Clinical presentations and outcome of severe acute respiratory syndrome in children
Identifieur interne : 001247 ( Pmc/Corpus ); précédent : 001246; suivant : 001248Clinical presentations and outcome of severe acute respiratory syndrome in children
Auteurs : Kle Hon ; Cw Leung ; Wtf Cheng ; Pks Chan ; Wcw Chu ; Yw Kwan ; Am Li ; Nc Fong ; Pc Ng ; Mc Chiu ; Ck Li ; Js Tam ; Tf FokSource :
- Lancet (London, England) [ 0140-6736 ] ; 2003.
Abstract
Hong Kong has been severely affected by severe acute respiratory syndrome (SARS). Contact in households and healthcare settings is thought to be important for transmission, putting children at particular risk. Most data so far, however, have been for adults. We prospectively followed up the first ten children with SARS managed during the early phase of the epidemic in Hong Kong. All the children had been in close contact with infected adults. Persistent fever, cough, progressive radiographic changes of chest and lymphopenia were noted in all patients. The children were treated with high-dose ribavirin, oral prednisolone, or intravenous methylprednisolone, with no short-term adverse effects. Four teenagers required oxygen therapy and two needed assisted ventilation. None of the younger children required oxygen supplementation. Compared with adults and teenagers, SARS seems to have a less aggressive clinical course in younger children.
Url:
DOI: 10.1016/S0140-6736(03)13364-8
PubMed: 12767737
PubMed Central: 7112484
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical presentations and outcome of severe acute respiratory syndrome in children</title><author><name sortKey="Hon, Kle" sort="Hon, Kle" uniqKey="Hon K" first="Kle" last="Hon">Kle Hon</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Leung, Cw" sort="Leung, Cw" uniqKey="Leung C" first="Cw" last="Leung">Cw Leung</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Cheng, Wtf" sort="Cheng, Wtf" uniqKey="Cheng W" first="Wtf" last="Cheng">Wtf Cheng</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Chan, Pks" sort="Chan, Pks" uniqKey="Chan P" first="Pks" last="Chan">Pks Chan</name><affiliation><nlm:aff id="aff2">Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Chu, Wcw" sort="Chu, Wcw" uniqKey="Chu W" first="Wcw" last="Chu">Wcw Chu</name><affiliation><nlm:aff id="aff3">Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Kwan, Yw" sort="Kwan, Yw" uniqKey="Kwan Y" first="Yw" last="Kwan">Yw Kwan</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Li, Am" sort="Li, Am" uniqKey="Li A" first="Am" last="Li">Am Li</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Fong, Nc" sort="Fong, Nc" uniqKey="Fong N" first="Nc" last="Fong">Nc Fong</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Ng, Pc" sort="Ng, Pc" uniqKey="Ng P" first="Pc" last="Ng">Pc Ng</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Chiu, Mc" sort="Chiu, Mc" uniqKey="Chiu M" first="Mc" last="Chiu">Mc Chiu</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Li, Ck" sort="Li, Ck" uniqKey="Li C" first="Ck" last="Li">Ck Li</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Tam, Js" sort="Tam, Js" uniqKey="Tam J" first="Js" last="Tam">Js Tam</name><affiliation><nlm:aff id="aff2">Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Fok, Tf" sort="Fok, Tf" uniqKey="Fok T" first="Tf" last="Fok">Tf Fok</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">12767737</idno><idno type="pmc">7112484</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7112484</idno><idno type="RBID">PMC:7112484</idno><idno type="doi">10.1016/S0140-6736(03)13364-8</idno><date when="2003">2003</date><idno type="wicri:Area/Pmc/Corpus">001247</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001247</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical presentations and outcome of severe acute respiratory syndrome in children</title><author><name sortKey="Hon, Kle" sort="Hon, Kle" uniqKey="Hon K" first="Kle" last="Hon">Kle Hon</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Leung, Cw" sort="Leung, Cw" uniqKey="Leung C" first="Cw" last="Leung">Cw Leung</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Cheng, Wtf" sort="Cheng, Wtf" uniqKey="Cheng W" first="Wtf" last="Cheng">Wtf Cheng</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Chan, Pks" sort="Chan, Pks" uniqKey="Chan P" first="Pks" last="Chan">Pks Chan</name><affiliation><nlm:aff id="aff2">Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Chu, Wcw" sort="Chu, Wcw" uniqKey="Chu W" first="Wcw" last="Chu">Wcw Chu</name><affiliation><nlm:aff id="aff3">Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Kwan, Yw" sort="Kwan, Yw" uniqKey="Kwan Y" first="Yw" last="Kwan">Yw Kwan</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Li, Am" sort="Li, Am" uniqKey="Li A" first="Am" last="Li">Am Li</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Fong, Nc" sort="Fong, Nc" uniqKey="Fong