Initial otolaryngological manifestations of severe acute respiratory syndrome in Taiwan.
OBJECTIVE
To provide a clue for screening severe acute respiratory syndrome (SARS), a highly transmissible disease with health care workers at particular risk, in the early stage from an otolaryngological perspective.


METHODS
Prospective study.


METHODS
Community hospital.


METHODS
Between April 17 and April 26, 2003, 32 consecutive patients with SARS were encountered. Investigation consisted of local examination of ear, nose, and throat fields; palpation of the nuchal areas; and plain chest radiography. Analyses of throat swab samples using reverse transcription-polymerase chain reaction were conducted.


RESULTS
Clinical manifestations included fever in 31 patients (97%), followed by cough, dyspnea, chill, headache, sore throat, diarrhea, rhinorrhea, and otalgia. Neither the pharyngeal wall nor the tonsillar area demonstrated hyperemia. There was no lymphadenopathy in the neck. Plain chest radiographs revealed consolidation in 25 (78%) of 32 patients. Results of reverse transcription-polymerase chain reaction analysis targeting the novel coronavirus present in throat swab samples were positive in 19 (66%) of 29 patients tested. Twenty-eight patients required supplemental oxygen, and 14 patients were intubated with mechanical ventilation. Twenty-eight patients survived and 4 patients died.


CONCLUSIONS
When presented with a patient with flulike symptoms such as fever and/or cough, but no pharyngeal hyperemia or neck lymphadenopathy, physicians should be alerted to the possibility of SARS. In contrast, evidence of inflammatory signs in the otolaryngological field may explain the flulike symptoms, and serve as a differential diagnostic tool between influenza and SARS.
Chen
Hsin-Chi
HC
Department of Otolaryngology, Municipal Ho-Ping Hospital, Taipei, Taiwan.
Young
Yi-Ho
YH
Luo
Jyh-Perng
JP
Tsai
Hui-Ju
HJ
Ho
Sung-Jung
SJ
Yeh
Chi-Huang
CH
Huang
Lien-Chi
LC
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000150:complications / Q000175:diagnosis*; D013624:Taiwan