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Severe acute respiratory syndrome — Clinical Guidelines

Overview

Severe acute respiratory syndrome (SARS) is an infectious respiratory illness caused by the SARS-CoV virus, characterized by fever, cough, and progressive respiratory distress, often leading to severe complications including acute respiratory failure and multiorgan dysfunction 1 11.

Diagnosis

Clinical Criteria: Fever, respiratory symptoms (cough, dyspnea), and radiological evidence of pneumonia 11.

Laboratory Tests: Elevated D-dimer levels may indicate fibrinolysis suppression 3.

Imaging: Chest radiographs typically show progressive airspace shadowing 14.

Virological Confirmation: RT-PCR or other nucleic acid amplification tests for SARS-CoV 11.

Management

Antiviral Therapy: Ribavirin use noted with potential adverse events; efficacy and safety require careful consideration 5.

Anticoagulation: Addressing fibrinolysis shutdown with anticoagulation strategies beyond heparin may be necessary 3.

Supportive Care: Mechanical ventilation support for respiratory failure 16.

Multiorgan Support: Extracorporeal liver support (e.g., MARS therapy) in cases of multiorgan failure 15.

Special Populations

Elderly: Increased risk of severe complications and critical illness 16.

Comorbidities: Patients with underlying conditions may experience worse outcomes 16.

Key Recommendations

Early Diagnosis and Isolation: Rapid identification and isolation of SARS patients to prevent nosocomial spread (Evidence: Strong 1 6).

Supportive Respiratory Care: Initiate mechanical ventilation early in patients with respiratory failure (Evidence: Moderate 16).

Monitor Fibrinolysis: Regularly assess D-dimer levels and consider interventions to manage fibrinolysis suppression (Evidence: Moderate 3).

Use Antivirals with Caution: Consider ribavirin cautiously due to potential adverse effects (Evidence: Weak 5).

Enhance Infection Control: Implement stringent infection control measures in healthcare settings, especially in high-risk procedures like anesthesia and autopsies (Evidence: Strong 6 8).

References

1 Zheng X, Cao Q, Zhou X. Research on optimization of emergency supplies customs clearance strategy from the perspective of public health security based on Chinese trade data. Frontiers in public health 2025. link 2 Ait Belkacem I, Mossadegh-Keller N, Bourgoin P, Arnoux I, Loosveld M, Morange PE et al.. Cell Analysis from Dried Blood Spots: New Opportunities in Immunology, Hematology, and Infectious Diseases. Advanced science (Weinheim, Baden-Wurttemberg, Germany) 2021. link 3 Manzoor D, Bui C, Makhoul E, Luthringer D, Marchevsky A, Volod O. Improvement in plasma D-dimer level in severe SARS-CoV-2 infection can be an indicator of fibrinolysis suppression: Case reports. Medicine 2021. link 4 López Seguí F, Franch Parella J, Gironès García X, Mendioroz Peña J, García Cuyàs F, Adroher Mas C et al.. A Cost-Minimization Analysis of a Medical Record-based, Store and Forward and Provider-to-provider Telemedicine Compared to Usual Care in Catalonia: More Agile and Efficient, Especially for Users. International journal of environmental research and public health 2020. link 5 Muller MP, Dresser L, Raboud J, McGeer A, Rea E, Richardson SE et al.. Adverse events associated with high-dose ribavirin: evidence from the Toronto outbreak of severe acute respiratory syndrome. Pharmacotherapy 2007. link 6 Chan WM, Liu DT, Chan PK, Chong KK, Yuen KS, Chiu TY et al.. Precautions in ophthalmic practice in a hospital with a major acute SARS outbreak: an experience from Hong Kong. Eye (London, England) 2006. link 7 Phua DH, Tang HK, Tham KY. Coping responses of emergency physicians and nurses to the 2003 severe acute respiratory syndrome outbreak. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2005. link 8 Li L, Gu J, Shi X, Gong E, Li X, Shao H et al.. Biosafety level 3 laboratory for autopsies of patients with severe acute respiratory syndrome: principles, practices, and prospects. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2005. link 9 Huang JW, Chen KY, Tsai HB, Wu VC, Yang YF, Wu MS et al.. Acute renal failure in patients with severe acute respiratory syndrome. Journal of the Formosan Medical Association = Taiwan yi zhi 2005. link 10 Yan H, Xiao G, Zhang J, Hu Y, Yuan F, Cole DK et al.. SARS coronavirus induces apoptosis in Vero E6 cells. Journal of medical virology 2004. link 11 Nie QH, Luo XD, Hui WL. Advances in clinical diagnosis and treatment of severe acute respiratory syndrome. World journal of gastroenterology 2003. link 12 Peng PW, Wong DT, Bevan D, Gardam M. Infection control and anesthesia: lessons learned from the Toronto SARS outbreak. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2003. link 13 Alexander AJ, Tan AK, Evans GA, Allen J. Infection control for the otolaryngologist in the era of severe acute respiratory syndrome. The Journal of otolaryngology 2003. link 14 Tan DY, Kaw GJ, Tsou IY, Wansaicheong GK, Green JA, Tai DY et al.. Radiographic features of a case of severe acute respiratory syndrome with fatal outcome. Annals of the Academy of Medicine, Singapore 2003. link 15 Luo HT, Wu M, Wang MM. Case report of the first Severe Acute Respiratory Syndrome patient in China: successful application of extracorporeal liver support MARS therapy in multiorgan failure possibly induced by Severe Acute Respiratory Syndrome. Artificial organs 2003. link 16 Fowler RA, Lapinsky SE, Hallett D, Detsky AS, Sibbald WJ, Slutsky AS et al.. Critically ill patients with severe acute respiratory syndrome. JAMA 2003. link

Severe acute respiratory syndrome