A cluster of cases of severe acute respiratory syndrome in Hong Kong

N Engl J Med. 2003 May 15;348(20):1977-85. doi: 10.1056/NEJMoa030666. Epub 2003 Mar 31.


Background: Information on the clinical features of the severe acute respiratory syndrome (SARS) will be of value to physicians caring for patients suspected of having this disorder.

Methods: We abstracted data on the clinical presentation and course of disease in 10 epidemiologically linked Chinese patients (5 men and 5 women 38 to 72 years old) in whom SARS was diagnosed between February 22, 2003, and March 22, 2003, at our hospitals in Hong Kong, China.

Results: Exposure between the source patient and subsequent patients ranged from minimal to that between patient and health care provider. The incubation period ranged from 2 to 11 days. All patients presented with fever (temperature, >38 degrees C for over 24 hours), and most presented with rigor, dry cough, dyspnea, malaise, headache, and hypoxemia. Physical examination of the chest revealed crackles and percussion dullness. Lymphopenia was observed in nine patients, and most patients had mildly elevated aminotransferase levels but normal serum creatinine levels. Serial chest radiographs showed progressive air-space disease. Two patients died of progressive respiratory failure; histologic analysis of their lungs showed diffuse alveolar damage. There was no evidence of infection by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila. All patients received corticosteroid and ribavirin therapy a mean (+/-SD) of 9.6+/-5.42 days after the onset of symptoms, and eight were treated earlier with a combination of beta-lactams and macrolide for 4+/-1.9 days, with no clinical or radiologic efficacy.

Conclusions: SARS appears to be infectious in origin. Fever followed by rapidly progressive respiratory compromise is the key complex of signs and symptoms from which the syndrome derives its name. The microbiologic origins of SARS remain unclear.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Contact Tracing
  • Disease Outbreaks*
  • Drug Therapy, Combination
  • Female
  • Hong Kong / epidemiology
  • Humans
  • Lung / diagnostic imaging
  • Male
  • Middle Aged
  • Radiography
  • Ribavirin / therapeutic use
  • Severe Acute Respiratory Syndrome / drug therapy
  • Severe Acute Respiratory Syndrome / epidemiology*
  • Severe Acute Respiratory Syndrome / microbiology
  • Severe Acute Respiratory Syndrome / transmission


  • Adrenal Cortex Hormones
  • Antiviral Agents
  • Ribavirin