1
|
Ishiguro T, Toriba R, Uozumi R, Numagami H, Shimizu Y. Histologic Characteristics and Clinical Courses of Primary Viral Pneumonia Other than COVID-19. Intern Med 2023; 62:3609-3617. [PMID: 37779065 PMCID: PMC10781553 DOI: 10.2169/internalmedicine.2433-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
Objective To clarify both the histologic changes in primary viral pneumonia other than COVID-19 and whether patients with severe lung injury (SLI) on biopsy specimens progress to severe respiratory insufficiency. Methods Patients with primary viral pneumonia other than COVID-19, who underwent lung tissue biopsy, were retrospectively studied. Patients Forty-three patients (41 living patients and 2 autopsied cases) were included in the study. Results Nine patients had SLI, whereas most of patients who recovered from primary viral pneumonia showed a nonspecific epithelial injury pattern. One patient underwent a biopsy under mechanical ventilation. Two of 8 (25.0%) patients on ambient air or low-flow oxygen therapy progressed to a severe respiratory condition and then to death, while only 1 (3.1%) of 32 patients without SLI progressed to a severe respiratory condition and death (p=0.096). The proportion of patients who required O2 treatment for ≥2 weeks was higher in patients with SLI than in those without SLI (p=0.033). The 2 autopsy cases showed a typical pattern of diffuse alveolar damage, with both showing hyaline membranes. Non-specific histologic findings were present in 32 patients without SLI. Conclusion Some patients with SLI progressed to severe respiratory insufficiency, whereas those without SLI rarely progressed to severe respiratory insufficiency or death. The frequency of patients progressing to a severe respiratory condition or death did not differ significantly between those with and without SLI. The proportion of patients who required longer O2 treatment was higher in SLI group than in those without SLI.
Collapse
Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Riho Toriba
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Ryuji Uozumi
- Department of Industrial Engineering and Economics, Tokyo Institute of Technology, Japan
| | - Hidehiro Numagami
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| |
Collapse
|
2
|
The Clinical Presentation and Immunology of Viral Pneumonia and Implications for Management of Coronavirus Disease 2019. Crit Care Explor 2020; 2:e0109. [PMID: 32426751 PMCID: PMC7188425 DOI: 10.1097/cce.0000000000000109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This review will briefly examine the clinical presentation and important immunology of viral pneumonia with a focus on severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019).
Collapse
|
3
|
Nuñez-Conde A, Marquez-Algaba E, Falcó V, Almirante B, Burgos J. Organizing pneumonia secondary to influenza infection: Two case reports and a literature review. Enferm Infecc Microbiol Clin 2019; 38:123-126. [PMID: 31126691 DOI: 10.1016/j.eimc.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Organizing pneumonia (OP) is a rare complication of influenza virus infection but scarce data are available. The recognition of this entity is important because require appropriate treatment. METHODS We report two cases and perform a systematic review on PubMed database. Only cases with histological confirmation of OP and influenza virus positive laboratory test were included. RESULTS We collected 16 patients. Median age was 52 year, 20% of patients were smokers and 43.8% had not any comorbidity. Influenza A virus infection was diagnosed in 75%. Clinical manifestation consisted on a respiratory deterioration with a median time of appearance of 14 days. Radiological pattern observed was ground-glass opacities with consolidations. Survival was observed in 12 patients (75%). All three patients who did not receive steroid treatment died. CONCLUSION Physicians must be aware that patients with influenza infection with a torpid course could be developing OP and prompt corticoid therapy should be instaured.
