Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009-2010
Pathology and virology findings in cases of fatal influenza A H1N1 virus infection in 2009-2010
复制标题
DOI：
10.1111/j.1365-2559.2011.04081.x
复制
发表时间：
2012-01-01
期刊：
影响因子：
6.4
通讯作者：
Joshi, Kusum
中科院分区：
文献类型：
--
作者：
Bal, Amanjit;Suri, Vikas;Joshi, Kusum
目的：描述印度北部致命性H1N1流感病毒感染病例的病理表现、病毒抗原的免疫组化定位和不同器官的组织逆转录酶聚合酶链反应（RT-PCR）结果。方法与结果：采用咽拭子实时RT-PCR （rRT-PCR）检测H1N1病毒阳性的患者9例。潜在的危险因素包括怀孕、呼吸系统疾病、风湿性心脏病和慢性肾病。所有病例的病理表现均为气管炎、坏死性细支气管炎和弥漫性肺泡损伤。免疫组化法可在气管支气管树上皮、支气管腺、腺导管中观察到流感病毒抗原，在肺泡上皮细胞中也可观察到流感病毒抗原。在三例尸检病例中，电子显微镜证实了病毒颗粒。H1N1病毒RNA的组织rRT-PCR在肺样本中呈阳性，但在其他器官中呈阴性。继发细菌性肺炎、巨细胞病毒感染、血管侵袭性接合菌病。结论：肺部的表现与过去大流行中描述的相似。注意到以前未报道的继发性真菌和病毒感染。虽然本研究中的病例数量很少，但研究结果强化了肺外器官的变化可归因于多器官功能障碍综合征而不是病毒细胞病变效应的观点，并且没有病毒经胎盘传播。
Aims: To describe the pathological findings, immunohistochemical localization of viral antigen and tissue reverse transcriptase polymerase chain reaction (RT-PCR) findings of different organs in cases of fatal H1N1 influenza virus infection from North India.Methods and results: Nine patients positive for H1N1 virus by a throat swab real-time RT-PCR (rRT-PCR) were included. Underlying risk factors included pregnancy, respiratory diseases, rheumatic heart disease, and chronic kidney disease. Pathological evidence of tracheitis, necrotizing bronchiolitis and diffuse alveolar damage was noted in all of the cases. Influenza viral antigen was observed by immunohistochemistry in the epithelium of the tracheobronchial tree, bronchial glands, gland ducts, and, less frequently, the alveolar epithelial cells. Viral particles were confirmed by electron microscopy in three autopsy cases. Tissue rRT-PCR for H1N1 viral RNA was positive in lung samples, but negative in other organs. Secondary bacterial pneumonia, cytomegalovirus infection and angio-invasive zygomycosis were detected.Conclusions: The pulmonary findings are similar to those described in past pandemics. Secondary fungal and viral infections, which have not been reported previously, were noted. Although the number of cases in this study is small, the findings reinforce the notion that changes in extrapulmonary organs are attributable to multiorgan dysfunction syndrome rather than a viral cytopathic effect, and that there is no transplacental transmission of virus.