N" first="Nc" last="Fong">Nc Fong</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Ng, Pc" sort="Ng, Pc" uniqKey="Ng P" first="Pc" last="Ng">Pc Ng</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Chiu, Mc" sort="Chiu, Mc" uniqKey="Chiu M" first="Mc" last="Chiu">Mc Chiu</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Li, Ck" sort="Li, Ck" uniqKey="Li C" first="Ck" last="Li">Ck Li</name><affiliation><nlm:aff id="aff4">Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</nlm:aff></affiliation></author><author><name sortKey="Tam, Js" sort="Tam, Js" uniqKey="Tam J" first="Js" last="Tam">Js Tam</name><affiliation><nlm:aff id="aff2">Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author><author><name sortKey="Fok, Tf" sort="Fok, Tf" uniqKey="Fok T" first="Tf" last="Fok">Tf Fok</name><affiliation><nlm:aff id="aff1">Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</nlm:aff></affiliation></author></analytic><series><title level="j">Lancet (London, England)</title><idno type="ISSN">0140-6736</idno><idno type="eISSN">1474-547X</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><p>Hong Kong has been severely affected by severe acute respiratory syndrome (SARS). Contact in households and healthcare settings is thought to be important for transmission, putting children at particular risk. Most data so far, however, have been for adults. We prospectively followed up the first ten children with SARS managed during the early phase of the epidemic in Hong Kong. All the children had been in close contact with infected adults. Persistent fever, cough, progressive radiographic changes of chest and lymphopenia were noted in all patients. The children were treated with high-dose ribavirin, oral prednisolone, or intravenous methylprednisolone, with no short-term adverse effects. Four teenagers required oxygen therapy and two needed assisted ventilation. None of the younger children required oxygen supplementation. Compared with adults and teenagers, SARS seems to have a less aggressive clinical course in younger children.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Peiris, Jsm" uniqKey="Peiris J">JSM Peiris</name></author><author><name sortKey="Lai, St" uniqKey="Lai S">ST Lai</name></author><author><name sortKey="Poon, Llm" uniqKey="Poon L">LLM Poon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, N" uniqKey="Lee N">N Lee</name></author><author><name sortKey="Hui, D" uniqKey="Hui D">D Hui</name></author><author><name sortKey="Wu, A" uniqKey="Wu A">A Wu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cairo, M" uniqKey="Cairo M">M Cairo</name></author><author><name sortKey="Brancho, F" uniqKey="Brancho F">F Brancho</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Dw" uniqKey="Smith D">DW Smith</name></author><author><name sortKey="Frankel, Lr" uniqKey="Frankel L">LR Frankel</name></author><author><name sortKey="Mathers, Lh" uniqKey="Mathers L">LH Mathers</name></author><author><name sortKey="Tang, At" uniqKey="Tang A">AT Tang</name></author><author><name sortKey="Ariagno, Rl" uniqKey="Ariagno R">RL Ariagno</name></author><author><name sortKey="Prober, Cg" uniqKey="Prober C">CG Prober</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet</journal-id><journal-id journal-id-type="iso-abbrev">Lancet</journal-id><journal-title-group><journal-title>Lancet (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0140-6736</issn><issn pub-type="epub">1474-547X</issn><publisher><publisher-name>Elsevier Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">12767737</article-id><article-id pub-id-type="pmc">7112484</article-id><article-id pub-id-type="publisher-id">S0140-6736(03)13364-8</article-id><article-id pub-id-type="doi">10.1016/S0140-6736(03)13364-8</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Clinical presentations and outcome of severe acute respiratory syndrome in children</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hon</surname><given-names>KLE</given-names></name><degrees>FAAP</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Leung</surname><given-names>CW</given-names></name><degrees>FRCPCH</degrees><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Cheng</surname><given-names>WTF</given-names></name><degrees>MRCPCH</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Chan</surname><given-names>PKS</given-names></name><degrees>MD</degrees><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Chu</surname><given-names>WCW</given-names></name><degrees>FRCR</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Kwan</surname><given-names>YW</given-names></name><degrees>MRCP</degrees><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>AM</given-names></name><degrees>MRCP</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Fong</surname><given-names>NC</given-names></name><degrees>MRCP