Severe acute respiratory syndrome

Background

• SARS = Severe Acute Respiratory Syndrome
• Mainly Asia
  • Commonly isolated from civet cat
• Coronavirus spread by respiratory droplet transmission

Clinical Features

• Fever, Chills
• Myalgias
• Headache
• Non-productive cough

Differential Diagnosis

Influenza-Like Illness

• Influenza
• Parainfluenza
• URI
• Pneumonia
• Sinusitis
• Toxic exposure
• Pyelonephritis
• Bronchitis
• Coronavirus
  • MERS-CoV
  • SARS-CoV
  • 2019-nCoV (COVID-19)

Cough

Acute (< 3 wks)

• URI (rhinitis, sinusitis, pertussis)
• LRI (bronchitis, pneumonia)
• Influenza
• Allergy
• Asthma
• Environmental irritants
• Transient airway hyperresponsiveness
• Foreign body
• SARS

Chronic (> 8 wks)

• Postinfectious; pertussis
• Smoking and/or chronic bronchitis
• Postnasal discharge
• Asthma
• GERD
• ACEI/ARB
• CHF
• Lung cancer or intrathoracic mass
• Emphysema
• Interstitial lung disease
• Psychiatric

Causes of Pneumonia

Bacteria

• Gram-positive
  • Streptococcus pneumoniae
  • Staphylococcus aureus
• Gram-negative
  • Haemophilus influenzae
  • Klebsiella pneumoniae
  • Escherichia coli
  • Pseudomonas aeruginosa
  • Moraxella catarrhalis
• Atypical pneumonia
  • Chlamydophila pneumoniae
  • Chlamydophila psittaci
  • Mycoplasma pneumoniae
  • Coxiella burnetti
  • Legionella pneumophila

Viral

• Common
  • Influenza
  • Respiratory syncytial virus
  • Parainfluenza
• Rarer
  • Adenovirus
  • Metapneumovirus
  • Severe acute respiratory syndrome (SARS)
  • Middle east respiratory syndrome coronavirus (MERS)
  • 2019-nCoV (COVID-19)
• Cause other diseases, but sometimes cause pneumonia
  • Herpes simplex virus
  • Varicella-zoster (VZV)
  • Measles
  • Rubella
  • Cytomegalovirus
  • Smallpox
  • Dengue

Fungal

• Histoplasmosis
• Coccidioidomycosis
• Blastomycosis
• Pneumocystis jirovecii pneumonia (PCP)
• Sporotrichosis
• Cryptococcosis
• Aspergillosis
• Candidiasis

Parasitic

• Ascariasis
• Schistosomiasis
• Toxoplasma gondii

Evaluation

• CXR (abnormal in 75% of cases at presentation)
  • Patchy consolidation in peripheral lung fields

A chest X-ray showing increased opacity in both lungs, indicative of pneumonia, in a patient with SARS

Management

• Empiric treatment for Bacterial Pneumonia
• Ribavirin
• Methylprednisolone

Disposition

• Admit

See Also

• Cough
• Coronavirus