PubMed Journals: N Engl J Med
Source: PMID: 12690092
⇦ ⇨ N Engl J Med. 2003 May 15;348(20):1953-66.
⇩ Epub 2003 Apr 10.
A novel coronavirus associated with
severe acute respiratory syndrome.
Ksiazek TG(1), Erdman D, Goldsmith CS, Zaki
SR, Peret T, Emery S, Tong S, Urbani C,
Comer JA, Lim W, Rollin PE, Dowell SF, Ling
AE, Humphrey CD, Shieh WJ, Guarner J, Paddock
CD, Rota P, Fields B, DeRisi J, Yang JY,
Cox N, Hughes JM, LeDuc JW, Bellini WJ,
Anderson LJ; SARS Working Group.
(1) Special Pathogens Branch, National Center
for Infectious Diseases,
Centers for Disease Control and Prevention,
Comment in N Engl J Med. 2003 Aug 14;349(7):709.
N Engl J Med. 2003 May 15;348(20):1948-51.
BACKGROUND: A worldwide outbreak of
severe acute respiratory syndrome (SARS)
has been associated with exposures originating from
a single ill health care worker from Guangdong
Province, China. We conducted studies to
identify the etiologic agent of this outbreak.
METHODS: We received clinical specimens
from patients in seven countries and tested
them, using virus-isolation techniques,
electron-microscopical and histologic studies,
and molecular and serologic assays, in an
attempt to identify a wide range of potential
pathogens. RESULTS: None of the previously
described respiratory pathogens were consistently
identified. However, a novel coronavirus
was isolated from patients who met the case
definition of SARS. Cytopathological features
were noted in Vero E6 cells inoculated with
a throat-swab specimen. Electron-microscopical
examination revealed ultrastructural features
characteristic of coronaviruses. Immunohistochemical
and immunofluorescence staining revealed
reactivity with group I coronavirus polyclonal
antibodies. Consensus coronavirus primers
designed to amplify a fragment of the polymerase
gene by reverse transcription-polymerase
chain reaction (RT-PCR) were used to obtain
a sequence that clearly identified the isolate
as a unique coronavirus only distantly related
to previously sequenced coronaviruses. With
specific diagnostic RT-PCR primers we identified
several identical nucleotide sequences in
12 patients from several locations, a finding
consistent with a point-source outbreak.
Indirect fluorescence antibody tests and
enzyme-linked immunosorbent assays made
with the new isolate have been used to demonstrate
a virus-specific serologic response. This
virus may never before have circulated in
the U.S. population. CONCLUSIONS: A novel
coronavirus is associated with this outbreak,
and the evidence indicates that this virus
has an etiologic role in SARS. Because of
the death of Dr. Carlo Urbani, we propose
that our first isolate be named the Urbani
strain of SARS-associated coronavirus.
Copyright 2003 Massachusetts Medical Society
DOI: 10.1056/NEJMoa030781 PMID: 12690092
[Indexed for MEDLINE]