Multiple organ infection and the pathogenesis of SARS

Gu, Jiang; Gong, Encong; Zhang, Bo; Zheng, Jie; Gao, Zifen; Zhong, Yanfeng; Zou, Wanzhong; Zhan, Jun; Wang, Shenglan; Xie, Zhigang; Zhuang, Hui; Wu, Bingquan; Zhong, Haohao; Shao, Hongquan; Fang, Weigang; Gao, Dongshia; Pei, Fei; Li, Xingwang; He, Zhongpin; Xu, Danzhen; Shi, Xeying; Anderson, Virginia M.; Leong, Anthony S.-Y.

Autopsies were performed on 18 patients who were suspected to have died of SARS infections; 15 died between June and August 2003 (7 confirmed as SARS) and 3 died in April 2004 (one confirmed as SARS). The World Health Organization's diagnostic criteria for SARS (25) were used for clinical diagnoses. These included SARS contact history, sudden onset of high fever, respiratory symptoms, chest X-ray findings, and unresponsiveness to antibiotic therapy. The clinical data on the 18 autopsied cases is presented in Table IV . Retrospective analysis of suspected SARS cases provided a comparison between true and misdiagnosed SARS cases. The confirmation of SARS infection was made by real-time RT-PCR demonstration of the SARS virus-specific sequence in blood or tissue samples or SARS antibody positivity in the sera of the patients. Cases were considered to represent a misdiagnosis when repeated testing for SARS-specific antibody was negative (each case tested at least twice, with tests 2 wk apart). The misdiagnosis rate in one of our hospitals was ‫.%53ف‬ These patients were admitted to the hospital because of SARS-like symptoms, and in the initial period of the SARS epidemic, specific antibody tests and SARS genomic sequence detection were not available for confirmation. Misdiagnosed cases were treated similarly to confirmed cases of SARS. Autopsy tissue samples from 6 age-matched and otherwise healthy subjects who died of head trauma served as controls.