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Clinical Aspects of Severe Acute Respiratory Syndrome (Sars)



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Clinical Aspects of Severe Acute Respiratory Syndrome (Sars) by Chung-Ming Chu
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This dissertation, "Clinical Aspects of Severe Acute Respiratory Syndrome (SARS)" by Chung-ming, Chu, 朱頌明, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: ABSTRACT of thesis entitled Clinical Aspects of Severe Acute Respiratory Syndrome (SARS) Submitted by Chung-ming Chu for the degree of Doctor of Medicine at The University of Hong Kong in October 2005 Severe acute respiratory syndrome (SARS) is a newly emerged viral pneumonia caused by SARS-associated coronavirus (SARS-CoV). This thesis aims to describe the various clinical aspects of SARS. In the first study, the clinical course of SARS in 75 patients was prospectively examined. SARS began as an influenza-like illness. HRCT of the thorax and repeated RT-PCR testing were helpful in making the diagnosis. SARS appeared to be tri-phasic: after an initial phase of pneumonic illness which improved transiently, most patients deteriorated clinico-radiologically in the second phase. ARDS developed in 20% of patients in phase 3. Quantitative PCR of nasopharyngeal aspirates showed a peak at day 10. The characteristic progression of disease may reflect the interplay between viral replication and immuno-pathological damage. Spontaneous pneumomediastinum (SP) is a newly recognised complication of SARS. In the second study, SP was found to develop in 11.6% of 112 patients. SP was associated with more intubation. SP appeared to be a characteristic and frequent complication of SARS. The duration of infectivity in SARS is unknown. In the third study, the RT- PCR positivity for SARS-CoV in 45 SARS patients was followed. Time to RT-PCR conversion ranged from 2 to 81 days. A significant proportion (40%) of SARS patients remained RT-PCR positive after discharge. It is prudent to advise patients to adhere to strict personal hygiene on discharge until RT-PCR becomes negative. SARS carries a considerable mortality. In the fourth study, potential predictors of survival were analyzed in 133 SARS patients. Thirty-two patients i (24.1%) met ARDS criteria and 24 patients (18%) of the cohort died. Higher initial viral load in NP specimen, older age and active comorbidity were independently associated with worse survival. The cause of the massive community outbreak that occurred in the Amoy Gardens, Hong Kong, remained enigmatic. In the fifth study, the initial NP viral loads of 79 SARS patients from the Amoy Garden were correlated with the geographical distribution of their residences. Significantly higher NP viral loads were found in patients living in the adjacent units of the same block inhabited by the index case (Block E) than in patients living downstream of a proposed airborne spread. The observation lends support to the theory of an unusual airborne spread. In the sixth study, the clinical response of patients with SARS to a combination of lopinavir/ritonavir (LPV/r) and ribavirin was examined after in vitro testing. Forty-one patients with SARS were treated with a combination of LPV/r and ribavirin in an open-label trial. Their outcomes were compared with historical controls of 111 patients treated with ribavirin only. The 21-day adverse outcome (ARDS or death) was significantly lower in the treatment group than in the historical controls (2.4% versus 28.8%, p Other compounds maybe potentially useful in the treatment of SARS: interferons, convalescen
Release date NZ
January 26th, 2017
Created by
Country of Publication
United States
colour illustrations
Open Dissertation Press
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