</degrees><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Ng</surname><given-names>PC</given-names></name><degrees>MD</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author"><name><surname>Chiu</surname><given-names>MC</given-names></name><degrees>FRCP</degrees><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Li</surname><given-names>CK</given-names></name><degrees>MD</degrees><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author"><name><surname>Tam</surname><given-names>JS</given-names></name><degrees>PhD</degrees><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Fok</surname><given-names>TF</given-names></name><degrees>Prof</degrees><degrees>MD</degrees><email>taifaifok@cuhk.edu.hk</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="cor1" ref-type="corresp">*</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</aff><aff id="aff2"><label>b</label>Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</aff><aff id="aff3"><label>c</label>Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Adminstrative Region, China</aff><aff id="aff4"><label>d</label>Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong</aff><author-notes><corresp id="cor1"><label>*</label>Correspondence to: Prof T F Fok, Department of Paediatrics, Chinese University of Hong Kong, 6/F, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong, Special Administrative Region, China <email>taifaifok@cuhk.edu.hk</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>15</day><month>5</month><year>2003</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><day>17</day><month>5</month><year>2003</year></pub-date><pub-date pub-type="epub"><day>15</day><month>5</month><year>2003</year></pub-date><volume>361</volume><issue>9370</issue><fpage>1701</fpage><lpage>1703</lpage><permissions><copyright-statement>Copyright © 2003 Elsevier Ltd. All rights reserved.</copyright-statement><copyright-year>2003</copyright-year><copyright-holder>Elsevier Ltd</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract><title>Summary</title><p>Hong Kong has been severely affected by severe acute respiratory syndrome (SARS). Contact in households and healthcare settings is thought to be important for transmission, putting children at particular risk. Most data so far, however, have been for adults. We prospectively followed up the first ten children with SARS managed during the early phase of the epidemic in Hong Kong. All the children had been in close contact with infected adults. Persistent fever, cough, progressive radiographic changes of chest and lymphopenia were noted in all patients. The children were treated with high-dose ribavirin, oral prednisolone, or intravenous methylprednisolone, with no short-term adverse effects. Four teenagers required oxygen therapy and two needed assisted ventilation. None of the younger children required oxygen supplementation. Compared with adults and teenagers, SARS seems to have a less aggressive clinical course in younger children.</p></abstract></article-meta></front><body><p id="para10">Since late February, 2003, WHO has received reports of outbreaks of a severe form of atypical pneumonia in Vietnam, Hong Kong, and Singapore. Hong Kong is the most severely affected city. WHO has referred to this unusual form of severe pneumonia as severe acute respiratory syndrome (SARS).<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> The surveillance case definition of SARS is: history of high fever (>38·C); one or more respiratory symptoms, including cough, shortness of breath, and difficulty breathing; and close contact within 10 days before onset of symptoms with a person who has been diagnosed with SARS, history of travel within 10 days before onset before symptoms to an area with reported foci of SARS transmission, or both.<xref rid="bib1" ref-type="bibr"><sup>1</sup></xref> Household contact and contacts in health-care settings are believed to be important routes of transmission.<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref> This transmission route could put children at particular risk, but most data available so far have been in adults. We therefore decided to report our experience in treating children with SARS.</p><p id="para20">Between March 13 and 28, 2003, ten children with suspected SARS were admitted to and managed at the Prince of Wales and Princess Margaret Hospitals, Hong Kong. We prospectively followed up the clinical, laboratory, and radiological profiles and treatment outcomes of these children. Microbiological investigations were done to detect common bacterial and viral pathogens associated with community-acquired pneumonia.