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Lessons Learn from SARS The Etiology ,Pathology and Clinical Features of SARS. Nantong Medical College The Department of Pathology Chen Li. Introduction.
Nantong Medical College
The Department of Pathology
SARS is a condition of unknown cause that has recently been recognized in patients in Asia , North America , and Europe . This report summarizes the initial epidemiologic findings , pathologic description , clinical and diagnostic findings.
On march 24 ,scientists at the CDC in USA and in Hong Kong announced that a new coronavirus had been isolated from patients with SARS.
This coronavirus(COV) has been named publicly by the WHO and member laboratories as “SARS virus”.
This is a novel virus that is not closelt related to any of the known clusters of coronaviruses.
E(small membrane protein)
Some small nonstructure ORFs
The SARS genomic sequence has been deposited into Genbank (Accession AY274119.3 , Apr. 18 03, Canada)
The nucleotide position ,associated ORF and putative transcription regulatory sequences(TRSs).
The SARS genomic sequence has been deposited into Genbank (Accession AY278554, Apr.18 03, USA)
early protein synthesis
later protein synthesis
229E---6 days in suspension
3 hours after drying on surfaces
OC43---<1hour after drying on surfaces
SARS virus---4-5 days on drying plastic film
5 days in excrements
10 days in urine
15 days in blood
High tempreture 56c 90min or 75c 30min
Ultraviolet 30 min
Other disinfectants handling effectively
Cov are divided into three serotypes,
The SARS virus is the fouth ?
Severe exudate and tansudate inflammation congestion,edema and formation of hyline membrane
Capillary highly dilatation and congestion
Scanty interstitial inflammatory-cell infiltrates
Multinucleated syncytial giant cells and abundant foamy macrophages,no conspicuous viral inclusions
in lung of SARS patient
Diffuse alveolar damage with proliferation of Alveolar epithelial typeⅡ
Virus inclusion (Macchiavell staining )
Immunoalkline phosphatase with napthol-fast red substrate and hematoxylin counterstain (FAF X250)
Intraalveolar and interstitial mononuclar cells suggesting a possible viral cause were also noted , but no viral inclusion were seen .
Multifocal hemorrhage and necrosis
Proliferation of histocytes in the surrounding tissue
phagocytosis of histocytes
1. Diffuse alveolar damage
2. Severe exudate and tansudate but no infection evidence in lung
3. Proliferation of Alveolar epithelial typeⅡ
4. Syncytial giant cells pneumonia
5. Hyline membrane formation
6. Lung solidification
7. The main cause of death is the progressing respiratory failure caused by lung damaging, which also have relationships with immuno-pathological change of the patients.
1. Epidemiology (contact and influential area)
2. Symptoms and signs (fever, dry cough ,myolgia ,
diarrhea and the number of viruses in sputum is
3. Laboratory tests: WBC↓,LC ↓ (CD4+ ↓,CD8+↓)
4. X-ray: patches and confluent air-space opacification
5. No effective to antibiotics，partially effective to
SARS has spread rapidly becouse during the incubation period , which appears to be between 1 day and 11 days.With a median of about 5 days, patients can transmit the disorder to others.
age mortabity rate
<24 year-old <1%
45-64 year-old 15%
>65 year-old >50%
15 SARS cases
normal radiographic appearance
2-day history of fever, chills and myalgia
Figure 1 - CXR at the time of diagnosis showed ill-defined air space opacification in right lower zone
Figure 2 - CXR after 3 days showed partial resoulation of consolidative changes in right lower zone. There is a new finding of ill-defined air space opacification in left lower zone
Figure 3 - CXR after another 4 days showed progressive resolution of the changes in both lower zones
fever, chills and malaise
Figure 1 - CXR (7 days after admission) showed ill-defined air space opacification in periphery of right lower zone
Figure 3 - CXR (after another 4 days) showed marked resolution of the consolidative changes in both lungs after treatment
Figure 2 - CXR (2 days later) showed progression of air space opacification in right lower zone and a new finding of similar changes in left mid and lower zones after initial treatment
with fever, chills and myalgia for 2 days
Figure 1 - CXR showed ill-defined air-space opacity in periphery of left upper and mid zones
Figure 3 - CXR (after another 7 days) showed resolution of radiographic changes after successful treatment
Figure 2 - CXR (after 5 days) showed progressive air-space opacities in both lungs
15 MARCH 2003(On presentation to A&E)
19 MARCH 2003
20 MARCH 2003
home with one week history of fever,
dry cough and myalgia
Day 7 - Patient became hypoxic & required subsequent intubation. CXR showed bilateral widespread air-space infiltrates
Day 1 - CXR showed subtle left lower zone air-space infiltrates
Day 5 - CXR showed left lower zone consolidation became more obvious
Case 7: 30-year-old worker with one week history of fever, dry cough and myalgia
Fig 3: (day 5 after onset of symptoms)Air-space opacification in the periphery of middle lobe abutting the superior aspect of the horizontal fissure
Fig 2: (day 4 after onset of symptoms)Confluent air-space opacification in left lower zone
Fig 1: (day 3 after onset of symptoms)Ill-defined air-space opacification in right lower zone
with fever, chills and myalgia for 2 days
Fig1: (day 2 after onset of symptoms)Middle lobe air-space opacity obscuring part of right heart border
Fig 2: (day 3 after onset of symptoms)Ill-defined opacity in left lower zone
Fig 3: (day 4 after onset of symptoms)Bilateral lower zones air-space opacities in para-cardiac areas after successful treatment.
Fig 1: (day 4 after onset of symptoms)Peripheral segmental air-space opacification in right upper lobe
Fig 2: (day 5 after onset of symptoms)Patchy peripheral opacities involving both lower lobes
Fig 3: (day 6 after onset of symptoms)Multi-focal ill-defined air-space opacities in both lower and right upper zones
Fig 1: (day 4 after onset of symptoms)Peripheral patchy opacification in right upper and left lower zones
Fig 2: (day 5 after onset of symptoms)Patchy air-space opacification in both mid and lower zones
Fig 3: (day 7 after onset of symptoms)Multi-focal diffuse air-space opacities in both lungs
Fig 1: (day 5 after onset of symptoms)Multi-focal confluent areas of air-space opacities in both lungs
Fig 2: (day 6 after onset of symptoms)Diffuse and widespread consolidative changes in both lungs (patient is intubated)
A follow-up chest radiograph showed progression of the disease , with mulotiple, bilateral ateas of involvement.
A subsequent chest radiograph shows improvement of bilateral lung opacities after therapy.
An obvious area of air-space shadowing on the leftside
6-year-old girl presented with fever, running nose and cough. CXR on admission showed focal air-space consolidation in left upper zone
2-year-old boy presented with febrile convulsion and cough. CXR on admission showed air-space opacities in left mid and lower zones
5-year-old girl presented with fever for 4 days. CXR showed air-space opacity in left lower zone
The results of research on SARS may give some hints to the clinical therapy
Although progress has been extraordinarily rapid because of unprecedented worldwide scientific cooperation , there is still a lot to be learned.
Lessons learn from SARS