SARS Patients Research Articles

SARS-CoV-2 vs. SARS-CoV-1 management: antibiotics and inflammasome modulators potential.

The coronavirus SARS-CoV-2 at the origin of COVID-19 shares more than 70% genetic similarity with SARS-CoV-1 that was at the origin of 2003 SARS. Infection-associated symptoms are very similar between SARS and COVID-19 diseases and are the same as community-acquired pneumonia symptoms. Antibiotics were empirically given to SARS patients in the early stages of the pathology whereas a different strategy has been decided in the management of COVID-19 pandemic with a worldwide shutdown. The cytokine storm, both identified in SARS and COVID-19 severe cases, is generated through inflammasome activation, which opens therapeutic perspectives to counteract the pathogenic inflammation. As corticoids have numerous side effects that limit their use, focusing on anti-inflammasome agents could represent a safer alternative for patients with severe COVID-19.

Comparison of Confirmed COVID-19 with SARS and MERS Cases - Clinical Characteristics, Laboratory Findings, Radiographic Signs and Outcomes: A Systematic Review and Meta-Analysis

Introduction: In the current time where we face a COVID-19 pandemic, prevention, and rapid diagnosis of infected patients is crucial. Within this large-scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID-19, SARS, and MERS to find unique features. Method: We searched all relevant literature published up to February 28, 2020, from Embase, Scopus, PubMed, Web of Science, and the Cochrane library to collect the studies that reported clinical and laboratory characteristics of corona-infected patients. The study quality was assessed with the Critical Appraisal Checklist. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. Result: Overall 114 articles included in this study; 52,251 COVID-19 confirmed patients (20 studies), 10,037 SARS (51 studies), and 8,139 MERS patients (43 studies) were included. The most common symptom among COVID-19 85.6 % (95% CI 73 -93, p < 0.001), SARS 96 % (95% CI 93-97.6, p < 0.001), and MERS 74 % (95% CI 63.5 -83.5, p < 0.001) was fever, respectively. Analysis showed that 84 % (95% CI 78-8.5, p < 0.001) of COVID-19 patients, 86% (95% 77-92, p < 0.001) of SARS patients, and 74.7% (95% 56.5-87, p < 0.001) of MERS patients had an abnormal chest X-ray. The mortality rate in COVID-19 5.6% (95% CI 2.5-12.5, p < 0.001), SARS 13 % (95% 9-17, p < 0.001), and MERS were 35 % (95% CI 31-39, p < 0.001) between all confirmed patients. Conclusions: Fever and cough are the most common symptoms of COVID-19, SARS, and MERS infected patients. Thrombocytosis in COVID-19 patients was more than twice as frequent as in SARS, and MERS confirmed cases. At the time of submission, the mortality rate in COVID-19 confirmed cases is lower than SARS and MERS infected patients. Clinical outcomes and findings would be biased by reporting only confirmed cases, and it should be considered when interpreting the data. Funding Statement: Dr. Bahr receives funding from the National Institutes of Neurological Diseases and Stroke of the National Institutes of Health, K23 NS110470. Declaration of Interests: The authors have declared that no competing interests exist. Ethics Approval Statement: Study has been registered in the PROSPERO database (ID 176106).

The relationship of the range and location of osteonecrosis of the femoral head with the dose of steroid in SARS patients.

