Posted on 03/17/2003 7:08:39 PM PST by Mother Abigail
Wolfgang Preiser
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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
We're coming, Mother Abigail...but Boulder just ain't exactly right yet. Too many weird folk still living in that city.
The Centers for Disease Control and Prevention, HHS, has received reports of outbreaks of a severe form of pneumonia (also being referred to as Severe Acute Respiratory Syndrome, or SARS) in Hong Kong SAR, Vietnam, and Guangdong Province in China, Canada, Singapore, Thailand, Germany and Switzerland. Approximately 170 suspected cases had been reported as of March 17. Cases appear to primarily involve health-care workers caring for patients with SARS and close family contacts. CDC is working closely with WHO and country partners in efforts to define the etiology of this infection, to track patterns of its transmission, and to determine effective strategies for its control and prevention. At the present time, a CDC travel advisory recommends that persons with elective or non-essential travel to Hong Kong SAR, Guangdong Province and Hanoi, Vietnam consider postponing such travel. Additional information is available at http://www.cdc.gov and http://www.who.int.
What an absurd, vapid and selfish remark. Pleasure travel exposes far more people to pathogens than a single med conference could, not to mention business travel. People with a little money (or borrowing it) simply *must* get itchy feet. I detest travel, myself. should I blame those who bring the bugs home for no better reason than their collection of boring snapshots?
Those same docs are also dying (at least two so far) from being exposed to sicky patients. Maybe they should just stay home when the phone rings, and patient is sick? With a silly comment like that, it must be tempting. Your docs and staff are what stands between you and your recurring "old man's friend".
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