History and exam
Key diagnostic factors
common
presence of risk factors
fever
cough
Common in the early respiratory phase (2-7 days from the onset of symptoms) of the disease. Usually non-productive.
myalgia
Prominent in the prodromal phase of the disease. The patient complains of muscle aches.
dyspnoea
Prominent later in the course of the disease (8-12 days from the onset of symptoms). Ranges from mild to severe.
Other diagnostic factors
common
chills or rigors
Usually associated with fever.
malaise
Present in the prodromal phase of the disease.
headache
Usually present in the prodromal phase of the disease.
watery diarrhoea
Occurs in 20% to 25% of the patients, usually late in the course of the disease (second week) and together with recurrence of fever. Usually watery without blood or mucus.[11]
tachypnoea
A respiratory rate of >20 breaths per minute is present in patients with respiratory distress.
tachycardia
Usually present in patients with fever and/or respiratory distress.
cyanosis
A low oxygen saturation is present in patients with respiratory failure progressing to ARDS.
uncommon
nausea and vomiting
Non-specific symptom, present in many viral infections. Reported frequency up to 19.5%.[1]
sore throat
May be present early in the course of disease.
sputum production
May be present, but cough is usually non-productive.
chest pain
If present, appears late in the course of the disease.
pleurisy
If present, appears late in the course of the disease.
rhinorrhoea
Appears mainly in children and infants, who present with a milder course of the disease with associated rhinorrhoea in 50% of cases.[38]
dizziness
Non-specific symptom, present in many viral infections. Reported frequency varies from 4.2% to 43%.[1]
arthralgia
Common symptom of many viral infections. Reported frequency up to 10.4%.[1]
abdominal pain
Reported frequency 3.5%.[1]
seizure
A severe acute neurological syndrome has been reported in patients who developed status epilepticus. SARS-CoV RNA has been detected in cerebrospinal fluid.[39]
delirium
May be present in older adult patients, who often have an atypical presentation of symptoms.[40]
rales
Present in less than one third of cases. Clinically less severe than would be expected from the radiological findings.[3]
inspiratory crackles
Auscultation of the chest may reveal inspiratory crackles.
bronchial breathing
Auscultation of the chest may reveal bronchial breathing.
Risk factors
strong
travel to affected area
History of recent travel within 10 days of the onset of symptoms to a foreign or domestic location with documented or suspected recent transmission of SARS raises suspicion of the infection.[21]
close contact with infected individuals
Risk of transmission is enhanced by close, prolonged contact with an infected individual.[22] Transmission in hospitals was a major factor in the amplification of outbreaks, and a significant proportion of those affected were healthcare workers. Healthcare workers, especially those who are exposed to respiratory secretions of a SARS patient (for example, when intubating, suctioning, manipulating oxygen masks, or applying non-invasive ventilation), are at increased risk of infection. In addition, household members in close proximity to a SARS patient, such as those involved in direct patient care, have a higher risk of acquiring SARS.[23]
laboratory work on SARS-CoV
Cases of SARS infection have been reported in research laboratories working on SARS-CoV.[24] Providing guidelines for biosafety standards and maintaining continuous vigilance can minimise the risk of such transmission.
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