S A R S

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??????????????? ????? ???
S A R S
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SARS????
3
???
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????(I)

• High Fever(gt100.4F gt38.0C)
• Sometimes is associated with chills and rigors
• Other symptoms headache, malaise, and myalgia.
• Typically, no rash and neurologic or
  gastrointestinal findings
• Some patients have reported diarrheaor loose
  stool

CDC
S A R S
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Clinical manifestations

• Fever near 100
• Chills, rigor, or both 73.2
• Myalgia 60.9
• Cough gt50
• Headache gt50
• Lymphopenia69.6
• Thrombocytopenia 44.8
• Elevated LDH 71.0
• ?CPK 32.1

NEJM(92-4-7) Prince of Wales Hospital,
Hong Kong
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????(II)

• Incubation 2--7 days, up to 10 days
• Dry, nonproductive cough or dyspnea
• 10--20 of cases, the respiratory illness is
  severe enough to require intubation and
  mechanical ventilation.
• Chest radiographs might be normal during the
  febrile prodrome

CDC
S A R S
7
????(III)

• Late stages of SARS some also have shown areas
  of consolidation.
• Early absolute lymphocyte count is often
  decreased
• White blood cell counts normal or decreased
• Approximately 50 leukopenia and
  thrombocytopenia or low-normal platelet counts
  (50,000--150,000/µL)

CDC
S A R S
8
????(IV)

• ? CPK levels (as high as 3,000 IU/L) and hepatic
  transaminases (2X to 6X the upper limits of
  normal)
• LDH may be elevated
• Normal renal function
• Severity of illness mild illness to death

CDC
S A R S
9
CXR presentation Hong Kong
NEJM
NTUH
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NEJM(92-4-7) Prince of Wales Hospital,
Hong Kong
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NEJM(92-4-7) Prince of Wales Hospital,
Hong Kong
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NEJM(92-4-7) Prince of Wales Hospital,
Hong Kong
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Chest X-ray characteristic findings

• Unilateral , predominantly peripheral areas of
  consolidation
• One week? progressed rapidly to bilateral patchy
  consolidation
• Extent of lung opacities correlated with the
  deterioration in respiratory function.
• CT bilateral peripheral air-space ground glass
  consolidation

NEJM(92-4-7) Prince of Wales Hospital,
Hong Kong
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CXR presentationCase 1
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92-3-08
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92-3-10
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Case 250Y/O Female
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92-3-14
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92-3-15
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92-3-20
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Case 325Y/O Male
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92-3-20
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92-3-26
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Coronavirus ???????
92-3-27 Press release
UHK
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CDC
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CDC
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????

• ????????(BAL) ?????
• ??SARS ?? 10?/CC
• ????????????, 50-60
• ???? 40-50???, 3??10-12
• ??3????? 40??????
• ??20
• ??10-20

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SARS ?????????

• RT-PCR??? 50??? 1-2 ?
• Real Time PCR gt90???(100-1000 copies) 2 ??
• ????????(IFA)97???
• 2-3 weeks
• ???? ELISA, ??,???

41
??

• ???(1-7 days)??????????
• ???(7-14 days) ???????,???? ?????
• ???(14 -- ) ????,????
• ???? / ????

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Ribavirin

• Oral form 2gm Stat and then 600 mg BID( gt75 KG)
  400 mg morning 600 mg evening( lt75kg) for 10
  days
• NEJM(92-4-7) oral 1.2gm Q 8h
• IV 400 mg Q8h
• No more an adequate management

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What are the current treatments and the expected
outcome?(Hong Kong)

• The Medical Team led by Professor Joseph Sung in
  the Prince of Wales Hospital has gathered the
  world's greatest clinical experience in the
  treatment of SARS in the past 3 weeks.
• The combination of an anti-viral drug and
  corticosteroid plus other intensive supportive
  treatment has resulted in about 90 good response
  in patients who were treated soon after the onset
  of symptoms.  

UHK
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?SARS????????????

• ????3?14????????????????????,??????????????????,??
  ?????????????????,??????????
• ????,??????????????????

48

• SARS???????????,????????????????????,?????????????
  ???????
• ??????????,????????,????????????,??????

49

• SARS???????,????????????,?????????????,???????????
  ????
• ????????,???????????,??????????????????????????

50

• ??????????,??????,?????????????,??????????????????
  ??????????????????,???????????????????????
• ?????SARS???????????????????

51

• ???????????,?????????,??????20??????,??????21?????
  ??
• ?????????,???43????,?????????????,?????21

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?SARS???????????

• ??SARS?????????????????,????????????,?????????????
  ?????,??????????????????,???????????????

53

• ????????,????????????

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SARS????????????
?? ?????(Flu) ?????(Flu) ????(Cold) ????(pneumonia) ??????????(SARS)
??? ??? ??????? ?? ???????? ???????
???? ???? ???? ???? ???? ???? ????
????? ????? ??????????????? ??????,????? ????????????? ??(??38?)
??? ??? ???????? ?????,???? ????????
?? ?? ??(????38?) ?????,?????,?????????? ???? ??2??? (????38?)
?? ?? ????????? ????????? ???????
55
?? ?????(Flu) ?????(Flu) ????(Cold) ????(pneumonia) ??????????(SARS)
?? ?? ???????????,????????????? ?????? ??????,??????,?????????????? ??????????
????? ????? ????????1-2????????,???????? ?????????? ??,??????,????,?????? ??
?? ?? ????1-2?,??????? ?????? ??????7? ????????????????3
??? ??? ???,???????????????????,??????????? ???? ????????????????(Septicaemia) ???????,??????????????? ???????????????????????????
??? ??? ?????1-4? 2-7?,??10?
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SARS???????

• ??
• ?????????SARS?,?????????????
• ???????N95??????/?????????????
• ???????????????,???????????
• ????????,????????????????????????
• ????????????????????????

57
SARS???????

• A.??????
• ?????????????,?????,?????,??/??????
• ?????(????)/?????????
• ???????????,???????????
• ??????????????(Transport Medium)?
• ?10ml???????,?????????????????

58
SARS???????

• ?????
• ??????10ml????????,?????????????
• ??????????????
• ???????????????
• ??????
• ??????????
• ??????????
• ????????????????
• ????????????(Transport Medium)????

59
SARS???????

• ??????
• ?????????
• ???????2??
• ???????,?????(510?)
• ???????????(Transport Medium)?

60
SARS???????

• B.??/????(???)
• ??????????,??????????
• ????????,?????????2ml??????(Transport
  Medium)???????
• ?????????????????????
• ??????????????????????

61
SARS???????

• C.????
• ???????????
• ??5ml?????????
• D.????
• ??70???2 povidone iodine????????,?????????
• ??4ml?????????(?EDTA?,???)

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SARS????????
14
7
??-7
?? 0

• 1.???(17?)?????,?????
• 2.???(714?)???????(cytokine storm),???????,????
• 3.???(14?)????(????) ?????/????
• ?????????????

???
???
???
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• Thanks for your attention