A Note on SARS
(Severe Acute Respiratory Syndrome) with the Possibility of Homeopathy.
Causative agent.
Clinical Features
Laboratory Diagnosis
Management
Treatment
Homoeopathic Treatment
Homoeopathic Prophylaxis
Prevention
Please note
SARS in India
Other
sites about SARS
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Causative agent.
SARS is supposed to be caused by a ‘Corona Virus’ found
out very recently and named “SARS Virus” by WHO. This virus is of animal
origin and usually is not found in humans. Postulations are there that the virus
is a genetic mutation of animal corona virus due to causes not yet known. It is
also propagated that the virus is a man made one created for biological weapon
purpose and accidentally leaked out.
The incubation period
is 2--7 (up to 10) days.
The period of infectivity is not yet ascertained but
supposed to be about 10 days too from the onset of symptoms.
Mode of infection is by droplets and direct contact
as it is an air born disease. Contaminated formites may
also spread it.
Although a few close
contacts of patients with SARS have developed a similar illness, the majority
have remained well. Some close contacts have reported a mild, febrile illness
without respiratory signs or symptoms, suggesting the illness might not always
progress to the respiratory phase.
Clinical Features
A Suspect case of SARS is one with respiratory
illness of unknown etiology with onset since February 1, 2003, and the following
criteria.
1. Measured temperature greater than 100.4°F (greater than 38°C) AND
2. One or
more clinical findings of respiratory illness (e.g., cough, shortness of breath,
difficulty breathing, or hypoxia) AND
3. Travel or transit within
10 days of onset of symptoms to the following areas. People's Republic of China
(i.e., mainland China and Hong Kong Special Administrative Region); Hanoi,
Vietnam; Singapore; and Toronto; Canada OR
4. Close contact (means having cared for, having lived with, or having direct
contact with respiratory secretions and/or body fluids of a patient known to be
a suspect SARS case) within 10 days of onset of symptoms with a person known to be
a suspect SARS case.
A
Probable case
is a suspect
case with one of the following:
1. Radiographic evidence of pneumonia or respiratory distress syndrome
2. Autopsy findings consistent with respiratory distress syndrome without an
identifiable cause
The severity of illness
might be highly variable, ranging from mild illness to death. It affects those
between 25--70 years. A few suspected cases of SARS have been reported
among children of 15 or below.
It begins generally with a prodrome of fever
(>100.4°F [>38.0°C]) often high, sometimes associated with chills and
rigors, and also with headache, dizziness, malaise, and myalgia.
There may sore throat, and running nose. At the
onset of illness, some persons have mild respiratory symptoms with cough. Note that
rash and neurologic or gastrointestinal findings are typically, absent but diarrhoea
is reported in some during the febrile prodrome.
After 3--7 days, a lower respiratory phase begins with the onset of a dry, nonproductive cough or dyspnoea, which might be accompanied by or progress to hypoxemia. In 10%--20% of cases, the respiratory illness is severe enough to require intubation and mechanical ventilation. The case-fatality rate among persons with illness meeting the current WHO case definition is of approximately 5%.
Laboratory Diagnosis
Initial diagnostic
testing for suspected SARS patients should include chest X’ ray, blood routine
and cultures, pulse oximetry, sputum Gram's stain and culture, and testing for
viral respiratory pathogens, notably influenza A and B and respiratory syncytial
virus. Legionella and pneumococcal urinary antigen testing are advanced
procedures.
Chest X’ ray in majority
shows in the respiratory phase characteristic early focal interstitial
infiltrates progressing to more generalized, patchy, interstitial
infiltrates. In the late stages some show areas of consolidation also.
The absolute
lymphocyte count is often decreased. Overall WBC counts are also
generally normal or decreased. Leucopoenia and thrombocytopenia or low-normal
platelet counts (50,000--150,000/µL) are seen in 50% of patients at the
peak of the respiratory illness. Early in the respiratory phase, elevated creatine
phosphokinase levels (as high as 3,000 IU/L) and hepatic
transaminases (two to six times the upper limits of normal) have been
noted. Renal function remain normal in the majority.
Serum
antibody tests, including both enzyme immunoassay (EIA, or ELISA) and indirect
immunofluorescence antibody (IFA) formats. Reverse transcription-polymerase
chain reaction (RT-PCR) testing is also available. This test can detect
coronavirus RNA in clinical specimens, including serum, stool, and nasal
secretions and are costly. Viral isolation for the new coronavirus also has been
done but is still more costly.
Latest
A new test devised latest (April 18th 2003) can detect the presence of the
corona virus in nasal swabs or throat cultures before an antibody response is
detectable. Prior to the development of this new rapid test, diagnostic tests
for SARS could detect the corona virus antibodies that are produced after
infection, which in some cases is within 14 days of illness onset, or as long as
21 days after onset of fever. By contrast, the new test is often positive
early in the disease, and the procedure can be completed within a few
hours.
(For more details visit http://www.clinchem.org/cgi/content/full/49/4/DC1)
Management
This consists of the
general management measures for febrile/respiratory diseases with special
emphasis on isolation and prevention of spread. Institutional treatment is
needed, as there are chances for hypoxaemia and respiratory arrest.
