SARS Associated Corona Virus (SCV)

975 Konu 114 SARS Associated Corona Virus (SCV) $\GÕQ06$56$VVRFLDWHG&RURQD9LUXV6&9(G&HQJL]0ÕVÕUOÕJLO$\GÕQ7ÕSYHGLúKHNLPOL LQGH genel ve özel Mikrobiyoloji. Konu 114. Sa:975-* QHú\D\ÕQHYL$QNDUD *(1(/g=(//ø./(5 %X KDVWDOÕN \ÕOÕQÕQ LNLQFL \DUÕVÕQGD X]DNGR X $V\D GD JULSDO LQIHNVL\RQ JLEL RUWD\D oõnpõúwõu 6ROXQXP \HWPH]OL L VHEHEL\OH O POH VRQXoODQDQ YDND VD\ÕVÕ KHU JHoHQ D\JLGHUHNDUWPÕúWÕU%XKDVWDOÕ DVHUWDNXWVROXQXPVHQGURPXDQODPÕQD JHOHQ6HYHUH$FXWH5HVSLUDWRU\6\QGURPH6$56LVPLYHULOPLúWLU &'& YH ' Q\D VD OÕN UJ W QH LON UDSRUODU dlq +RQJ.RQJ.DQDGD øqgrqh]\d)lolslqohu6lqjdsxu7d\odqgyh9lhwqdp GDQJHOPLúWLU\ÕOÕúXEDWÕQGD KDVWDOÕN WDP RODUDN WDQÕPODQDELOPLúWLU 'DKD VRQUD øqjlowhuh 6ORYHQ\D $PHULND $OPDQ\D GDQYDNDUDSRUODUÕJHOPLúWLU-Nisan- WH ONHGHWHVSLWHGLOPLúNHQ- 0D\ÕV-WDULKLQHNDGDUWRSODP ONHGHQYDNDUDSRUODUÕELOGLULOPLúWLU HastalDUÕQ or X - \Dú DUDVÕQGDGÕU \DúÕQ DOWÕQGD VDGHFH ELUNDo YDND YDUGÕU +DVWDODU DUDVÕQGD FLQVL\HW D\ÕUÕPÕ WHVSLW HGLOHPHPLúWLU %XQDUD PHQHUNHN KDVWDODUÕQRUDQÕFLYDUÕQGDGÕU (7.(1ø (OGHNL ELOJLOHUH J UH6$56KDVWDOÕ ÕQÕQ HWNHQL NRURQDYLUXV 7RU VXúXGXU%X virusa SARS-DVVRFLDWHG&RURQD9LUXV6&9LVPLYHULOPLúWLU'L HUNRURQDYLUXVODUJLEL 80-QPE \ NO QGHSOHRPRUILNVIHULNYH\DHOLSVúHNOLQGHKHOLNDOVLPHWULGHGLU < ]H\LQGHNL oõnõqwõodu SHSORPHU QP JHQLúOL LQGH QP X]XQOX XQGDGÕU 7HN VDUPDO51$VÕYDUGÕUdHYUHVLQGH-QPNDOÕQOÕ ÕQGDOLSLWELU]DUÕEXOXQXU6&9µQX izole edip Macaca fascicularis PD\PXQODUÕQD KDVWDOÕ Õ EXODúWÕUPDN P PN Q ROPXúWXU Bu virusun 29751-ED]oLIWOLNJHQRPXQXQVHNDQVÕWHVSLWHGLOPLúWLUWDQe ORF 2SHQ5HDGLQJ)UDPHXFXEXOXQPDNWDGÕU%XUDGDQDQODúÕOGÕ ÕQDJ UHL\LELOLQHQKHU iki koronavirus genomuna (HCoV-OC43 ve HCoV-229E) orta seviyede bir benzerlik göstermektedir (300 nükleotitten %50-NDGDUÕEHQ]HPHNWHGLU 6$56 KDVWDVÕQÕQ VROXQXP VÕYÕODUÕQGDQ KXPDQ PHWDSQHXPRYLUXV L]ROH HGLOPLúWLU %X GXUXPGD PHWDSQHXPRYLUXV XQ ELU NR-LQIHNW U P ROGX X YH\D 6$56 KDVWDOÕ ÕQÕQEXLNLYLUXVXQELUOLNWHOL LLOHPLPH\GDQDoÕNWÕ Õ\ROXQGDGH LúLNJ U úohu YDUGÕU SINIFLANDIRMASI: $VOÕQGD Coronaviridae IDPLO\DVÕQGD \HU DODQ YLUXVODUÕQ E \ N or XQOX X VDGHFH KD\YDQGD KDVWDOÕN \DSDU %XQODUÕQ LoHULVLQGH LQVDQGD VROXQXP \ROX KDVWDOÕ ÕQDVHEHSRODQ+XPDQUHVSLUDWRU\&RURQD9LUXV+&9µXQUKLQRYLUXVODUJLEL VWVROXQXP\ROXQGDKDVWDOÕN\DSDELOGL L QFHGHQELOLQL\RUGX\ÕOÕQGD7\UHOYH %\QRHD\UÕFD\ÕOÕQGD+DPUHYH3URFNQRZEXYLUXVXVR XNDOJÕQOÕ ÕEHOLUWLOHUL RODQ LQVDQÕQ QD]RIDULQJHDO \ÕNDPD VX\XQGDQ L]ROH HGHUHN J Q OO LQVDQODUD X\JXODPÕú YH EX LQVDQODUGD VR XN DOJÕQOÕ ÕQD EHQ]HU ELU KDVWDOÕN ROXúWXUPD\Õ EDúDUPÕúODUGÕ%XYLUXVODUDVÕUDVÕ\OD%YH(LVPLQLYHUPLúOHUGL GHWDQH

976 GDKD NRURQDYLUXV WHVSLW HGLOPLúWLU <HQL EXOXQDQODUÕQ or X VÕoDQGD YH NXúODUGD SQ PRQL\DSDELOGL LLoLQYH OG U F ROPDGÕ ÕLoLQ ]HULQGH\HWHULQFHGXUXOPDPÕúWÕ 6&9LVHPXKWHPHOHQEXYLUXVODUGDQELUWDQHVLQLQVSRQWDQPXWDV\RQJHoLUPLú ELUIRUPXGXU%L\RORMLNVDYDúDPDFÕ\ODJHQHWLNP KHQGLVOHULWDUDIÕQGDQ\DUDWÕOGÕ ÕQD GDLUV \OHQWLOHUGHYDUGÕU $17ø-(1<$3,6,h5(7ø/0(6ø SCV viryonun kapsitindeki M(pro) antijeni, konak dokuda replikasyon IDDOL\HWOHULQL \ QHWHQ ELU SURWHLQD]GÕU GL HU LVPL &/SUR GXU 9LUXVXQ D\UÕFD KHPDJO WLQLQOHULYDUGÕU%XKHPDJO WLQLQOHU0\[RYLUXVODUGDROGX XJLELHULWURVLWOHUGHQ NHQGLOL LQGHQD\UÕOPD]ODU Transmissible gastroenteritis virus (TGEV) un M(pro) antijeni ile SCV un 0SURDQWLMHQLDUDVÕQGDPROHN OHUELUEHQ]HUOLNYDUGÕU%XVHEHSOH7*(9LQIHNVL\RQX geçirenlerin anti-6&9dqwlnruxwdúõpdoduõp PN QG U &RURQDYLULGDHIDPLO\DVÕQGDNLYLUXVODUIDUNOÕDQWLMHQLNJXUXEDD\UÕOÕUODUg]J O RODUDN 6&9 XQ KDQJL DQWLMHQLN JXUXS LoHULVLQH \HUOHúWLULOHFH L KHQ ] NHVLQOLN ND]DQPDPÕúWÕUDPDKHUELUJXUXSLoLQGH\HUDODQNRURQDYLUXVODUGL HUJXUXEXQ \HOHUL LOH odusud] UHDNVL\RQ YHUHELOPHNWHGLU %X ]HOOLN NRURQDYLUXV WHúKLV NLWOerinin SCV WDQÕVÕQGDNXOODQÕOPDVÕNROD\OÕ ÕQÕJHWLULU Koronaviruslar, insan embriyonu trekae organ kültüründe, bebek fare EH\QLQGHWHNWDEDNDOÕGRNXN OW UOHULQGH UHWLOHELOLU6&9LoLQHQX\JXQYDVDW9HUR( hücre kültürüdür. 'ø5(1d/ø/ø. dhyuhnrúxooduõqdgluhqfl RUWDPÕQQHPPLNWDUÕQD YHVÕFDNOÕ ÕQDED OÕGÕU.XUX RUWDPGD ]DPDQOD LQIHNWLYLWHVLQL ND\EHGHU 6R XNWD YH Y FXW VDOJÕODUÕQÕQ LoHULVLQGH daha uzun süre infektif kalabilir. 