</p><p id="para30">We treated all patients with combined corticosteroids, antivirals, and antibacterial agents. Intravenous cefotaxime, oral clarithromycin, and oral ribavirin (40 mg/kg daily, given in two or three doses) were started if a diagnosis of SARS was suspected on admission. Oral prednisolone (0·5 mg/kg daily at Prince of Wales Hospital, and 2·0 mg/kg daily at Princess Margaret Hospital) was added if fever persisted after 48 h. In addition, we treated patients who had moderate symptoms of high fluctuating fever and notable malaise with intravenous ribavirin (20 mg/kg daily, given in three doses) and hydrocortisone (2 mg/kg every 6 h) immediately after admission. For patients who had persistent fever and progressive worsening clinically or radiologically, we used pulse intravenous methylprednisolone (10–20 mg/kg). Ribavirin was administered for 1–2 weeks and corticosteroid dose was tapered over 2–4 weeks.</p><p id="para40">All children satisfied the WHO case definition for SARS and all had been in close contact with infected adults. The demographic, clinical, and laboratory data are shown in the <xref rid="tbl1" ref-type="table">table</xref>. Fever was a consistent symptom in all children, and lasted for a median duration of 6 days (range 3–11). There was no clinically significant drop in haemoglobin concentrations during treatment with ribavirin. In eight patients, corticosteroid was added to the regimen when fever did not subside. Pulse methylprednisolone was given to one young child (patient 2) and four teenagers (patients 6–9). Within 2 days of corticosteroid administration, all but one patient (patient 9) became afebrile. The same four teenagers developed respiratory distress and oxygen desaturation on day 5, 4, 6 and 7, respectively, after the onset of fever. These children were placed under strict isolation for 21 days and became asymptomatic before discharge.<table-wrap position="float" id="tbl1"><label>Table</label><caption><p>Clinical features and treatment outcomes among SARS children</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th colspan="10" align="left"><bold>Patient number</bold><hr></hr></th></tr><tr><th></th><th align="left"><bold>1</bold></th><th align="left"><bold>2</bold></th><th align="left"><bold>3</bold></th><th align="left"><bold>4</bold></th><th align="left"><bold>5</bold></th><th align="left"><bold>6</bold></th><th align="left"><bold>7</bold></th><th align="left"><bold>8</bold></th><th align="left"><bold>9</bold></th><th align="left"><bold>10</bold></th></tr></thead><tbody><tr><td align="left"><bold>Age (years)</bold><hr></hr></td><td align="left">1·5<hr></hr></td><td align="left">2·2<hr></hr></td><td align="left">5·1<hr></hr></td><td align="left">6·2<hr></hr></td><td align="left">7·5<hr></hr></td><td align="left">13·2<hr></hr></td><td align="left">13·3<hr></hr></td><td align="left">15·6<hr></hr></td><td align="left">15·6<hr></hr></td><td align="left">16·4<hr></hr></td></tr><tr><td align="left"><bold>Sex (M/F)</bold><hr></hr></td><td align="left">F<hr></hr></td><td align="left">M<hr></hr></td><td align="left">F<hr></hr></td><td align="left">F<hr></hr></td><td align="left">M<hr></hr></td><td align="left">F<hr></hr></td><td align="left">F<hr></hr></td><td align="left">F<hr></hr></td><td align="left">F<hr></hr></td><td align="left">F<hr></hr></td></tr><tr><td colspan="11" align="left"><bold>Clinical features</bold></td></tr><tr><td align="left">Fever</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td></tr><tr><td align="left">Dyspnoea</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">Runny nose</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">No</td><td align="left">Yes</td><td align="left">No</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">Cough</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td></tr><tr><td align="left">Sore throat</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">No</td></tr><tr><td align="left">Chills/rigors</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td></tr><tr><td align="left">Myalgia</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td></tr><tr><td align="left">Headache</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">No</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td><td align="left">Yes</td></tr><tr><td align="left">Other</td><td align="left">‥</td><td align="left">Febrile convulsion</td><td align="left">‥</td><td align="left">‥</td><td align="left">Dizziness</td><td align="left">Nausea</td><td align="left">Abdominal pain</td><td align="left">‥</td><td align="left">Nausea</td><td align="left">‥</td></tr><tr><td align="left">Contact history<hr></hr></td><td align="left">Community outbreak<hr></hr></td><td align="left">Grandmother<hr></hr></td><td align="left">Grandmother<hr></hr></td><td align="left">Family doctor<hr></hr></td><td align="left">Parents<hr></hr></td><td align="left">Health-care worker<hr></hr></td><td align="left">Community outbreak<hr></hr></td><td align="left">Mother<xref rid="tbl1fn1" ref-type="table-fn">*</xref><hr></hr></td><td