Collapse
Affiliation(s)
- Andrea Nuñez-Conde
- Internal Medicine Department, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Marquez-Algaba
- Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquin Burgos
- Infectious Diseases Department, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| |
Collapse
|
4
|
Mouse Models Reveal Role of T-Cytotoxic and T-Reg Cells in Immune Response to Influenza: Implications for Vaccine Design. Viruses 2019; 11:v11010052. [PMID: 30641955 PMCID: PMC6356589 DOI: 10.3390/v11010052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 01/04/2023] Open
Abstract
Immunopathologic examination of the lungs of mouse models of experimental influenza virus infection provides new insights into the immune response in this disease. First, there is rapidly developing perivascular and peribronchial infiltration of the lung with T-cells. This is followed by invasion of T-cells into the bronchiolar epithelium, and separation of epithelial cells from each other and from the basement membrane leading to defoliation of the bronchial epithelium. The intraepithelial reaction may involve either CD8 or CD4 T-cytotoxic cells and is analogous to a viral exanthema of the skin, such as measles and smallpox, which occur when the immune response against these infections is activated and the infected cells are attacked by T-cytotoxic cells. Then there is formation of B-cell follicles adjacent to bronchi, i.e., induced bronchial associated lymphoid tissue (iBALT). iBALT reacts like the cortex of a lymph node and is a site for a local immune response not only to the original viral infection, but also related viral infections (heterologous immunity). Proliferation of Type II pneumocytes and/or terminal bronchial epithelial cells may extend into the adjacent lung leading to large zones filled with tumor-like epithelial cells. The effective killing of influenza virus infected epithelial cells by T-cytotoxic cells and induction of iBALT suggests that adding the induction of these components might greatly increase the efficacy of influenza vaccination.
Collapse
|
5
|
Taylor MS, Chivukula RR, Myers LC, Jeck WR, Waghray A, Tata PR, Selig MK, O'Donnell WJ, Farver CF, Thompson BT, Rajagopal J, Kradin RL. A Conserved Distal Lung Regenerative Pathway in Acute Lung Injury. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:1149-1160. [PMID: 29476724 DOI: 10.1016/j.ajpath.2018.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 12/05/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
Improved tools have led to a burgeoning understanding of lung regeneration in mice, but it is not yet known how these insights may be relevant to acute lung injury in humans. We report in detail two cases of fulminant idiopathic acute lung injury requiring extracorporeal membrane oxygenation in previously healthy young adults with acute respiratory distress syndrome, one of whom required lung transplantation. Biopsy specimens showed diffuse alveolar injury with a striking paucity of alveolar epithelial regeneration, rare hyaline membranes, and diffuse contiguous airspace lining by macrophages. This novel constellation was termed diffuse alveolar injury with delayed epithelization. In addition, mirroring data from murine models of lung injury/regeneration, peribronchiolar basaloid pods (previously described as squamous metaplasia) and ciliated bronchiolarization were identified in these patients and in 39% of 57 historical cases with diffuse alveolar damage. These findings demonstrate a common and clinically relevant human disease correlate for murine models of severe acute lung injury. Evidence suggests that peribronchiolar basaloid pods and bronchiolarization are related spatially and temporally and likely represent overlapping sequential stages of the response to severe distal airway injury.
Collapse
Affiliation(s)
- Martin S Taylor
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Raghu R Chivukula
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura C Myers
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - William R Jeck
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Avinash Waghray
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Purushothama R Tata
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Martin K Selig
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Walter J O'Donnell
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Carol F Farver
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - B Taylor Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jayaraj Rajagopal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard L Kradin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| |
Collapse
|
6
|
|
7
|
Abstract
A wide variety of insults can produce acute lung damage, inclusive of those that injure the lungs directly. The clinical syndrome of acute onset respiratory distress, dyspnea, and bilateral infiltrates is referred to as acute respiratory distress syndrome. The histologic counterpart of acute respiratory distress syndrome is diffuse alveolar damage, classically characterized by hyaline membranes. Other histologic features of acute lung injury include intraalveolar fibrin, organization, interstitial edema, and reactive pneumocytes. Diffuse alveolar damage and other histologic features of acute lung injury are nonspecific as to etiology, and once identified require the pathologist to search the biopsy for further features that may help identify a specific etiology. This chapter reviews the temporal sequence of acute lung injury and explores the large variety of specific etiologic causes with emphasis on helpful histologic features to identify.
Collapse
|
8
|
Abstract
A review of pulmonary infections of all types with diagnostic and morphological features.
