A_novel_coronavirus_associated_with_severe_acute_respiratory_syndrome

A_novel_coronavirus_associated_with_severe_acute_respiratory_syndrome

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n engl j med 348;20 www.nejm.org may 15, 2003 1953 The new england journal of medicine established in 1812 may 15 , 2003 vol. 348 no. 20 A Novel Coronavirus Associated with Severe Acute Respiratory Syndrome Thomas G. Ksiazek, D.V.M., Ph.D., Dean Erdman, Dr.P.H., Cynthia S. Goldsmith, M.S., Sherif R. Zaki, M.D., Ph.D., Teresa Peret, Ph.D., Shannon Emery, B.S., Suxiang Tong, Ph.D., Carlo Urbani, M.D.,* James A. Comer, Ph.D., M.P.H., Wilina Lim, M.D., Pierre E. Rollin, M.D., Scott F. Dowell, M.D., M.P.H., Ai-Ee Ling, M.D., Charles D. Humphrey, Ph.D., Wun-Ju Shieh, M.D., Ph.D., Jeannette Guarner, M.D., Christopher D. Paddock, M.D., M.P.H.T.M., Paul Rota, Ph.D., Barry Fields, Ph.D., Joseph DeRisi, Ph.D., Jyh-Yuan Yang, Ph.D., Nancy Cox, Ph.D., James M. Hughes, M.D., James W. LeDuc, Ph.D., William J. Bellini, Ph.D., Larry J. Anderson, M.D., and the SARS Working Group† abstract From the Special Pathogens Branch (T.G.K., J.A.C., P.E.R.), Respiratory and Enteric Virus Branch (D.E., T.P., S.E., S.T., P.R., W.J.B., L.J.A.), Infectious Disease Pathology Ac- tivity (C.S.G., S.R.Z., C.D.H., W.-J.S., J.G., C.D.P.), Influenza Branch (N.C.), Division of Bacterial and Mycotic Diseases (B.F.), and Office of the Director, Division of Viral and Rickettsial Diseases (J.W.L.), and Office of the Director, National Center for Infec- tious Diseases (J.M.H.), National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta; the World Health Organization, Hanoi, Vietnam (C.U.); the Government Virus Unit, Queen Mary Hospital, Hong Kong, China (W.L.); the International Emerging Infectious Dis- eases Program, Bangkok, Thailand (S.F.D.); the Department of Pathology, Singapore General Hospital (A.-E.L.); the University of California, San Francisco (J.D.); and the Center for Disease Control, Department of Health, Taipei, Taiwan (J.-Y. Y.). *Deceased. †Members of the SARS (Severe Acute Res- piratory Syndrome) Working Group are listed in the Appendix. This article was published at www.nejm.org on April 10, 2003. N Engl J Med 2003;348:1953-66. Copyright © 2003 Massachusetts Medical Society. 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 Prov- ince, 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 stain- ing revealed reactivity with group I coronavirus polyclonal antibodies. Consensus coro- navirus primers designed to amplify a fragment of the polymerase gene by reverse tran-
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