AFRO-NETS> Severe Acute Respiratory Syndrome (SARS): Clinical Presentation & Management

[A Odutola <chpss_abo@yahoo.com>]

Severe Acute Respiratory Syndrome (SARS): Clinical Presentation & Management
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Dear All,

The clinical information below is presented especially for the bene-
fit of health care providers in those Africa countries (Ethiopia, 
Kenya, Tanzania, South Africa, Nigeria, etc.) with substantial traf-
fic to and from the Asia region. 

Hope it is found useful.

A. Odutola
mailto:chpss_abo@yahoo.com


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Severe Acute Respiratory Syndrome (SARS): Clinical Presentation & 
Management

World Health Organisation
Published Date: March 24 2003


Introduction

Severe Acute Respiratory Syndrome (SARS) is a disease of unknown eti-
ology that has recently been described in patients in Asia, North 
America, and Europe. It has been associated with air travellers in 
the Asia region.

The information in this report (though preliminary) derives from a 
WHO account of the clinical characteristics of SARS patients treated 
in Hong Kong Special Administrative Region (China), Taiwan (China), 
Thailand, Singapore, the United Kingdom, Slovenia, Canada and the 
United States since mid-February 2003. Although cases are yet to be 
described in Africa, it is not to be assumed that this SARS does not 
affect Africans.

Age: Most patients identified as of March 21, 2003 have been previ-
ously healthy adults aged 25-70 years. A few suspected cases of SARS 
have been reported among children (<15 years).

Incubation: The incubation period of SARS is usually 2-7 days but may 
be as long as 10 days. 

Clinical Presentation: 
a) Febrile phase: The illness generally begins with a prodromal fever 
(>38°C), which is often high, sometimes associated with chills and 
rigors and sometimes accompanied by other symptoms including head-
ache, malaise, and myalgias. 

At the onset of illness, some cases have mild respiratory symptoms. 
Typically, rash and neurologic or gastrointestinal findings are ab-
sent, although a few patients have reported diarrhoea during the feb-
rile episode.

b) Respiratory phase: After 3-7 days, a lower respiratory phase be-
gins with the onset of a dry, non-productive cough or dyspnea that 
may be accompanied by or progress to hypoxemia. In 10%-20% of cases, 
the respiratory illness is severe enough to require intubation and 
mechanical ventilation. 

The case fatality among persons with illness meeting the current WHO 
case definition for probable and suspected cases of SARS is around 
3%.

Investigations: 
a) Chest radiographs may be normal during the febrile period and 
throughout the course of illness.

However, in a substantial proportion of patients, the respiratory 
phase is characterized by early focal infiltrates progressing to more 
generalized, patchy, interstitial infiltrates. Some chest radiographs 
from patients in the late stages of SARS have also shown areas of 
consolidation.

b) Laboratory: Early in the course of disease, the absolute lympho-
cyte count is often decreased. Overall white cell counts have gener-
ally been normal or decreased. At the peak of the respiratory ill-
ness, up to half of patients have leukopenia and thrombocytopenia or 
low-normal platelet counts (50,000 ­ 150,000 / ul). 

Early in the respiratory phase, elevated creatine phosphokinase lev-
els (up to 3000 IU/L) and hepatic transaminases (2- to 6-times the 
upper limits of normal) have been noted. 

Renal function has remained normal in the majority of patients.

Management

Management of suspect cases 
* Patients with symptoms of suspicious of SARS should be isolated im-
  mediately to designated examination rooms or wards and issued with 
  surgical mask. 
* Detailed clinical, travel and contact history including occurrence
  of acute respiratory diseases in contact persons during the last 10
  days should be obtained and recorded 
* Obtain chest X-ray (CXR) and full blood count (FBC) 
* If CXR is normal, provide advice on personal hygiene, avoidance of
  crowded areas and public transportation and advise patient to re-
  main at home until well. If patient remains well after ten days of
  onset of initial symptoms, discharge with advice to seek medical
  care if respiratory symptoms worsen.
* If CXR demonstrates uni- or bi-lateral infiltrates with or without
  interstitial infiltration, then consider as a probable case and
  proceed as follows: 

Management of probable cases
* Hospitalize under isolation or grouped with other SARS cases 
* Take sample for following laboratory investigation and exclusion of
  known causes of atypical pneumonia: 
i. throat and/or nasopharyngeal swabs and cold agglutinins (Weil-
Felix or Widal test) 
ii. blood for culture and serology 
iii. urine for urinalysis
iv. bronchoalveolar lavage
v. blood for full blood count on alternate days; 
vi. conduct chext X-Ray as clinically indicated and 
vii. postmortem examination as appropriate 

All specimens should advisedly be collected on alternate days and in-
vestigated in laboratories with proper containment facilities (BL3). 
This process should be coordinated with in-country national public 
health authority.

Management of contacts of suspected and probable cases

* Provide reassurance Record name and contact details 
* Provide advice in the event of fever or respiratory symptoms to: 
i. immediately report to doctor/physician/health authority 
ii. not report to work until advised by health authority 
iii. minimize contact with family members and friends and avoid pub-
lic places until advised by health authority.

Treatment

Treatment regimens have included a variety of antibiotics to presump-
tively treat known bacterial agents of atypical pneumonia but broad-
spectrum antibiotics have not appeared to have any proven effect in 
halting SARS progression to date. 

In several locations, therapy has also included the use of intrave-
nous antiviral agents such as oseltamivir or ribavirin. This may have 
stabilized the condition of one critically ill patient. 

Steroids have also been given orally or intravenously to patients in 
combination with ribavirin and other antimicrobials. 

At present, the most efficacious treatment regime, if any is unknown.

Sources:
1. http://www.who.int/csr/sars/clinical/en/
2. http://www.who.int/csr/sars/management/en/

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