Severe acute respiratory syndrome (SARS)  is a rapidly spreading, potentially fatal infectious viral disease. Etiology SARS-associated coronavirus (SARS-CoV)  Incubation Period 2-7 days But may be as long as 10 days Air way droplets containing living Virus SARS-CoV spreads from one person to another mainly through close contact with someone who is infected with SARS.  When a person with SARS coughs or sneezes without covering his or her mouth, respiratory droplets containing living virus can spray up to 3 feet and invade the mucous membranes of another person. It is not known whether SARS can spread more broadly through the air. Initial tests in patients suspected of having SARS include the following: Pulse oximetry Blood cultures Sputum Gram stain and culture Viral respiratory pathogen tests, notably influenza A and B viruses and respiratory syncytial virus HRCT(High-resolution computed tomography)

1. Infectious Diseases Associated
with Fever- Part II
Dr. Koshila Peduruarachchi
Department of Cikitsa
Faculty of Indigenous Medicine
Gampaha Wickramarachchi University of Indigenous Medicine
4/27/2022
Dr.Koshy

2. SARS- Severe Acute Respiratory Syndrome
• Severe acute respiratory syndrome
(SARS) is a rapidly spreading,
potentially fatal infectious viral disease.
• Etiology
• SARS-associated coronavirus (SARS-
CoV)
• Incubation Period
• 2-7 days
• But may be as long as 10 days
4/27/2022 Dr.Koshy

3. •Transmission
• Air way droplets containing living Virus
• SARS-CoV spreads from one person to another mainly through close
contact with someone who is infected with SARS.
• When a person with SARS coughs or sneezes without covering his or
her mouth, respiratory droplets containing living virus can spray up to
3 feet and invade the mucous membranes of another person.
• It is not known whether SARS can spread more broadly through the
air.
4/27/2022 Dr.Koshy

4. • P
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5. • Signs and Symptoms
• Stage 1
• Fever (>100.4°F [38°C])
• Fatigue
• Headaches
• Chills
• Myalgias
• Malaise
• Anorexia
• Less common features;
• Sputum production
• Sore throat
• Coryza
• Nausea and vomiting
• Dizziness
• Diarrhea
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6. • Stage 2 is the lower respiratory tract phase
• Dry cough
• Dyspnea
• Progressive hypoxemia in many cases
• Respiratory failure that requires mechanical ventilation in
some cases
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7. • Investigation
• Initial tests in patients suspected of having SARS include the
following:
• Pulse oximetry
• Blood cultures
• Sputum Gram stain and culture
• Viral respiratory pathogen tests, notably influenza A and B
viruses and respiratory syncytial virus
• HRCT(High-resolution computed tomography)
4/27/2022 Dr.Koshy

8. • Diagnosis
• Modest lymphopenia, leukopenia, and
thrombocytopenia: Series have shown white blood cell
(WBC) counts of less than 3.5 x 109/L and lymphopenia
of less than approximately 1 x 109/L
• Mild hyponatremia and hypokalemia
• Elevated levels of lactate dehydrogenase, alanine
aminotransferase, and hepatic transaminase
• Elevated creatine kinase level
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9. • Chest radiography results in
SARS are as follows:
• In early-stage SARS, an infiltrate
in the retrocardiac region
• Ground-glass opacification, with
or without thickening of the
intralobular or interlobular
interstitium
• Frank consolidation
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10. • Management
• No definitive medication protocol specific to SARS has been
developed, although various treatment regimens have been
tried without proven success.
• 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
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11. D/D
• Influenza AH1N1
• Acute Coryza
4/27/2022 Dr.Koshy

12. • Prevention
• Wash their hands regularly with warm water and soap.
• Avoid touching their eyes, nose, and mouth.
• Use disposable tissues instead of their hands to cover their
mouths when they cough, and throw tissues away
immediately after use.
• As parents, you should follow public health
recommendations if you are in the area of an epidemic.
4/27/2022 Dr.Koshy

13. COVID-19
• Background
• Coronavirus disease 2019 (COVID-19) is defined as illness caused by a
novel coronavirus called severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified
amid an outbreak of respiratory illness cases in Wuhan City, Hubei
Province, China.
• It was initially reported to the WHO on December 31, 2019.
• On January 30, 2020, the WHO declared the COVID-19 outbreak a
global health emergency.
• On March 11, 2020, the WHO declared COVID-19 a global pandemic, its
first such designation since declaring H1N1 influenza a pandemic in 2009
4/27/2022 Dr.Koshy

