Clinical presentation and outcome of severe acute respiratory syndrome in dialysis patients.
There was a major outbreak of severe acute respiratory syndrome (SARS) affecting more than 300 patients occurring in a private housing estate in Hong Kong, in which an infected renal patient was suspected to be the primary source. It is unknown whether renal patients would represent a distinct group of patients who share some characteristics that could predispose them to have higher infectivity. In this context, we have encountered 4 dialysis patients contracting SARS in a minor outbreak, which involved 11 patients and 4 health care workers, in a medical ward of a regional hospital. Of these 4 dialysis patients, 1 patient was receiving hemodialysis while the other 3 patients were on continuous ambulatory peritoneal dialysis. Fever and radiological changes were their dominant presenting features. All were having positive results for SARS-associated coronavirus ribonucleic acid by reverse transcriptase-polymerase chain reaction performed on their nasopharyngeal aspirates or stool samples. It appeared that treatment with high-dose intravenous ribavirin and corticosteroids could only resolve the fever, but it could not stop the disease progression. All 4 patients developed respiratory failure requiring mechanical ventilation on days 9 through 12. At the end, all of the patients died from sudden cardiac arrest, which was associated with acute myocardial infarction in 2 cases. From this small case series, it appeared that dialysis patients might have an aggressive clinical course and poor outcome after contracting SARS. However, a large-scale study is required to further examine this issue, and further investigation into the immunologic abnormalities associated with the uremic state in this group of patients is also warranted.
Wong
Ping-Nam
PN
Department of Medicine and Geriatrics and Intensive Care Unit, Kwong Wah Hospital, Kowloon, Hong Kong SAR, China. apnwong@yahoo.com
Mak
Siu-Ka
SK
Lo
Kin-Yee
KY
Tong
Gensy M W
GM
Wong
Yuk
Y
Watt
Chi-Leung
CL
Wong
Andrew K M
AK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D004196:Disease Outbreaks; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D017758:Infectious Disease Transmission, Patient-to-Professional; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008506:Medical Waste; D008875:Middle Aged; D010356:Patient Isolation; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
D008506:Medical Waste