Comparison of acute pneumonia caused by SARS-CoV-2 and other respiratory viruses in children:a retrospective multi-center cohort study during COVID-19 outbreak

Background:Until January 18,2021,coronavirus disease-2019(COVID-19)has infected more than 93 million individuals and has caused a certain degree of panic.Viral pneumonia caused by common viruses such as respiratory syncytial virus,rhinovirus,human metapneumovirus,human bocavirus,and parainfluenza viruses have been more common in children.However,the incidence of COVID-19 in children was significantly lower than that in adults.The purpose of this study was to describe the clinical manifestations,treatment and outcomes of COVID-19 in children compared with those of other sources of viral pneumonia diagnosed during the COVID-19 outbreak.Methods:Children with COVID-19 and viral pneumonia admitted to 20 hospitals were enrolled in this retrospective multi-center cohort study.A total of 64 children with COVID-19 were defined as the COVID-19 cohort,of which 40 children who developed pneumonia were defined as the COVID-19 pneumonia cohort.Another 284 children with pneumonia caused by other viruses were defined as the viral pneumonia cohort.The epidemiologic,clinical,and laboratory findings were compared by Kolmogorov-Smirnov test,t-test,Mann-Whitney U test and Contingency table method.Drug usage,immunotherapy,blood transfusion,and need for oxygen support were collected as the treatment indexes.Mortality,intensive care needs and symptomatic duration were collected as the outcome indicators.Results:Compared with the viral pneumonia cohort,children in the COVID-19 cohort were mostly exposed to family members confirmed to have COVID-19(53/64 vs.23/284),were of older median age(6.3 years vs.3.2 years),and had a higher proportion of ground-glass opacity(GGO)on computed tomography(18/40 vs.0/38,P<0.001).Children in the COVID-19 pneumonia cohort had a lower proportion of severe cases(1/40 vs.38/284,P=0.048),and lower cases with high fever(3/40 vs.167/284,P<0.001),requiring intensive care(1/40 vs.32/284,P<0.047)and with shorter symptomatic duration(median 5d vs.8d,P<0.001).The proportion of cases with evaluated inflammatory indicators,biochemical indicators related to organ or tissue damage,D-dimer and secondary bacterial infection were lower in the COVID-19 pneumonia cohort than those in the viral pneumonia cohort(P<0.05).No statistical differences were found in the duration of positive PCR results from pharyngeal swabs in 25 children with COVID-19 who received antiviral drugs(lopinavir-ritonavir,ribavirin,and arbidol)as compared with duration in 39 children without antiviral therapy(median 10d vs.9d,P=0.885).Conclusions:The symptoms and severity of COVID-19 pneumonia in children were no more severe than those in children with other viral pneumonia.Lopinavir-ritonavir,ribavirin and arbidol do not shorten the duration of positive PCR results from pharyngeal swabs in children with COVID-19.During the COVID-19 outbreak,attention also must be given to children with infection by other pathogens infection.

Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 - 20, 2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3) the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8%) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24. 4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological features. Early recognition, prompt isolation, and appropriate therapy are the key to combate this infection.

A summary of diagnosis and treatment experience of novel coronavirus pneumonia

The current epidemic situation of the COVID-19 is still serious.As a designated unit for the diagnosis of COVID-19 in Hainan Province,We,The Second Affiliated Hospital of Hainan Medical University,established a multidisciplinary integrated individualized treatment team.We emphasized early improvement of relevant examinations,early antiviral treatment,dynamic monitoring of inflammatory markers and imaging changes.In addition,nutritional support,psychological intervention,and Chinese medicine treatment also play an important role.We summarized the experience in the diagnosis and treatment process for the reference of clinicians.

Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance.Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls.Results The numbers of CD3 +, CD4 +, and CD8 + lymphocytes all significantly decreased in acute phase of patients with SARS [(722±533)/μl, (438 ±353)/μl, (307±217)/μl)] compared with those in normal controls [ (1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0. 01) ], which was different from what we observed in patients with AIDS who had decreased CD4 + [ (296±298)/μl] but increased CD8 + [ (818 ±566)/μl counts. The counts of CD3+, CD4+, and CD8 + lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4 + counts less than 200/μl. As the patients' condition improved, CD3 +, CD4 +, and CD8 + counts gradually returned to normal ranges.Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease.Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology.Results The patients in the study consisted of 42 males and 36 females, aged 20 -75 yrs (mean age 37. 5±11. 6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15. 3%) with WBCs <4. 0 x109/L, 49 cases (62. 8%) ranging between (4. 0-10. 0) ×10~9/L and 17 cases (21. 8%) over 10. 0×10~9/L. The average was(7. 58 ?. 96) x 109/L, with 0. 75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died.Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.

Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019:protocol of a randomized controlled trial

Background:At the end of 2019,a novel coronavirus outbreak causative organism has been subsequently designated the 2019 novel coronavirus(2019-nCoV).The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear,and warrants further investigation.Methods:The present study will be conducted as an open-labeled,randomized,controlled trial.We will enrol 48 subjects from Chongqing Public Health Medical Center.Each eligible subject will be assigned to an intervention group(methylprednisolone via intravenous injection at a dose of 1-2 mg/kg/day for 3 days)or a control group(no glucocorticoid use)randomly,at a 1:1 ratio.Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points.We will use the clinical improvement rate as our primary endpoint.Secondary endpoints include the timing of clinical improvement after intervention,duration of mechanical ventilation,duration of hospitalization,overall incidence of adverse events,as well as rate of adverse events at each visit,and mortality at 2 and 4 weeks.Discussion:The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades.Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past.However,there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease,or indeed in other types of severe respiratory disease.In this study,we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019.

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2(COVID-19),SARS-CoV(SARS)and MERS-CoV(MERS)using a systemic review.Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19,SARS and MERS pneumonia respectively.Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists.Vote-counting method was employed to include cases of each group.Data of patients’manifestations in early chest CT including lesion patterns,distribution of lesions and specific imaging signs for the three groups were extracted and recorded.Data were compared and analyzed using SPSS 22.0.Results A total of 24 studies were included,composing of 10 studies of COVID-19,5 studies of MERS and 9 studies of SARS.The included CT exams were 147,40,and 122 respectively.For the early CT features of the 3 pneumonias,the basic lesion pattern with respect to"mixed ground glass opacity(GGO)and consolidation,GGO mainly,or consolidation mainly"was similar among the 3 groups(χ^2=7.966,P>0.05).There were no significant differences on the lesion distribution(χ^2=13.053,P>0.05)and predominate involvement of the subpleural area of bilateral lower lobes(χ^2=4.809,P>0.05)among the 3 groups.The lesions appeared more focal in COVID-19 pneumonia at early phase(χ^2=23.509,P<0.05).The proportions of crazy-paving pattern(χ^2=23.037,P<0.001),organizing pneumonia pattern(P<0.05)and pleural effusions(P<0.001)in COVID-19 pneumonia were significantly lower than the other two.Although rarely shown in the early CT findings of all three viral pneumonias,the fibrotic changes were more frequent in SARS than COVID-19 and MERS(χ^2=6.275,P<0.05).For other imaging signs,only the MERS pneumonia demonstrated tree-in-buds,cavitation,and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia(χ^2=22.412,P<0.05).No pneumothorax,pneumomediastinum and lymphadenopathy was present for each group.Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns,including GGO and consolidation,bilateral distribution,and predominant involvement of the subpleural area and the lower lobes.Early signs of COVID-19 pneumonia showed less severity of inflammation.Early fibrotic changes appeared in SARS only.MERS had more severe inflammatory changes including cavitation and pleural effusion.The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

Genome sequencing and characterization analysis of a Beijing isolate of chicken coronavirus infectious bronchitis virus

