Abstract
ObjectiveThe intent of this study was to examine the recovery of individuals who had been hospitalized for severe acute respiratory syndrome (SARS) in the year following their discharge from the hospital. Parameters studied included serum levels of SARS coronavirus (SARS-CoV) IgG antibody, tests of lung function, and imaging data to evaluate changes in lung fibrosis. In addition, we explored the incidence of femoral head necrosis in some of the individuals recovering from SARS.MethodsThe subjects of this study were 383 clinically diagnosed SARS patients in Beijing, China. They were tested regularly for serum levels of SARS-CoV IgG antibody and lung function and were given chest X-rays and/or high resolution computerized tomography (HRCT) examinations at the Chinese PLA General Hospital during the 12 months that followed their release from the hospital. Those individuals who were found to have lung diffusion abnormities (transfer coefficient for carbon monoxide [DLCO] < 80% of predicted value [pred]) received regular lung function tests and HRCT examinations in the follow-up phase in order to document the changes in their lung condition. Some patients who complained of joint pain were given magnetic resonance imaging (MRI) examinations of their femoral heads.FindingsOf all the subjects, 81.2% (311 of 383 patients) tested positive for serum SARS-CoV IgG. Of those testing positive, 27.3% (85 of 311 patients) were suffering from lung diffusion abnormities (DLCO < 80% pred) and 21.5% (67 of 311 patients) exhibited lung fibrotic changes. In the 12 month duration of this study, all of the 40 patients with lung diffusion abnormities who were examined exhibited some improvement of lung function and fibrosis detected by radiography. Of the individuals receiving MRI examinations, 23.1% (18 of 78 patients) showed signs of femoral head necrosis.InterpretationThe lack of sero-positive SARS-CoV in some individuals suggests that there may have been some misdiagnosed cases among the subjects included in this study. Of those testing positive, the serum levels of SARS-CoV IgG antibody decreased significantly during the 12 months after hospital discharge. Additionally, we found that the individuals who had lung fibrosis showed some spontaneous recovery. Finally, some of the subjects developed femoral head necrosis.
Highlights
Severe acute respiratory syndrome (SARS) is a new infectious disease in humans
Of the 311 individuals testing positive for SARS-CoV IgG, there were 85 with abnormal DLCO (27.3%, 85/311), in contrast to just 3 cases with abnormal DLCO among the 72 subjects testing negative for SARS-CoV IgG (4.2%, 3/72)
Follow-up surveys of SARS patients in the convalescent phase are needed for recognizing the clinical characteristics of this disease and reevaluation of the therapeutic treatments [2,7]
Summary
Severe acute respiratory syndrome (SARS) is a new infectious disease in humans. The first victim of SARS to be diagnosed was a businessman from the city of Foshan in Guangdong Province, China. There have been few reports about the relationship between the prognosis for recovery and the degree of lung injury caused by the SARS-CoV. A study of the serum levels of the specific IgG antibody against SARS-CoV is needed because it is the major immunologic protection to aid in recovery and is essential to avoid repeated infection with SARS-CoV. It has been 14 months since the World Health Organization officially declared the global outbreak of SARS to be under control [2]. The phenomenon of femoral head necrosis was investigated in those SARS patients who complained of chronic bone and joint pain during the one year follow-up after discharge from the hospital
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