Collapse
|
9
|
|
10
|
Fino KK, Yang L, Silveyra P, Hu S, Umstead TM, DiAngelo S, Halstead ES, Cooper TK, Abraham T, Takahashi Y, Zhou Z, Wang HG, Chroneos ZC. SH3GLB2/endophilin B2 regulates lung homeostasis and recovery from severe influenza A virus infection. Sci Rep 2017; 7:7262. [PMID: 28779131 PMCID: PMC5544693 DOI: 10.1038/s41598-017-07724-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022] Open
Abstract
New influenza A viruses that emerge frequently elicit composite inflammatory responses to both infection and structural damage of alveolar-capillary barrier cells that hinders regeneration of respiratory function. The host factors that relinquish restoration of lung health to enduring lung injury are insufficiently understood. Here, we investigated the role of endophilin B2 (B2) in susceptibility to severe influenza infection. WT and B2-deficient mice were infected with H1N1 PR8 by intranasal administration and course of influenza pneumonia, inflammatory, and tissue responses were monitored over time. Disruption of B2 enhanced recovery from severe influenza infection as indicated by swift body weight recovery and significantly better survival of endophilin B2-deficient mice compared to WT mice. Compared to WT mice, the B2-deficient lungs exhibited induction of genes that express surfactant proteins, ABCA3, GM-CSF, podoplanin, and caveolin mRNA after 7 days, temporal induction of CCAAT/enhancer binding protein CEBPα, β, and δ mRNAs 3-14 days after infection, and differences in alveolar extracellular matrix integrity and respiratory mechanics. Flow cytometry and gene expression studies demonstrated robust recovery of alveolar macrophages and recruitment of CD4+ lymphocytes in B2-deficient lungs. Targeting of endophilin B2 alleviates adverse effects of IAV infection on respiratory and immune cells enabling restoration of alveolar homeostasis.
Collapse
Affiliation(s)
- Kristin K Fino
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Linlin Yang
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Patricia Silveyra
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
- Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Sanmei Hu
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Todd M Umstead
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Susan DiAngelo
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - E Scott Halstead
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA
- Department of Pediatrics, Critical Care Medicine, Pennsylvania State University College of Medicine, Pennsylvania, USA
- Children's Hospital, Penn State Health Milton S. Hershey Medical Center, Pennsylvania, USA
| | - Timothy K Cooper
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Pennsylvania, USA
- Department Pathology, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Thomas Abraham
- Department of Neural and Behavioral Sciences, and the Microscopy Imaging Facility, Pennsylvania, USA
| | - Yoshinori Takahashi
- Department of Pediatrics, Hematology Oncology, Pennsylvania State University College of Medicine, Pennsylvania, USA
| | - Zhixiang Zhou
- The College of Life Science and Bioengineering, Beijing University of Technology, Beijing, China
| | - Hong Gang Wang
- Department of Pediatrics, Hematology Oncology, Pennsylvania State University College of Medicine, Pennsylvania, USA.
- Department of Pharmacology, Pennsylvania State University College of Medicine, Pennsylvania, USA.
| | - Zissis C Chroneos
- Department of Pediatrics, Pulmonary Immunology and Physiology Laboratory, Pennsylvania State University College of Medicine, Pennsylvania, USA.
- Department of Microbiology and Immunology, Pennsylvania State University College of Medicine, Pennsylvania, USA.
| |
Collapse
|
11
|
El Seify MY, Fouda EM, Ibrahim HM, Fathy MM, Husseiny Ahmed AA, Khater WS, El Deen NNMS, Abouzeid HGM, Hegazy NRA, Elbanna HSS. Microbial Etiology of Community-Acquired Pneumonia Among Infants and Children Admitted to the Pediatric Hospital, Ain Shams University. Eur J Microbiol Immunol (Bp) 2016; 6:206-214. [PMID: 27766169 PMCID: PMC5063013 DOI: 10.1556/1886.2016.00022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/09/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND While recognizing the etiology of community-acquired pneumonia is necessary for formulating local antimicrobial guidelines, limited data is published about this etiology in Egyptian pediatric patients. OBJECTIVES To determine the frequency of bacterial and viral pathogens causing community-acquired pneumonia (CAP) among immunocompetent Egyptian infants and preschool children. METHODS Ninety infants and preschool-age children admitted to our hospital with CAP were prospectively included in the study. Etiological agents were identified using conventional bacteriological identification methods and IgM antibodies detection against common atypical respiratory bacteria and viruses. RESULTS An etiology was identified in 59 patients (65.5%). Bacterial pathogens were detected in 43 (47.8%) of the cases while viral pathogens were detected in 23 (25.5%). Coinfection with more than one etiologic agent was evident in seven patients (7.8%). The most common typical bacterial cause of pneumonia was Staphylococcus aureus (n = 12, 13.3%), followed by Streptococcus pneumoniae and Klebsiella pneumoniae (n = 7, 7.8%, each). The commonest atypical bacterium was Mycoplasma pneumoniae (n = 10, 11.1%), whereas the commonest viral etiology was influenza viruses (n = 11, 12.2%). CONCLUSION Although we could not determine the causative agent in some studied cases, this study provides preliminary data regarding the spectrum and frequency of microorganisms causing CAP in Egyptian infants and preschool children.
