title: Severe acute respiratory syndrome in surgical patients: a diagnostic dilemma.
abstract: 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.
authors.affiliation: Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Felicia Li Sher
authors.initials: FL
authors.lastname: Tan
authors.forename: Wee Lim
authors.initials: WL
authors.lastname: Loo
authors.forename: Seck Guan
authors.initials: SG
authors.lastname: Tan
authors.forename: Chow Yin
authors.initials: CY
authors.lastname: Wong
authors.forename: Yu-Meng
authors.initials: YM
authors.lastname: Tan
mesh_terms: 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