Objective To explore the relationship of the necrosis range and location of osteonecrosis of femoral head with the dose of steroid. Methods Thirty-four cases with steroid induced osteonecrosis of femoral head after SARS were included, collected the dosage of steroid of all cases. All the cases were divid-ed into three groups according to the gross of the steroid, A group 5000 rag. The cases were divided into two groups according to the every day average dosage of the steroid: 1 group 160 mg. All hips were examined with MRI to survey the angle of necro-sis in the mid-coronal image and mid-cross section image, then the range of necrosis were evaluated through calculating the necrosis index (NI) after 6 months with steroid. The cases were divided into A, B, C1, C2 four groups according to location of necrosis that Sugano suggested to explore the relationship of the range and the location of necrosis. Results 1) The relationship of the steroid gross and the range of necrosis: no signif- icance in NI among A, B and C groups. 2) The relationship of the every day average dosage of the steroid and the range of necrosis: no significance in NI between group 1 and group 2. 3) The relationship between the range and the location of necrosis: no significance in NI between groups A, B, C1. The NI of the three areas respectively was significantly less than that at C2 area. Conclusion 1) There is no positive correla-tion between the range of necrosis and the steroid gross or the every day average dosage of the steroid. 2)The small range necrosis occurred in femoral head that matched along with the medial part of the edge of the acetabulum, the range of necrosis is big if the necrosis extending to the lateral of the acetabular edge. Key words: Glucocorticoids; Femur head necrosis; Severe acute respiratory syndrome

MRI Features of Osteonecrosis of the Femoral Head in Recovered SARS Patients: Follow- up with MR Imaging

目的 分析严重急性呼吸综合征(SARS)康复者发生股骨头缺血性坏死的MRI表现.方法对92例SARS康复者的184个股骨头(随访1年以上)以MRI对骨头缺血性坏死进行普查.结果184个股骨头中,10个(5.4%)发生了缺血性骨坏死,其中4例为双侧股骨头坏死,2例为单侧股骨头坏死;在MRI上9个(90.0%)股骨头缺血性坏死为典型的双线征,而仅有1个(10%)表现为骨髓水肿(边缘模糊的髓腔内T1WI低信号,T2WI及STIR高信号的骨髓水肿).全部股骨头坏死均为早期改变,其中Ⅰ期2个,Ⅱ期8个;有髋关节症状组和无髋关节症状组对照发现,两组股骨头缺血性坏死率无统计学差异.结论MRI是SARS康复患者股骨头坏死随访筛选检查的一种有效方法,不管有无髋关节症状,对SARS康复患者进行合理的MRI随访是非常必要的。

Investigation by comparison on the posttraumatic stress response among SARS patients, hospital staffs and the public exposed to SARS

Objective This paper focuses on the investigation of the occurrence and influential factors of post-traumatic stress disorder (PTSD)in SARS patients, hospital staffs and the public expo sed to SARS. Methodes Three groups were assessed by scale of self-compiled stressor Questionnaire, impact of event scale-revised (IES-R) , PSSS, SCSQ, SES and EPQ. Results 1. The incidence of PTSD symptoms in the three groups were 55.1% ,25.8 % and 31.18 %. 2. The main cause of the different incidence was the difference of the stressor intensity and characters. Negative coping was the risk factor of SARS patients and the public; Self-esteem was the protected factor of SARS patients and the hospital staffs; Social support was a protected factor on the hospital staffs. 3. Comparing to the first investigate in September,2003 ,the data of follow-up study in September,2004 showed that the prevalence items significant decreased. Conclusions 1. The investigation concludes that all three groups of people exposed o SARS exhibit PTSD symptom. SARS patients have the highest occurrence ( P ＜ 0.01 ). 2. The main influencing factors of different incidence of PTSD in different groups are intensities and characteristics of stressors. Different people who had PTSD symptoms have different influencing factors. 3. With the change of time , the PTSD symptoms significant relieve with the attenuation gradually of exposure degree of stressor. Key words: Severe acute respiratory syndrome; Stress disorder; Post-traumatic

