What are Some Symptoms of Sever's Syndrome?

Severe acute respiratory syndrome (SARS), commonly known as infectious atypical pneumonia, also known as atypical pneumonia. It is a special pneumonia caused by SARS coronavirus (SARS-CoV), which is obviously contagious and can affect multiple organ systems. The World Health Organization (WHO) named it severe acute respiratory syndrome (SARS). Clinical manifestations include fever, fatigue, headache, muscle and joint pain and other systemic symptoms and dry cough, chest tightness, dyspnea and other respiratory symptoms. Some cases may have gastrointestinal symptoms such as diarrhea; chest X-ray examination can show inflammatory lung infiltrates The laboratory examination of peripheral white blood cell count is normal or decreased, and antibacterial treatment is not effective. Severe cases show marked dyspnea and can quickly develop into acute respiratory distress syndrome (ARDS).

Liu Hong

(Deputy Chief Physician)

Department of Infectious Diseases, Tianjin Infectious Diseases Hospital

Severe acute respiratory syndrome (SARS), commonly known as infectious atypical pneumonia, also known as atypical pneumonia. It is a special pneumonia caused by SARS coronavirus (SARS-CoV), which is obviously contagious and can affect multiple organ systems. The World Health Organization (WHO) named it severe acute respiratory syndrome (SARS). Clinical manifestations include fever, fatigue, headache, muscle and joint pain and other systemic symptoms and dry cough, chest tightness, dyspnea and other respiratory symptoms. Some cases may have gastrointestinal symptoms such as diarrhea; chest X-ray examination can show inflammatory lung infiltration The laboratory examination of peripheral white blood cell count is normal or decreased, and antibacterial treatment is not effective. Severe cases show marked dyspnea and can quickly develop into acute respiratory distress syndrome (ARDS).

nickname

Infectious atypical pneumonia

English name

Sever? Acute? Respiratory? Syndrome, SARS

Visiting department

Respiratory Medicine

Common causes

Caused by SARS Coronavirus (SARS-CoV)

Common symptoms

Fever, fatigue, headache, sore muscles and joints, dry cough, chest tightness, dyspnea, etc.

Contagious

Have

way for spreading

Respiratory infections

Causes of severe acute respiratory syndrome

Coronavirus infections occur mainly in the winter and spring seasons and are widely distributed throughout the world. The virus includes three groups. The first and second groups are mainly mammalian coronaviruses, and the third group mainly include avian coronaviruses. There are two types of human coronaviruses (HCo-229E, HCoV-OC43), which are important pathogens of human respiratory infections. 20% of common colds in humans are caused by coronaviruses. Coronavirus is also one of the important causes of acute exacerbation of chronic bronchitis in adults. Genomics results show that the genes of SARS-CoV are different from the typical coronaviruses of the three known groups. The first group of virus sera can react with SARS-CoV, but the serum of patients with SARS cannot react with known coronaviruses. . Therefore, as a new coronavirus, SARS-CoV can be classified into the fourth group.

Clinical manifestations of severe acute respiratory syndrome

The incubation period is 2-10 days. Onset is rapid, with fever as the first symptom. Body temperature is usually greater than 38 ° C, and there may be chills, cough, sputum sputum, occasional bloodshot sputum, palpitations, shortness of breath, or respiratory distress. May be accompanied by muscle aches, headaches, joint pain, fatigue, and diarrhea. Patients often did not have upper airway catarrh symptoms. Pulmonary signs are not obvious, and some patients may hear a slight wet murmur or have signs of pulmonary consolidation.

Severe Acute Respiratory Syndrome

Laboratory inspection

(1) The white blood cell count of the peripheral blood is generally normal or decreased; often the lymphocyte count is reduced [if the lymphocyte count is less than 0.9 × 10 ^[9] / L, it is of great significance for diagnosis; if the lymphocyte count is between (0.9 1.2) × 10 ^[9] / L, the diagnosis is only suspicious]; some patients have thrombocytopenia.

(2) T lymphocyte subpopulation counts are often seen early in the onset of CD4 ⁺ and CD8 ⁺ cell counts, and the ratio of the two is normal or decreased.

2. Chest imaging

In the early stage of the lesion, flaky, patchy ground glass density shadows of varying degrees appeared in the lungs, and a few were lung consolidation shadows. Shadows are often multiple or / and bilateral changes, and progress in the course of the onset, some cases progress rapidly, short-term integration into a large sheet shadow.

A chest radiograph may be difficult to detect when the lung lesions are in the early stages, with small or thin shadows, or their location coincides with heart and / or large vessel shadows. If the early X-ray chest radiograph is negative, a dynamic review is needed on the 1st to 2nd days. If available, a CT scan of the chest can be arranged to help detect early mild lesions or lesions that overlap with cardiac and / or large vessel shadows.

