Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 23 September 2011, last major update September 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.
● Severe Acute Respiratory Syndrome
● Caused by SARS-associated coronavirus, a new member of Coronaviridae (Am J Clin Pathol 2004;121:574)
● Transmission by respiratory secretions
● Antibodies may not appear until 28 days after onset; molecular tests have greatest yield during second week of illness (Arch Pathol Lab Med 2004;128:1346)
● Outbreaks worldwide in 2002-2003 with more than 8,000 cases and over 750 deaths; the last reported case was laboratory associated and occurred in 2004
● Virus localized to pneumocytes (Am J Clin Pathol 2004;121:574)
● Diffuse alveolar damage (DAD) varying based on duration of illness
● 10 or fewer days: acute phase DAD, airspace edema, bronchiolar fibrin and small airway injury
● 11+ days: organizing phase DAD, type II pneumocyte hyperplasia and marked reactive atypia, squamous metaplasia, multinucleated giant cells and acute bronchopneumonia
● Acute phase DAD: hyaline membranes lining alveolar walls, interstitial and airspace edema, interstitial infiltrates of inflammatory cells and vascular congestion
● Organizing-phase DAD: fibroblast proliferation in interstitium and air spaces
● Small airway injury: loss of cilia, bronchiole epithelial denudation, deposition of fibrin within the lumen and on exposed basement membranes
● May have coinfections with CMV, Aspergillosis
Hyaline membranes / diffuse alveolar damage
● SARS-associated coronavirus by RT-PCR at autopsy (Mod Pathol 2005;18:1)
● Hum Pathol 2003;34:743
End of Lung-nontumor > Infections > SARS
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