Avian infectious bronchitis virus (AIBV) is classified as a member of the genus coronavirus in the family coronaviridae. The enveloped virus has a positive-sense, sin-gle-stranded RNA genome of approximately 28 kilo-bases, which has a 5′ cap structure and 3′ polyadenylation tract. The complete genome sequence of infectious bronchitis virus (IBV), Beijing isolate, was determined by cloning sequencing and primer walking. The whole genome is 27733 nucleotides in length, has ten open reading frames: 5′-orf1a-orf1ab-s-3a- 3b-e-m- 6a-6b-n-3′. Alignments of the genome sequence of IBV Beijing isolate with those of two AIBV strains and one SARS coronavirus were performed respectively. The genome sequence of IBV Beijing isolate compared with that of the IBV strain LX4 (uncompleted, 19440 bp in size) was 91.2% similarity. However, the full-length genome sequence of IBV Beijing isolate was 85.2% identity to that of IBV Strain Beaudette, and was only 50.8% homology to that of SARS coronavirus. The results showed that the genome of IBV has remarkable variation. And IBV Beijing isolate is not closely related to SARS coronavirus. Phylogenetic analyses based on the whole genome sequence, S protein, M protein and N pro-tein, also showed that AIBV Beijing isolate is lone virus in group Ⅲ and is distant from SARS coronavirus. In conclu-sion, this study will contribute to the studies of diagnosis and diseases control on IBV in China.

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.

Major Depressive Disorder as a Post COVID Infection Sequela

COVID-19 has taken the world by storm, producing a multitude of concerning sequela in all genders and age groups. One surprising finding is the onset of depression post COVID recovery in patients with no past medical history of psychiatric illness. The following case report discusses a 52-year-old female with a past medical history of pneumonia secondary to COVID-19 in April 2021, who presented with recurrent falls and a syncopal episode. On review of systems, it was discovered that the patient has new onset depression since recovering from COVID related pneumonia. Patient has yet to follow up with an outpatient psychiatrist.

新型冠状病毒流行前后儿科急诊感染性疾病谱的变化特征分析

目的探讨新型冠状病毒(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)流行前后儿科急诊感染性疾病谱的变化特征。方法选取2019年1月20日至2022年7月31日首都医科大学附属北京儿童医院急诊内科就诊的患儿,根据就诊时间分为SARS-CoV-2流行前期(简称流行前期)和SARS-CoV-2流行期(简称流行期),分析流行前期及流行期儿童感染性疾病谱的变化情况。结果共纳入患儿94707例次,其中男55476例次,女39231例次,年龄29 d~18岁,平均(4.9±4.1)岁。流行前期就诊29590例次,其中感染性疾病发病率为54.8%(16203/29590);流行期就诊65117例次,感染性疾病发病率为42.4%(27645/65117)。与流行前期相比,流行期呼吸系统感染发病率减少了39.8%(其中肺炎减少56.9%,流行性感冒减少53.6%)、消化系统感染减少19.4%、中枢神经系统感染减少49.2%、泌尿系感染减少4.7%、其他感染减少26.3%。除泌尿系感染外,流行期各类型感染性疾病就诊人数占全年总就诊人数的比例均低于流行前期,差异均有统计学意义(P<0.05)。与流行前期相比,流行期第一年的一、二、三级应急响应时期感染性疾病分别减少了74.9%、60.9%、39.8%,差异均有统计学意义(P<0.05);且流行期第一年呼吸系统和消化系统感染的冬季就诊高峰值明显减少;流行期中枢神经系统感染的夏季就诊高峰季消失。结论相比SARS-CoV-2流行前期,流行期呼吸道感染、消化道感染及中枢神经系统感染的发生率显著减少,可能与应急响应措施相关。

一种防止气溶胶环境扩散新型垃圾桶的设计

垃圾桶是日常生产、生活过程中,用于投放和储存废弃物的卫生用具。脚踩翻盖式垃圾桶是目前市面上销售的主流产品,但其顶盖开启、闭合的设计方式存在一定的不合理性,会在垃圾桶内外产生气体的压力梯度差,进而引起气溶胶的环境扩散。对于医疗卫生机构内设置的垃圾桶而言,其内部的医疗废弃物往往携带有多种致病微生物,如果在使用过程中生物气溶胶产生并扩散到环境中,会增加就诊患者及医务工作者感染呼吸系统烈性传染病的风险。本团队为此研究并设计了一种能防止气溶胶环境扩散的新型垃圾桶,该装置主要由桶体和多个可折叠的折片构成,后者两端设置在滑槽内,通过滑槽将多个折片的运动轨迹限定为水平运动,避免开启、闭合过程中在桶内外产生气体压力的变化,从而降低包括气溶胶在内的污物环境扩散的风险,并获得了国家实用新型专利(专利号:ZL 202021271827.3)。

