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      Detection of SARS-associated Coronavirus in Throat Wash and Saliva in Early Diagnosis

      research-article
      Author(s): * , † , † , 1 , * , 1 , † , * , * , * , ‡ , * , † , † , † , † , † , † , † , † , † , § , § , * , * , * , * , † , † , , members of the SARS Research Group of the National Taiwan University, National Taiwan University Hospital
      Publication date (Print):
      Journal: Emerging Infectious Diseases
      Publisher: Centers for Disease Control and Prevention
      Keywords: severe acute respiratory syndrome, SARS, coronavirus, CoV, Taiwan, perspective

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          Abstract

          Early detection of SARS-CoV in throat wash and saliva suggests that these specimens are ideal for SARS diagnosis.

          Abstract

          The severe acute respiratory syndrome–associated coronavirus (SARS-CoV) is thought to be transmitted primarily through dispersal of droplets, but little is known about the load of SARS-CoV in oral droplets. We examined oral specimens, including throat wash and saliva, and found large amounts of SARS-CoV RNA in both throat wash (9.58 x 10 2 to 5.93 x 10 6 copies/mL) and saliva (7.08 x 10 3 to 6.38 x 10 8 copies/mL) from all specimens of 17 consecutive probable SARS case-patients, supporting the possibility of transmission through oral droplets. Immunofluorescence study showed replication of SARS-CoV in the cells derived from throat wash, demonstrating the possibility of developing a convenient antigen detection assay. This finding, with the high detection rate a median of 4 days after disease onset and before the development of lung lesions in four patients, suggests that throat wash and saliva should be included in sample collection guidelines for SARS diagnosis.

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          Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong

          Christl Donnelly, Azra C. Ghani, Gabriel Leung … (2003)
          Summary Background Health authorities worldwide, especially in the Asia Pacific region, are seeking effective public-health interventions in the continuing epidemic of severe acute respiratory syndrome (SARS). We assessed the epidemiology of SARS in Hong Kong. Methods We included 1425 cases reported up to April 28, 2003. An integrated database was constructed from several sources containing information on epidemiological, demographic, and clinical variables. We estimated the key epidemiological distributions: infection to onset, onset to admission, admission to death, and admission to discharge. We measured associations between the estimated case fatality rate and patients’age and the time from onset to admission. Findings After the initial phase of exponential growth, the rate of confirmed cases fell to less than 20 per day by April 28. Public-health interventions included encouragement to report to hospital rapidly after the onset of clinical symptoms, contact tracing for confirmed and suspected cases, and quarantining, monitoring, and restricting the travel of contacts. The mean incubation period of the disease is estimated to be 6.4 days (95% Cl 5.2–7.7). The mean time from onset of clinical symptoms to admission to hospital varied between 3 and 5 days, with longer times earlier in the epidemic. The estimated case fatality rate was 13.2% (9.8–16.8) for patients younger than 60 years and 43.3% (35.2–52.4) for patients aged 60 years or older assuming a parametric γ distribution. A non-parametric method yielded estimates of 6.8% (4.0–9.6) and 55.0% (45.3–64.7), respectively. Case clusters have played an important part in the course of the epidemic. Interpretation Patients’age was strongly associated with outcome. The time between onset of symptoms and admission to hospital did not alter outcome, but shorter intervals will be important to the wider population by restricting the infectious period before patients are placed in quarantine. Published online May 7, 2003 http://image.thelancet.com/extras/03art4453web.pdf
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            Coronavirus as a possible cause of severe acute respiratory syndrome.

            V Cheng, A. Yung, J. S. Malik Peiris … (2003)
            An outbreak of severe acute respiratory syndrome (SARS) has been reported in Hong Kong. We investigated the viral cause and clinical presentation among 50 patients. We analysed case notes and microbiological findings for 50 patients with SARS, representing more than five separate epidemiologically linked transmission clusters. We defined the clinical presentation and risk factors associated with severe disease and investigated the causal agents by chest radiography and laboratory testing of nasopharyngeal aspirates and sera samples. We compared the laboratory findings with those submitted for microbiological investigation of other diseases from patients whose identity was masked. Patients' age ranged from 23 to 74 years. Fever, chills, myalgia, and cough were the most frequent complaints. When compared with chest radiographic changes, respiratory symptoms and auscultatory findings were disproportionally mild. Patients who were household contacts of other infected people and had older age, lymphopenia, and liver dysfunction were associated with severe disease. A virus belonging to the family Coronaviridae was isolated from two patients. By use of serological and reverse-transcriptase PCR specific for this virus, 45 of 50 patients with SARS, but no controls, had evidence of infection with this virus. A coronavirus was isolated from patients with SARS that might be the primary agent associated with this disease. Serological and molecular tests specific for the virus permitted a definitive laboratory diagnosis to be made and allowed further investigation to define whether other cofactors play a part in disease progression.
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              Update: Outbreak of severe acute respiratory syndrome--worldwide, 2003.

              (2003)
              CDC continues to support the World Health Organization (WHO) in the investigation of a multicountry outbreak of unexplained atypical pneumonia referred to as severe acute respiratory syndrome (SARS). This report includes summaries of the epidemiologic investigations and public health responses in several affected locations where CDC is collaborating with international and national health authorities. This report also describes an unusual cluster of cases associated with a hotel in Hong Kong and identifies the potential etiologic agent of SARS. Epidemiologic and laboratory investigations of SAPS are ongoing.
              Article 0 comments Cited 79 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): July 2004
                Volume: 10
                Issue: 7
                Pages: 1213-1219
                Affiliations
                [* ]National Taiwan University, Taipei, Taiwan;
                [† ]National Taiwan University Hospital, Taipei, Taiwan;
                [‡ ]National Health Research Institute, Taipei, Taiwan;
                [§ ]Center for Disease Control, Taipei, Taiwan
                Author notes
                Address for correspondence: Shan-Chwen Chang, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan; fax: 8862-23971412; email: sc4030@ 123456ha.mc.ntu.edu.tw
                Article
                Publisher ID: 03-1113
                DOI: 10.3201/eid1007.031113
                PMC ID: 3323313
                PubMed ID: 15324540
                SO-VID: efbe6198-4b4d-4a6c-ae53-78a1c06ca0cd
                History
                Categories
                Subject: Research
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: severe acute respiratory syndrome,sars,coronavirus,cov,taiwan,perspective
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: severe acute respiratory syndrome, sars, coronavirus, cov, taiwan, perspective

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