Influenza A virus infection complicated by fatal myocarditis
Influenza A virus infection complicated by fatal myocarditis
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DOI：
10.1097/00000433-200012000-00016
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发表时间：
2000-12-01
影响因子：
1
通讯作者：
Zaki, SR
中科院分区：
文献类型：
--
作者：
Nolte, KB;Alakija, P;Zaki, SR
流感病毒通常会引起发热性呼吸道疾病，但它也会出现各种其他临床表现。我们报告一个致命的病例心肌炎与甲型流感感染。一名先前健康的11岁女孩在家中突然出现致命性虚脱前约1周出现不适和发热。尸检显示心包积液、混合淋巴细胞性和嗜酸性心肌炎、轻度淋巴细胞性间质性肺炎、局灶性支气管/细支气管粘膜坏死和符合哮喘的组织学变化。通过从死后鼻咽拭子中分离出病毒，证实了甲型流感（H3 N2）感染。从心脏和肺组织中分离病毒的尝试没有成功。针对甲型流感抗原的免疫组织化学检测和甲型流感遗传物质的原位杂交显示支气管上皮细胞染色阳性，而心脏切片呈阴性。猝死是流感的罕见并发症，可能由心肌炎引起。法医病理学家应该意识到，死后鼻咽拭子的病毒培养和肺组织的免疫组化或原位杂交程序可能是必要的，以实现诊断。由于在心脏组织中既不能鉴定出可培养的病毒，也不能鉴定出流感病毒抗原，因此本例流感性心肌炎的发病机制不太可能是病毒直接感染心肌的结果。在流感感染期间发生心肌炎的危险因素尚不清楚。
Influenza virus typically causes a febrile respiratory illness, but it can present with a variety of other clinical manifestations. We report a fatal case of myocarditis associated with influenza A infection. A previously healthy 11-year-old girl had malaise and fever for approximately 1 week before a sudden, witnessed fatal collapse at home. Autopsy revealed a pericardial effusion, a mixed lymphocytic and neutrophilic myocarditis, a mild lymphocytic interstitial pneumonia, focal bronchial/bronchiolar mucosal necrosis, and histologic changes consistent with asthma. Infection with influenza A (H3N2) was confirmed by virus isolation from a postmortem nasopharyngeal swab. Attempts to isolate virus from heart and lung tissue were unsuccessful. Immunohistochemical tests directed against influenza A antigens and in situ hybridization for influenza A genetic material demonstrated positive staining in bronchial epithelial cells, whereas heart sections were negative. Sudden death is a rare complication of influenza and may be caused by myocarditis. Forensic pathologists should be aware that postmortem nasopharyngeal swabs for viral culture and immunohistochemical or in situ hybridization procedures on lung tissue might be necessary to achieve a diagnosis. Because neither culturable virus nor influenza viral antigen could be identified in heart tissue, the pathogenesis of influenza myocarditis in this case is unlikely to be the result of direct infection of myocardium by the virus. The risk factors for developing myocarditis during an influenza infection are unknown.