Severe Acute Respiratory Syndrome

1
??????????

• ???? ???

2
??????21 Mar 2003

• ??????????(SARS)????????????,?????????????????????
  ?????2003?2????,??????????????????????????????????
  ??????????????????????????????,?????????????
• ??2003?3?21?,???????25?70???????????SARS???????(lt
  15?)?

3
????

• SARS???????2?7?,??????10???????????????(gt38?),????
  ?,???????????????????????????????????????????????
  ??????????????????,???????????????????
• 3?7?????????(lower respiratory phase),????????,???
  ????????????10-20???,????????????????????????????
  ?SARS???(probable)??????????????3?

4
??X?

• ???????,??????,??X?????????????????,?????(respirat
  ory phase)??????????(focal)??,??????????(patchy)??
  ?????
• ??SARS???????X????????????(consolidation)?

5
????

• ?????,??????????,???????????????????????????,?????
  ???????????????,?????????????(?????????)?
• ????????,???????????????(creatinine
  phosphokinase,???????3000????)?????(hepatic
  transaminase,?????????2?6?)????????????????

6
????

• ??????????????????????????,???????oseltamivir?riba
  virin???????
• ??????????,???ribavirin????????????
• ?????,?????????????

7
? ?

• ?????,?????????????????SARS???
• ????ribavirin?????????????????(???????)?

8
SARS????????(26 March 2003, WHO)

• ?????????????,?10?SARS?????????????????
• ???????SARS???????????,?????????
• WHO http//www.who.int/csr/sars/cliniciansconfere
  nce/en/
• CDC (TW) http//203.65.72.83/ch/dpc/ShowPublicatio
  n.ASP?RecNo2901

9
????

• ?????SARS?????????,???????????????????,???????????
  ???????????????????????????????(?????????3?4??),??
  ?X????????????
• WHO http//www.who.int/csr/sars/cliniciansconfere
  nce/en/
• CDC (TW) http//203.65.72.83/ch/dpc/ShowPublicatio
  n.ASP?RecNo2901

10
????

• ?????,???X?????????,???????????????(????????????),
  ?????????X????????????????,????????????80?90????
  ????????????????????,???????,???????????????(ARDS
  ),????????,???????????????????????????????????????
  ??????(??????,co-morbid factor)???
• WHO http//www.who.int/csr/sars/cliniciansconfere
  nce/en/
• CDC (TW) http//203.65.72.83/ch/dpc/ShowPublicatio
  n.ASP?RecNo2901

11
????

• ????,????40???????????????????????????????
• WHO http//www.who.int/csr/sars/cliniciansconfere
  nce/en/
• CDC (TW) http//203.65.72.83/ch/dpc/ShowPublicatio
  n.ASP?RecNo2901

12
??

• ????????????????,???????????????????Ribavirin(????
  ?????)??????????????,?????????????????????????????
  ?,???????,???????????

13
????(Suspect Case)

• ?2003?2?1?????
• ???(gt38?)?
• ?????????????,??????????????
• ????????????????
• ??????????SARS???????(????????SARS??,?????????????
  ????????????)
• ?????????SARS???????(??WHO 2003?3?26?????,???????
  ??????????????????)

14
?????(Probable Case)

• ???????X????????,?????????(Respiratory Distress
  Syndrome)
• ?
• ?????????????????,?????????????????????????
• ?????????????,SARS?????????,????????????????????
  ????????

15
??????

• ??WHO 2003?3?26?????,?????????????????????????
• ????(affected area)????

16
WHO?? 2003/2/12003/3/26??????1400
?? ???? ??? ?????
??? 19 3 ?
??????? 792 31 ?
?? 316 10 ?
?? 6 0 ?
?? 1 0 ?
?? 4 0 ?
??? 3 0 ?
?????? 2 0 ?
??? 74 1 ?
?? 2 0 ???
?? 3 0 ?
?? 3 0 ?
?? 40 0 ???
?? 58 4 ?
?? 1323 49  
17
????? ????

