Starting from day 6, the patient's fever and chest condition gradually improved. However, over the next 2 weeks, 138 persons (mostly healthcare workers) who had been in contact with him had onset of a similar illness with high fever and pneumonia. The patient was subsequently confirmed to be the index case-patient in this hospital outbreak of SARS. Three family members were also infected. Further history showed that he had visited a hotel in Kowloon, Hong Kong, where a 64-year-old physician from southern China had stayed for 2 days; this physician later died of severe atypical pneumonia 10 days after admission to a regional hospital in Kowloon. The cause of the illness was not known at the time of the physician's death.
Our patient was identified as the index case-patient 5 days after the onset of this large outbreak at the Prince of Wales Hospital, as he was the first patient who had the characteristic clinical, radiologic, and laboratory features of SARS and had epidemiologic links with other infected persons. After 8 days, use of the nebulized bronchodilator was stopped because of the possibility of enhancing SARS transmission, and the patient was isolated in a private room with negative-pressure ventilation. Healthcare workers entering the room wore disposable gloves and N95 masks. After the patient completed a 7-day course of cefotaxime and a 10-day course of clarithromycin, his pneumonia recovered gradually, and serial chest radiographs confirmed resolution of his consolidation (Figure, part C). His diarrhea and other systemic symptoms also resolved spontaneously.
An immunofluorescence test for antibody against SARS-CoV subsequently confirmed an elevated titer of 1:5,120 in convalescent-phase serum collected on day 21 of illness. Polymerase chain reaction of nasopharyngeal aspirate was negative for coronavirus. Convalescent-phase serum was negative for other atypical pneumonia organisms, including adenovirus, psittacosis, Q fever, influenza A and B, and mycoplasma. Repeat complete blood count showed that lymphocytes and thrombocytes had returned to normal, along with serum creatinine and alanine transaminase levels.
The patient was isolated in a private room until day 27 of his hospital stay, when his nasopharyngeal aspirate and urine samples were confirmed to be negative for SARS-CoV. Repeat chest radiograph at follow-up 2 weeks later showed no residual parenchymal opacity, and the patient remained asymptomatic.