Severe acute respiratory syndrome (SARS) in children: epidemiology, presentation and management

T F Leung, G W K Wong, K L E Hon, T F Fok, T F Leung, G W K Wong, K L E Hon, T F Fok

Abstract

Severe acute respiratory syndrome (SARS) is a newly recognised and highly contagious respiratory infection caused by a new strain of coronavirus. The disease can result in progressive respiratory failure in adults and the mortality rate has been reported to be 8-15%. This infection spreads by droplet transmission and children appear to acquire SARS through close household contact exposure to infected adults. Disease severity is, however, much milder in the paediatric age group. The common laboratory findings in infected children and adolescents include lymphopaenia and elevated levels of lactate dehydrogenase and creatinine phosphokinase. Air space consolidation is commonly seen during the course of the illness although chest radiographs are normal on presentation in half of the cases. The pathophysiology of SARS appears to be related to immunological dysregulation in response to the coronavirus infection. The optimal treatment of SARS in children remains to be determined. No case fatality in infected children has been reported. The early and proper isolation of infected adults, meticulous infection control measures in the hospital setting, exhaustive contact tracing and quarantine measures are important steps in preventing the spread of the disease among health care workers and into the community. The development of a sensitive and rapid test for early diagnosis is underway. Further controlled trials are necessary to define the optimal treatment of this infection in children.

Figures

Fig. 1
Fig. 1
Computer tomography of the thorax showing ground glass consolidation in the peripheral lung regions in a 3-year-old boy.

References

    1. World Health Organization. Acute respiratory syndrome in China. (accessed 11 February 2003).
    1. Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS). (accessed 7 May 2003).
    1. Centers for Disease Control and Prevention. Severe acute respiratory syndrome (SARS). (accessed 20 May 2003).
    1. Tsang K.W, Ho P.L, Ooi G.C. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N. Engl. J. Med. 2003;348:1977–1985.
    1. Lee N, Hui D.S, Wu A. A major outbreak of severe acute respiratory syndrome in Hong Kong. N. Engl. J. Med. 2003;348:1986–1994.
    1. Poutanen S.M, Low D.E, Henry B. Identification of severe acute respiratory syndrome in Canada. N. Engl. J. Med. 2003;348:1995–2005.
    1. Hsu L.Y, Lee C.C, Green J.A. Severe acute respiratory syndrome (SARS) in Singapore: clinical features of index patient and initial contacts. Emerg. Infect. Dis. 2003;9:713–717.
    1. Booth C.M, Matukas L.M, Tomlinson G.A. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289:2801–2809.
    1. Peiris J.S, Chu C.M, Cheng V.C. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361:1767–1772.
    1. World Health Organization. WHO collaborative multi-centre research project on severe acute respiratory syndrome (SARS) diagnosis. (accessed 9 May 2003).
    1. Periris J.S, Lai S.T, Poon L.L.M. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003;361:1319–1325.
    1. Ksiazek T.G, Erdman D, Goldsmith C. A novel coronavirus associated with severe acute respiratory. N. Engl. J. Med. 2003;348:1953–1966.
    1. Cavanagh D. Nidovirales: a new order comprising Coronaviridae and Arteriviridae. Arch Virol. 1997;142:629–633.
    1. Siddell SG, Snijder EJ. Coronaviruses, toroviruses, and arteriviruses. In: Mahy BWJ, Collier L. (eds) Tropley and Wilson’s Microbiology and Microbial Infections. London: Edward Arnold; 1998; 463–484.
    1. Wege H, Siddell S, ter Meulen V. The biology and pathogenesis of coronaviruses. Curr. Top. Microbiol. Immunol. 1982;99:165–200.
    1. Centers for Disease Control and Prevention. Interpreting SARS test results. (accessed 9 May 2003).
    1. Rota P.A, Oberste M.S, Monroe S.S. Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003;300:1394–1399.
    1. Marra M.A, Jones S.J.M, Astell C.R. The genome sequence of the SARS-associated coronavirus. Science. 2003;300:1399–1404.
    1. Chiu W.K, Cheung P.C, Ng K.L. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr. Crit. Care Med. 2003;4:279–283.
    1. Hon E.K, Leung C.W, Cheng W.T. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet. 2003;361:1701–1703.
    1. Rainer T.H, Cameron P.A, Smit D. Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study. BMJ. 2003;326:1354–1358.
    1. Fisher D.A, Lim T.K, Lim Y.T. Atypical presentations of SARS. Lancet. 2003;361:1740.
    1. Wong R.S.M, Wu A, To K.F. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ. 2003;326:1358–1362.
    1. Wong G.W.K, Hui D.S.C. Severe acute respiratory syndrome (SARS): epidemiology, diagnosis and treatment. Thorax. 2003;58:558–560.
    1. Donnelly C.A, Ghani A.C, Leung G.M. Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003;361:1761–1766.
    1. Nicholls J.M, Poon L.L.M, Lee K.C. Lung pathology of fatal severe acute respiratory syndrome. Lancet. 2003;361:1773–1778.
    1. Cinatl J, Morgenstern B, Bauer G. Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus. Lancet. 2003;361:2045–2046.
    1. Seto W.H, Tsang D, Yung R.W. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS) Lancet. 2003;361:1519–1520.
    1. World Health Organization. Hospital infection control guidance for severe acute respiratory syndrome (SARS). (accessed 3 June 2003).
    1. World Health Organization. First data on stability and resistance of SARS coronavirus compiled by members of WHO laboratory network. (accessed 4 May 2003).

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe