Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome

doi:10.1056/NEJMoa030747

Volume 348:1967-1976		May 15, 2003		Number 20

Identification of a Novel Coronavirus in Patients with Severe Acute Respiratory Syndrome

Christian Drosten, M.D., Stephan Günther, M.D., Wolfgang Preiser, M.D., Sylvie van der Werf, Ph.D., Hans-Reinhard Brodt, M.D., Stephan Becker, Ph.D., Holger Rabenau, Ph.D., Marcus Panning, M.D., Larissa Kolesnikova, Ph.D., Ron A.M. Fouchier, Ph.D., Annemarie Berger, Ph.D., Ana-Maria Burguière, Ph.D., Jindrich Cinatl, Ph.D., Markus Eickmann, Ph.D., Nicolas Escriou, Ph.D., Klaus Grywna, M.Sc., Stefanie Kramme, M.D., Jean-Claude Manuguerra, Ph.D., Stefanie Müller, M.Sc., Volker Rickerts, M.D., Martin Stürmer, Ph.D., Simon Vieth, Hans-Dieter Klenk, M.D., Albert D.M.E. Osterhaus, Ph.D., Herbert Schmitz, M.D., and Hans Wilhelm Doerr, M.D.

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ABSTRACT

Background Abstract

The severe acute respiratory syndrome (SARS) has recently beenidentified as a new clinical entity. SARS is thought to be causedby an unknown infectious agent.

Methods Clinical specimens from patients with SARS were searchedfor unknown viruses with the use of cell cultures and moleculartechniques.

Results A novel coronavirus was identified in patients withSARS. The virus was isolated in cell culture, and a sequence300 nucleotides in length was obtained by a polymerase-chain-reaction(PCR)–based random-amplification procedure. Genetic characterizationindicated that the virus is only distantly related to knowncoronaviruses (identical in 50 to 60 percent of the nucleotidesequence). On the basis of the obtained sequence, conventionaland real-time PCR assays for specific and sensitive detectionof the novel virus were established. Virus was detected in avariety of clinical specimens from patients with SARS but notin controls. High concentrations of viral RNA of up to 100 millionmolecules per milliliter were found in sputum. Viral RNA wasalso detected at extremely low concentrations in plasma duringthe acute phase and in feces during the late convalescent phase.Infected patients showed seroconversion on the Vero cells inwhich the virus was isolated.

Conclusions The novel coronavirus might have a role in causingSARS.

Source Information

From the Bernhard Nocht Institute for Tropical Medicine, National Reference Center for Tropical Infectious Diseases, Hamburg (C.D., S.G., M.P., K.G., S.K., S.M., S.V., H.S.); the Institute of Medical Virology (W.P., H.R., A.B., J.C., M.S., H.W.D.) and the Medical Clinic III (H.-R.B., V.R.), Johann Wolfgang Goethe University, Frankfurt am Main; and the Institute of Virology, Philipps University, Marburg (S.B., L.K., M.E., H.-D.K.) — all in Germany; the Pasteur Institute, Molecular Genetics of Respiratory Tract Viruses, National Influenza Center (Northern France), Paris (S.W., A.-M.B., N.E., J.-C.M.); and the Institute of Virology, Erasmus University, Rotterdam, the Netherlands (R.A.M.F., A.D.M.E.O.).

Drs. Drosten and Günther contributed equally to this article.

This article was published at www.nejm.org on April 10, 2003.

Address reprint requests to Dr. Drosten at the Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht Str. 74, 20359 Hamburg, Germany, or at drosten{at}bni-hamburg.de.

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N Engl J Med 2003; 349:707-708, Aug 14, 2003. Correspondence

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