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Severe acute respiratory syndrome SARS , now known to be caused by a coronavirus, probably originated in Guangdong province in southern China in late The first major outbreak occurred in Guangzhou, the capital of Guangdong, between January and March This study reviews the clinical presentation, laboratory findings and response to four different treatment protocols.
Case notes and laboratory findings were analysed and outcome measures were collected prospectively. The SARS outbreak in Guangdong province and the outbreak in Guangzhou associated with hospitals in the city are described, documenting clinical and laboratory features in a cohort of patients randomly allocated to four treatment regimens.
Patients were infected by close contact in either family or health-care settings, particularly following procedures likely to generate aerosols of respiratory secretions e. The most frequent chest X-ray changes were patchy consolidation with progression to bilateral bronchopneumonia over days. Thirty-six cases developed adult respiratory distress syndrome ARDS , of whom 11 died. There was no response to antibiotics. The best response no deaths was seen in the group of 60 patients receiving early high-dose steroids and nasal CPAP continuous airway positive pressure ventilation; the other three treatment groups had significant mortality.
Cross-infection to medical and nursing staff was completely prevented in one hospital by rigid adherence to barrier precautions during contact with infected patients. The use of rapid case identification and quarantine has controlled the outbreak in Guangzhou, in which more than patients have been infected. Early administration of high-dose steroids and CPAP ventilation appears to offer the best supportive treatment with a reduced mortality compared with other treatment regimens.
Abstract Severe acute respiratory syndrome SARS , now known to be caused by a coronavirus, probably originated in Guangdong province in southern China in late Publication types Research Support, Non-U.