Correspondence
The Severe Acute Respiratory Syndrome
N Engl J Med 2004; 350:1797April 22, 2004
- Article
To the Editor:
In their review article on the severe acute respiratory syndrome (SARS) (Dec. 18 issue),1 Peiris et al. describe the “initial” chest radiograph as abnormal in 60 to 100 percent of cases, depending on the interval between the onset of fever and hospital admission. “Initial” has been clearly defined in a report (which is cited) on 40 probable cases in Toronto.2 The mean interval from the date of exposure to the first abnormal chest radiograph was 11.9 days (range, 4 to 26), and the mean time from the onset of fever to an abnormal radiograph was 5.0 days (range, 1 to 19). This report also stated that in the subgroup of patients with a normal initial radiograph, the mean time from the onset of fever to an abnormal radiograph was 6 days (range, 2 to 19).
In our hospital, an outbreak occurred between April 27 and May 2, 2003, and was controlled without secondary transmission. Seven members of the medical staff were affected, with positive enzyme-linked immunosorbent assays for antibody specific to the SARS-associated coronavirus. Chest radiography was performed at least every two days after the onset of fever. The mean time from the onset of fever to the first abnormal radiograph was 8.9 days (range, 2 to 13); the mean time from exposure to the first abnormal radiograph was 13.3 days (range, 10 to 16). Hence, an abnormal chest radiograph is not an early sign of SARS. Furthermore, chest radiographs may be normal throughout the course of illness.3,4
The explanation for both the prolonged interval from the onset of fever to the first abnormal chest radiograph and the high percentage of abnormal chest radiographs on admission may be that the patients with SARS usually did not visit the hospital in the early days of their illness. As more has been learned about SARS, fever-screening clinics have been established in many hospitals. And people with fever alone will be visiting the hospital earlier than in previous outbreaks of SARS. The concept that initial chest radiographs are abnormal in 60 to 100 percent of patients with SARS should be adjusted, and in patients with fever, SARS should not be ruled out because of a normal initial chest radiograph.
4 ReferencesJia-Fong Lue, M.D.
Municipal Chung-Hsing Hospital, Taipei 24120, Taiwan
jack3993@hotmail.com 1
Peiris JSM ,Yuen KY ,Osterhuis ADME ,Stohr K . The severe acute respiratory syndrome. N Engl J Med 2003;349:2431-2441
Full Text | Web of Science | Medline2
Grinblat L ,Shulman H ,Glickman A ,Matukas L ,Paul N . Severe acute respiratory syndrome: radiographic review of 40 probable cases in Toronto, Canada. Radiology 2003;228:802-809
CrossRef | Web of Science | Medline3
World Health Organization. Preliminary clinical description of severe acute respiratory syndrome. (Accessed April 1, 2004, at http://www.who.int/csr/sars/clinical/en/.)
4
Preliminary clinical description of severe acute respiratory syndrome. MMWR Morb Mortal Wkly Rep 2003;52:255-256
Medline
