A novel coronavirus associated with severe acute respiratory syndrome

Thomas Ksiazek, Dean Erdman, Cynthia S. Goldsmith, Sherif R. Zaki, Teresa Peret, Shannon Emery, Suxiang Tong, Carlo Urbani, James A. Comer, Wilina Lim, Pierre E. Rollin, Scott F. Dowell, Ai Ee Ling, Charles D. Humphrey, Wun Ju Shieh, Jeannette Guarner, Christopher D. Paddock, Paul Roca, Barry Fields, Joseph DeRisi & 6 others Jyh Yuan Yang, Nancy Cox, James M. Hughes, James LeDuc, William J. Bellini, Larry J. Anderson

Research output: Contribution to journalArticle

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Abstract

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 throatswab 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.

Original languageEnglish (US)
Pages (from-to)1953-1966
Number of pages14
JournalNew England Journal of Medicine
Volume348
Issue number20
DOIs
StatePublished - May 15 2003
Externally publishedYes

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Severe Acute Respiratory Syndrome
Coronavirus
Disease Outbreaks
Viruses
Reverse Transcription
Electrons
Polymerase Chain Reaction
Vero Cells
Antibodies
Fluorescent Antibody Technique
China
Fluorescence
Enzyme-Linked Immunosorbent Assay
Staining and Labeling
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ksiazek, T., Erdman, D., Goldsmith, C. S., Zaki, S. R., Peret, T., Emery, S., ... Anderson, L. J. (2003). A novel coronavirus associated with severe acute respiratory syndrome. New England Journal of Medicine, 348(20), 1953-1966. https://doi.org/10.1056/NEJMoa030781

A novel coronavirus associated with severe acute respiratory syndrome. / Ksiazek, Thomas; Erdman, Dean; Goldsmith, Cynthia S.; Zaki, Sherif R.; Peret, Teresa; Emery, Shannon; Tong, Suxiang; Urbani, Carlo; Comer, James A.; Lim, Wilina; Rollin, Pierre E.; Dowell, Scott F.; Ling, Ai Ee; Humphrey, Charles D.; Shieh, Wun Ju; Guarner, Jeannette; Paddock, Christopher D.; Roca, Paul; Fields, Barry; DeRisi, Joseph; Yang, Jyh Yuan; Cox, Nancy; Hughes, James M.; LeDuc, James; Bellini, William J.; Anderson, Larry J.

In: New England Journal of Medicine, Vol. 348, No. 20, 15.05.2003, p. 1953-1966.

Research output: Contribution to journalArticle

Ksiazek, T, 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, Roca, P, Fields, B, DeRisi, J, Yang, JY, Cox, N, Hughes, JM, LeDuc, J, Bellini, WJ & Anderson, LJ 2003, 'A novel coronavirus associated with severe acute respiratory syndrome', New England Journal of Medicine, vol. 348, no. 20, pp. 1953-1966. https://doi.org/10.1056/NEJMoa030781
Ksiazek, Thomas ; Erdman, Dean ; Goldsmith, Cynthia S. ; Zaki, Sherif R. ; Peret, Teresa ; Emery, Shannon ; Tong, Suxiang ; Urbani, Carlo ; Comer, James A. ; Lim, Wilina ; Rollin, Pierre E. ; Dowell, Scott F. ; Ling, Ai Ee ; Humphrey, Charles D. ; Shieh, Wun Ju ; Guarner, Jeannette ; Paddock, Christopher D. ; Roca, Paul ; Fields, Barry ; DeRisi, Joseph ; Yang, Jyh Yuan ; Cox, Nancy ; Hughes, James M. ; LeDuc, James ; Bellini, William J. ; Anderson, Larry J. / A novel coronavirus associated with severe acute respiratory syndrome. In: New England Journal of Medicine. 2003 ; Vol. 348, No. 20. pp. 1953-1966.
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AU - Emery, Shannon

AU - Tong, Suxiang

AU - Urbani, Carlo

AU - Comer, James A.

AU - Lim, Wilina

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