传染病疫情期间大型集中隔离场所卫生管理

大型集中隔离场所的出现是中国对新型冠状病毒感染(COVID-19)实施“乙类甲管”特殊情形下切断疫情传播途径、控制潜在传染源的重要举措。本文结合大型集中隔离场所特点和运行管理模式,对其投入运行前的人员配置与职责、管理制度、物资保障,投入运行后的食品安全保障、通风与空调使用、污水与垃圾处理、病媒生物防制、电梯使用与消防安全以及应急处置等风险点进行了回顾与梳理,并提出有针对性的卫生管理要求与措施。

中药及其复方治疗病毒性肺炎研究进展

病毒性肺炎是由呼吸道病毒感染鼻腔、咽喉后向下发展引起的肺部炎症。2019年暴发的新型冠状病毒感染(COVID-19)严重威胁人类的生命健康,中医药在治疗COVID-19感染者中发挥着重要作用,且预后良好。对于病毒性肺炎,西医多采用对症治疗如抗病毒、抗细菌及真菌治疗,而中医药治疗病毒性肺炎并不仅仅针对病毒本身,而是通过对机体的整体调节,如增强机体免疫应答等来达到治疗作用。通过检索国内外文献中关于中药及其复方对病毒性肺炎的治疗作用及机制,发现栀子、板蓝根和金银花等单味中药治疗病毒性肺炎效果良好,中药复方如清肺口服液、犀角地黄汤合银翘散、蒿芩清胆汤、麻杏石甘汤、清燥救肺汤等在临床上应用广泛且效果显著,中药复方共包含152味中药,以入肺经的药物频次最多,其中甘草、黄芩、苦杏仁、金银花和麻黄使用最多;作用机制主要与抗炎、抗病毒和免疫调节有关,本研究为今后中药及其复方治疗病毒性肺炎的作用机制研究及其临床应用提供参考。

三种消毒方式对不同材质感染性外包装消毒效果观察

目的对比含氯消毒剂、复合季铵盐消毒剂、紫外消毒灯三种消毒方式对纸板、铝合金、聚丙烯塑料三种材质感染性物质外包装的消毒效果。方法选择金黄色葡萄球菌、大肠杆菌作为指示菌,分别使用含氯消毒剂、复合季铵盐消毒剂、紫外消毒灯对纸板、铝合金、聚丙烯塑料三种材质包装箱进行模拟现场消毒。在消毒前后进行指示菌采样,依据《现场消毒评价标准》(WS/T 797-2022)进行消毒效果判定。结果纸板、铝合金、聚丙烯塑料包装箱使用含氯消毒剂后对金黄色葡萄球菌、大肠杆菌的杀灭对数值均>3.9,使用复合季铵盐消毒剂后的杀灭对数值均>4.5,使用紫外线消毒后的杀灭对数值均>4.3。方差分析结果显示三种材质包装箱使用同种消毒方式后的杀灭对数值差异无统计学意义(P>0.05)。结论含氯消毒剂、复合季铵盐消毒剂、紫外消毒灯对纸板、铝合金、聚丙烯塑料三种包装材质均具有良好的消毒效果。

3种常发冠状病毒的反向遗传技术及应用进展

冠状病毒是一类引起动物和人类疾病的有包膜RNA病毒,可导致人和动物发病,危害严重,如严重急性呼吸综合征病毒、中东呼吸综合征病毒、新型冠状病毒等,尤其是2019年末暴发的新型冠状病毒更是呈现全球大流行,严重危害了人健康和阻滞了全球经济发展。而鸡传染性支气管炎病毒和猪流行性腹泻病毒则是2种常见的严重危害家禽和生猪养殖的病原。本文简述了新型冠状病毒、鸡传染性支气管炎病毒和猪流行性腹泻病毒3种冠状病毒的流行趋势,着重介绍了反向遗传学技术在这3种病毒研究中的应用现状,以期能为冠状病毒等单股正链RNA病毒的研究提供一定参考的意义。

Diagnosis and treatment of novel coronavirus pneumonia based on the theory of traditional Chinese medicine