Collapse
Affiliation(s)
| | - Eman Mahmoud Fouda
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Maha Muhammad Fathy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Walaa Shawky Khater
- Medical Microbiology and Immunology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | | |
Collapse
|
12
|
Parsons CS, Helm EJ. Pneumonia and acute respiratory distress syndrome. IMAGING 2016. [DOI: 10.1183/2312508x.10003315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
13
|
Ishiguro T, Takayanagi N, Kanauchi T, Uozumi R, Kawate E, Takaku Y, Kagiyama N, Shimizu Y, Hoshi T, Morita S, Sugita Y. Clinical and Radiographic Comparison of Influenza Virus-associated Pneumonia among Three Viral Subtypes. Intern Med 2016; 55:731-7. [PMID: 27041156 DOI: 10.2169/internalmedicine.55.5227] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Presently, the predominant subtypes of influenza viruses in the world, except for those in local epidemics, include influenza pandemic H1N1 2009 (pH1N1), H3N2, and B viruses. There are few reports on the differences in the clinical features, radiographic findings, treatment, and outcomes of influenza virus-associated pneumonia among these three viral subtypes. The purpose of this study was to investigate whether the clinical features, radiographic findings, treatment, and outcomes differ among the viral subtypes. METHODS We retrospectively analyzed 96 patients with influenza virus-associated pneumonia whose viral subtypes were clarified. RESULTS Patients with pH1N1 virus-associated pneumonia tended to be young. The frequency of primary viral pneumonia differed among the virus-associated pneumonia subtypes (pH1N1, 80%; H3N2, 26.5%; and B, 31%). Patients with pH1N1 virus-associated pneumonia more frequently showed bilateral ground-glass opacities (GGOs), which affected more lobes than in patients with H3N2 and B virus-associated pneumonia. However, patients with H3N2 virus-associated pneumonia showed a higher frequency of consolidation and diffuse bronchial wall thickening than did the patients with pH1N1 virus-associated pneumonia. The severity and mortality did not differ among the three pneumonia subtypes. CONCLUSION In the patients who developed influenza virus-associated pneumonia, those with pH1N1 virus-associated pneumonia frequently developed primary viral pneumonia resulting in bilateral and broad areas of GGOs on imaging, whereas patients with H3N2 virus-associated pneumonia frequently showed consolidation and diffuse bronchial wall thickening on pulmonary imaging.
Collapse
MESH Headings
- Adult
- Female
- Humans
- Influenza A Virus, H1N1 Subtype/isolation & purification
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza B virus/isolation & purification
- Influenza, Human/complications
- Influenza, Human/diagnostic imaging
- Influenza, Human/physiopathology
- Influenza, Human/therapy
- Influenza, Human/virology
- Lung/diagnostic imaging
- Lung/physiopathology
- Lung/virology
- Male
- Middle Aged
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pneumonia, Viral/virology
- Radiography, Thoracic
- Retrospective Studies
- Satellite Viruses
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Sell S. Immunopathology of Experimental Models of Syphilis, Influenza, and Asthma. FORUM ON IMMUNOPATHOLOGICAL DISEASES AND THERAPEUTICS 2016; 7:225-236. [PMID: 29876142 PMCID: PMC5985826 DOI: 10.1615/forumimmundisther.2017020136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The introduction of immunopathologic reaction classification in the 1960s led to a major advance in understanding immune effector mechanisms and how lesions of immunopathologic diseases developed. In this article, immunopathologic mechanisms are presented for experimental models of syphilis, influenza, and asthma. The chancre of syphilis is a delayed hypersensitivity skin reaction that is initiated by sensitized T cells that activate macrophages to phagocytose and kill the infecting organism, Treponema pallidum, in interstitial tissues. The primary immune effector mechanism in experimental influenza is T-cell-mediated cytotoxicity that kills infected epithelial cells, bronchial lining cells, and Type-II pneumocytes, in a manner similar to viral exanthema. The bronchial lesions of the experimental model of asthma in mice are preceded by an immune complex vasculitis and not an immunoglobulin E-mediated mast cell mechanism.
