[Severe acute respiratory syndrome (SARS). The questions raised by the management of a patient in Besançon and Strasbourg].
BACKGROUND
In mid-June 2003, 8500 probable cases of Severe Acute respiratory Syndrome (SARS) responsible for 800 deaths in 29 countries were reported by the World Health Organization (WHO). In France, 5 probable cases of SARS were diagnosed until May 2003. We report the case of one of the 5 French cases, hospitalized successively in Besançon then in Strasbourg.


METHODS
This 54 year-old man was infected during the Air France flight from Hanoi to Paris via Bangkok by the index case, who himself had been contaminated at the French hospital in Hanoi and who was hospitalized in a critical state in the Tourcoing hospital shortly after his arrival in France. The first clinical signs (fever and dry cough) appeared 4 days after contact with the index case. The chest X-ray showed a pulmonary consolidation 6 days after the first clinical symptoms. Blood test revealed deep lymphopenia and elevated LDH. The patient finally recovered with a treatment combining ribavirin and steroids.


CONCLUSIONS
The clinical symptoms of SARS are unspecific and its evolution may be misleading. The epidemiological context (contact with the index case) is a key point for the diagnosis. The management of such a patient requires the careful protection of contacts, the adequation between medical and paramedical staff and excess work and communication to the general public.
Lesens
O
O
Service des maladies infectieuses et tropicales, Clinique médicale A, Hôpitaux Universitaires, Strasbourg. olivier.lesens@wanadoo.fr
Hustache-Mathieu
L
L
Hansmann
Y
Y
Remy
V
V
Hoen
B
B
Christmann
D
D
D000401:Aircraft; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D002681:China; D017934:Coronavirus / Q000302:isolation & purification; D018352:Coronavirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D003937:Diagnosis, Differential; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination; D005602:France; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation; D010359:Patient Readmission; D016133:Polymerase Chain Reaction; D012254:Ribavirin / Q000008:administration & dosage; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000635:transmission; D014057:Tomography, X-Ray Computed; D014195:Travel
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D012254:Ribavirin; C007133:hydrocortisone hemisuccinate; D006854:Hydrocortisone