Biomedical Engineering Reference
In-Depth Information
All SCAP patients admitted to the general and
medical intensive care units (ICU and MICU)
in our institution were reviewed in accordance
with this direction. It transpired that etiological
diagnosis could be identified in a single patient,
a 55-year old Hong Kong gentleman who had
made frequent business travels to Shenzhen in the
Guangdong Province of Southern China. Admitted
on January 22, 2003 to an acute medical ward
with respiratory distress and bilateral pneumonia,
he was intubated a few hours later in the MICU,
but died after 12 days from intractable acute respi-
ratory distress syndrome (ARDS) due to unre-
solving pneumonia. None of the healthcare workers
(HCW) contacting this patient in the general ward
and MICU had fallen ill during his stay. His
stored sera, checked in May 2003 retrospectively,
confirmed SARS-CoV infection, but this case did
not provide us with any clues about an impending
infectious disease outbreak, nor were there unusual
increases in the number of SCAP in Hong Kong
throughout the 2003 winter season. At that time,
the possible candidate organisms for the pneu-
monia outbreak in China were thought to be the
usual organisms of atypical pneumonia or the
avian influenza (H5N1) virus [4]. A new emerging
organism did not rank high as etiological agent,
and bioterrorism attack with an existing or a genet-
ically engineered virus had not come to mind. The
Panel reminded all frontline HCW to take droplet
precautions on contacting pneumonia patients. By
February 20, 2003, the Chinese authorities had
reported to WHO that
Chlamydia pneumoniae
was the likely organism responsible for the recent
outbreak of pneumonia [3].
showed bilateral basal pneumonic infiltrates. He
was treated as for community-acquired pneumonia
(CAP) and was placed in an open 8-bed cubicle
(42m
2
area) in the ward, with positive pressure
ventilation at five air changes per hour (ACH).
Because of a report about a fatal case of avian
influenza from another hospital in a returnee from
China at about the same time [5], for the benefit
of doubt our patient was transferred to an isola-
tion room (13m
2
, 8 ACH) on Day 2. After his
nasopharyngeal aspirates (NPA) proved negative
for influenza A and adenovirus on Day 3, he was
moved back to the open cubicle. He then developed
diarrhea and CXR continued to deteriorate despite
standard antibiotics according to CAP treatment
guideline [6]. On Day 6 (March 7, 13 days from
symptom onset), he desaturated and was trans-
ferred to an isolation room in MICU for non-
invasive ventilation (NIV) through a facial mask.
On Day 8 (Day 15 from symptom onset), he was
intubated because of increasing acute respiratory
failure (ARF). Two intubating physicians wore
protective garments against contamination by HIV
(surgical mask, full-face shield, gown, and gloves),
while nurses stood on the side of the bed and
wore surgical masks, gown and gloves but not face
shields. On Day 14 (March 15, 2003), the World
Health Organization (WHO) published the case
definition of suspected SARS at the WHO website,
which in retrospect matched the presentation of this
patient. He died on Day 15 from intractable acute
respiratory distress syndrome (ARDS). Subsequent
serology against the SARS-CoV was strongly posi-
tive. None of the HCW in MICU contracted SARS.
Thirty-two HCW in ward A5 had been exposed
to this patient from March 2 to March 7, 2003. On
March 9, a nurse from the same ward was admitted
with pneumonia and was placed in an isolation
room in A5 ward. By March 12, four other HCW
from the same ward had requested sick leave due
to upper respiratory tract illnesses. As an infec-
tious condition was suspected, all were called back
for medical review, blood tests, and CXR. Healthy
HCW of the same ward were similarly screened.
All CAP patients admitted in the preceding month
were reviewed. The patient described above was
23.3 Recognition of the Outbreak
in PYNEH
Another 44-year-old Hong Kong businessman was
admitted to an acute medical ward (ward A5)
of PYNEH on March 2, 2003 for fever, cough,
and sputum for one week. He had also trav-
eled to Guangdong, Southern China on February
22-23, 2003. The White cell count was not
elevated, lymphocyte was 1.0
10
9
/L, and HIV
serology was negative. Chest radiograph (CXR)
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