, 2003, Hsieh et al., 2004 and Lai et al., 2005a). Spontaneous pneumomediastium was found in about 12% of cases (Chu et al., 2004b), whereas 26% of

patients developed barotrauma during mechanical ventilation (Gomersall et al., 2004). In addition to upper MAPK inhibitor and lower respiratory tract disease, extrapulmonary manifestations were also reported for SARS. These included liver and renal impairment (Chau et al., 2004 and Chu et al., 2005c), bradycardia and hypotension due to diastolic cardiac dysfunction (Li et al., 2003), pulmonary arterial thrombosis (Ng et al., 2005), rhabdomyolysis (Wang et al., 2003b), neuromuscular disorder (Tsai et al., 2004), and an acute neurological syndrome with status epilepticus (Lau et al., 2004d). Lymphopenia, leucopenia, thrombocytopenia were commonly observed GSK126 research buy (Lee et al., 2003). The diagnostic criteria for SARS were based on a list of clinical features suggested by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) during the initial phase of the epidemic. According to the WHO criteria,

a suspected case was defined as a person presenting after 1 November 2002 who had a history of fever >38 °C, with cough or difficulty breathing, and had close contact with a person who was a suspected or probable case of SARS, or had a history of traveling to or residing in an area with transmission of SARS within 10 days

before the onset of symptoms. In addition, a person with an unexplained acute respiratory illness resulting Monoiodotyrosine in death, with epidemiological exposure similar to that described above, but on whom no autopsy was performed, also fulfilled the clinical criteria of suspected SARS. A probable case of SARS was defined as a suspected case with chest X-ray evidence of infiltrates consistent with pneumonia or acute respiratory distress syndrome, with a positive test result for SARS-CoV by one or more laboratory diagnostic assays, and/or with autopsy findings consistent with the pathology of ARDS, without an identifiable cause (WHO, 2003b). The overall accuracy of the WHO guidelines for identifying suspected SARS was found to be 83% with an negative predictive value of 86% (Rainer et al., 2003). A laboratory case definition for the diagnosis of a re-emergence of SARS was set up by the WHO after the epidemic. A person with clinically suggestive symptoms and signs and with one or more positive laboratory findings including 1.