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Lung Damage From SARS Could Be From Immune Response To Infection

May 08, 2003

Results of a three-week follow-up study of 75 people with SARS from the Amoy Garden housing block in Hong Kong provide a new insight into the progression of severe acute respiratory syndrome (SARS). The study, fast-tracked for early publication, is published on THE LANCET'S website - www.thelancet.com

A major outbreak of SARS involving 321 patients occurred in Amoy Garden, a high-rise housing estate in Hong Kong around March 24. Investigations suggested that the source of the outbreak was linked to a faulty sewage system, initially contaminated by the excreta of a person with SARS infection who visited the housing block. The first 75 adult patients, belonging to 57 households, were admitted with a clinical diagnosis of SARS to the United Christian hospital. K Y Yuen, Malik Peiris, and colleagues from the University of Hong Kong and the United Christian Hospital, Hong Kong, prospectively studied these 75 patients to establish the pathogenesis and the impact of SARS treatment.

The patients were followed up for 3 weeks and were given standard treatment (the antiviral agent ribavirin and corticosteroids). A similar pattern emerged for many of the patients, with symptoms improving throughout the first week of hospital admission but then worsening in the second week: fever and pneumonia initially improved but 85% of patients developed recurrent fever after nine days; 73% had watery diarrhoea after a week in hospital;

80% had X-rays suggesting worsening lung condition after one week, and just under half of the patients had reduced respiratory function after 8.6 days. 45% of patients who had improved respiratory function after initial lung damage then developed pulmonary lesions in different locations. 20% of patients developed acute respiratory distress syndrome (ARDS) in the third week which required mechanical ventilation. The investigators comment that the results suggest that the clinical deterioration of patients in the second week after hospitalisation is unrelated to uncontrolled viral replication but may be associated with an excessive response by the immune system to infection by the SARS virus.

Lancet