Follow-up study on mental symptoms of SARS patients

ObjectiveTo investigate mental symptoms of SARS patients and its related factors for three periods—admission, discharge and three months after SARS crisis and to carry out mental intervention and effect evaluation. Methods114 SARS patients were assessed by scale of self-compiled Common Status Questionnaire, SCL-90, PSSS, SCSQ, SES and EPQ. Results1.The SCL-90 total and factors scores including obsessive-compulsion, phobic anxiety went up during discharge compared with admission score:153.34±62.72/150.50±56.66,1.80±0.80/1.71±0.71,1.48±0.74/1.38±0.63. After that,these factors scores went score: 138.47±50.91/153.34±62.72,1.76±0.78/1.80±0.80,1.36±0.61/1.48±0.74 down. The factors scores of somatization and depression descended continuously for three period score:1.85±0.90/1.77±0.84/1.60±0.75,1.81±0.87/1.78±0.85/1.59±0.75,1.79±0.78/1.76±0.84/1.50±0.66. 2.The incidence on factors of obsessive-compulsive, interpersonal sensitivity, phobic anxiety ascended during discharge compared with admission. Then,these factors scores descended. The other factors went down continually for three periods(P0.05;Anxiety incidence decreased from 0.298 to 0.289 to 0.14,P0.05).3. The self-esteem was influencing factor on mental symptoms of SARS patients for three periods. Conscientious condition severity was influencing factor in admission and discharge.Negative coping was influencing factor in discharge and three months after SARS crisis. Education was influencing factor in three months after SARS crisis.4.After intervention,the most mental symptoms of 35 SARS patients had mental problems were improved. Dissimilarly, a part of mental symptoms got severity (Somatization score increased from 1.58±0.78 to 2.08±0.82,P0.01).Conclusions1.SARS patients exist severe mood disorders and have different influencing factors for three periods. They should be evaluated continuously and be intervened in time.2.The effect of mental intervention by telephone is not uncertainty.

Follow-up study on mental symptoms of SARS patients

目的 追踪研究SARS患者入院、出院及出院3个月后3个阶段心理状况及影响因素,对有心理问题的SARS患者进行心理干预并进行干预效果评价.方法采用自拟一般状况调查表、症状自评量表(SCL-90)、领悟社会支持量表(PSSS)、简易应对方式问卷(SCSQ)、自尊量表(SES)、艾森克个性问卷(EPQ)作为工具,对114名SARS患者进行追踪调查.结果 1.SCL-90总分、强迫、恐怖因子分出院较人院时有上升[均分分别为(153.34±62.72)分/(150.50±56.66)分,(1.80±0.80)分/(1.71±0.71)分,(1.48±0.74)分/(1.38±0.63)分],之后开始下降[均分分别为(138.47±50.91)分/(153.34±62.72)分,(1.76±0.78)分/(1.80±0.80)分,(1.36±0.61)分/(1.48±0.74)分];躯体化、抑郁、焦虑因子分随时间变化逐渐下降[均分分别为(1.85±0.90)分/(1.77±0.84)分/(1.60±0.75)分,(1.81±0.87)分/(1.78±0.85)分/(1.59±0.75)分,(1.79±0.78)分/(1.76±0.84)分/(1.50±0.66)分].2.强迫、人际敏感、恐怖问题发生率,出院时较入院时上升,之后开始下降(P＞0.05).其他因子发生率,随着时间的推移逐渐下降(焦虑发生率由0.298降到0.289再降到0.14,P＜0.05).3.自尊在3个研究阶段均是SARS患者心理症状的影响因素;自觉病情严重程度是从入院到出院时的影响因素;消极应对是从出院和出院后3月时的影响因素;文化程度是出院后3月时的影响因素.4.电话心理干项后SARS患者SCL-90总分及大部分因子分下降(P＞0.05),部分因子分尤其躯体化(P＜0.01)反而上升[躯体化由(1.58±0.78)分上升到(2.08±0.82)分,P＜0.01].结论 1.SARS患者在各期均存在明显的情绪障碍且影响因素不完全相同,临床应该持续评估其心理状态,并进行及时干预.2.经心理干预后SARS患者心理症状减轻不明显,部分症状反而加重。

Pathology of Guinea Pigs Experimentally Infected with a Novel Reovirus and Coronavirus Isolated from SARS Patients

