Posted on 03/17/2003 7:08:39 PM PST by Mother Abigail
Wolfgang Preiser
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We report on a patient admitted the day before yesterday (Sat 15 Mar 2003) to our Isolation Unit with atypical pneumonia, together with his travel companions. The patient is a medical doctor from Singapore who treated one of the earliest cases of SARS there between 3 and 9 Mar 2003. On 9 Mar 2003 he himself developed fever (39.4°C), myalgia and bone pain but did not have cough, dyspnoea or sore throat. Despite this, he flew to New York City to attend a medical meeting, accompanied by his wife who is also a doctor and by his mother-in-law. In New York he experienced a disseminated, transient rash. Because of persistent fever he sought medical attention in New York. A chest X-ray revealed a pneumonic infiltrate of the lingula (left lobe), and antibiotic treatment using levofloxacin was initiated.
Because he continued to feel unwell, he decided to return to Singapore via Frankfurt on 14 Mar 2003. During the first leg of this flight he developed fever again with deterioration of his general condition. In addition, his mother-in-law had developed a sore throat the day before and became febrile on the day of departure (14 Mar 2003). In accordance with the global alert about cases of atypical pneumonia recently issued by WHO \, an international health alert was declared after consultation between the Ministry of Health of Singapore and the German Health Authorities and the plane was met at Frankfurt airport by health officials. The index patient, his mother-in-law and his pregnant wife - who felt well and had no signs or symptoms - were admitted to the Isolation Unit at Frankfurt University Hospital under full biosafety precautions.
At admission, the index patient was still febrile up to 39.6°C, with elevated CRP [C-reactive protein - used to assess an acute phase reaction in inflammatory and infective processes with an elevated value interpreted as an indication of an acute phase response or active disease - Mod.MPP], leukopenia and mild elevation of transaminases and LDH. His chest X-ray still showed an infiltrate of the lingula. Antibiotic treatment was broadened by adding imipenem, vancomycin, doxycyclin and oseltamivir to levofloxacin. Nevertheless, he has now developed a cough and difficulty breathing and today transiently requires oxygen through a mask at 4 l/min. CRP and white blood cell count increase, other laboratory markers have not changed significantly since admission. The pulmonary infiltrates now extend to the left and right upper lobes.
His mother-in-law is currently afebrile, but she also developed a cough; since admission, her CRP has increased from 6.8 mg/dl to 9.9 mg/dl (normal range, <0.5 mg/dl), and her white blood cell count decreased slightly from 10.2/nl to 8.8/nl. Her chest X-ray shows no abnormalities. Coagulation parameters and renal function are normal in both patients. She is on imipenem, and levofloxacin, doxycyclin and tamiflu. Emergency microbiological tests undertaken in Frankfurt have yielded no evidence of Legionella infection; electron microscopy of respiratory swab samples was negative for virus particles, and testing for influenza antigen was negative. The results of viral cultures are pending. Further tests for influenza viruses are being performed by the Institute for Virology in Marburg and the Robert Koch Institute in Berlin; so far, the results of electron microscopy and PCR are negative.
Further testing (serology, PCR etc.) is under way. Up to Sunday [16 Mar 2003], the patient's wife has remained well without any symptoms; she is quarantined in a side room apart from her relatives. Over the past hours, however, she, too, has developed a fever (38.2 C at 8 PM local time, later 37.6 C spontaneously). Therefore we started treatment of the pregnant wife with erythromycin. After thorough cleaning and disinfection, the aircraft has in the meantime flown back to Singapore, albeit without passengers, due to demands by the Singaporean authorities. 83 fellow passengers resident in Germany are currently under "domestic quarantine"; they have been told to stay at home during the incubation period of 2 to 7 days and are being looked after by their local health authorities. -- PD Dr. med. H.-R. Brodt Dr. M. Eichel Infectious Diseases Dept., Medical Clinic III Dr. W. Preiser Institute for Medical Virology J. W. Goethe University Hospital Frankfurt am Main Germany
With no protection at all? (With something as virulent as this SARS seems to be, just a little resistance might be the difference between life and death.)
Exactly. I would think doctors in southeast Asia would by now be at the forefront of video phone conferencing, what with all those commercials on TV where even Asian kids are doing it in school.
Does this doctor work for Saddam Hussein? Is he a member of the Religion of Peace? The latter seems unlikely, Singapore has some of them, but not many. Still what is wrong with this guy, after a farily long term exposure to a patient with a fairly serious illness for which the causitive agent is unknown, travels to a medical convention on another contienent, thereby exposeing not just more people, but a whole bunch of doctors to it? If he doesn't work for SH, maybe he should.
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