Eight-month prospective study of 14 patients with hospital-acquired severe acute respiratory syndrome.
OBJECTIVE
To define the clinical characteristics and clinical course of hospital-acquired severe acute respiratory syndrome (SARS).


METHODS
This 8-month prospective study of 14 patients with hospital-acquired SARS in Taipei, Taiwan, was conducted from April through December 2003.


RESULTS
The most common presenting symptoms in our 14 patients with hospital-acquired SARS were fever, dyspnea, dizziness, malaise, diarrhea, dry cough, muscle pain, and chills. Lymphopenia and elevated serum levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were the most common Initial laboratory findings. Initial chest radiographs revealed various pattern abnormalities and normal results. Five of the 14 patients required mechanical ventilation. The need for mechanical ventilation was associated with bilateral lung involvement on the initial chest radiograph and higher peak levels of LDH and CRP. Clinical severity of disease varied from mild to severe. At 8 months after disease onset, patients with mild or moderate SARS had normal findings or only focal fibrosis on chest high-resolution computed tomography. However, bilateral fibrotic changes remained in the 4 patients who had recovered from severe SARS, 1 of whom had mild restrictive ventilatory impairment. One patient with severe SARS died; she was elderly and had other comorbidities. Five additional patients had reduced diffusing capacity.


CONCLUSIONS
The clinical picture of our patients presenting with hospital-acquired SARS revealed atypical pneumonia associated with lymphopenia, elevated serum levels of LDH, rapid clinical deterioration, and lack of response to empirical antibiotic therapy. Substantially elevated levels of LDH and CRP correlated with severe illness requiring mechanical ventilatory support. In those receiving mechanical ventilation, pulmonary function was only mildly reduced at 6 to 8 months after acute illness, consistent with the natural history of acute respiratory distress syndrome due to other causes.
Chiang
Chi-Huei
CH
Chest Department, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan. chiang01@vghtpe.gov.tw
Shih
Jen-Fu
JF
Su
Wei-Juin
WJ
Perng
Reury-Perng
RP
D000328:Adult; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008231:Lymphopenia; D008297:Male; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D018709:Statistics, Nonparametric; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
D007770:L-Lactate Dehydrogenase