Collapse
Affiliation(s)
- Stewart Sell
- Wadsworth Center, New York State Department of Health, Empire State Plaza, Albany, NY, 12201; Albany College of Pharmacy and Health Sciences, 106 New Scotland Avenue Albany, NY, 12208; Division of Biological Sciences, University at Albany, 1400 Washington Avenue, Albany, NY, 12222
| |
Collapse
|
15
|
Shenoy ES, Lai PS, Shepard JAO, Kradin RL. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 39-2015. A 22-Year-Old Man with Hypoxemia and Shock. N Engl J Med 2015; 373:2456-66. [PMID: 26672848 DOI: 10.1056/nejmcpc1507212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Diagnosis, Differential
- Fatal Outcome
- Herpesvirus 2, Human
- Humans
- Hypoxia/etiology
- Influenza A Virus, H3N2 Subtype/isolation & purification
- Influenza, Human/complications
- Influenza, Human/diagnosis
- Influenza, Human/virology
- Lung/diagnostic imaging
- Lung/pathology
- Male
- Pneumonia, Staphylococcal/diagnosis
- Pneumonia, Staphylococcal/etiology
- Pneumonia, Viral/etiology
- Pneumonia, Viral/virology
- Polymerase Chain Reaction
- Radiography
- Respiratory Insufficiency/etiology
- Shock/etiology
- Young Adult
Collapse
|
16
|
Sell S, Guest I, McKinstry KK, Strutt TM, Kohlmeier JE, Brincks E, Tighe M, Blackman MA, Woodland DL, Dutton RW, Swain SL. Intraepithelial T-cell cytotoxicity, induced bronchus-associated lymphoid tissue, and proliferation of pneumocytes in experimental mouse models of influenza. Viral Immunol 2015; 27:484-96. [PMID: 25479178 DOI: 10.1089/vim.2014.0077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Immunopathologic examination of the lungs of mice with experimental influenza virus infection reveals three prominent findings. (i) There is rapidly developing perivascular (arterial) and peribronchial infiltration with T-cells and invasion of T-cells into the bronchiolar epithelium, separation of epithelial cells from each other and from the basement membrane, leading to defoliation of the bronchial epithelium. This reaction is analogous to a viral exanthema of the skin, such as measles and smallpox. This previously described but unappreciated reaction most likely is an effective way to eliminate virus-infected cells, but may contribute to acute toxicity and mortality. (ii) After this, there is formation of dense collections of lymphocytes adjacent to bronchi consisting mainly of B-cells, with a scattering of T-cells and macrophages. This is known as induced bronchial-associated lymphoid tissue (iBALT) and correlates with increased interleukin (IL)-17 in the lung. iBALT provides sites for a local immune reaction in the lung to both the original infection and related viral infections (heterologous immunity). (iii) Within the first 2-3 weeks, there is proliferation of type II pneumocytes and/or terminal bronchial epithelial cells extending from the terminal bronchioles into the adjacent alveoli, eventually leading to large zones of the lung filled with tumor-like epithelial cells with squamous metaplasia. The proliferation correlates with IL-17 and IL-22 expression, and the extent of this reaction appears to be determined by the availability of T-regulatory cells.
Collapse
Affiliation(s)
- Stewart Sell
- 1 New York State Department of Health, Wadsworth Center , Albany, New York
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Dawn E Jaroszewski
- Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic, Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | | | | |
Collapse
|
18
|
Ishiguro T, Takayanagi N, Shimizu Y, Kagiyama N, Yanagisawa T, Sugita Y. A patient who survived primary seasonal influenza viral pneumonia: histologic findings obtained via bronchoscopy. Intern Med 2013; 52:2795-800. [PMID: 24334588 DOI: 10.2169/internalmedicine.52.1273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The histological findings and clinical course of primary seasonal influenza viral pneumonia have not been fully elucidated. We herein report the case of a 65-year-old man with primary seasonal influenza viral pneumonia. The patient presented with fever, myalgia, general fatigue and dyspnea of seven days duration. Chest computed tomography showed bilateral ground-glass opacity and consolidation. A rapid influenza virus antigen test was positive for influenza A virus. We diagnosed him as having community-acquired influenza pneumonia and started therapy with antibiotics plus oseltamivir; however, his symptoms, respiratory condition and radiological findings deteriorated. Polymerase chain reaction following bronchoscopy showed the bronchoalveolar lavage fluid to be positive for the influenza A virus. A right lower lobe transbronchial lung biopsy revealed type II pneumocyte metaplasia, acute and chronic interstitial infiltrates and alveolar organization without hyaline membranes or fibrin thrombi in the vascular lumen. Treatment with prednisolone at a dose of 60 mg/day (1 mg/kg) resulted in an improvement. The patient was discharged on hospital day 15. Two weeks after admission, the serum antibody titer for influenza A (H3N2) had increased significantly. No other pathogens were found either serologically or in the respiratory samples, and we diagnosed the patient to therefore have primary influenza viral pneumonia.
