Introduction

The first diagnosis of severe acute respiratory syndrome (SARS) in North America was made in Toronto on 13 March 2003. This was the first recognized case of the disease outside of Asia. By 2 June, 198 cases of probable SARS were reported in Canada, 30 (15%) of whom had died. In the US at the same time 66 cases of probable SARS had been reported, none of whom had died.

The first patient with SARS in North America was a 78-year-old woman who returned home to Toronto on 23 February 2003 after a visit to relatives in Hong Kong. Two days later she developed fever, myalgia, sore throat and mild non-productive cough. Five days later she developed increasing cough and dyspnoea. She died 3 days later, on 5 March, at home, 9 days after the onset of her illness. The diagnosis of SARS was only made in retrospect.

The index patient's 43-year-old son developed fever and sweating on 27 February, 2 days after his mother first noted the symptoms. He subsequently developed non-productive cough, chest pain, and dyspnoea and eventually high fever (temperature, 39.8°C).

A chest radiograph revealed bilateral lower lobe consolidation. He was admitted to the hospital with a diagnosis of community-acquired pneumonia. On the 2nd day after admission, he developed respiratory failure, was intubated and received mechanical ventilation.