Jiang Gu 1 , 4 , Encong Gong 1 , Bo Zhang 1 , Jie Zheng 1 , Zifen Gao 1 , Yanfeng Zhong 1 , Wanzhong Zou 1 , Jun Zhan 1 , Shenglan Wang 1 , Zhigang Xie 1 , Hui Zhuang 2 , Bingquan Wu 1 , Haohao Zhong 1 , Hongquan Shao 1 , Weigang Fang 1 , Dongshia Gao 1 , Fei Pei 1 , Xingwang Li 3 , Zhongpin He 3 , Danzhen Xu 3 , Xeying Shi 1 , Virginia M. Anderson 4 , Anthony S.-Y. Leong 5
1 August 2005
After >8,000 infections and >700 deaths worldwide, the pathogenesis of the new infectious disease, severe acute respiratory syndrome (SARS), remains poorly understood. We investigated 18 autopsies of patients who had suspected SARS; 8 cases were confirmed as SARS. We evaluated white blood cells from 22 confirmed SARS patients at various stages of the disease. T lymphocyte counts in 65 confirmed and 35 misdiagnosed SARS cases also were analyzed retrospectively. SARS viral particles and genomic sequence were detected in a large number of circulating lymphocytes, monocytes, and lymphoid tissues, as well as in the epithelial cells of the respiratory tract, the mucosa of the intestine, the epithelium of the renal distal tubules, the neurons of the brain, and macrophages in different organs. SARS virus seemed to be capable of infecting multiple cell types in several organs; immune cells and pulmonary epithelium were identified as the main sites of injury. A comprehensive theory of pathogenesis is proposed for SARS with immune and lung damage as key features.