Collapse
Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | | | | | | | | | | |
Collapse
|
19
|
Shelke VN, Kolhapure RM, Kadam D, Sangle S, Chadha MC, Basu A, Mishra AC. Pathologic study of pandemic influenza A (H1N1) 2009 cases from India. Pathol Int 2012; 62:36-42. [PMID: 22192802 DOI: 10.1111/j.1440-1827.2011.02751.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The pandemic influenza A (H1N1) 2009 originated in Mexico and rapidly spread to the United States and many other countries. India reported the first pandemic influenza case in May 2009. Autopsy studies describing the pathology of pandemic influenza infection in humans have appeared in the literature and most of these were from Western countries. We present the clinicopathologic features in 46 fatal cases with confirmed pandemic influenza A (H1N1) 2009 virus infection during August 2009 to October 2010. Postmortem needle biopsy tissues were examined for histopathological changes and distribution of virus antigen by immunohistochemistry. The results are comparable with previous autopsy studies. Diffuse alveolar damage was the consistent finding in the lung tissues. However, underlying medical conditions were not noted in the cases from present study. Consistent presence of viral antigen was noted in the bronchiolar epithelium without any reference to the duration of illness. This study also emphasizes the use of the postmortem needle biopsy technique whenever an autopsy is not possible.
Collapse
Affiliation(s)
- Vijay N Shelke
- Department of Electron Microscopy and Histopath, Byramjee Jeejeebhoy Medical College and Hospital, Pune, India.
| | | | | | | | | | | | | |
Collapse
|
20
|
Wu XN, Yu CH, Cai W, Hua J, Li SQ, Wang W. Protective effect of a polyphenolic rich extract from Magnolia officinalis bark on influenza virus-induced pneumonia in mice. JOURNAL OF ETHNOPHARMACOLOGY 2011; 134:191-4. [PMID: 21146600 DOI: 10.1016/j.jep.2010.11.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2010] [Revised: 10/20/2010] [Accepted: 11/28/2010] [Indexed: 05/21/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Magnolia officinalis bark is used in traditional Chinese medicine for the treatment of cough, colds, fever, chronic bronchitis and stomach ailments. AIM OF THE STUDY To investigate therapeutic effects of polyphenol rich extract from M. officinalis bark (MPE) in influenza virus A-infected mice, and to provide evidence for the inflammation response and immunomodulatory potential during infection. MATERIALS AND METHODS Mice were infected with influenza virus A (IVA) and MPE at doses of 10 and 20mg/kg were orally administrated daily for 5 days after challenge. The levels of serum L-6 and TNF-α were determined by ELISA while protein expressions of NF-κB and TLR3 were detected by western blotting analysis. RESULTS MPE exhibited significant therapeutical effects on reducing levels of serum NO, IL-6 and TNF-α, inhibiting pneumonia, decreasing lung viral titers and sensitizing IVA-induced apoptosis through down-regulation of NF-κB and TLR3 protein expression in the lung tissue of IVA-infected mice. CONCLUSIONS MPE could exhibit preventive and therapeutical effects on IVA-infected mice as a suppressor of the production of inflammatory mediators, NO and pro-inflammatory cytokines, TNF-α and IL-6. These effects appeared to be mediated, at least in part, by an inhibition of TLR3 and NF-κB activation. Therefore, MPE could provide a safe and effective therapeutic approach for influenza and its subsequent viral pneumonia.
