1. Medical History

1.1 The patient has had close contact with Severe Acute Respiratory Syndrome (SARS) patients or similar cases in recent two weeks, or there is accurate evidence of SARS cases that have infected this patient.

1.2 The patient is living in or has visited a SARS epidemic-stricken area in the past two weeks.

2. Symptoms and Pathology

A fever of 38˚C or higher, which is associated with more than one of the following pathological signs: cough, tachypnea, dyspnea, respiratory distress syndrome, moist rales, and pulmonary consolidation.

3. Laboratory Examination

No white blood cell (WBC) count rise, it may even decreases.

4. Pulmonary Imaging Examination

Reticular change, flaky or striped infiltrative shadows in varying degrees found in the lungs.

5. Little effect shown after using antibiotics.

Clinical Diagnosis of SARS

Once the source of the disease is identified and clinical examinations are made based on the patient's medical history, symptoms and pathology, laboratory examination, and pulmonary imaging examination, a definite diagnosis can be made.

Suspected Case of SARS: 1.1+2+3 or 1.2+2+3+4

Clinically Diagnosed Case of SARS: 1.1+2+3+4 or 1.2+2+3+4+5

Clinical Diagnostic Criteria for Serious Case of SARS

Any case of SARS meeting one of the following criteria can be diagnosed as a serious case of SARS:

1. Pathological changes have occurred in multiple lung lobes, or chest radiographs show the focus of infection has expanded over 50 percent within 48 hours.

2. The patient has difficulty breathing, with a respiratory frequency of more than 30 times per minute.

3. The patient suffers from hypoxemia. Under the condition of inhaling oxygen of 3-5 l/m, the patient's SaO2 is less than 93 percent, and oxygenation index less than 300 mmHg.

4. The patient suffers from shock, acute respiratory distress syndrome (ARDS) or multiple organ dysfunction syndrome (MODS).

Notes:

1. "Close contact" means nursing or visiting a SARS patient, co-living with a SARS patient (including hospitalization), or directly touching a SARS patient's respiratory tract secretion and body fluid.

2. "SARS-stricken area" refers to a region where cases of primary SARS have occurred and caused spread of the illness. It does not include regions where the imported SARS cases have occurred and caused certain spread of the illness.

3. A SARS patient may have symptoms of headache, joints pains, malaise, myalgia, thoracodynia, and diarrhea.

4. While diagnosing and treating SARS cases, doctors should rule out the possibility of other lung diseases with similar clinical manifestations, such as primary bacterial or fungal pneumonia, pulmonary tuberculosis (TB), lung tumor, non-infective interstitial lung diseases (ILD), pneumonedema, atelectasis, pulmonary embolism, pulmonary infiltration with eosinophilia, and pulmonary angeitis.

*Source material from Ministry of Health

(China.org.cn April 9, 2003)