兒童嚴重急性呼吸道症候群臨床研究
Date Issued
2004
Date
2004
Author(s)
黃立民
DOI
922751B002013Y
Abstract
Background and purpose: Severe acute respiratory syndrome (SARS) is an
emerging infectious disease caused by a novel SARS-associated coronavirus
(SARS-CoV). In contrast to most viral diseases, clinical data about SARS are limited
to adults and little about pediatric SARS have been reported. The purpose of this
study is to identify the seroepidemiology and clinical features of SARS in pediatric
patients. We also tried to clarify the transmission route and infectivity of pediatric
SARS patients. Meanwhile, fever and pneumonia are common diseases in children. It
is challenging to distinguish SARS from other respiratory tract infections in pediatric
populations during the outbreak period. Therefore, we also try to develop the reliable
and easy to perform tools for rapid diagnosis of SARS and epidemiological study.
Methods: We collected blood samples from patients younger than 18 years old
and admitted to National Taiwan University Hospital pediatric wards or visited
pediatric emergency department. Serum IgG to SARS-CoV was tested by indirect
immunofluorescent assay (IFA). The sensitivity and specificity of IFA were detected
by the 86 sera from documented adult SARS patients and the 204 negative sera
collected 2 years ago. Both the sensitivity and the specificity were 100%. Virus
culture or detection of viral RNA by PCR from throat or nasopharyngeal swabs was
done in some patients. We analyzed the clinical features of the cases with positive
antibody response or culture/PCR result and measured the antibodies of family
members living in the same household with the index case. We also test the different
reagents and reaction intervals to optimize the performance of the IgG ELISA.
Results: After adjusted the buffer contents and the reaction intervals, the IgG
ELISA reached the sensitivity of 96.4% and the specificity of 100%. From April 2003
to October 2003, a total of 422 serum samples were collected. Six patients were
seropositive for IgG anti-SARS CoV and one excreted SARS CoV in the feces.
Among them, 5 patients were experiencing pneumonia. They accounted for 1.66% of
all patients and 2.79% of the patients with respiratory tract infections. The clinical
features of SARS patients were not specific. None of the SARS patients developed
respiratory failure. However, coinfections with other pathogens were common in
pediatric SARS patients (4/5). All the family members of the index case had negative
antibody response.
Conclusion: Few children were infected during the outbreak period in Taiwan in
2003. Pediatric SARS patients usually ran a benign disease course. The clinical
features were not specific to distinguish SARS from pneumonia caused by other
pathogens. Coinfection was common. Pediatric SARS patients were less contagious
than adult patients. No intra-familial spread was documented. The whole virus antigen
IgG ELISA is easy to perform and with high sensitivity and specificity. It can be used
for rapid diagnosis during the SARS outbreak period and for seroepidemiology study.
SDGs
Publisher
臺北市：國立臺灣大學醫學院小兒科
Type
report
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