Severe acute respiratory syndrome in surgical patients: a diagnostic dilemma.
BACKGROUND
The diagnosis of severe acute respiratory syndrome (SARS) in surgical patients can potentially be missed based on current World Health Organization (WHO) case definitions.


METHODS
We report a retrospective case series of 10 surgical inpatients diagnosed with SARS following an outbreak in the surgical wards. Patients were included if they fulfilled the WHO case definition of probable SARS, had an active surgical problem and were admitted to the surgical wards during the outbreak period. Clinical histories, laboratory investigations and radiological findings were reviewed and analyzed.


RESULTS
The mean age of the cohort was 57.6 years (range: 38-78 years). Nine patients had concomitant medical conditions. Three patients were in the early postoperative period, while the remaining seven were admitted for surgical related infections. All patients presented with fever, but only eight had accompanying respiratory symptoms. Lymphopenia and raised lactate dehydrogenase (LDH) was seen in seven patients. Eight patients had positive bacterial cultures. The primary abnormality on chest radiograph was air-space opacification. Rapid progression of radiological changes was seen in seven patients. Mortality rate for our cohort is 20%.


CONCLUSIONS
The diagnosis of SARS in surgical patients differs from that previously described in normal patients. An apparent cause of fever and positive blood cultures cannot exclude a diagnosis of SARS. The current WHO case definition could result in delayed or even missed diagnosis. Early isolation of febrile patients with a positive contact history must be undertaken, even in the face of another identifiable cause.
Tan
Felicia Li Sher
FL
Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
Loo
Wee Lim
WL
Tan
Seck Guan
SG
Wong
Chow Yin
CY
Tan
Yu-Meng
YM
D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D045169:Severe Acute Respiratory Syndrome / Q000175:diagnosis* / Q000453:epidemiology