6&9 QXQ OLSLW ]DUIÕ EXOXQPDVÕ VHEHEL\OH DONRO YH HWHU JLEL OLSLW o ] Fülere IHYNDODGHGX\DUOÕGÕU $QWLVHSWLNOHUH GX\DUOÕGÕU $QWLW EHUN OR DQWLVHSWLNOHU YH KLSR LOH NÕVD V UHGH LQKLEH ROXU 'URSOHWOHU KDOLQGH KDYD\D NDUÕúWÕ ÕQGD DQWLVHSWLN X\JXODPDVÕ VSUH\ úhnolqghropdoõgõu'xydu]hplqyhnrqwdplqhpdwhu\doklsryh\ddonollü antiseptik solüsyonlar ile silinmelidir. <$37,ö,+$67$/,./$5 øqvdqgd YH PD\PXQGD 6$56 KDVWDOÕ Õ \DSWÕ Õ ELOLQPHNWHGLU $\QÕ DLOHGHNL GL HU YLUXVODUD EHQ]HU RODUDN KD\YDQGD SQ PRQL HWNHQL ROPDVÕ GD PXKWHPHOGLU +DVWDOÕN ED]Õ LQVDQODUGD VXENOLQLN VH\UHWPHNWHGLU %D]Õ LQVDQODUGD LVH OG U F RODELOPHNWHGLU %D ÕúÕNOÕN EÕUDNÕS EÕUDNPDGÕ Õ KHQ ] LQFHOHQPHPLúWLU 'X\DUOÕ ELUH\OHUGH ELOKDVVD GL\DEHWLNOHUGH SURJQR]XQ D ÕU VH\UHWPHVL P PN QG U % W Q YDNDODU D\QÕ VHUWOLNWH VH\UHWPH] $NFL HU EHOLUWLVL ELOH YHUPHGHQ L\LOHúHQ YDNDODU YDUGÕU.URQLNOHúWL LUDSRUHGLOPHPLúWLU3RUW UO NUDSRUHGLOPHPLúWLU %(/ø57ø/(5ø øqn EDV\RQ SHU\RGX - J QG U DPD J QH NDGDU X]D\DELOLU øqn EDV\RQ peryodu uzun olan vakalar daha hafif seyreder. 5DVWODQPDVÕNOÕ ÕQDJ UHLONNOLQLNEHOLUWLOHUL\ NVHNDWHú!ƒ&KX]XUVX]OXN KLVVL WLWUHPH ER D] \DQPDVÕ NV U N NDV D UÕVÕ EDú D UÕVÕ ELODWHUDO SQ PRQL VROXQXPXQ GHULQOL LQLQ NÕVDOPDVÕ YH\D ]RU QHIHV DOPD úhnolqghglu $OÕúÕODJHOPLú VROXQXP\ROXKDVWDOÕ ÕQDEHQ]HUEHlirtiler verir. ' N QW UHQDO JDVWURLQWHVWLQDO YH Q URORMLN EXOJXVX \RNWXU %D]Õ YDNDODUGD \ NVHNDWHúG QHPLQGHGL\DUHUDSRUHGLOPLúWLU

977 +DVWDODUÕQ - QGH LON EHOLUWL DWHúWLU VLQGH ú PH YH WLWUHPH %49- ÕQGDNDVD UÕVÕ-69 unda öksürüktür, %42 sinde ise ilk belirti dispnedir. 9DNDODUÕQ DQFDN - NDGDUÕQGD KDVWDOÕ ÕQ J U OPHVLQGHQ -7 gün sonra DOWVROXQXP\ROODUÕ ROD\DNDWÕOÕUgNV U NNXUXYHVHUWWLUGLVSQHJHQHOOLNOHVRQUDGDQ RUWD\D oõndu (QW EDV\RQ YH\D YHQWLODV\RQ FLKD]Õ LOH VROXQXPD \DUGÕP HGLOPHVL JHUHNHELOLU%XQDUD PHQYDNDODUÕQVDGHFH-NDGDUÕKLSRNVLVROXQXPNROODSVÕYH O PLOHVRQXoODQDELOLU'LDEHWOLKDVWDODUGD6$56VHEHEL\OH O PRUDQÕWXU +DVWDOÕN DWLSLN EHOLUWLOHU GH YHUHELOLU guqh LQ GLVHPLQH LQWravasküler NRDJ ORSDWL EHOLUWLVL YHUHQ ELU KDVWDQÕQ DNFL HU U QWJHQOHULQGH ELU GH LúLNOLN J U OPHPLú DPD NRPS WHUL]H WRPRJUDIL &7 LOH DNFL HUGH NRQVROLGH RGDNODU WHVSLW HGLOPLú YH VROXQXP VDOJÕVÕQGD 6&9 J VWHULOPLúWLU 7LSLN 6$56 NOLQL L VRQUDGDQ JHOLúPLúWLU (UNHQG QHPGHDNFL HUU QWJHQOHULQRUPDOJ U QW YHULUøOHUOH\HQG QHPOHUGH ohnlohq DNFL HU U QWJHQOHULQGH IRNDO LQWHUVWLV\DO LQILOWUDWODUD ED OÕ NRQVROLGH VDKDODU hemen daima tespit edilir. TANI: (Q VDGÕN WDQÕ \ QWHPL DNFL HULQ UDG\RORMLN RODUDN LQFHOHQPHVLGLU 6DOJÕQ E OJHVLQGHNL6$56ú SKHOLYDNDODUGDU QWJHQYHNDQEXOJXODUÕWHúKLVLoLQ\HWHUOLGLU +DVWDOÕ ÕQ HUNHQ G QHPLQGH YH\D LON GHID RUWD\D oõnwõ ÕQGD VROXQXP VDOJÕODUÕQGD HOHNWURQPLNURVNRSLOHYLU V QYDUOÕ ÕQÕJ VWHUPHNYH\DN OW UGH retmek gerekebilir. Koronaviruslara özgül immünolojik testler SCV için de uygulanabilir. Radyolojik testler: $NFL HU URQWJHQLQGH NRQVROLGDV\RQ DUDQPDOÕGÕU $NFL HU SHUN V\RQGD GROJXQGXURVN OWDV\RQLSXFXYHUPH\HELOLU%LUoDOÕúPDGDU QWJHQEHOLUWLVLYHren 23 KDVWD KHQ ] U QWJHQ EHOLUWLVL YHUPH\HQ 6$56 KDVWDVÕ YH U QWJHQ EHOLUWLVL YHUPH\HQ WDQH 6$56 ú SKHOL KDVWDQÕQ DNFL HUL RSDVLWH YH NRQVROLGDV\RQ DoÕVÕQGDQ&7LOHLQFHOHQPLú6$56KDVWDOÕ ÕQÕQU QWJHQEHOLUWLVLYHUPHGHQ QFH&7 LOHWHúKLVHGLOHELOHFH LJ U OP úw U7RSODPWDQHHWNLOHQHQDNFL HUVHJPHQWLQGHQ WDQHVL DNFL HULQ DOW OREXGXU +HSVLQGH RUWDN EXOJX RSDVLILNDV\RQ JURXQG-glass opacification), konsolidasyon, interlobuler septalarda ve interstisyal fragmanlarda NDOÕQODúPDGÕU 5 QWJHQ EHOLUWLVL YHUPHGHQ QFH EX OH]\RQODUÕQ VD\ÕVÕ YH odsõ N o NW UDNFL HULQSHULIHULQGH\HUOHúLUOHU5 QWJHQGHEHOLUWLYHUHQOH]\RQODUJHQHOOLNOH DNFL HULQKHPPHUNH]LQGHKHPGHSHULIHULQGHRODELOLUOHUDPDVDQWUDOOH]\RQODUKHPHQ KHUYDNDGDVD\ÕFDD]GÕU øpp QRORMLNWHVWOHU 6ROXQXP VDOJÕODUÕQGD JXUXS, NRURQDYLUXV SROLNORQDO DQWLNRUODUÕQ IORUHVDQ ER\DODUOD J VWHULOPHVL WDQÕ\D \DUGÕP HGHU 6ROXQXP VDOJÕODUÕQÕQ 9HUR ( K FUH kültürüne inokülasyonu ile virusun gösterilmesi veya serolojik olarak koronaviruslara ]J ONRURQDYLUXVUHYHUVWUDQVNULSWD]ODUÕLOH\DSÕODQ3&5WHVWOHULWDQÕ\ÕGR UXODU Transmisyon elektron mikroskopunda standart boyama prosedürü ile lobut úhnolqghnlshsorphuohull]ohqhelolu Hematolojik testler: Erken dönemde lökopeni yoktur veya a]gõudpdohqirvlwvd\õvõd]dopõúrodudn EXOXQXU+DVWDODUÕQ LQGHODFWDWHGHK\GURJHQDVH!8/ LQGHNUHDWLQ fosfokinaz yükselebilir (>3,000 IU/L), hepatik transaminazlar normalin 2- NDWÕQD kadar yükselebilir. +DVWDODUÕQVLQGHLONYHRUtak laboratuvar bulgusu lactate dehydrogenase \ NVHOPHVLGLU ÕQGDKLSRNDOVHPL- VÕQGDOHQIRSHQLVLQGHUKLQRUUKHD GÕU