Treatment
Conventional
treatment regimens is to use several antibiotics to presumptively treat known
bacterial agents of atypical pneumonia. In several locations, antiviral agents
such as oseltamivir or ribavirin are also used. Steroids have also been
administered orally or intravenously to patients in combination with ribavirin
and other antimicrobials. At present, the most efficacious treatment regimen, if
any, is unknown.
Homoeopathic Treatment
As presently there is no definite medicines in allopathy
for SARS except offering ventilators, oxygen support therapy, antibiotic cover
and some nonspecific antiviral medications, it will be the only wise thing that homoeopathic medicines are evaluated and incorporated in the treatment of
SARS.
The following are the drugs* can be of use for SARS based on symptom similarily.
Aconitum napellus, Ailanthus glandulosa, Arsenicum album,
Baptisia, Belladonna, Bryonia, Chelidonium majus, Crotalus horridus, Hepar sulph, Ipecac, Kali carb,
Lachesis, Muriatic acid, Natrum sulphuricum, Nux vomica, Pulsatilla, Phosphorus, and Rhus tox.
Out of these Aconitum, Arsenicum, Belladonna, Bryonia and Ipecac may be
particularly use full in the early stages and Ailanthus glandulosa, , Kali carb, Lachesis, and
phosphorus in the late stages.
Veratrum viride mother tincture is said to be particularly
effective in containing the illness.
The available actual symptoms** of SARS on analysing, including detailed repertorisation and reference to the Materia medica gave the following medicines as the leading ones.
Phosphorus, Bryonia, Lachesis, Arsenicum, Rhus tox and Baptisia.
Prophylaxis
Based on the recent analysing (see above) of actual
symptoms**
of SARS and on our experience with massive prophylactic work with marked success
against Leptospirosis, Dengue, Japanese Encephalitis and Cholera, we suggest Phosphorus
as the best Prophylactic drug against SARS.
The dosage can be adjusted as 2 pills of no. 40
medicated with Phosphorus 200c taken two times daily for five
days.
Twenty two persons from Kerala
who attended a conference at Singapore took Phosphorus and
reported safe even after ten days of returning.
Dr. Muraleedharan (drvmurali@sancharnet.in)
from Trichur, Kerala.
Pulsatilla is one of the the best medicines for common viral
infections both as a preventive and curative, if required an intercurrent of
Thuja will enhance its powers. According to Dr. Mansoor Ali.
Dr Jean Doherty, suggests Oscillococcinum 200 as 1st line
defence if contact with Sars.
Dr. Manish Bhatia gives Chelidonium majus
as a prophylactic drug.
Please
contact us with more disease specific and
individual symptoms if you have so that we can work out more effective
Homoeopathic drugs.
Prevention
No known preventive
measures are identified presently except avoidance of contact.
Please note
This is a notifiable
disease and should be reported to the local public health authorities.
Clinicians should save any available clinical specimens (respiratory, blood, and
serum) for additional testing until a specific diagnosis is made.
Clinicians evaluating suspected cases should use standard precautions (e.g., hand hygiene) together with airborne (e.g., N-95 respirator/face mask) and contact (e.g., gowns and gloves) precautions. Until the mode of transmission will be defined more precisely, eye protection is also recommended. These will be updated as more clinical and epidemiologic information becomes available
As of August 15th, 2003, (from
November 1st 2002) a total
of 8456 SARS cases with 809 deaths have been reported from 25 countries,
including 220 probable cases in the United States. Main land China and Hong Kong remains the worst affected
area on the globe with 5329 and 1755 reported cases, including 348 and 296
deaths respectively. It
is also to be noted that as late as the end of June 2003 WHO declared the
mainland China and Hon Kong as areas where SARS is under control and they are
also lifted the travel ban to these nations.
SARS in
India
Till the beginning of 2003 only 3
cases of SARS have been reported in India with no deaths. Virologists are of the
opinion that this is because of the extreme heat in India. Also it is proved
that the virus cannot survive out side human body for more than 3-4 days in this
extreme conditions. But however the picture may change according to them once
the monsoon begins. There may be a dramatic change in the environment in favour
of the virus and there may be a sudden escalation of cases. But we rightly thought
there
is not enough evidence for a nation wide action or panic in this regard as
evident from the fact that SARS never caused casualties here in the monsoon of
2003, 04 or 05!
Refences
http://homedpa.com/sars.htm
http://www.hpathy.com/diseases/Pneumonia.asp
http://www.e-homoeopathy.com/sars.htm
http://www.who.int/csr/don/2003_04_07/en/
http://www.who.int/wer/pdf/2003/wer7812.pdf/
http://www.who.int/entity/csr/sars/country/en
http://www.cdc.gov/ncidod/sars
http://www.swissinfo.org/sen/Swissinfo.html?siteSect=143&sid=1744511
Latest
info...
SARS or suspected
to be likely infection has struck again Singapore in early September 2003.
Confirmation of the same as well as more news never materialized as most
probably there were no such episodes. Any way it
didn't escalate to an epidemic to the knowledge of any of us. Any body having
actual symptoms from any cases may please contact
Dr.
Abdul Gafar.
*Compiled
by Dr. Abdul Gafar with
the help of Dr. Sudinkumar and
Dr.
Mansoor Ali
**With help from Catherine
Creel ccreel@adelphia.net
And Luise Kunkle's website: http://www.bar-do.net/symptoms_compilation.htm.
Repertorial help from
Dr.
Mansoor Ali
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