SARS SYMPTOMS

- majority of patients identified as having SARS have been adults aged 25--70 years who were previously healthy. Few suspected cases of SARS have been reported among children aged under 15 years.

- incubation period appears to be 5-7 days, with isolated reports suggesting an incubation period of as long as 10 days.

- rapid onset of high fever (greater than 100.4), which then settles - followed by muscle aches

- chills, rigors - headache - sore throat - dry cough - shortness of breath - relapse after two to three days of getting better (chills and
rigors with high fever) - acute respiratory distress accompanying the relapse (some need to have a tube inserted in their windpipe to help
them breathe)

- chest x-ray may initially be clear, but changes start on day 3-4 (bases in
particular). Chest x-rays continue to worsen and most patients demonstrate bilateral changes with interstitial infiltrations (fluid build-up
between cells in the lungs). These infiltrations produce x-rays with a characteristic cloudy appearance.

- Patients then fall into one of 2 groups. The majority, 80 to 90 percent of patients at day
6 or 7, show improvement in signs and symptoms. A second smaller group, progress to a more severe form of SARS, many of whom develop acute respiratory distress syndrome and require mechanical ventilatory support. Though mortality associated with the more severe group is high, a
number of patients have remained on ventilator support for prolonged periods of time.
Mortality in the severe group appears to be linked to a patient's other illnesses (co-morbid factors).

- The case-fatality rate among persons with illness meeting the current WHO case definition of SARS is approximately 3.7 percent (as of 3/26/03).

- confusion - diarrhea - muscle stiffness (may be the same as aches noted above?) - malaise - loss of appetite - rash - gastrointestinal upset -
pleuritic chest pain - lightheadedness - hemoptysis (coughing up of blood) -

Early laboratory findings may include thrombocytopenia (low platelet count) - leucopenia (low white blood cell count) - as illness progresses, most develop bilateral and symmetrical pulmonary infiltrates - most have
some elevation in transaminases (AST/ALT/GGT 1- 3x upper limit of normal) - possible elevations in creatine kinase - bone pain (from the doctor in Singapore)

- elevated CRP (C-reactive protein - used to assess an acute phase reaction in inflammatory and infective processes with an elevated value
interpreted as an indication of an acute phase response or active disease.)

- Patients are lymphopenic with platelets decreasing over 3-4 days after initially being normal. APTT (activated partial thromboplastin time) is prolonged, PT (prothrombin time) tends to be normal. LFTS (liver function tests) are difficult to interpret because of various drug effects. If anything low rise (100) in ALT (alternately called SGPT. This test is used
to determine if a patient has liver damage. ALT is an enzyme involved in the metabolism of the amino acid alanine.).

- Patients invariably have an elevated CPK (creatine phosphokinase). No ECG
changes and Troponin T I (coronary artery disease marker) negative. Post mortem on an Indonesian maid (not at Prince of Wales Hospital) showed
evidence of ARDS (Acute Respiratory Distress Syndrome) and myocarditis

- In the majority of patients, renal function has remained normal.

- The severity of illness might be highly variable, ranging from mild illness to death. Although a few close contacts of patients with SARS have developed a similar illness, the majority have remained well. Some close
contacts have reported a mild, febrile illness without respiratory signs or symptoms, suggesting the illness might not always progress to the
respiratory phase.

Statement by WHO on 3/17/03:

The disease is spread from person to person but only through close contact with a case. To date, almost all reported cases have occurred in health
workers involved in the direct care of reported cases or in close contacts, such as family members. There is no evidence to date that the disease spreads though casual contact.

Emergency testing currently being done in Frankfurt (as of 3/18/03) has so
far found NO evidence of the following:

*Legionella infection
*Virus particles
*Influenza antigen

Further testing and results of viral cultures are pending.

As of 3/26/03:

Prognostic Indicators:

Generally, patients over 40 with other illnesses are more likely to progress to the severe form of the disease.

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Regards,<br /><b>Simone H</b><br /><br /><i>Aude Sapere</i><br /><br />"Never be a passive listener or learner" ~ Christian Gottfried Hahnemann