978 øohuoh\hqg QHPGHKDVWDODUÕQ-VLQGHWURPERVLWRSHQLYDUGÕU-- 150,000/µL). $\ÕUGHGLFLWDQÕ Balgam ve kaq ER\DQDUDN YH N OW U \DSÕODUDN EDNWHUL\HO SQ PRQL HOLPLQH edilmelidir. Atipik pnömoni etkenleri (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophiladudqpdoõyhholplqhhglopholglu,qioxhq]d$% YHVROXQXPVLQVLW\DOYLUXVKDVWDOÕNODUÕQGDQD\UÕOPDVÕJHUHNOLGLU 7('$9ø +DVWD NDUDQWLQD\D DOÕQPDOÕGÕU +DVWDQÕQ \DNÕQ WHPDVWD EXOXQGX X \DNÕQODUÕ X\DUÕOPDOÕYHHQD]ELUKDIWDER\XQFDDNFL HUEHOLUWLOHULL]OHQPHOLGLU %X J QN ELOJLOHULPL]H J UH EX KDVWDOÕN DQWLEL\RWLNULEDYLULQNRUWLNRVWHUoid oo V LOH WHGDYL HGLOPHNWHGLU $WLSLN EDNWHUL\HO SQ PRQLGH NXOODQÕODQ ELU DQWLEL\RWLN verilmesinin sebebi konservatiftir. Mesela beta laktam veya bir makrolit seçilebilir. 0DNVLPXPHIHNWLIGR]KDVWDQÕQNLORVXQDX\JXQELoLPGHD\DUODQÕU Ribavirin isenrurqdyluxvodu ]HULQHHWNLOLRODQDQWLYLUDOLODoWÕU5LEDYLULQ LQGR]X J QGH GHID J GÕU 5LEDYLULQ X\JXODQDQ 6$56 OÕ KDVWDODUÕQ VÕQGD KHPROL] J U OPHNWH XQGDKHPRJORELQVHYL\HVLJG/ QLQDOWÕQDG úphnwhglu$pdkdod en uygun tedavidir. RLEDYLULQNRQWUHQGLNHROGX XQGD2VHOWDPLYLUYHULOHELOLU.RUWLNRVWHURLGOHU RUDO YH\DSDUHQWHUDO \ROGDQ YHULOHELOLU7HUFLKDQ øqwudyhq ] PHWK\OSUHGQLVRORQHPJYHULOLUYHKDVWDQÕQVROXQXPXJ ]OHPDOWÕQGDWXWXOXU Antibiyotik, ribavirin ve methylprednisoorqhlohwhgdylhglohq6$56ú SKHOL YDNDGD WDQHVL KÕ]OD YH NDOÕFÕ RODUDN G ]HOPLú KDVWD GDKD \DYDú RODUDN G ]HOPLú KDVWDODUGDQ VDGHFH WDQHVLQH QRQLQYD]LI YHQWLODV\RQ RNVLMHQ PDVNHVL X\JXODPDNJHUHNOLROPXúHQW EDV\RQJHUHNPHPLú O PJ U OPHPLúWLU 5LQRYLUXV&SURLQKLELW UOHULQL6&9 XQ0SURDQWLMHQLQLKHGHIDODFDNúHNLOGH PRGLIL\HHGHUHN\HQLWHGDYLPHWRWODUÕDUDQPDNWDGÕU (3ø'(0ø<2/2-ø +DVWDOÕ ÕQ ONHOHUDUDVÕ\D\ÕOPDVÕQGDVH\DKDWHGHQLQVDQODUÕQYHKD\YDQODUÕQ URO YDUGÕU.XOXoNDV UHVLQLQ\DNODúÕNELUKDIWDNDGDUROPDVÕVHEHEL\OHELUKDIWDGDQ GDKD X]XQ V UHQ GHQL]DúÕUÕ \ROFXOXNODUGD JHPL LOH VH\DKDW HGHQOHULQ KDVWDOÕ Õ EHOLUWLOHUL RUWD\D oõnpdgdq WDúÕPDVÕ N o N ELU LKWLPDOGLU +DOEXNL PLNURRUJDQL]PD LOH infekte olan ama henüz hloelueholuwlyhuph\hqelulqvdqõqxodnlohvh\dkdwhghuhnelu