LATEST SARS UPDATE - DETAILED MEDICAL INFORMATION

ProMed ^ | 03-17-03 | WOlfgang Preiser

[Mother Abigail]

Wolfgang Preiser

---------------------

We report on a patient admitted the day before yesterday (Sat 15 Mar 2003) to our Isolation Unit with atypical pneumonia, together with his travel companions. The patient is a medical doctor from Singapore who treated one of the earliest cases of SARS there between 3 and 9 Mar 2003. On 9 Mar 2003 he himself developed fever (39.4°C), myalgia and bone pain but did not have cough, dyspnoea or sore throat. Despite this, he flew to New York City to attend a medical meeting, accompanied by his wife who is also a doctor and by his mother-in-law. In New York he experienced a disseminated, transient rash. Because of persistent fever he sought medical attention in New York. A chest X-ray revealed a pneumonic infiltrate of the lingula (left lobe), and antibiotic treatment using levofloxacin was initiated.

Because he continued to feel unwell, he decided to return to Singapore via Frankfurt on 14 Mar 2003. During the first leg of this flight he developed fever again with deterioration of his general condition. In addition, his mother-in-law had developed a sore throat the day before and became febrile on the day of departure (14 Mar 2003). In accordance with the global alert about cases of atypical pneumonia recently issued by WHO \, an international health alert was declared after consultation between the Ministry of Health of Singapore and the German Health Authorities and the plane was met at Frankfurt airport by health officials. The index patient, his mother-in-law and his pregnant wife - who felt well and had no signs or symptoms - were admitted to the Isolation Unit at Frankfurt University Hospital under full biosafety precautions.

At admission, the index patient was still febrile up to 39.6°C, with 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 - Mod.MPP], leukopenia and mild elevation of transaminases and LDH. His chest X-ray still showed an infiltrate of the lingula. Antibiotic treatment was broadened by adding imipenem, vancomycin, doxycyclin and oseltamivir to levofloxacin. Nevertheless, he has now developed a cough and difficulty breathing and today transiently requires oxygen through a mask at 4 l/min. CRP and white blood cell count increase, other laboratory markers have not changed significantly since admission. The pulmonary infiltrates now extend to the left and right upper lobes.

His mother-in-law is currently afebrile, but she also developed a cough; since admission, her CRP has increased from 6.8 mg/dl to 9.9 mg/dl (normal range, <0.5 mg/dl), and her white blood cell count decreased slightly from 10.2/nl to 8.8/nl. Her chest X-ray shows no abnormalities. Coagulation parameters and renal function are normal in both patients. She is on imipenem, and levofloxacin, doxycyclin and tamiflu. Emergency microbiological tests undertaken in Frankfurt have yielded no evidence of Legionella infection; electron microscopy of respiratory swab samples was negative for virus particles, and testing for influenza antigen was negative. The results of viral cultures are pending. Further tests for influenza viruses are being performed by the Institute for Virology in Marburg and the Robert Koch Institute in Berlin; so far, the results of electron microscopy and PCR are negative.

Further testing (serology, PCR etc.) is under way. Up to Sunday [16 Mar 2003], the patient's wife has remained well without any symptoms; she is quarantined in a side room apart from her relatives. Over the past hours, however, she, too, has developed a fever (38.2 C at 8 PM local time, later 37.6 C spontaneously). Therefore we started treatment of the pregnant wife with erythromycin. After thorough cleaning and disinfection, the aircraft has in the meantime flown back to Singapore, albeit without passengers, due to demands by the Singaporean authorities. 83 fellow passengers resident in Germany are currently under "domestic quarantine"; they have been told to stay at home during the incubation period of 2 to 7 days and are being looked after by their local health authorities. -- PD Dr. med. H.-R. Brodt Dr. M. Eichel Infectious Diseases Dept., Medical Clinic III Dr. W. Preiser Institute for Medical Virology J. W. Goethe University Hospital Frankfurt am Main Germany

[Cicero]

Excellent post. An earlier article speculated that a virus was involved, but it appeared to be only speculation. But this article does seem to make bacterial infection unlikely.

[Mother Abigail]

A man who shared a Toronto hospital room with a patient believed have [SARS] and an Edmonton-area woman just back from Hong Kong are the latest people believed to have fallen ill with the disease that is puzzling health experts around the globe. That brings to 11 the number of probable and suspected cases in Canada, public health officials said Monday.

[Mother Abigail]

In Australia two women who had recently travelled to China have been hospitalised with symptoms, French news agency AFP reported, although doctors stressed there was no proof they were suffering from the illness.

The Perth woman - aged in her 50s - returned from Hong Kong last week and was admitted to Sir Charles Gairdner Hospital as a precaution on Monday, a hospital spokeswoman said. Similarly, doctors at Ballarat Base Hospital [Victoria] are waiting on tests on a 47-year-old Ballarat woman, who returned from a visit to China on Saturday and was admitted on Sunday night with a flu-like illness. [From the second newswire: 47-year-old woman was being treated at Ballarat Base Hospital, while a 44-year-old man was in a stable condition at Royal Melbourne Hospital, making a total of 2 suspected cases in Victoria Australia, the woman returned from China, the man from Hong Kong. -

[NewRomeTacitus]

Great. The illness that tries to kill me every few years has mutated into plague status. All this diversity and multiculturalism has literally evolved a living nightmare.