14. • Illness caused by SARS-CoV-2 was
termed COVID-19 by the WHO, the
acronym derived from "coronavirus
disease 2019." The name was chosen
to avoid stigmatizing the virus's origins
in terms of populations, geography, or
animal associations.
• On February 11, 2020, the Coronavirus
Study Group of the International
Committee on Taxonomy of Viruses
issued a statement announcing an
official designation for the novel virus:
severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2).
4/27/2022 Dr.Koshy

15. • Etiology
• SARS-CoV-2
• Mode of Transmission
• exposure to respiratory droplets carrying infectious virus
• Additional methods include contact transmission (eg, shaking
hands) and airborne transmission of droplets that linger in the
air over long distances (usually greater than 6 feet).
• Virus released in respiratory secretions (eg, during coughing,
sneezing, talking) can infect other individuals via contact with
mucous membranes.
4/27/2022 Dr.Koshy

16. • Mutations of SARS- COV 2
• Delta
• The Delta variant (B.1.617.2) that was first identified in India
• Alpha
• B.1.1.7 variant (Alpha) which was first detected in the United Kingdom
• Beta
• The E484K mutation was found initially in the South Africa VOC
(B.1.351
• Gamma
• The Brazil VOC P.1 (Gamma) was responsible an enormous second
surge of infections.
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17. • Pathogenesis
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18. • Risk Factors
• Patients having ,
• Cancer
• Cerebrovascular disease
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Diabetes mellitus, type 1 and type 2
• Heart conditions (eg, heart failure, coronary artery disease,
cardiomyopathies)
• Immunocompromised state from solid organ transplant
• Obesity (BMI 30 kg/m 2 or greater)
• Pregnancy
• Smoking, current or former
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19. • Children with certain underlying
conditions
• Down syndrome
• HIV (human immunodeficiency virus)
• Neurologic conditions, including
dementia
• Overweight (BMI 25 to less than 30
kg/m 2)
• Other lung disease (including interstitial
lung disease, pulmonary fibrosis,
pulmonary hypertension)
• Use of corticosteroids or other
immunosuppressive medications
• Immune deficiencies
• Use of corticosteroids or other
immunosuppressive medications
• Cystic fibrosis
• Thalassemia
• Asthma
• Hypertension
• Immune deficiencies
• Liver disease
• Use of corticosteroids or other
immunosuppressive medication
• Cystic fibrosis
• Thalassemia
• Asthma
• Hypertension
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20. • Signs and Symptoms
• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea
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21. • Other symptoms
• Sputum production
• Malaise
• Respiratory distress
• Neurologic (eg, headache, altered mentality)
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22. • Complications
• Pneumonia
• Acute Respiratory Distress Syndrome
• Cardiac Injury
• Arrythmia
• Septic Shock
• Liver Dysfunction
• Acute Kidney Injury
• Multiorgan Failure
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23. CXR changes in Covid-19 Patients
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24. • Investigation
• PCR
• Rapid Antigen Test
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25. • Prognosis
• During January to December 2020, the estimated 2020
age-adjusted death rate increased for the first time
since 2017, with an increase of 15.9% compared with
2019, from 715.2 to 828.7 deaths per 100,000
population. COVID-19 was the underlying or a
contributing cause of 377,883 deaths (91.5 deaths per
100,000). COVID-19 death rates were highest among
males, older adults, non-Hispanic American Indian or
Alaska Native (AI/AN) persons, and Hispanic persons.
Age-adjusted death rates was highest among Black
(1105.3) and AI/AN persons (1024).
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26. • Prevention
• Handwashing with soap and water for at least 20 seconds. An
alcohol-based hand sanitizer may be used if soap and water are
unavailable.
• Individuals should avoid touching their eyes, nose, and mouth
with unwashed hands.
• Individuals should avoid close contact with sick people.
• Sick people should stay at home (eg, from work, school).
• Coughs and sneezes should be covered with a tissue, followed
by disposal of the tissue in the trash.
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