EDúND ONH\H JLUPHVL SHN P PN QG U % \OH ELU KDVWD KDYDDODQÕQGD PXD\HQH HGLOHUHN RUWD\D oõnduõodpd] =DWHQ XOXVODUDUDVÕ KDYD\ROODUÕ OLPDQODU NDUJR PHUNH]OHULNRQWURODOWÕQGDWXWXOPDVÕQDUD men 7-Mart-2003 te Toronto da birisi 144 NLúLOLNGL HULNLúL\LYHVD OÕNoDOÕúDQÕQÕHWNLOH\HQLNLVDOJÕQUDSRUHGLOPLúWLU 2-Nisan-WDULKLQGHEXKDVWDOÕNWDQNLúL OP úyhpxkwhphohqnlúl KDVWDODQPÕúWÕU (VHU \D\ÕQD KD]ÕUODQGÕ Õ VÕUDGD 0D\ÕV WDULKL LWDEDUÕ LOH EX KDVWDOÕNWDQ NLúL OP ú PXKWHPHOHQ NLúL KDVWDODQPÕúWÕU %X UDNDPODU KDVWDOÕ ÕQLOHUOHPHKÕ]ÕQÕJ VWHUPHNWHGLU honhpl]ghkhq ]KLo6$56YDNDVÕELOGLULOPHPLúWLU &'& ú SKHOL YDNDODUÕQ UDSRU HGLOPHVL LoLQ ELU Lnternet adresi ve bir telefon ELOGLUPLúWLUhttp://www.cdc.gov/ncidod/sars, 770-488-7100). %8/$ù0$-KORUNMA: %XODúPD\DNÕQWHPDVLOHROXU 9LUXVXQGURSOHWOHULOHoHYUH\HVDoÕOGÕ ÕELOLQPHNWHGLU6ROXQXPVDOJÕODUÕQGDYH ELOKDVVDDWHúOLG QHPGHGÕúNÕGD6&9WHVSLWHGLOPLúWLU'ROD\ÕVÕ\ODKDVWDQÕQE W Q oõnduwõoduõlqihnwlindexohglopholglu2uwdnnxoodqõpdudooduõ\dwdn\dvwõnndúõnkdyox JL\VLOHU ELU V UH YLUXV EXOXQGXUDELOLUOHU +DVWDQÕQ NXOODQÕP Hú\DODUÕ NRQWDPLQH

979 PDWHU\DORODUDNNDEXOHGLOPHOLGLU<DNÕQWHPDVWDEXOXQPDN S úphnd\qõhú\doduõ NXOODQPDN GXUXPXQGD EXODúPD P PN QG U 6&9 GURSOHWOHU KDOLQGH KDYD\D VDoÕOÕU YH\DY FXWVDOJÕODUÕLOHHú\DODUDEXODúDELOLU'URSOHWOHULQVROXQPDVÕJ ]EXUXQD Õ] PXNR]DVÕQDWHPDVHWPHVLLQIHNVL\RQXEXODúWÕUDELOLU +DVWDQÕQ PO EDOJDPÕQGD PLO\RQ YLUDO 51$ WHVSLW HGLOPLúWLU +DOEXNL YLUXVKDVWDQÕQVHUXPGDoRNGDKDD]PLNWDUGDEXOXQXU Hastalar daima 1) eldiven, 2)koruyucu önlük ve 3)maske ile muayene HGLOPHOLGLUHOOHULQ\ÕNDQPDVÕELOKDVVD QHPOLGLU0DVNHJ ]OHULGHLoHULVLQHDODFDN úhnloghropdoõgõu0dvnhqlqnrux\xfxhwnlvlgl HUE W Q QOHPOHUGHQID]ODGÕU 6$56 KDVWDOÕ ÕQD \DNDODQDQ KDVWDKDQH SHUVRQHOL ]HULQGH JHUL\H G Q N incelemelerde bu G UW QOHPGHQHQD]ELULVLQLDOPDGÕ ÕWHVSLWHGLOPLúWLU%X QOHPOHUL DODQ KDVWDKDQH SHUVRQHOLQGH KDVWDOÕ D UDVWODQPDPÕúWÕU0DVNHQLQNRUX\XFXOX X S ]HO QO Q NRUX\XFXOX XQGDQ S YH HO \ÕNDPDQÕQ NRUX\XFXOX XQGDQ S ID]ODGÕU øqihnwh RODQODUÕQ KHSVLQLQ HQ D] ELU GHID PDVNHVLQLoÕNDUWWÕNODUÕWHVSLWHGLOPLúWLUS 8QXWPDPDN JHUHNLUNL YDNDODUÕQ QHPOL ELU NÕVPÕ KDVWDKDQHOHUGHQ EXODúPDúHNOLQGHROPDNWDGÕU+DVWDKDQH QFHVLQGHEXODúPDGDKDD]GÕU%XVHEHSOH VD OÕN SHUVRQHOLQLQ QFH NHQGLVLQL VRQUD EDúNDODUÕQÕ NRUXPDN LoLQ GURSOHWOHU LOH P FDGHOHHWPHVLúDUWWÕU +HQ ]ELUDúÕVÕ\RNWXU KAYNAKLAR: 1.