align="left">Mother<xref rid="tbl1fn1" ref-type="table-fn">*</xref><hr></hr></td><td align="left">Healthcare worker<hr></hr></td></tr><tr><td colspan="11" align="left"><bold>Laboratory findings</bold></td></tr><tr><td align="left">Lowest Lymphocyte count (×10<sup>9</sup>/L)</td><td align="left">3·0 (day 3)</td><td align="left">1·1 (day 3)</td><td align="left">1·1 (day 4)</td><td align="left">1·1 (day 3)</td><td align="left">1·2 (day 4)</td><td align="left">0·8 (day 6)</td><td align="left">0·7 (day 4)</td><td align="left">0·4 (day 6)</td><td align="left">0·3 (day 4)</td><td align="left">0·7 (day 4)</td></tr><tr><td align="left">Lowest platelet count (×10<sup>9</sup>/L)</td><td align="left">345</td><td align="left">216</td><td align="left">143</td><td align="left">196</td><td align="left">131</td><td align="left">178</td><td align="left">147</td><td align="left">136</td><td align="left">131</td><td align="left">209</td></tr><tr><td align="left">Highest serum LDH (U/L)<xref rid="tbl1fn2" ref-type="table-fn">†</xref></td><td align="left">376</td><td align="left">308</td><td align="left">324</td><td align="left">273</td><td align="left">332</td><td align="left">286</td><td align="left">676</td><td align="left">392</td><td align="left">431</td><td align="left">208</td></tr><tr><td align="left">Highest serum ALT (U/L))<xref rid="tbl1fn3" ref-type="table-fn">‡</xref><hr></hr></td><td align="left">29<hr></hr></td><td align="left">35<hr></hr></td><td align="left">25<hr></hr></td><td align="left">12<hr></hr></td><td align="left">38<hr></hr></td><td align="left">45<hr></hr></td><td align="left">44<hr></hr></td><td align="left">95<hr></hr></td><td align="left">65<hr></hr></td><td align="left">168<hr></hr></td></tr><tr><td colspan="11" align="left"><bold>Radiological findings</bold></td></tr><tr><td align="left">Initial chest radiograph</td><td align="left">Right lower-zone focal</td><td align="left">Right perihilar</td><td align="left">Left middle-zone consolidation</td><td align="left">Left upper-zone consolidation</td><td align="left">Right upper-zone consolidation</td><td align="left">Right lower-zone consolidation</td><td align="left">Left and right lower-zone consolidation</td><td align="left">Left lower-zone consolidation</td><td align="left">Left lower-zone consolidation</td><td align="left">Normal</td></tr><tr><td align="left">Progressive changes of chest radiograph</td><td align="left">Increased right lower zone consolidation (day 2)</td><td align="left">Progress to involve right upper zone (day 8)</td><td align="left">Increased left middle-zone consolidation (day 5)</td><td align="left">Increased left upper-zone consolidation (day 4)</td><td align="left">Increased right upper- zone consolidation (day 5)</td><td align="left">Increased right lower- zone consolidation (day 5)</td><td align="left">Increased right and left upper-zone consolidation (day 6)</td><td align="left">Diffuse confluence left and right lower zones (day 9)</td><td align="left">Diffuse confluence right and left lower zones (day 11)</td><td align="left">Normal</td></tr><tr><td align="left">Findings on CT of thorax<hr></hr></td><td align="left">None<hr></hr></td><td align="left">Bilateral multifocal air space consolidations<hr></hr></td><td align="left">None<hr></hr></td><td align="left">None<hr></hr></td><td align="left">None<hr></hr></td><td align="left">None<hr></hr></td><td align="left">None<hr></hr></td><td align="left">None<hr></hr></td><td align="left">None<hr></hr></td><td align="left">Consolidation at right basal segments<hr></hr></td></tr><tr><td colspan="11" align="left"><bold>Treatment and outcome</bold></td></tr><tr><td align="left">Oral ribavirin</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Prescribed</td></tr><tr><td align="left">IV ribavirin</td><td align="left">Not prescribed</td><td align="left">Prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Not</td></tr><tr><td align="left">Oral prednisolone/IV hydrocortisone</td><td align="left">Not prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Not prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Not prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td><td align="left">Prescribed</td></tr><tr><td align="left">IV pulse methyl-prednisolone</td><td align="left">Not prescribed</td><td align="left">Twice (day 10)</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Once (day 6)</td><td align="left">Three times (days 4–6)</td><td align="left">Once (days 6)</td><td align="left">Once (day 7)</td><td align="left">Not</td></tr><tr><td align="left">Duration of fever (days</td><td align="left">4</td><td align="left">6</td><td align="left">7</td><td align="left">3</td><td align="left">6</td><td align="left">6</td><td align="left">5</td><td align="left">10</td><td align="left">11</td><td align="left">4</td></tr><tr><td align="left">Ventilatory