[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:

1. The College of American Pathologists web site [CAP]

2. The U. S. Government's Communicable Diseases Center web site

3. Masur H, et. al., SARS Editorial, JAMA 289(21):2861-2863, 4 June 2003.(posted on-line at JAMA)

(posted 21 March 2003; latest addition 11 January 2009)