Regular chest X-ray imaging review is performed to observe the dynamic changes of lung lesions.

3. Specific pathogen detection

(1) SARS-CoV serum-specific antibodies are detected 10 days after the onset of IFA, and SARS-CoV-specific antibodies can be detected in the patient's serum (if using enzyme-linked immunosorbent assay (ELISA), 21 days after onset). From the advanced stage to the recovery stage, the antibody conversion or antibody titer increased four-fold or more, which is of etiological significance. The first serum specimen should be collected as soon as possible.

(2) SARS-CoVRNA detection Accurate SARS-CoVRNA detection has early diagnostic significance. RT-PCR method is used to detect SARS-CoV RNA from respiratory tract secretions, blood or feces samples, especially for multiple, multiple specimens, and multiple kits to detect SARS, with the exception of pollution and technical problems. -CoVRNA is positive, which is of great support for the diagnosis of pathogens.

(3) Other early diagnostic methods Immunofluorescent antibody test for detection of SARS-CoV-specific structural proteins in nasopharyngeal or airway exfoliated cells, and detection methods such as gene chip technology, are for further study.

Diagnosis of severe acute respiratory syndrome

The diagnosis of SARS can be made by combining the above epidemiological history, clinical symptoms and signs, general laboratory tests, chest X-ray imaging changes, and positive SARS aetiology tests to exclude other diseases with similar manifestations.

Treatment of severe acute respiratory syndrome

1. Surveillance and general treatment

(1) The general treatment and condition monitoring are basically the same as those of non-severe patients, but patients with severe illness should also strengthen the monitoring of vital signs, fluid volume, ECG and blood glucose. When blood glucose is higher than normal, insulin can be used to keep it in the normal range, which can help reduce complications.

(2) Respiratory support therapy should be used to monitor SPO ₂ (blood oxygen saturation) for patients with severe SARS. The decrease in SPO ₂ after the activity is an early manifestation of respiratory failure and should be treated in a timely manner.

(3) Oxygen therapy For severe cases, even if there is hypoxia in the resting state, continuous nasal tube oxygen should be given. Patients with hypoxemia usually require a higher inhaled oxygen flow rate to maintain SPO ₂ at 93% or more. If necessary, a mask can be used to inhale oxygen. Try to avoid activities from oxygen therapy (such as going to the toilet, medical examination, etc.). If the oxygen flow rate is 5 liters / minute (or the concentration of inhaled oxygen is 40%), SPO _{2 is} <93%, but the breathing rate is still 30 times / minute or more, and the respiratory load is still maintained at a high level. Non-invasive artificial ventilation should be considered in a timely manner. Some patients develop severe hypoxemia, which requires intubation and invasive mechanical ventilation.

2. Application of glucocorticoids

For severe cases that meet the criteria for acute lung injury, glucocorticoids should be used in a timely and regular manner to reduce lung exudation, injury, and later pulmonary fibrosis, and to improve the oxygenation function of the lung. Long-term, large-dose Combined.

3. Clinical nutrition support

Due to malnutrition in most severely ill patients, patients should be encouraged to eat easily digestible foods at an early stage. When the condition worsens and can not eat normally, clinical nutritional support should be given in a timely manner, and a combination of enteral nutrition and parenteral nutrition should be adopted to appropriately increase the proportion of fat to reduce the load on the lungs. Medium / long chain mixed fat emulsion has little effect on liver function and immunity. Too much protein may have adverse effects on liver and kidney function. To add water-soluble and fat-soluble vitamins. Try to keep plasma albumin at normal levels.

4. Prevention and treatment of secondary infections

Severe patients are usually immunocompromised, and secondary infections need to be closely monitored and treated in a timely manner. Preventive anti-infective treatment can be performed if necessary.

5. Recovery period

Focus on patient tracking and management. As far as individual SARS patients are concerned, follow-up visits during the recovery period can understand the occurrence and severity of patients 'physical dysfunction and psychological disorders, which is helpful to develop targeted interventions to minimize the adverse effects on patients' physiology and psychology . More importantly, the follow-up work during the recovery period of SARS patients will help to comprehensively understand SARS. The results are useful for predicting the scale of SARS in the future, formulating reasonable preventive measures, and understanding the body's self-repair after SARS-CoV infection. The laws are of great significance. During the treatment of SARS in China in the previous paragraph, a large number of drugs have been widely used, such as glucocorticoids, antivirals, antibacterials, and immunomodulators. Therefore, in the follow-up process, we should pay attention to distinguish some abnormalities from SARS itself , Or from therapeutic drugs.