Guinea pigs were inoculated with a reovirus (ReoV) and coronavirus (SARS-CoV) isolated from SARS patients to determine their potential role in the etiology of SARS. Animals infected with ReoV died between day 22 and day 30 postinoculation (PI) while 70% of the animals inoculated with ReoV and SARS-CoV died between day 4 to day 7 PI. The titer of neutralizing antibodies against ReoV and SARS-CoV ranged from 80 to 160 when the animals were inoculated with the two viruses, respectively, while the titer of the antibodies was just below 10 in coinfections. The animal inoculated with ReoV developed diffuse alveolar damage similar to the exudative and leakage inflammation found in SARS patients, and was characterized by diffuse hemorrhage, fibroid exudation, hyaline membrane formation, and type II pneumocytes hyperplasia in alveolar interstitia. The pulmonary epithelial necrosis, excoriation, and early fibrosis of pulmonary tissue were only observed in ReoV-SARS-CoV groups and in SARS-CoV/ReoV groups. Other typical pathological changes included hemorrhagic necrosis in lymph nodes and spleen and hydropic degeneration in the liver. On the contrary, guinea pigs infected with SARS-CoV only developed interstitial pneumonitis. Our experiment demonstrate that ReoV might be one of the primary causes of SARS, since simultaneous coinfection can duplicate the typical pathological changes similar to that of SARS patients. This guinea pig model may provide a useful animal model for SARS.

Detection of autoimmune parameter of SARS patients

To explore whether autoimmune phenomena exist in SARS patients, and to seek for unusual autoimmune antibodies in SARS patients. Autoantibodies against cell nuclei (ANA), autoantibodies against smooth muscles (SMA), autoantibodies against parietal cells (PCA), autoantibodies against heart cells (HRA) were detected by using immunofluorescence, and autoantibodies against live-kidney microsomes (LKM) and anti-M2 antibodies were detected by ELISA in sera taken from 27 SARS patients and 18 healthy controls. Immunofluorescence was used to localize the targets antigens in slides with biochips of lung (monkey) of SARS associated antibodies. ANA, AMA, LKM and SMA were found positive in 3, 1, 1, and 1 of the 27 SARS sera. In 18 healthy control sera, one ANA and one AMA were positive. Statistical analysis showed that there were no difference between two groups in every item detected. Twenty-six of 27 SARS patients and 5 of 18 healthy controls had strongly stained columnar epithelia of the bronchiole, especially the lumen border of the epithelia?the difference between two groups was significant. No antibodies against organs but lung were found in SARS patients. There are auto antibodies against lung tissues in sera of SARS patients.

Receptor-binding ability of fragments 260-600 and 397-796 of SARS-associated coronavirus spike protein

To investigate the interaction between the host cell and the truncated S fragments to identify the receptor-binding domain of the spike (S) protein of SARS-associated coronavirus (SARS-CoV). Two different fragments S260-600 and S397-796 of the SARS-CoV S protein were expressed in Escherichia coli (E.coli) using a pET expression vector, respectively. The two recombinant proteins were separately verified by Western blot, purified by nickel-affinity chromatography, and incubated with Vero cells, a susceptible cell line of SARS-CoV infection, for cell binding assay. After the sequential probing with sera from convalescent SARS-patients and FITC-labeled anti-human IgG, the cells were analyzed by flow cytometry. The NIH 3T3 cell, a non-permissive cell line of SARS-CoV infection, was used as controls. The recombinant proteins S260-600 and S397-796 were efficiently expressed in an insoluble form in E.coli. The appropriate expression of the proteins was confirmed by Western blotting using both SARS patients' sera and anti-6 x histidine antibody. The flow cytometry results showed that the both proteins were able to bind Vero cells, but the binding ability of S260-600 was somewhat stronger than that of S397-796. In contrast, the S260-600 protein did not bind NIH3T3 cells. Both S260-600 and S397-796 exhibited different receptor binding activity. The S260-600 fragment probably contains the important receptor binding domain and could be a potential candidate for the development of SARS vaccine and anti-SARS therapeutics.