support</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Not prescribed</td><td align="left">Nasal cannula (days 5-9)</td><td align="left">Nasal cannula (days 4-10)</td><td align="left">Face mask (days 7-8; 12-15), BiPAP (days 8-12)</td><td align="left">Face mask (days 7-10; 13-19), IPPV (days 10-13)</td><td align="left">Not prescribed</td></tr><tr><td align="left">Maximum oxygen requirement</td><td align="left">Air</td><td align="left">Air</td><td align="left">Air</td><td align="left">Air</td><td align="left">Air</td><td align="left">2 L/min</td><td align="left">3 L/min</td><td align="left">50%</td><td align="left">50%</td><td align="left">Air</td></tr></tbody></table><table-wrap-foot><fn><p>LDH=lactic dehydrogenase. ALT=alanine aminotransferase. IV=intravenous. BiPAP=bi-level positive airway pressure. IPPV=intermittent positive pressure ventilation.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn1"><label>*</label><p>Mother of twin sisters (patients 8 and 9) is health-care assistant.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn2"><label>†</label><p>Normal range 110-230 U/L.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn3"><label>‡</label><p>Normal range 1-40 U/L.</p></fn></table-wrap-foot></table-wrap></p><p id="para50">Nine children had abnormal chest radiographs on presentation. The primary abnormality was air-space opacification. Of the five children aged 12 years or younger (patients 1–5), four presented with focal segmental consolidation. Patient 2 had ill-defined patchy consolidation, but CT of the thorax showed multifocal air-space consolidation. All these patients had mild progressive consolidative change on serial chest radiographs but complete resolution was achieved within 14 days. The typical radiographic changes in one patient are shown in the <xref rid="fig1" ref-type="fig">figure</xref>. Three of the five teenagers (patients 7–9) presented with bilateral lower-lobe opacification at presentation, which progressed rapidly within days. Despite clinical improvement, these consolidative changes persisted into the 2nd week of the illness. Patient 10 showed no abnormality on chest radiography at presentation, but high-resolution CT confirmed focal consolidation in the right lower lobe. In CT of the thorax in patients 2 and 6, the characteristic features of peripheral and alveolar opacities simulated the radiological appearances of bronchiolitis obliterans organising pneumonia. Four teenagers required supplemental oxygen, one required bi-level positive airway pressure and intermittent positive-pressure ventilation. Respiratory distress developed 4–7 days after presentation.<fig id="fig1"><label>Figure 1</label><caption><p>Serial chest radiographs of patient 5, who presented with fever and cough A=ill-defined air-space consolidation in periphery of right upper lobe and abutting horizontal fissure. B=Increased consolidation in right upper zone on day 5.</p></caption><graphic xlink:href="gr1_lrg"></graphic></fig></p><p id="para60">Lymphopenia (0·3–3·0 · 10<sup>9</sup>/L) was reported in all patients, but the teenagers were generally more severely affected than the younger children. Lymphopenia mostly occurred between days 3 and 7, after the onset of fever. No bacteria, fungi, mycoplasma, chlamydia, or common respiratory viruses were detected by the laboratory investigations. Coronavirus was isolated by viral culture from the nasopharyngeal aspirates of patients 2 and 3. Reverse-transcriptase PCR targeting the novel coronavirus present in the nasopharyngeal aspirate samples was positive in four of six children tested (patients 1, 7, 9, and 10).</p><p id="para70">We noted two distinct patterns of clinical presentation among the children we studied. Teenage patients presented with symptoms of malaise, myalgia, chill, and rigor similar to those of adults,<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref> whereas the younger children presented mainly with cough and runny nose, and none had chills, rigor, or myalgia. The clinical course was much milder and shorter among younger patients, and radiological changes were milder and generally resolved more quickly than in the teenagers. All paediatric patients had clinically important lymphopenia,<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> but it was more severe among the teenage children. However, since young children normally have higher lymphocyte counts than adults, the interpretation of results must take into account the patients' ages.<xref rid="bib4" ref-type="bibr"><sup>4</sup></xref> Furthermore, lymphopenia frequently resolves when the disease is improving.</p><p id="para80">We adopted a treatment regimen of ribavirin and steroids similar to that used in adult SARS patients.