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SARS can strike without severe symptoms

Infection Control Monitor, February 13, 2004

A new study published in the February 15 issue of The Journal of Infectious Diseases found that SARS could appear with only mild symptoms as well as severe ones.

SARS emerged last year as a syndrome in which fever and myalgia progressed rapidly to pneumonia and respiratory distress. But the study, reported by Khek-Yu Ho, P.A. Tambyah, and coworkers in Singapore, suggests that early detection of future SARS cases will require attention to milder cases.

The study looked at 372 health care workers at a large teaching hospital where 21 patients with SARS, including five of the hospital's staff, were treated. Researchers used a questionnaire to determine which workers had direct contact with SARS patients, which had no direct contact but were exposed, and which were not exposed. Subjects provided serum samples at the time of possible SARS exposure and about 31 days later. Researchers screened samples for SARS antibodies and confirmed those with positive results.

None of the 260 hospital workers classified as not exposed was seropositive for the virus. Of 112 classified as exposed, eight were seropositive. Four of the eight had direct contact with SARS-infected patients; the others had been in wards where SARS patients had been before transfer to a SARS facility. All eight had fever, but only six also had radiographic evidence of pneumonia and thus met clinical criteria for SARS. Symptoms in the two mildly infected subjects included chills, myalgia or cough, all of which resolved within three days of symptomatic therapy.

The researchers said their study was the first to demonstrate SARS infections in health care workers with normal chest X-rays. Both clinical SARS and milder illness developed in those who were exposed to but not in direct contact with infected patients, suggesting that infection can occur regardless of the intensity of exposure. However, there was no disease transmission involving workers in other areas of the hospital, nor was there secondary transmission involving the two subjects with mild disease.

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