• ???????????????????????
• ???????????????,????????????,??24????????????????
  ????????????
• ????????????????????
• ????????????(??????????????)?

18
???? ????

• Oropharyngeal or nasopharyngeal swabs
• ?????????(?EDTA)?510 cc
• Urine 1020 cc
• ??????
• ????(Rectal swab)-????

19
?????? ??

• ???SARS???,???????,??????????????????????????????
  ????????,???????????????????,????????????????????S
  ARS?????????????,?????SARS???

20
??

• ????SARS????,?????,?????
• ???????(???????)
• ?????,?????????
• ????????????
• ????????????????????
• ?????????????????,????
• ???????,??????????????
• ????????SARS???????????
• ??

21

• ??????SARS???????????????,????????,???????????????
  ?????????????????(??????????)????????

22

• ?????????????????????,???????????,???????????????
  ??????(NIOSH)???0.3?????N95?????,????????????,????
  ????,???????
• ???????????,????????SARS??????,????N95???????????,
  ???????????????

23

• ????????????????,?????????????????????????????????
  ??????,????????????????,????????????????????????
• ???????????????????,??????????????????????????????
  (????????????????)?,??????
• ????????????????????????????,????????????

24
????????

• ??????????????????????????,?????????????
• ?????????,?????????????????????
• ??????????????,???????????
• ?????????????,?????????
• ?????,??????????,????????
• http//www.cdc.gov.tw/atyp/

25
???????

• ???????????????????
• ??????????
• ??????????????????????????????,?????????????????
• ????X??????????????
• ???X???????
• 1.???????????,?????????????????,??????????????????
  ?
• 2.?????,??????????????,?????
• ???X??????????????(???????),???????????????

26
????????

• ??????????SARS?????????
• ????????,????????????????
• 1.???/?????,?????????(cold agglutinins,??Weli-Feli
  x reaction?Widals test)
• 2.?????????????
• 3.??
• 4.????????
• 5.???????????
• ????????????,???????????????(?????????)??????,????
  ?????????????????????
• ?????????????
• ?????????X???
• ?????????

27
??????????????

• ???????
• ??????????
• ?????????????????
• 1.???????????
• 2.??????,????????
• 3.??????,????????
• 4.??????????

28
SARS?????????

• ???????
• ???2???,
• ???
• ??????????
• ???(???)??????
• ?????????
• ??????(creatinine phosphokinase)?????
• ???????
• ???????
• ??X?????????

29
????????

• ????????????(??)????,???????38????????????
• ??????????????,????????X????????(full blood
  count)??????????????????????????????,????????????
  ??????????????X???????????????
• ??,???????????????????????,???????????
• ??????????(????????)????????????,?????????????????
  ?2??(???????),??????????,????????????????,????????
  ??????,????????????????

30
Paramyxoviridae

• The family of Paramyxoviridae contains viruses
  that induce a wide range of distinct clinical
  illnesses in humans.
• These include measles virus, which in rare
  instances is followed by subacute sclerosing
  panencephalitis (SSPE) mumps virus, which has
  symptoms of parotitis, orchitis and encephalitis,
  and the parainfluenza viruses which are
  respiratory pathogens.
• Taxonomy

31
Animal Paramyxovirus
32
Human Paramyxovirus

• Virions are enveloped and enclose a helical
  nucleocapsid containing negative-sense
  single-stranded RNA.
• Most virions are roughly spherical (about 200nm
  in diameter) but they can be much larger and more
  pleomorphic.
• The virus envelope is a lipid bilayer, studded
  with virus encoded glycoproteins which have
  properties of haemagglutinationand fusion (the F
  protein).

33
Coronaviridae

• Positive-senes ssRNA viruses
• There are now 13 species in this Family, which
  infect not only man but cattle, pigs, rodents,
  cats, dogs and birds (some are serious veterinary
  pathogens, especially chickens).
• Include coronavirus and torovirus
• Taxonomy

34
Bovine Coronavirus