NEJM -- A Novel Coronavirus Associated with Severe = Acute Respiratory Syndrome

From: Subject: NEJM -- A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome Date: Wed, 7 May 2003 10:29:24 +0300 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0057_01C31483.878C3550"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1106 This is a multi-part message in MIME format. ------=_NextPart_000_0057_01C31483.878C3550 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://content.nejm.org/cgi/content/abstract/NEJMoa030781v1 NEJM -- A Novel Coronavirus Associated with Severe = Acute Respiratory Syndrome

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Published at www.nejm.org April 10, 2003=20 (10.1056/NEJMoa030781) =

A Novel = Coronavirus=20 Associated with Severe Acute Respiratory = Syndrome
Thomas G. Ksiazek, D.V.M., Ph.D., Dean = Erdman, Dr.P.H.,=20 Cynthia Goldsmith, M.S., Sherif R. Zaki, M.D., Ph.D., Teresa Peret, = Ph.D.,=20 Shannon Emery, Suxiang Tong, Ph.D., Carlo Urbani, M.D., James A. Comer, = Ph.D.,=20 M.P.H., Wilina Lim, Pierre E. Rollin, M.D., Scott Dowell, M.D., M.P.H., = Ai-Ee=20 Ling, M.D., Charles Humphrey, Ph.D., Wun-Ju Shieh, M.D., Jeannette = Guarner,=20 M.D., Christopher D. Paddock, M.D., Paul Rota, Ph.D., Barry Fields, = Ph.D.,=20 Joseph DeRisi, Ph.D., Jyh-Yuan Yang, Ph.D., Nancy Cox, Ph.D., James = Hughes,=20 M.D., James W. LeDuc, Ph.D., William Bellini, Ph.D., Larry J. Anderson, = M.D.,=20 for the SARS Working Group

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3D-=20 Ksiazek, T.=20 G.

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ABSTRACT=20

Background A worldwide outbreak of severe acute = respiratory⁼²⁰syndrome (SARS) has been associated with exposures = originating⁼²⁰from a single ill health care worker from Guangdong Province,⁼China. We conducted studies to identify the etiologic agent⁼of=20 this outbreak.

Methods We received clinical specimens from⁼patients in six=20 countries and tested them, using virus isolationtechniques,=20 electron-microscopical and histologic studies, andmolecular = and=20 serologic assays, in an attempt to identify awide range of = potential=20 pathogens.

Results No classic respiratoryor bacterial = respiratory=20 pathogen was consistently identified.However, a novel = coronavirus=20 was isolated from patients whomet the case definition of = SARS.=20 Cytopathological features werenoted microscopically in Vero = E6 cells=20 inoculated with a throat-swabspecimen. = Electron-microscopical=20 examination of cultures revealedultrastructural features=20 characteristic of coronaviruses. Immunohistochemicaland=20 immunofluorescence staining revealed reactivity with groupI=20 coronavirus polyclonal antibodies. Consensus coronavirus primers⁼²⁰designed to amplify a fragment of the polymerase gene by = reverse⁼²⁰transcription-polymerase chain reaction (RT-PCR) were used to⁼obtain a sequence that clearly identified the isolate as a = unique⁼²⁰coronavirus only distantly related to previously sequenced=20 coronaviruses.With specific diagnostic RT-PCR primers we = identified=20 severalidentical nucleotide sequences in 12 patients from = several=20 locations,a finding consistent with a point source outbreak. = Indirectfluorescent antibody tests and enzyme-linked = immunosorbent=20 assaysmade with the new coronavirus isolate have been used = to=20 demonstratea virus-specific serologic response. Preliminary = studies=20 suggestthat this virus may never before have infected the = U.S.=20 population.

ConclusionsA novel coronavirus is associated with = this=20 outbreak, and theevidence indicates that this virus has an = etiologic=20 role inSARS. The name Urbani SARS-associated coronavirus is=20 proposedfor the virus.

Notice: Because of possible public health implications,⁼²⁰this article has been published at www.nejm.org on April 10,⁼²⁰2003. It will appear in the May 15, 2003, issue of the = Journal.=20

Clickon "PDF of this article" for the full text.=20

Comments and = questions?=20 Please contact=20 us.

The New=20 England Journal of Medicine is owned, published, and copyrighted =A9 = 2003=20 Massachusetts Medical = Society. All=20 rights reserved.

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