Identification of Severe Acute Respiratory Syndrome in Canada
Susan M. Poutanen, M.D., M.P.H., Donald E. Low, M.D., Bonnie Henry, M.D., Sandy Finkelstein, M.D., David Rose, M.D., Karen Green, R.N., Raymond Tellier, M.D., Ryan Draker, B.Sc., Dena Adachi, M.Sc., Melissa Ayers, B.Sc., Adrienne K. Chan, M.D., Danuta M. Skowronski, M.D., M.H.Sc., Irving Salit, M.D., Andrew E. Simor, M.D., Arthur S. Slutsky, M.D., Patrick W. Doyle, M.D., M.H.Sc., Mel Krajden, M.D., Martin Petric, Ph.D., Robert C. Brunham, M.D., Allison J. McGeer, M.D., for the National Microbiology Laboratory, Canada, and the Canadian Severe Acute Respiratory Syndrome Study Team
Background Severe acute respiratory syndrome (SARS) is a conditionof unknown cause that has recently been recognized in patientsin Asia, North America, and Europe. This report summarizes theinitial epidemiologic findings, clinical description, and diagnosticfindings that followed the identification of SARS in Canada.
Methods SARS was first identified in Canada in early March 2003.We collected epidemiologic, clinical, and diagnostic data fromeach of the first 10 cases prospectively as they were identified.Specimens from all cases were sent to local, provincial, national,and international laboratories for studies to identify an etiologicagent.
Results The patients ranged from 24 to 78 years old; 60 percentwere men. Transmission occurred only after close contact. Themost common presenting symptoms were fever (in 100 percent ofcases) and malaise (in 70 percent), followed by nonproductivecough (in 100 percent) and dyspnea (in 80 percent) associatedwith infiltrates on chest radiography (in 100 percent). Lymphopenia(in 89 percent of those for whom data were available), elevatedlactate dehydrogenase levels (in 80 percent), elevated aspartateaminotransferase levels (in 78 percent), and elevated creatininekinase levels (in 56 percent) were common. Empirical therapymost commonly included antibiotics, oseltamivir, and intravenousribavirin. Mechanical ventilation was required in five patients.Three patients died, and five have had clinical improvement.The results of laboratory investigations were negative or notclinically significant except for the amplification of humanmetapneumovirus from respiratory specimens from five of ninepatients and the isolation and amplification of a novel coronavirusfrom five of nine patients. In four cases both pathogens wereisolated.
Conclusions SARS is a condition associated with substantialmorbidity and mortality. It appears to be of viral origin, withpatterns suggesting droplet or contact transmission. The roleof human metapneumovirus, a novel coronavirus, or both requiresfurther investigation.
Source Information
From the Toronto Medical Laboratories and Mount Sinai Hospital Department of Microbiology, Toronto (S.M.P., D.E.L., K.G., A.J.M.); the Department of Laboratory Medicine and Pathobiology (S.M.P., D.E.L., R.T., A.E.S., A.J.M.), Department of Medicine Division of Infectious Diseases (D.E.L., A.K.C., I.S., A.E.S., A.J.M.), and Department of Medicine and Interdepartmental Division of Critical Care (A.S.S.), University of Toronto, Toronto; the City of Toronto Public Health Department (B.H.); Scarborough Hospital, Toronto (S.F., D.R.); the Hospital for Sick Children, Toronto (R.T., R.D., D.A., M.A.); Epidemiology Services (D.M.S.) and Laboratory Services (M.K., M.P.), British Columbia Centre for Disease Control, Vancouver; University Health Network, Toronto (I.S.); Sunnybrook and Women's College Health Sciences Centre, Toronto (A.E.S.); St. Michael's Hospital, Toronto (A.S.S.); the Department of Pathology and Laboratory Medicine, Vancouver Hospital and Health Sciences Centre and University of British Columbia, Vancouver (P.W.D.); and the University of British Columbia Centre for Disease Control, Vancouver (R.C.B.) — all in Canada. This article was published at www.nejm.org on March 31, 2003.
Address reprint requests to Dr. McGeer at the Toronto Medical Laboratories and Mount Sinai Hospital, Department of Microbiology, 600 University Ave., Rm. 1460, Toronto, ON M5G 1X5, Canada.
Pseudo-SARS
Johnson S., Patel M., Mullane K., Tsang K. W., Ho P. L., Low D. E.
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N Engl J Med 2003;
349:709-711, Aug 14, 2003.
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