Since the outbreak of novel coronavirus pneumonia(coronavirus disease 2019,COVID-19),it has rapidly spread to 187 countries,causing serious harm to the health of people and a huge social burden.However,currently,drugs specifically approved for clinical use are not available,except for vaccines against COVID-19 that are being evaluated.Traditional Chinese medicine(TCM)is capable of performing syndrome differentiation and treatment according to the clinical manifestations of patients,and has a better ability of epidemic prevention and control.The authors comprehensively analyzed the etiology and pathogenesis of COVID-19 based on the theory of TCM,and discussed its syndrome differentiation,treatment and prevention measures so as to provide strategies and reference for the prevention and treatment with TCM.

1例地方非典型肺炎病例病理及病原学发现

目的 研究非典型肺炎 /严重的急性呼吸综合征 (SARS)的病理学特点 ,并探讨其病原 ,为临床防治提供依据。方法 采用光镜、透射电镜、组织化学和免疫组织化学技术方法 ,对 1例地方SARS死亡病例 (属国家卫生部公布的死亡病例之一 )进行观察研究。结果 该例SARS的肺部病变为严重的急性间质性渗漏出性炎 ,肺泡间隔为以淋巴细胞为主的炎细胞浸润 ,伴 2 0 %～ 30 %肺泡腔内透明膜形成 ;弥漫性肺泡上皮损伤 ,呈凋亡及脱失改变 ;光镜下偶见肺泡上皮内病毒包涵体样结构 ;组织化学染色显示 ,超过 30 %的肺泡上皮细胞病毒包涵体染色阳性 ,而衣原体包涵体染色阳性细胞不足 5 %。肺外器官主要表现为淋巴结、脾脏等免疫器官较广泛的出血坏死性炎 ,组织细胞反应性增生及噬红细胞现象 ,双侧肾上腺局灶性出血坏死性炎。电镜观察 ,肺组织内I、II型肺泡上皮细胞、血管内皮细胞 ,部分心肌细胞及淋巴结内组织细胞和淋巴细胞内均查见较多病毒样颗粒 ,大小为 10 0～ 15 0nm ,有光晕或花环状包膜 ,病毒样颗粒主要分布于细胞胞质内 ,少部分见于扩张的内质网内 ;肺外肝等组织内较易查见衣原体样颗粒 ,但肺泡组织内鲜见。死者本人及源自广东省的SARS患者恢复期血清IgM和 (或 )IgG与其肺组织呈阳性反应。结论 肺部明显的急性间质?

中西医结合治疗非典型肺炎103例临床观察

目的:观察中西医结合方法治疗非典型肺炎的疗效。方法:西医采用营养支持、呼吸机辅助通气、抗感染及糖皮质激素等方法治疗;中药根据中医辨证分期选方用药。统计学方法采用描述性分析法。结果:103中治愈96例(93.2%),死亡7例(6.8％);入院治疗后退热时间为(6.72±3.95)天;胸片复查病灶完全吸收94例,病灶吸收时间(18.13±8.99)天;2例胸片呈局部纤维索条样改变。结论:SARS属中医“温病”范畴,采用中西医结合治疗有积极作用。

医院内SARS暴发流行的临床分析

目的 :总结严重急性呼吸综合征 (SARS,或称传染性非典型肺炎 ,IAP)的临床表现、诊断和治疗 ,以及外界输入性病例引起暴发流行的传染链特点。方法 :对 2例外院输入病例的临床资料和传染链进行分析 ,并总结 4 1例 SARS患者的临床资料。结果 :1SARS患者的传染性极强 ,防范不当可使大量人群感染 ;2 SARS的临床特征主要是发热 (10 0 .0 % ) ,有相当部分患者在发病初期 (1～ 3d)呼吸道症状并不明显 (占 5 3.7% ) ,并伴有外周血白细胞 (5 2 .6 % )和淋巴细胞 (6 8.4 % )比例减少 ;3早期给予利巴韦林、甲基氢化泼尼松和免疫增强治疗对控制病情的进一步发展有一定效果。结论 :重视防范、早发现、早隔离和早治疗 ,对改善 SARS的预后和控制其蔓延有着十分重要的意义。