SARS (Severe Acute Respiratory Syndrome), an atypical pneumonia of unknown aetiology, was recognized at the end of February 2003. The World Health Organization (WHO) is co-ordinating the international investigation with the assistance of the Global Outbreak Alert and Response Network and is working closely with health authorities in the affected countries to provide epidemiological, clinical and logistical support as required.
Cause:
Tests have not yet conclusively identified the causative agent of SARS. The possible involvement of an influenza virus was an initial concern. On March 25, CDC announced that its scientists had detected a previously unrecognized coronavirus in 2 patients with SARS. These findings are preliminary and do not provide conclusive evidence that coronavirus is the cause of SARS.
Coronaviruses:
Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed under a microscope. These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals.
Evidence to suggest that coronaviruses may be linked with SARS:
CDC scientists were able to isolate a virus from the tissues of two patients who had SARS and then used several laboratory methods to characterize the agent.
Examination by electron microscopy revealed that the virus had the distinctive shape and appearance of coronaviruses. Tests of serum specimens from patients with SARS showed that the patients appeared to have recently been infected with this coronavirus. Other tests demonstrated that coronavirus was present in a variety of clinical specimens from patients, including nose and throat swabs.
Symptoms & Signs of SARS:
The main symptoms of SARS are high fever (> 38? Celsius), dry cough, shortness of breath or breathing difficulties.
The illness begins generally with a fever, and is sometimes associated with chills or other symptoms, including headache, malaise, and body aches. Some persons also experience mild respiratory symptoms at the outset.
After 3 to 7 days, the person may develop a dry, nonproductive cough that might be accompanied by or progress to the point where insufficient oxygen is getting to the blood. In 10% to 20% of cases, patients will require mechanical ventilation.
Changes in chest X-rays indicative of pneumonia also occur.
SARS may be associated with other symptoms, including headache, muscular stiffness, loss of appetite, malaise, confusion, rash and diarrhoea.
SARS is contagious – transmission of the disease:
Based on currently available evidence, close contact with an infected person is needed for the infective agent to spread from one person to another.
Contact with aerosolized (exhaled) droplets and bodily secretions from an infected person appears to be important.
To date, the majority of cases have occurred in hospital workers who have cared for SARS patients and the close family members of these patients.
However, the amount of the infective agent needed to cause an infection has not yet been determined.
Incubation Period:
SARS appears to be less infectious than influenza.
The incubation period is short, estimated to range from 2-7 days, with 3-5 days being more common, however, isolated reports have suggested an incubation period as long as 10 days.
However, the speed of international travel creates a risk that cases can rapidly spread around the world.
First case of SARS reported:
On 26 February, a man was admitted to hospital in Hanoi with high fever, dry cough, myalgia (muscle soreness) and mild sore throat.
Over the next four days he developed increasing breathing difficulties, severe thrombocytopenia (low platelet count) and signs of adult respiratory distress syndrome requiring ventilator support.
Precautions for travellers:
This illness can be severe and, due to global travel, has spread to several countries in a relatively short period of time.
However, SARS is not highly contagious when protective measures are used, and the percentage of cases that have been fatal is low.
WHO has not recommended restricting travel to any destination in the world.
However, all travellers should be aware of the main symptoms and signs of SARS, as given above. People who have these symptoms and have been in close contact with a person who has been diagnosed with SARS, or have a recent history of travel to areas where cases of SARS have been spreading, should seek medical attention and inform health care staff of recent travel.
Travellers who develop these symptoms are advised not to undertake further travel until fully recovered.
Treatment for SARS:
While some medicines have been tried, no drug can, at this time, be recommended for prophylaxis or treatment.
Antibiotics do not appear to be effective.
Symptoms should be treated by adequately protected health professionals.
Management of Severe Acute Respiratory Syndrome (SARS)
Management of Probable Cases
* Hospitalize under isolation or cohort with other probable SARS cases
* Take samples to exclude standard causes of pneumonia (including atypical causes)
* Take samples for SARS investigation including:
White blood cell count, platelet count, creatine phosphokinase, liver function tests, urea and electrolytes and C reactive protein
* At the time of admission the use of antibiotics for the treatment of community-acquired pneumonia with atypical cover is recommended.
* Pay particular attention to therapies/interventions which may cause aerolization such as the use of nebulisers with a bronchodilator, chest physiotherapy, bronchoscopy, gastroscopy, any procedure/intervention which may disrupt the respiratory tract. Take the appropriate precautions if you feel that patients require the intervention/therapy.
* In SARS, numerous antibiotic therapies have been tried with no clear effect. Ribavirin with or without use of steroids has been used in an increasing number of patients. But, in the absence of clinical indicators, its effectiveness has not been proven. It has been proposed that a coordinated multicentred approach to establishing the effectiveness of ribavirin therapy be examined.
Management of Contacts
A contact is defined as a person who has had close contact during the 10 days preceding the onset of symptoms, with a person who is a suspect or probable case of SARS.
A close contact is a person who has cared for, has lived with, or had direct contact with respiratory secretions or body fluids of a suspect or probable case of SARS
Management of Contacts of Probable Cases
* Give information on SARS to the contact
* Place under active surveillance for 10 days
* Ensure contact is visited or telephoned daily by a member of the public health care team
* Record temperature daily
* Contact is free to continue with usual activities; however:
* If the contact develops symptoms, the contact should be assessed at a health care facility after making arrangements for attendance
* The most consistent first symptom that is likely to appear is fever
Management of Contacts of Suspect Cases
* Give information on SARS to the contact
* Place under passive surveillance for 10 days
* Contact is free to continue with usual activities; however:
* If the contact develops any symptoms, the contact should self report via the telephone to the public health authority
* The most consistent first symptom which is likely to appear is fever
Homeopathy
As there is no known treatment for SARS, and if we repertorise the group of symptoms as mentioned above, we may come across following group of remedies:
Aconite, Bryonia, Kali-ars., Eup-perf., Zincum met.
Aconite: Sudden onset of the illness
Bryonia: Fever with dizziness
Eup-perf.: Fever with myalgia
Zincum met.: Fever with rigors
More information is required for finding Genus Epidemicaus (as mentioned in Hahnemann’s Organon stating about Epidemic Diseases in aphorism 100-102)
(Thanks to Julian Winston for inputs and WHO)