Lung Scarring Found in Hong Kong SARS Victims

HONG KONG (Reuters) - Doctors in Hong Kong have detected permanent damage, or scarring, in the lungs of some recovered SARS patients as scientists around the world race against time to uncover more about the deadly disease.

The territory, among the worst hit in the world from Severe Acute Respiratory Syndrome, faced more chilling news when authorities disclosed 12 discharged patients had experienced relapses. Six of them were still in hospital.

Scarring, or pulmonary fibrosis, occurs when lung tissues die and are unable to transport oxygen. The level of disability depends on the extent of the damage.

Radiologists at a major Hong Kong hospital said they found scarring in some recovered patients who had been severely ill.

"We have scanned 20 patients who have been discharged. I've seen a couple. One of them, there was obvious scarring which will probably be long-term if not permanent," Professor Anil Ahuja at the Prince of Wales Hospital told Reuters.

Gregory Antonio, another radiologist on Ahuja's team, said some patients had "patchy areas" that might eventually become scars. "I think there is a very high possibility there will be some scarring...for most of the patients."

But the doctors were uncertain whether the scarring was due to the disease or the cocktail of the anti-viral drug, ribavirin, and steroids used to treat SARS patients here.

Ahuja said: "It may be a consequence of the disease or the treatment. They've received high doses of steroids, a lot of oxygen, and that is probably...(making) a change in the lungs."

Scarring happens to some pneumonia and tuberculosis patients. A person with extensive lung scarring may even have problems walking up or down a few flights of stairs, said Antonio.

Medical experts in mainland China and the U.S. Centers for Disease Control and Prevention have questioned the use of the treatment in Hong Kong, saying there was no evidence to show they could fight SARS. But Hong Kong doctors say it works for more than 90 percent of SARS patients here.

Experts have identified the culprit virus as a new strain from the family of coronaviruses, which causes the common cold.

Travelers have spread the virus to almost 30 countries, where nearly 6,000 people have been infected almost 380 have died in the last two months since the flu-like virus first appeared in southern China in November.

With 1,589 infections and 157 people deaths, Hong Kong is the second worst-hit area after mainland China.

Doctors told Reuters on Thursday that the 12 patients who had been re-admitted for treatment may not have fully recovered when they were first discharged.

David Hui, a doctor taking care of SARS patients, said the SARS virus was similar to a number of others that take at least 21 days to run their course.

"If you release patients earlier, you run the risk of letting go people who only deteriorate later," he said.

Infectious disease expert Lo Wing-lok agreed but added that the relapses may have been due to secondary infections.

"The patients' immune systems may have been weakened by SARS or by steroids and bacterial infection may then happen," Lo said.

SARS Virus Found in Recovered HK Patients
33 minutes ago Add Science - Reuters to My Yahoo!

By Tan Ee Lyn

HONG KONG (Reuters) - Hong Kong doctors have discovered for the first time traces of the deadly SARS (news - web sites) virus in the stool and urine of patients thought to be free of the virus and discharged from hospital, officials said on Thursday.

The news came after doctors in Hong Kong found evidence of permanent lung scarring and possible cases of relapses in patients who had been infected with Severe Acute Respiratory Syndrome.

"Recovered patients have the virus in their stools and urine," David Hui, a doctor treating SARS patients, told Reuters.

Hong Kong's Director of Health told a news conference experts here were now trying to ascertain how long recovered patients in the territory may be passing the virus in their stools and urine.

"Most patients spend at least three weeks in hospital, they must be clear of any symptoms for five days before they can be released," said Margaret Chan, adding that those discharged must remain at home for another 14 days.

Tests were being done to see if the people found with the traces of the virus were infectious, doctors said.

Authorities said the disease killed another five people in the city and infected 11 others on Thursday, bringing the death toll to 162 and cumulative cases to 1,600.

Of these, 43 patients were discharged from hospital on Thursday, bringing the total number of discharged patients to 834. The government also said 102 recovering patients were in convalescence and were about to be discharged.

The disease has spread to more than 25 countries in the last two months, infected more than 6,000 people and killed nearly 400 of them since first emerging in southern China in November.

Symptoms include high fever, cough and pneumonia, and there is no standard treatment. Scientists say it is mainly passed by droplets through sneezing and coughing.

While daily numbers of new infections have fallen over the past week in Hong Kong, news on Wednesday that 12 people had to be readmitted to hospital brought fresh concerns. Six remain in hospital.

It was not clear if the 12 had suffered relapses.

Some doctors told Reuters these patients may not have fully recovered when they were first discharged, or that that their weakened immunity systems may have left them vulnerable to secondary infections.

Chan said experts were still trying to pinpoint the cause of the relapses but she stressed that hospitals in Hong Kong were extremely cautious when handling SARS patients.

The epidemic has brought businesses across Hong Kong to their knees. Tourists have disappeared as countries around the world warn their citizens against coming here and impose stringent checks on travelers from SARS affected areas.

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New find on SARS virulence
By Leigh Dayton and John Kerin
02may03

THE SARS virus is mutating at genetic "hot spots", claims an international expert who suggests this may explain why some people get sicker than others from Severe Acute Respiratory Syndrome.

Virologist Henry Niman of Harvard University yesterday reported evidence of several mutations in Coronavirus samples from mainland China and Hong Kong.

The World Health Organisation has said Coronavirus causes SARS.

"(This) may explain the virulent nature of the isolates (samples) that established SARS in Hanoi, Toronto, Singapore and possibly Hong Kong," Dr Niman said on the International Society for Infectious Diseases website.

Dominic Dwyer, a medical virologist with Westmead Hospital in Sydney, said: "It doesn't surprise me there are hot spots."

But Dr Dwyer agreed with University of Western Australia microbiologist and virologist David Smith, who said it was too early to know just what the mutations meant.

"We're waiting for more information to see if the variation is altering its capacity to cause disease or changing the type of disease," said Professor Smith.

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