search text   Advanced Search

This Article Full Text Full Text (PDF) P3Rs: Submit a response P3Rs: View responses Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Bitnun, A. Articles by Read, S. Search for Related Content PubMed PubMed Citation Articles by Bitnun, A. Articles by Read, S. Related Collections Infectious Disease & Immunity Related AAP Red Book topics: Coronaviruses

Children Hospitalized With Severe Acute Respiratory Syndrome-Related Illness in Toronto

Ari Bitnun, MD^*, Upton Allen, MBBS^*, Helen Heurter, BScN^*, Susan M. King, MD CM^*, Mary Anne Opavsky, MD, PhD^*, Elizabeth L. Ford-Jones, MD^*, Anne Matlow, MD, Ian Kitai, MD^*, Raymond Tellier, MD, Susan Richardson, MD, David Manson, MD, Paul Babyn, MD CM, Stanley Read, MD, PhD^* Other Members of the Hospital for Sick Children SARS Investigation Team

^* Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Department of Paediatric Laboratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Objective. An outbreak of severe acute respiratory syndrome (SARS) occurred in the greater Toronto area between February and June 2003. We describe the clinical, laboratory, and epidemiologic features of children who were admitted to the Hospital for Sick Children, Toronto, with a presumptive diagnosis of suspect or probable SARS.

Methods. A prospective investigational study protocol was established for the management of children with a presumptive diagnosis of suspect or probable SARS. All were ultimately classified as having probable SARS, suspect SARS, or another cause on the basis of their epidemiologic exposure, clinical and radiologic features, and results of microbiologic investigations.

Results. Twenty-five children were included; 10 were classified as probable SARS and 5 were classified as suspect SARS, and in 10 another cause was identified. The exposure consisted of direct contact with at least 1 adult probable SARS case in 11 children, travel from a World Health Organization-designated affected area in Asia in 9 children, and presence in a Toronto area hospital in which secondary SARS spread had occurred in 5 children. The predominant clinical manifestations of probable cases were fever, cough, and rhinorrhea. With the exception of 1 teenager, none of the children developed respiratory distress or an oxygen requirement, and all made full recoveries. Mild focal alveolar infiltrates were the predominant chest radiograph abnormality. Lymphopenia; neutropenia; thrombocytopenia; and elevated alanine aminotransferase, aspartate aminotransferase, and creatine kinase were present in some cases. Nasopharyngeal swab specimens were negative for the SARS-associated coronavirus by an in-house reverse transcriptase-polymerase chain reaction in all 25 children.

Conclusions. Our results indicate that SARS is a relatively mild and nonspecific respiratory illness in previously healthy young children. The presence of fever in conjunction with a SARS exposure history should prompt one to consider SARS as a possible diagnosis in children irrespective of the presence or absence of respiratory symptoms. Reverse-transcriptase polymerase chain reaction analysis of nasopharyngeal specimens seems to be of little utility for the diagnosis of SARS during the early symptomatic phase of this illness in young children.

Key Words: severe acute respiratory syndrome • reverse-transcriptase polymerase chain reaction • probable SARS • suspect SARS

Abbreviations: SARS, severe acute respiratory syndrome • WHO, World Health Organization • RT-PCR, reverse-transcriptase polymerase chain reaction • ALT, alanine aminotransferase • AST, aspartate aminotransferase • CPK, creatine kinase

This article has been cited by other articles:

				V. C. C. Cheng, S. K. P. Lau, P. C. Y. Woo, and K. Y. Yuen Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection Clin. Microbiol. Rev., October 1, 2007; 20(4): 660 - 694. [Abstract] [Full Text] [PDF]

				D. F. Koller, D. B. Nicholas, R. S. Goldie, R. Gearing, and E. K. Selkirk When Family-Centered Care Is Challenged by Infectious Disease: Pediatric Health Care Delivery During the SARS Outbreaks Qual Health Res, January 1, 2006; 16(1): 47 - 60. [Abstract] [PDF]

				A M Li and P C Ng Severe acute respiratory syndrome (SARS) in neonates and children Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2005; 90(6): F461 - F465. [Abstract] [Full Text] [PDF]

				F W T Cheng, P C Ng, W K Chiu, W C W Chu, A M Li, K L Lo, E K L Hon, E A S Nelson, T F Leung, W H Ng, et al. A case-control study of SARS versus community acquired pneumonia Arch. Dis. Child., July 1, 2005; 90(7): 747 - 749. [Abstract] [Full Text] [PDF]

				L.-Y. Chang, F.-Y. Huang, Y.-C. Wu, I.-J. Su, N.-C. Chiu, K.-T. Chen, H.-S. Wu, T.-H. Lin, S.-F. Peng, C.-L. Kao, et al. Childhood Severe Acute Respiratory Syndrome in Taiwan and How to Differentiate It From Childhood Influenza Infection Arch Pediatr Adolesc Med, November 1, 2004; 158(11): 1037 - 1042. [Abstract] [Full Text] [PDF]

				U. D Parashar and L. J Anderson Severe acute respiratory syndrome: review and lessons of the 2003 outbreak Int. J. Epidemiol., August 1, 2004; 33(4): 628 - 634. [Full Text] [PDF]

				D S C Hui, M C H Chan, A K Wu, and P C Ng Severe acute respiratory syndrome (SARS): epidemiology and clinical features Postgrad. Med. J., July 1, 2004; 80(945): 373 - 381. [Abstract] [Full Text] [PDF]

				Other articles noted: 14 Nov 2003 to 30 Jan 2004 Evid. Based Nurs., April 1, 2004; 7(2): e2 - e2. [Full Text] [PDF]

				S. Wallace Studies indicate disease was mild in children: SARS baffles researchers AAP News, October 1, 2003; 23(4): 145 - 152. [Full Text] [PDF]

P³Rs:

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2003 American Academy of Pediatrics. All rights reserved.