Cloning, purification, and antigenic characterization of three recombinant fragments derived from SARS-CoV S1 domain

The present study aimed to clone and express three fragments of genomic RNA derived from SARS associated coronavirus (SARS-CoV) S1 domain and to study its immunogenicity. The S1 domain gene was amplified by PCR with specific primers and was inserted into the prokaryotic expression vector pQE-30. Three fragments (40-751, 746-1344 and 746-2001 bp) derived from S1 domain produced after the recombinant plasmid (pQE-30/S1) was digested by restriction endonucleases. The three fragments were cloned into pQE-30 and expressed in M15 strains of Escherichia coli. The expression products, designated S1a, S1b and S1c respectively, were purified by Ni affinity chromatography. The immunogenicity was analyzed by Western Blot and ELISA using serologically confirmed sera from SARS patients and the sera from healthy donors was used as control at the same assay. Three recombinant plasmids (pQE-30/S1a, pQE-30/S1b, pQE-30/S1c) were constructed.Fusion proteins with relative molecular mass of 26,700, 22,500 and 46,000 dalton were successfully expressed with amounts of 35%, 35% and 30% of total cell protein and purified by Ni affinity chromatography, respectively. Western Blot and ELISA analysis showed that the S1c protein could be specifically recognized by the sera from SARS patients. The recombinant S1c protein was a good immunogen and has the potential to be used as a vaccine against SARS-CoV infection.

Sero-epidemiological characteristics of antibody to SARS-associated coronavirus in Gansu Province

To study the levels of SARS-associated coronavirus IgG antibody of SARS patients, people who closely contacted SARS patients and normal subjects in Gansu province. The levels of SARS-associated coronavirus IgG antibody were measured by ELISA. The material included acute and (or) recovery period sera of 9 SARS patients, sera from 1,109 doctors and nurses closely contacted with SARS patients, laboratory workers, personnel for disease control and prevention, persons who contacted SARS patients, and sera from 978 normal subjects. SARS coronavirus IgG antibody was detected positive in 6 of the 9 patients, it was still positive in the sera twelve months after recovery; 1 of the closely contacted persons and 3 normal subjects were found positive. The positive rate of SARS coronavirus IgG antibody of patients was consistent with the clinical diagnosis. The low positive rate of the persons who closely contacted SARS patients and normal subjects suggests that SARS probably had no subclinical infection.

Preparation of monoclonal antibodies against SARS coronavirus and staining usage in lung autopsy specimens

To prepare monoclonal antibodies against SARS coronavirus (SARS-CoV) on the purpose to explore the diagnosis methods of SARS. Female BALB/C mice were immunized with disinfected SARS-CoV (PUMC01) and the spleen cells were fused with myeloma NS-1 cells. The hybridoma cell strains were screened by enzyme-linked immunosorbent assay (ELISA), indirect fluorescent-antibody assay (IFA) and Western blotting. Autopsy lung tissue sections from SARS patients were stained with ascites of monoclonal antibody (M2 strain) by immunohistochemical technique. Six strains of hybridomas that produced the monoclonal antibodies against SARS-CoV were obtained. The hybridomas were tested to have specific reactions with SARS-CoV and no cross-reactivates with other common respiratory disease causing pathogens. Of the 6 strains, 1 was identified as the immunoglobulin G3 (IgG3) isotype, 5 were IgG1. Western blotting showed that one strain (M2) reacted with 68000- Dalton (68KD) protein and four strains with 27000-dalton (27KD) protein. Band of M4 stain was not got by western blotting. Brown particles were seen in macrophages and pneumocytes in autopsy lung tissues from SARS patients. Monoclonal antibodies we made were specific to the SARS-CoV, and they had been used to detect SARS-CoV in autopsy lung tissues specimens with positive results.

Factors of avascular necrosis of femoral head and osteoporosis in SARS patients' convalescence

