Severe acute respiratory syndrome-associated coronavirus in lung tissue.

Tony Mazzulli,Jagdish Butany,Barbara M Willey,Susan M Poutanen,Gabriella A Farcas,Donald E Low,Kevin C Kain,Sylvia L Asa

doi:10.3201/eid1001.030404

Abstract

Efforts to contain severe acute respiratory syndrome (SARS) have been limited by the lack of a standardized, sensitive, and specific test for SARS-associated coronavirus (CoV). We used a standardized reverse transcription-polymerase chain reaction assay to detect SARS-CoV in lung samples obtained from well-characterized patients who died of SARS and from those who died of other reasons. SARS-CoV was detected in all 22 postmortem lung tissues (to 109 viral copies/g) from 11 patients with probable SARS but was not detected in any of the 23 lung control samples (sample analysis was blinded). The sensitivity and specificity (95% confidence interval) were 100% (84.6% to 100%) and 100% (85.1% to 100%), respectively. Viral loads were significantly associated with a shorter course of illness but not with the use of ribavirin or steroids. CoV was consistently identified in the lungs of all patients who died of SARS but not in control patients, supporting a primary role for CoV in deaths.

Highlights

Efforts to contain severe acute respiratory syndrome (SARS) have been limited by the lack of a standardized, sensitive, and specific test for SARS-associated coronavirus (CoV)
By using a standardized reverse transcriptase-polymerase chain reaction (RT-PCR) assay, SARS-CoV has been unequivocally identified in the lung tissue of all patients who died with probable SARS but not in any of the controls
SARS-CoV was found in different lung samples from the same patient, suggesting that the virus is widely disseminated throughout the lung at the time of death

Summary

Introduction

Efforts to contain severe acute respiratory syndrome (SARS) have been limited by the lack of a standardized, sensitive, and specific test for SARS-associated coronavirus (CoV). Controversy remains over the etiology of SARS, the World Health Organization has declared a newly described virus known as the SARS-associated coronavirus (SARS-CoV) as the cause [2]. This announcement has led to a rapid proliferation of different in-house laboratory tests aimed at detecting either SARS-CoV–specific antibodies or SARS-CoV nucleic acid in clinical specimens. In a recent report of six fatal cases of SARS, SARS-CoV was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) in postmortem lung tissue in only four patients [5]. Lung tissue obtained at autopsy from well-characterized patients with SARS who died during the outbreak in Canada were compared to lung samples obtained at autopsy from patients without SARS who died during the outbreak and lung samples from patients who died before the outbreak

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