[mamarainsberry]

Pretty creepy post with your nick. Did you do that on purpose?

[Mother Abigail]

A British man returning from Hong Kong has been admitted to hospital with a suspected case - the UK's first. [from another newswire there was additional information on this case: The suspected case is a man who travelled from Hong Kong to Manchester via Amsterdam on Saturday. He is now being treated in isolation at the Infectious Diseases Unit at North Manchester General Hospital.]

[Pharmboy]

Other than the incubation period, this sounds similar to Hanta virus.

[Mother Abigail]

Two probable cases of SARS have been reported in Germany. Two women in Leipzig have been admitted to a quarantine ward. The women had been in Singapore and Vietnam for vacation and are now probably suffering from the new form of pneumonia. They have been transferred to the isolation ward, says the infectious diseases specialist Bernhard Ruf of the St. Georg Hospital in Leipzig.
****

[Pharmboy]

From the CDC:

Introduction to Hantavirus Pulmonary Syndrome (HPS)

Small But Deadly
Hantavirus pulmonary syndrome (HPS) has been recognized as a disease only recently in North America. So far, it's also fairly uncommon and the chances of becoming infected are low. However, HPS is potentially deadly and immediate intensive care is essential once symptoms appear.

The Mouse That Roared
Hantaviruses that cause HPS are carried by rodents, especially the deer mouse. You can become infected by exposure to their droppings, and the first signs of sickness (especially fever and muscle aches) appear 1 to 5 weeks later, followed by shortness of breath and coughing. Once this phase begins, the disease progresses rapidly, necessitating hospitalization and often ventilation within 24 hours.

Prevention is the best strategy, and it simply means taking some very practical steps to minimize your contact with rodents. HPS is not contagious from person to person in the United States.

[Mother Abigail]

A 33-year-old man suspected of being infected by a mysterious form of pneumonia that has sparked a World Health Organization warning was admitted to Ichilov Hospital in Tel Aviv on Monday after returning from Hong Kong and complaining of cough, fever, head and muscle pain, and general flu symptoms.

The Health Ministry emphasized there "is still no laboratory diagnosis of the patient's symptoms and there is no evidence of pneumonia." It was further noted the man was hospitalized due to caution and because of his recent return from Hong Kong.

[Mother Abigail]

You come and see me child..

[Marianne]

This morning our local talkshow host, Tom Bauerle, interviewed Steve Quayle (stevequayle.com), a terrorism expert.
Steve Quayle stated that so far they have not found either a viral or bacterial cause for SARS.
He stated that this is indicative of a genetically altered disease.
He reminded the audience about recent exhumations of Spanish Flu victims in order to study the cause.
He questioned whether this latest flu, using a genetically altered Spanish Flu, might be the cause.
Have you heard anything like this?

[Endeavor]

Seems like PCR would have identified Hanta, doesn't it?

[CathyRyan]

Map at bottom of this article shows Georgia USA? That is new to me anyone else here of this?

http://news.bbc.co.uk/2/hi/asia-pacific/2858439.stm

[Mother Abigail]

.."that so far they have not found either a viral or bacterial cause for SARS."

Health officials must confront two crucial questions: Is SARS an unknown form of a known disease like influenza? Or is it caused by a novel infectious agent? If past outbreaks of new diseases are a guide, the answers may take time in coming.

Tick-borne Lyme disease was regarded as a new disease when it was given that name in 1977. It took four years after its detection in Connecticut to identify the causative agent, a spirochete bacterium, Borrelia burgdorferi, a microbe that had been identified for decades. For example, the same disease occurred as early as 1909 in Sweden.

After Legionnaire's disease struck in Philadelphia in 1976, it took six months before discovery of the causative bacterium, Legionella pneumophila. Meanwhile, researchers pursued many blind avenues, including toxins. It took months to identify the Ebola virus from outbreaks in Africa.

When the disease now known as AIDS was first identified in 1981, scientists debated whether it was caused by an infectious agent or a toxin. It took about two years to discover what is now known as H.I.V. And two additional years passed, to 1985, for general scientific acceptance that H.I.V. caused AIDS.

[aristeides]

If it's some form of influenza, would a flu vaccine provide any protection at all?

[Mother Abigail]

NEW YORK (Reuters Health) - The U.S. Centers for Disease Control and Prevention (CDC) has received reports of at least 14 persons in the U.S. whose symptoms suggest they might have the mysterious illness that has been dubbed severe acute respiratory syndrome (SARS).

"These individuals are under active investigation," Dr. Julie Gerberding, director of the CDC, told reporters Monday during the first of what may be daily briefings from the agency on this emerging infectious disease. The agency is particularly concerned about four of these patients.

One of these?

The last 24 hours are getting a little blurred...

[Marianne]

Thank you for the information.
It appears Steve Quayle should wait a while before raising such questions.

[aristeides]

Sounds as if that report of a doubling of victims every few days continues to be true, at least roughly. At that rate, how long will it take for everybody to be infected?

Anybody care to estimate the mortality rate at this point?