Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever
- cough
- myalgia
- dyspnoea
Other diagnostic factors
- chills or rigors
- malaise
- headache
- watery diarrhoea
- tachypnoea
- tachycardia
- cyanosis
- nausea and vomiting
- sore throat
- sputum production
- chest pain
- pleurisy
- rhinorrhoea
- dizziness
- arthralgia
- abdominal pain
- seizure
- delirium
- rales
- inspiratory crackles
- bronchial breathing
Risk factors
- travel to affected area
- close contact with infected individuals
- laboratory work on SARS-CoV
Diagnostic investigations
1st investigations to order
- FBC
- aminotransferases
- lactate dehydrogenase
- creatine kinase
- blood culture
- sputum culture
- nasopharyngeal virus culture
- direct immunofluorescent antibody staining
- chest x-ray
- pulse oximetry
- reverse-transcription polymerase chain reaction (RT-PCR)
Investigations to consider
- ABG
- coagulation screen
- high-resolution CT (HRCT) of thorax
- serological testing for SARS-CoV-specific antibodies
- viral culture
Emerging tests
- rapid immunoswab assay for SARS-CoV detection
- monoclonal antibodies
Treatment algorithm
suspected SARS
confirmed SARS
Contributors
Authors
Georgia G. Pitsiou, MD, PhD
Associate Professor in Pulmonary Medicine
Aristotle University of Thessaloniki
Respiratory Failure Clinic
General Hospital G. Papanikolaou
Thessaloniki
Greece
Disclosures
GGP declares that she has no competing interests.
Ioannis P. Kioumis, MD, PhD
Professor in Pulmonary Medicine
Infectious Diseases
Aristotle University of Thessaloniki
Respiratory Failure Clinic
General Hospital G. Papanikolaou
Thessaloniki
Greece
Disclosures
IPK declares that he has no competing interests.
Peer reviewers
Tommy R. Tong, MD
Attending Pathologist
Montefiore Medical Center
Bronx
NY
Disclosures
TRT declares that he has no competing interests.
Sian Griffiths, OBE, MA, MB BChir, FFPHM, FRCP (Lon), FRCP (Edin), FHKCCM
Director of the School of Public Health
Chinese University of Hong Kong
Prince of Wales Hospital
New Territories
Hong Kong
Disclosures
SG declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Christian MD, Poutanen SM, Loutfy MR, et al. Severe acute respiratory syndrome. Clin Infect Dis. 2004;38:1420-1427.Full text Abstract
Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767-1772. Abstract
Mahony JB, Richardson S. Molecular diagnosis of severe acute respiratory syndrome: the state of the art. J Mol Diagn. 2005;7:551-559. Abstract
Peiris JS, Yuen KY, Osterhaus AD, et al. The severe acute respiratory syndrome. N Engl J Med. 2003;349:2431-2441. Abstract
Fowler RA, Lapinsky SE, Hallet D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290:367-373.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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