections. We now know that a coro-navirus is causing SARS, and we can discuss what we should consider doing for these patients.—<italic>V. C. C. Cheng, M. Peiris, and K. Y. 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