[lab samples handling, see below]
A recent media alert concerning this apparently new and highly
contagious pneumonitis originating in the Orient was followed up
on Tuesday, March 18, 2003 with Internet notice that physicians
in Hong Kong have produced electron micrographs identifying the
responsible infectious virus (SARS-associated coronavirus). The
apparent ease of contagion and resistance to any known treatment
are causes of legitimate concern in the appropriate clinical setting.
85% infected are not ill enough to seek medical care; 15% are & half
of those die (as of 6/03).
The signs and symptoms, including high fever and evidence of pneumonitis
and/or respiratory distress, coupled with recent travel to or from
the Orient and/or contact with a recent Orient traveler are potential
alerting factors. Another tip may be the tendency to have CBC lymphopenia
and elevated serum LDH. CDC recommendations, published on the Internet
on March 15, include standard evaluation procedures for acute pneumonitis
and respiratory insufficiency. These will include chest x-ray,
pulse oximetry, and blood and sputum cultures. If a suspect patient
is admitted to the hospital, Infection Control personnel should
be immediately notified. Airborne and contact precautions will
be instituted. Empiric antimicrobial coverage for the community-acquired
pneumonitis pathogens and supportive respiratory therapies are
indicated. The CDC, beginning 2 June 2003, began offering an
experimental lab test (in 100 labs around the USA) for the virus
associated this new respiratory syndrome (SARS).
In this country, and in our community, the traditional atypical
pneumonias are likely to be far more common than the new SARS infection.
Patients presenting with acute febrile pneumonitis who do not have
sputum gram stain and culture results reflecting a traditional
bacterial pathogen may now also warrant consideration for SARS, viral influenza,
and RSV testing. The primary atypical pneumonia agents: chlamydia,
legionella and mycoplasma may also warrant diagnostic consideration
and/or empiric treatment (the serologic "Atypical Pneumonia
Profile" is readily available [at our LML]...positive results for Legionella in our lab have been in patients not terribly ill, the disease likely to have been blunted by early empiric antibiotic treatment [CN09-1]).
***Our first case (3/31/03) admitted as "rule out
SARS" by one of our pulmonologists actually had acute CMV! We are working
on a 2nd as of 4/1/03.
Lab specimens: So, as to handling smears and samples
presented to the lab for stains and cultures: no special caution
other than the care one uses for all samples (as if they were from
an AIDS case or hepatitis C case).
References & update sources:
The College of American Pathologists web site
The U. S. Government's Communicable Diseases
Center web site
Masur H, et. al., SARS Editorial, JAMA 289(21):2861-2863,
4 June 2003.(posted on-line at JAMA)
21 March 2003; latest addition 11 January 2009)