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¹ Department of Pathology, Peking University, Beijing, China 100083
² Department of Microbiology, Peking University, Beijing, China 100083
³ Beijing Ditan Hospital, Beijing, China 100011
⁴ State University of New York Health Science Center at Brooklyn, Brooklyn, NY 11203
⁵ Hunter Area Pathology Services and Discipline of Anatomical Pathology, University of Newcastle, Newcastle, Australia 2310

CORRESPONDENCE Jiang Gu: jgu{at}privatedoctor.org

After >8,000 infections and >700 deaths worldwide, the pathogenesis of the new infectious disease, severe acute respiratory syndrome (SARS), remains poorly understood. We investigated 18 autopsies of patients who had suspected SARS; 8 cases were confirmed as SARS. We evaluated white blood cells from 22 confirmed SARS patients at various stages of the disease. T lymphocyte counts in 65 confirmed and 35 misdiagnosed SARS cases also were analyzed retrospectively. SARS viral particles and genomic sequence were detected in a large number of circulating lymphocytes, monocytes, and lymphoid tissues, as well as in the epithelial cells of the respiratory tract, the mucosa of the intestine, the epithelium of the renal distal tubules, the neurons of the brain, and macrophages in different organs. SARS virus seemed to be capable of infecting multiple cell types in several organs; immune cells and pulmonary epithelium were identified as the main sites of injury. A comprehensive theory of pathogenesis is proposed for SARS with immune and lung damage as key features.

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