The spectrum of severe acute respiratory syndrome-associated coronavirus infection.
BACKGROUND
Whether subclinical or atypical presentations of severe acute respiratory syndrome (SARS) occur and whether clinical judgment is accurate in detecting SARS are unknown.


OBJECTIVE
To describe the spectrum of SARS coronavirus infection in a large outbreak and to compare diagnoses based on clinical judgment with the SARS coronavirus test.


METHODS
Secondary analysis of prospectively collected clinical data and archived serum.


METHODS
A SARS screening clinic of a university hospital in the New Territories of Hong Kong.


METHODS
1221 patients attending the clinic between 12 March 2003 and 12 May 2003.


METHODS
SARS coronavirus serology.


RESULTS
145 of 553 (26%) patients had serologic evidence of SARS coronavirus infection. Of 910 patients who were managed without hospitalization, only 6 had serologic evidence of SARS. Five of the six patients had normal chest radiographs, and four had symptoms such as myalgia, chills, coughing, and feeling feverish. With the SARS coronavirus serologic test as the gold standard, the clinical diagnosis of probable SARS at hospitalization had a sensitivity of 0.96 (95% CI, 0.91 to 0.98) and a specificity of 0.96 (CI, 0.92 to 0.97).


CONCLUSIONS
Follow-up serologic samples were not obtained from almost half of the patients because they declined further testing. Some people living in the community who were infected but who had minor or no symptoms might not have visited the clinic.


CONCLUSIONS
There is little evidence of widespread subclinical or mild forms of SARS coronavirus infection. Clinical diagnoses during the outbreak were reasonable and resulted in appropriate triaging.
Rainer
Timothy H
TH
Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Trauma and Emergency Centre, Prince of Wales Hospital, Shatin, NT, Hong Kong. rainer1091@cuhk.edu.hk
Chan
Paul K S
PK
Ip
Margaret
M
Lee
Nelson
N
Hui
David S
DS
Smit
DeVilliers
D
Wu
Alan
A
Ahuja
Anil T
AT
Tam
John S
JS
Sung
Joseph J Y
JJ
Cameron
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006723:Hong Kong; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D045473:Severe acute respiratory syndrome-related coronavirus / Q000276:immunology; D012680:Sensitivity and Specificity; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis*
D000914:Antibodies, Viral