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'DIAGNOSIS / EVALUATION'
Initial
diagnostic testing for SARS patients should include chest
radiograph, PULSE OXIMETRY, BLOOD CULTURES, SPUTUM Gram’s
attain and culture, and testing for viral respiratory
pathogens, notable influenza A and B and respiratory
syncytial virus. A specimen for Legionella and pneumococcal
urinary antigen testing should also be considered. Clinician
should save any available specimens ( respiratory, blood,
and serum) for additional testing until a specific diagnosis
is made. Acute and convalescent (greater than 21 days onset
of symptoms) serum samples should be collected from each
patient who meets the SARS case definition.
Investigations
1. Chest Radiograph
Chest Radiograph
might be normal during the febrile prodrome and throughout
the course of illness. However, in a substantial proportion
of patients, the respiratory phase is characterized by early
focal interstitial infiltrates progressing to more
generalized, patchy, interstitial infiltrates. Some x-ray
from patients in late stages of SARS also have shown areas
of consolidation.
2. Blood Investigations
-
CBC - early
in course of disease - the absolute lymphocyte count is
often decreased. Overall white blood cell counts have
been normal or decreased.
At the peak of respiratory illness, approximately 50% of
patients have Leucopoenia, thrombocytopenia or
low-normal platelet counts.
-
Elevated
creatine phosphokinase levels (as high as 3000IV / L)
and hepatic transaminases (2-6 times higher)
have been noted.
-
Renal
function test - have been normal in majority of
patients.
-
Immunological assays -
Treatment Regimens
Treatment
regimens have included several antibiotics to presumptively
treat known bacterial agents of a typical pneumonia. In
several locations, therapy also has included antiviral
agents such as Oseltamivir or Ribavirin. Steriods have been
administered orally or intravenously to patients in
combination with ribavirin.
At present, the
most efficacious treatment regimen, if any is still UNKNOWN.
'CDC
RECOMMENDATIONS'
CDC has issued
recommendations and guidelines for people who may be
affected by this outbreak.
For individuals
considering travel to areas with SARS:
CDC has issued
two types of notices to travelers: advisories and alerts. A
travel advisory recommends that nonessential travel be
deferred; a travel alert does not advise against travel, but
informs travellers of a health concern and provides advice
about specific precautions.
For individuals
who must travel to an area with SARS:
CDC advices that
travelers in an area with SARS should wash their hands
frequently to protect against SARS infection. In addition,
CDC advices that travels may wish to avoid close contact
with large numbers of people as much as possible to minimize
the possibility of infection. CDC does not recommend the
routine use of masks or other personal protective equipment
while in public areas.
For individuals
who think they might have SARS:
People with
symptoms of SARS (fever greater than 100.4o F (>38o C)
accompanied by a cough and / or difficulty in breathing)
should consult a health-care provider. To help the –care
provider make a diagnosis, tell them about any recent travel
to places where SARS has been reported or whether there was
contact with someone who had these symptoms.
For family
members caring for someone with SARS:
The basic
precautions should be followed for 10 days after respiratory
symptoms and fever are gone. During that time, SARS patients
are asked to limit interactions outside the home (not go to
work, school, or other public areas).
For health -
care workers:
Transmission of
SARS to health - Care workers appears to have occurred after
close contact with sick people before recommended infection
control precautions were put into use. Clinicians evaluating
suspected cases should use standard precautions (Eg. - hand
hygiene) together with airborne (Eg - N - 95 repirator) and
contact (Eg - gloves and gowns) precautions. The suspected
cases or travelers coming from Endemic areas should be
isolated for a period of 3 weeks.
Management of
Symptomatic, Exposed Visitors:
Close contact
(e.g. family members) of SARS patients are at risk for
infection. Close contacts with either fever or respirator
symptoms should not be allowed to enter the health-care
facility as visitors and should be educated about this
policy. A system for screening SARS close contacts who are
visitors to the facility6 for fever or respiratory symptoms
should be in place. Health-care facilities should educate
all visitors about use of infection control precautions when
visiting SARS patients and their responsibility for
adherence to them.
References:
1) Centers for
Disease Control and Prevention. Outbreak of severe acute
respiratory syndrome worldwide, 2003.
2) World Health
Organisation. Who issues emergency travel advisory: severe
acute respiratory syndrome (SARS) spreads worldwide.
(accessed March 15, 2003). Available from:
URL : www.who.int/mediacentre/release/2003/pr23/en
3) Poutanen SM,
Low DE, Henry B, Finkelsstein S, Rose D,Green k, et al.
identification of sever acute respiratory syndrome in
CANADA. N Engl J Med 2003 Apr 10; (epub ahead of print).
4) Tsang KW, Ho,
PL, Ooi GC, Yee Wk, Wang T, Chan-Yeung M, et al. A cluster
of cases of severe acute respiratory syndrome in Hong Kong.
N Engl J Med 2003 Apr 11.
5) Lee N, Hui D,
Wu A, Chan P, Cameron P, Joynt GM, et al. a Major outbreak
of severe acute respiratory syndrome in Hong Kong. N Engl J
Med 2003 Apr 14.
6) JAPI - April
2003 (Vol.51)
7) BMJ - April
2003.
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