$NDQ(URO&RURQDYLUXVODU*HQHOYHg]HO9LURORML QF EDVNÕø]PLU6DUD\7ÕS.LWDEHYL 1994: 495-502. 2. Anand K, Ziebuhr J, Wadhwani P, et al., Coronavirus Main Proteinase (3CLpro) Structure: Basis for Design of Anti-SARS Drugs. Science, 2003; May 13 (in press). 3. Booth CM, Matukas LM, Tomlinson GA, et al.,clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto Area. JAMA, 2003; May 6 (in press). 4. Drosten C, Gunther S, Preiser W, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med, 2003; 348(20):1967-1976. 5. Fouchier RA, Kuiken T, Schutten M, et al. Aetiology: Koch's postulates fulfilled for SARS virus. Nature, 2003; 423(6937):240. 6. Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med, 2003; 348(20):1953-1966. 7. Lapinsky SE, Hawryluck L. ICU management of severe acute respiratory syndrome. Intensive Care Med, 2003; May 9 (in press). 8. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003; 348(20):1986-1994. 9. Rickerts V, Wolf T, Rottmann C, et al.clinical presentation and management of the severe acute respiratory syndrome (SARS). Dtsch Med Wochenschr, 2003; 128(20):1109-1114. 10. Marra MA, Jones SJ, Astell CR, et al. The Genome Sequence of the SARS-Associated Coronavirus. Science, 2003; May 1 (in press). 11. Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet 2003;361(9366):1319-25. 12. Seto WH, Tsang D, Yung R, et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet, 2003; 361(9368):1519-1520. 13. So LK, Lau AC, Yam LY, et al. Development of a standard treatment protocol for severe acute respiratory syndrome. Lancet, 2003; 361(9369):1615-1617. 14. Tsang KW, Ho PL, Ooi GC, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med, 2003; 348(20):1977-1985. 15. Wong KT, Antonio GE, Hui DS, et al. Thin-Section CT of Severe Acute Respiratory Syndrome: Evaluation of 74 Patients Exposed to or with the Disease. Radiology, 2003; May 8 (in press).