Pharmaceutical consulting patients with Severe Acute Respiratory Syndrome (SARS) Done by: Azimkhanova B Group: 502 phk B Accepted by: Bubeshova M SOUTH KAZAKHSTAN STATE FARMACEUTICAL ACADEMY

Plan : Severe Acute Respiratory Syndrome (SARS) SARS Case Definition Pathogenesis Severe Acute Respiratory Syndrome (SARS): Treatment MANAGEMENT OF SARS PAEDIATRIC PATIENT

Severe Acute Respiratory Syndrome (SARS): Epidemiology A worldwide outbreak of severe acute respiratory syndrome (SARS) has been associated with exposures originating from a single ill health care worker from Guangdong Province, China. 11 February, 2003: 305 cases and 5 death.

China's Ministry of Health on Sunday afternoon reported a total of 2,914 cases of severe acute respiratory syndrome (SARS) on the Chinese mainland by 10:00 a.m. April 27. Of the total, 1,299 patients had been discharged from hospitals upon recovery and 131 had died.

Severe Acute Respiratory Syndrome (SARS) Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name.

SARS Case Definition (April 23) Suspected case: –Measured temperature greater than F (greater than 38 0 C AND –One or more clinical findings of respiratory illness (e.g. cough, shortness of breath, difficulty in breathing, or hypoxia) AND –Travel within 10 days of onset of symptoms to an area with documented or suspected community transmission of SARS) OR close contact within 10 days of onset of symptoms with a person known to be a SARS suspect.

SARS Case Definition Probable case: –Radiographic evidence of pneumonia or respiratory distress syndrome. –Autopsy findings consistent with respiratory distress syndrome without an identifiable cause.

Severe Acute Respiratory Syndrome (SARS) Corona of spikes Made of S glycoprotein(red) Cell envelop derived from Host cell (green) Core (purplish) M protein caries the genetic material (RNA)

Pathogenesis Clinically, most infections cause a mild, self-limited disease (classical 'cold' or upset stomach), but there may be rare neurological complications. SARS is a form of viral pneumonia where infection encompasses the lower respiratory tract.

Pathogenesis They are transmitted by aerosols of respiratory secretions, by the faecal-oral route, and by mechanical transmission. Most virus growth occurs in epithelial cells. Occasionally the liver, kidneys, heart or eyes may be infected, as well as other cell types such as macrophages. In cold-type respiratory infections, growth appears to be localized to the epithelium of the upper respiratory tract.

SARS in Children Infants and young children Primary symptoms fever > 38 C (oral or tympanic) or rectal equivalent cough, respiratory distress, tachypnea Additional symptoms, which may precede primary Symptoms lethargy, irritability loss of appetite

Older children Primary symptoms as in infants and young children Additional symptoms, which may precede primary symptoms loss of appetite headache, malaise, fatigue,myalgias [even in the hours to day prior to onset of fever] diarrhea, confusion. In some cases, the headache may resolve, and fever, chills and shakes start shortly after. Respiratory symptoms may not start for 2-3 days later. Some patients have a period of improvement when fever resolves for hours, then fever returns and symptoms worsen.

Severe Acute Respiratory Syndrome (SARS): Treatment Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients.

MANAGEMENT OF SARS PAEDIATRIC PATIENT Hospitals must follow infection control guidelines: masking of patients (sugical mask) accompanying individuals are to wear N95 mask or equivalent e.g. PCM 2000 Staff protection with N95 masks, eye protection, gowns and gloves isolation of patient in a negative pressure room is preferred [ if not available, use a single room with door closed] Frequent handwashing continues to be critical

Is SARS really a threat? 40,000 Nepalese children die annually from pneumonia children die each day from waterborne diseases in world. Malaria is alive and well and killing more than 3000 African children every day influenza epidemic, an acute infection like SARS, which killed about 40 million people worldwide.

Management The CDC recommends that patients suspected of or confirmed as having SARS receive the same treatment that would be administered if they had any serious, community-acquired pneumonia. The following measures may be used: Isolate confirmed or suspected patients and provide aggressive treatment in a hospital setting

Mechanical ventilation and critical care treatment may be necessary during the illness. An infectious disease specialist, a pulmonary specialist, and/or a critical care specialist should direct the medical care team Communication with local and state health agencies, the CDC, and World Health Organization is critical

References: Novel Corona virus Associated with Severe Acute Respiratory Syndrome T.G. Ksiazek and Others A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong N. Lee and Others Identification of Severe Acute Respiratory Syndrome in Canada SM Poutanen and Others Editorial: Faster... but Fast Enough? Responding to the Epidemic of Severe Acute Respiratory Syndrome J.L. Gerberding