To explore the factors affecting the pathogenesis of avascular necrosis of femoral head and osteoporosis of SARS patients during convalescent stage. The clinical data of 40 SARS patients, 12 males and 28 females, aged 29 +/- 9, hospitalized from April to June 2003, were reviewed, targeted on the use of glucocorticoids. Three months after the discharge ELISA and indirect immunofluorescent antibody (IFA) assay were used to detect the serum IgG. Magnetic resonance imaging (MRI) was used to detect the damage of the head of femur and quantitative ultrasound (QUS) was used to detect osteoporosis at the left heel. The average total dosage of methylprednisolone was (4949 +/- 2959) mg, and the average course of treatment was (24 +/- 5) days (16 to 30 days). Twenty-three patients underwent ictus therapy of corticosteroids for (8 +/- 4) days. The extenuation time of corticosteroid' dosage was (33 +/- 26) mg/d. Of the 40 patients, 36 were IgG positive with an average A value of (0.91 +/- 0.24) and 4 patients were IgG negative. Twelve patients (30%) were with type I avascular necrosis of femoral head, including 3 cases with unilateral left--necrosis and 9 cases of bilateral necrosis. The other 28 patients were without necrosis. Two patients were suffering from osteoporosis and 30 patients were with bone density decrement. The average Z values of the parameter BUA and VOS were (-1.26 +/- 0. 53) and (-0.53 +/- 0.30) respectively. The corresponding T values of the parameter BUA and VOS were (-1.49 +/- 0.59) and (-0.65 +/- 0.05) respectively. The influencing factors of femoral necrosis included the degree of healing activity, the dosage summation of corticosteroids, and length of ictus therapy. The influencing factors of bone density included age, dosage summation, and length of ictus therapy. The influencing factors of the bone fabric and flexibility included the use and length of ictus therapy. Statistics showed that serum IgG was not related with avascular necrosis of femoral head and osteoporosis. The incidence rates of avascular necrosis of femoral head and of osteoporosis were higher in convalescent SARS patients than in general population. The influencing factors of femoral necrosis included the degree of healing activity, the dosage summation of corticosteroids, and length of ictus therapy. The influencing factors of bone density included age, dosage summation, and length of ictus therapy. The influencing factors of the bone fabric and flexibility included the use and length of ictus therapy. Statistics showed that serum IgG was not related with avascular necrosis of femoral head and osteoporosis. SARS virus may not affect the pathogenesis of avascular necrosis of femoral head and osteoporosis.

Pathological changes of lungs in patients with severity acute respiratory syndrome

To evaluate the progression in morphologic changes of lungs in SARS patients. Four cases of SARS with lung tissue samples available (including one for ultrastructural examination) were enrolled into the study. Histochemical study for VG, Masson, reticulin, orcein, PAS, sirius red stains and immunohistochemical study for vimentin, desmin, smooth muscle actin, HHF-35, CD34, F8, collagen types I and III were also performed. According to the morphologic changes, lung lesions in SARS were subcategorized into 3 phases: acute exudative inflammation, fibrous proliferation and the final fibrotic stage. Two cases belonged to the acute exudative phase, in which the course was less than 20 days. The principal lesions consisted of acute alveolar exudative inflammation, hyperplasia of alveolar epithelium, necrosis, alveolar hyaline membrane formation, alveolar desquamation and focal fibroplasia. The acute exudative protein was PAS-positive. There was an increase in reticulin fiber formation. The reactive fibroblasts were highlighted by desmin and vimentin. One case belonged to the fibroproliferative stage, in which the course was around 25 days. Major lesions included proliferative interstitial pneumonia with early pulmonary fibrosis. There was also evidence of organizing pneumonia, with an increase in reticulin fiber formation, which had a glomeruloid appearance on special stain. The mesenchymal cells showed either myofibroblastic (which expressed desmin, HHF-35, smooth muscle actin and vimentin) or fibroblastic (which expressed vimentin only) differentiation. Fibroelastosis and fibroplasia was also noted. The remaining case belonged to the fibrotic stage, in which the course was around 75 days. The main features included diffuse fibrosis and honeycomb change, which were highlighted by sirius red stain. Immunohistochemistry showed mainly types I and IV collagen fibers. In all lesions, there was also an increase of number of CD68-positive macrophages. The morphologic progression in lungs of SARS patients is characterized by the development of increased fibrosis. The primitive mesenchymal cells, hyperplastic alveolar epithelial cells and macrophages play an important role in the pathogenesis.