<xref rid="bib2" ref-type="bibr">2</xref>, <xref rid="bib3" ref-type="bibr">3</xref> Ribavirin is a broad-spectrum antiviral agent and has been used for treatment of severe respiratory syncytial virus infection in children.<xref rid="bib5" ref-type="bibr"><sup>5</sup></xref> Among our patients, short-term use of high-dose ribavirin was well tolerated and had no major short-term adverse effects such as severe haemolytic anaemia. In addition, high-dose corticosteroid was used in combination with the antiviral agent because severe immune-mediated damage of lung tissue was reported in postmortem examination of SARS patients.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref></p><p id="para90">Eight of the ten children had been attending school at the time of presentation. There was no evidence that they had spread the infection to their classmates. This finding is in sharp contrast to the experience reported among adults that SARS carries a very high infectivity rate.<xref rid="bib2" ref-type="bibr"><sup>2</sup></xref>,<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> At the time of our study, 22 adults had died in Hong Kong.<xref rid="bib3" ref-type="bibr"><sup>3</sup></xref> During the study period, around 30 children were suspected as having SARS in Hong Kong. So far, no child has died. Our preliminary findings suggest that young children develop a milder form of the disease with a less-aggressive clinical course than do teenagers and adults.</p></body><back><ref-list id="bibl10"><title>References</title><ref id="bib1"><label>1</label><element-citation publication-type="other" id="reference0005"><person-group person-group-type="author"><collab>WHO</collab></person-group><article-title>Case definition for surveillance of severe acute respiratory syndrome SARS</article-title><ext-link ext-link-type="uri" xlink:href="http://www.who.int/csr/sars/casedefinition">http://www.who.int/csr/sars/casedefinition</ext-link><comment>(accessed April 24, 2003)</comment></element-citation></ref><ref id="bib2"><label>2</label><element-citation publication-type="journal" id="reference0010"><person-group person-group-type="author"><name><surname>Peiris</surname><given-names>JSM</given-names></name><name><surname>Lai</surname><given-names>ST</given-names></name><name><surname>Poon</surname><given-names>LLM</given-names></name><collab>and members of the SARS study group</collab></person-group><article-title>Coronavirus as a possible cause of severe acute respiratory syndrome</article-title><source>Lancet</source><volume>361</volume><year>2003</year><fpage>1319</fpage><lpage>1325</lpage><pub-id pub-id-type="pmid">12711465</pub-id></element-citation></ref><ref id="bib3"><label>3</label><element-citation publication-type="other" id="reference0015"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>N</given-names></name><name><surname>Hui</surname><given-names>D</given-names></name><name><surname>Wu</surname><given-names>A</given-names></name></person-group><article-title>A major outbreak of severe acute respiratory syndrome in Hong Kong</article-title><ext-link ext-link-type="uri" xlink:href="http://content.nejm.org/cgi/reprint/NEJMoa030685v2.pdf">http://content.nejm.org/cgi/reprint/NEJMoa030685v2.pdf</ext-link><comment>(accessed April 24, 2003)</comment></element-citation></ref><ref id="bib4"><label>4</label><element-citation publication-type="book" id="reference0020"><person-group person-group-type="author"><name><surname>Cairo</surname><given-names>M</given-names></name><name><surname>Brancho</surname><given-names>F</given-names></name></person-group><chapter-title>Blood and blood-forming tissues</chapter-title><person-group person-group-type="editor"><name><surname>Rudolph</surname><given-names>AM</given-names></name></person-group><source>Rudolph's Pediatrics</source><edition>21st edn</edition><year>2002</year><publisher-name>McGraw Hill</publisher-name><publisher-loc>New York</publisher-loc><fpage>1548</fpage></element-citation></ref><ref id="bib5"><label>5</label><element-citation publication-type="journal" id="reference0025"><person-group person-group-type="author"><name><surname>Smith</surname><given-names>DW</given-names></name><name><surname>Frankel</surname><given-names>LR</given-names></name><name><surname>Mathers</surname><given-names>LH</given-names></name><name><surname>Tang</surname><given-names>AT</given-names></name><name><surname>Ariagno</surname><given-names>RL</given-names></name><name><surname>Prober</surname><given-names>CG</given-names></name></person-group><article-title>A controlled trial of aerosolized ribavirin in infants receiving mechanical ventilation for severe respiratory syncytial virus infection</article-title><source>N Engl J Med</source><volume>325</volume><year>1991</year><fpage>24</fpage><lpage>29</lpage><pub-id pub-id-type="pmid">1904551</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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