Electronic letters to:
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eLetters: Electronic letters published:
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Index Case Elderly Female Hong Kong Visitor
- Brian C Allen (24 November 2003)
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Difficulty in Diagnosing Mild Cases of Severe Respiratory Syndrome in Elderly
- Hing Ming Cheng (14 October 2003)
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Sars Deaths And Smoking
- Donald R Fuller (29 August 2003)
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Brian C Allen Independent Research
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bcallen33{at}hotmail.com Brian C Allen
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The authors have stated index case traveled to Hong Kong returning February 2003. The elderly female index purported staying at a Hotel on Kowloon Island where there had been 13 additonal cluster cases. The basic cluster informaton is contrary to a similar study prepared by authors from Princess Margaret Hospital et al, Hong Kong, China. The 272 cluster patients at this hospital represented the primary Hong Kong outbreak. I find no reference to any 13 hotel cluster patients that were diagnosed with the corona virus (SARS) admitted to Princess Margaret Hospital. Though, I could be mistaken. And/or it was a different treatment facility where those 13 cluster patients were treated. Is it posssible upon a new interview of family members that the decedant index case, in fact stayed in Amoy Gardens and/or visited overnight an apartment in Amoy Gardens? The Princess Margaret study states 170 patients all lived in Amoy Gardens and only one or two were same household. The 170 cluster did not know each other though they all resided there. Other patients were hospital personnel. There was a small grouping whose residence was not indicated. Kowloon is close to Amoy Gardens This minor discrepancy has an upmost importance in determining several factors. Did the Toronto index patient contract the same strain as Princess Margaret Hospital patients? An unknown vector was suspected and none has been found as yet. Science magazine this month has indicated the feral Asian Civet, but this is not common food in Hong Kong though it does confirm that SARS is 99.5% identical to the corona virus which infects civets. Is it possible that the deceased index case or her son's blood samples are still available that could be tested for specific protein antibodies not affiliated with SARS, but could possibly provide a clue to the vector? Your report is excellent, but does not confirm a direct tie to the major outbreak in Hong Kong. It is possible that the index case family, if Chinese did not have translators available when admitted to the Toronto hospital. The family representative who admitted the index case (since the patient was severely ill) might have mis-spoke or not have known all facts of the Hong Kong trip. They could not realize how pertinent detailed information would become to medical investigators. I would appreciate hearing from Dr. Bonnie Henry on this issue or any of her pier's. My research concerns a possible novel vector that protein antibodies could confirm if present in blood samples. Mr. B. Allen Los Angeles, California bcallen33@hotmail.com Conflict of Interest:None declared |
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Hing Ming Cheng Department of Medicine & Geriatrics, Tai Po Hospital, 9 Chuen On Road, Hong Kong, China
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chengehm{at}yahoo.com Hing Ming Cheng
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Difficulty in Diagnosing Mild Cases of Severe Respiratory Syndrome in Elderly Hing Ming Cheng FHKAM (Med), Timothy Kwok FRCP (London) Department of Medicine and Geriatrics, Tai Po Hospital, 9 Chuen On Road, Hong Kong, China In the CMAJ paper1 published on 19 August, 2003, Varia described 8 cases of SARS with possible hospital exposure to unidentified individual with SARS. Mortality was particularly high (90%) among elderly inpatients admitted before their SARS exposure. It is important to diagnose SARS, including mild cases, before it can spread to other persons. A seventy-eight-year-old woman with paroxysmal atrial fibrillation, hypertension and diabetes mellitus was admitted to our hospital in April, 2003 for symptomatic bradycardia. While under observation, an outbreak of SARS occurred in her ward. Nine days later, she developed fever (38.2¢XC) but no respiratory symptom. Mild air-space consolidation of right lower lobe appeared in her chest radiograph. She was lymphopenic (0.3x109/l) but had normal platelet count, serum lactate dehydrogenase and creatine kinase. Three sets of her nasopharyngeal aspirate, stool and urine were tested negative for SARS-CoV by reverse-transcriptase polymerase chain reaction (RT-PCR) and virus isolation. Her fever subsided with empirical cefoperazone/sulbactam and she remained well. After her discharge, we received the laboratory report on her day 15 titre for SARS-CoV which was significantly elevated at 640. Our case illustrated the difficulty in diagnosing mild SARS. Her case did not fulfill the WHO criteria for SARS which have a low sensitivity (26%2). Her SARS was only diagnosed with seroconversion in the convalescent phase. RT-PCR and virus isolation were not sensitive enough for the infection. This called for better diagnostic tests in the early phase3 to avoid stopping the deadly spread of SARS to other hospitalized patients. Reference 1. Varia M, Wilson S, Sarwal S, McGeer A, Gournis E, Galalnis E, Henry B, Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ 2003; 169(4):285-92 2. Rainer TH, Cameron PA, Smit DV, Ong KL, Hung ANW, Chan DPN, Chan LYS, Sung JJY. Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: perspective observational study. BMJ 2003; 326: 1354-58 3. Poon LL, Chan KH, Wong OK, Yam WC, Yuen KY, Guan Y, Lo YM, Peiris JS. Early diagnosis of SARS Coronavirus infection by real time RT-PCR. J Clin Virol 2003 Dec; 28(3): 233-8. Conflict of Interest:None declared |
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Donald R Fuller Retired ( Internal Medicine )
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laurdon{at}cyg.net Donald R Fuller
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The Investigation of a 'Nosocomial Outbreak of SARS' in table 3 gave the characteristics of Sars Deaths associated with the nosocomial outbreak.There is no mention of smoking.For 3 of the deaths 'No known comorbid condition' is listed. Were these 3, and also most of the other patients less than 60 years of age somkers or ex smokers? SARS deaths appear to be on a ventilator (respiratory related). Most smokers have a degree of cough/respiratory disease often ignored. Is smoking a factor, a comorbid factor in SARS deaths? Conflict of Interest:None declared |
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