The COX regression analysis on the use of corticosteroids in the treatment of SARS

To explore the effectiveness of corticosteroids (GCS) and to determine how to use it in the treatment of SARS. All reported probable cases in Beijing were reviewed. Those who fulfilled the diagnostic criteria with an integrity clinical record were recruited in the study. A database was established and all the clinical data, including patients' personal information, epidemiological history, underlying diseases, clinical manifestations, laboratory tests and therapies after hospitalization, as well as the outcome of the disease, were inputted under a quality control. Unifactor and COX multifactor regression analysis were done. The dose of GCS was all expressed in that of methylprednisolone. 1291 cases were in consistence with the demands mentioned above. Among them, 1084 cases (83.96%) had used GCS and 207 did not in the course of SARS. There was no significant difference of average age (t = -1.08, P = 0.2808) and the time from SARS onset to hospitalization (P = 0.2797) between the two groups. COX regression showed that the risk of fatality in the GCS group was higher than that of those who did not use GCS (RR = 1.334, 95% of CI: 0.588 - 3.026). In the patients with comorbidities, RR was 2.086 (95% of CI: 0.694 - 6.267), and RR was 0.536 (95% of CI: 0.146 - 1.970) in the patients with no comorbidity. In those without any comorbidity, the initial doses, maximal doses, average doses and cumulative doses all showed a 'J' shape change. An appropriate dose could keep RR to be the lowest whereas the doses either higher or lower than it could increase RR. The initial dose with the lowest RR was 80 - 160 mg/d, the maximum 80 - 160 mg/d, the average < 80 mg/d and the cumulative one 1000 - 3000 mg although there was no statistical significance (all P > 0.05). RR was less than 1 in non-comorbidity patients who initiated GCS therapy before the 15th day of the disease. RR was 1.415 (95% of CI: 0.195 - 10.257) in the patients who began to use GCS over this period. Counting from hospitalization, the time of GCS use also showed a 'J' type change of RR. The initiation of GCS from day 5 to 7 had the lowest RR (0.282, 95% of CI: 0.043 - 1.828) and that from day 8 to 14 was 1 (95% of CI: 0.150 - 6.654). In the treatment of SARS, GCS seems to be effective. An appropriate dose and a right time of application decrease the risk of death. The use of GCS in SARS patients with comorbidities should be with caution.

SARS-associated coronavirus transmission, United States.

To better assess the risk for transmission of the severe acute respiratory syndrome–associated coronavirus (SARS-CoV), we obtained serial specimens and clinical and exposure data from seven confirmed U.S. SARS patients and their 10 household contacts. SARS-CoV was detected in a day-14 sputum specimen from one case-patient and in five stool specimens from two case-patients. In one case-patient, SARS-CoV persisted in stool for at least 26 days after symptom onset. The highest amounts of virus were in the day-14 sputum sample and a day-14 stool sample. Residual respiratory symptoms were still present in recovered SARS case-patients 2 months after illness onset. Possible transmission of SARS-CoV occurred in one household contact, but this person had also traveled to a SARS-affected area. The data suggest that SARS-CoV is not always transmitted efficiently. Laboratory diagnosis of SARS-CoV infection is difficult; thus, sputum and stool specimens should be included in the diagnostic work-up for SARS-CoV infection.

Detection of RNA of SARS coronavirus in hospital sewage

In order to explore the existence of SARS coronavirus (Co-V) and/or its RNA in sewage of hospitals administered SARS patients. A novel electropositive filter was used to concentrate the SARS-CoV from the sewage of two hospitals administered SARS patients in Beijing, including twelve 2,500 ml sewage samples from the hospitals before disinfection, and ten 25,000 ml samples after disinfection; as well as cell culture, RT-PCR and sequencing of gene to detect and identify the viruses from sewage. There was no live SARS-CoV detected in the sewage in this study. The nucleic acid of SARS-CoV had been found in the 12 sewage samples before disinfection from both hospitals by semi-nested PCR. After disinfection, SARS-CoV RNA could only be detected from the samples from the 309th Hospital, and the others were negative. It provides evidence that there is no live SARS-Cov in the sewage from hospitals with SARS patients though SARS-CoV RNA can be detected.

Reovirus, isolated from SARS patients

Reovirus, isolated from SARS patients