Collapse
Affiliation(s)
- Xiao-Ning Wu
- Zhejiang Medical College, Hangzhou 310053, China
| | | | | | | | | | | |
Collapse
|
21
|
|
22
|
|
23
|
|
24
|
Svetlikova D, Kabat P, Ohradanova A, Pastorek J, Betakova T. Influenza A virus replication is inhibited in IFN-λ2 and IFN-λ3 transfected or stimulated cells. Antiviral Res 2010; 88:329-33. [PMID: 20969894 DOI: 10.1016/j.antiviral.2010.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/11/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
Interferons lambda (IFN-λ) are the most recently defined members of the class III cytokine family. To investigate whether IFN-λ2 and IFN-λ3 displayed antiviral activity against influenza A virus (IAV), a number of cell lines induced with IFNs - as well as two established cell lines (A549-IFN-λ2 and A549-IFN-λ3) - were infected with IAV. Our results indicate that IFN-λ2 has statistically significant antiviral activity in A549-IFN-λ2 (P=0.0028) although less so than IFN-λ3, which reduced viral titer to 10% (P<0.0001). The reverse was observed for cells treated with IFNs, with IFN-λ2-treated A549 cells inhibiting IAV infection more efficiently than IFN-λ3-treated A549 cells. The antiviral effect on IFN-stimulated cells was most apparent on Vero cells (compared with MDCK and HeLa). Both IFNs significantly inhibited IAV replication and inhibition was observed in a dose-dependent manner, with an optimal IFN concentration of 20 ng/ml. IFN-λ2 was more potent than IFN-λ3 on Vero cells while IFN-λ3 appeared more efficient than IFN-λ2 on MDCK and HeLa cells.
Collapse
Affiliation(s)
- Darina Svetlikova
- Institute of Virology, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | | | | | | | | |
Collapse
|
25
|
Rosen DG, Lopez AE, Anzalone ML, Wolf DA, Derrick SM, Florez LF, Gonsoulin ML, Hines MO, Mitchell RA, Phatak DR, Haden-Pinneri K, Sanchez LA. Postmortem findings in eight cases of influenza A/H1N1. Mod Pathol 2010; 23:1449-57. [PMID: 20802471 DOI: 10.1038/modpathol.2010.148] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In March and early April 2009, cases of a new swine-origin influenza A (H1N1) virus were diagnosed in Mexico and the United States. Influenza virus presents as a respiratory infection with high morbidity and mortality. We describe the postmortem findings of eight confirmed cases of influenza A/H1N1 in a medical examiner setting. The eight cases falling under the jurisdiction of the Harris County Medical Examiner (Houston, TX, USA) with confirmed influenza A/H1N1 infection between June and September 2009 were included in this study. All cases were males between 6 months and 54 years of age. All adult patients had a body mass index from 31 to 49.8 kg/m(2). Five cases had comorbid conditions including one case with sleep apnea and mental retardation, three cases with chronic ethanolism, and one case with thymoma, sarcoidosis, and myasthenia gravis. The remaining three cases had no pre-existing medical conditions. All patients presented with severe flu-like symptoms; yet, only five were febrile. Rapid influenza diagnostic tests were performed in three cases by primary-care physicians, two of which were negative. None of the patients received antiviral medication. The average disease duration time was 8.2 days (3-14 days). A wide range of histopathological findings including tracheitis, necrotizing bronchiolitis, alveolitis, intra-alveolar hemorrhage, and hyaline membranes, both in a focal and in a diffuse distribution, were identified. Influenza A/H1N1 viral infection presents with a wide range of histological findings in a diffuse or focal distribution; most consistently with tracheitis, necrotizing bronchiolitis, and alveolitis with extensive alveolar hemorrhage. These histopathological findings at autopsy along with a clinical history of flu-like symptoms should raise suspicion for influenza A/H1N1 infection, and postmortem analysis by the reverse transcription-polymerase chain reaction (RT-PCR) is recommended for an accurate diagnosis.
Collapse
|
26
|
Cornejo R, Llanos O, Fernández C, Carlos Díaz J, Cardemil G, Salguero J, Luengo C, Tobar E, Romero C, Gálvez LR. Organizing pneumonia in patients with severe respiratory failure due to novel A (H1N1) influenza. BMJ Case Rep 2010; 2010:bcr0220102708. [PMID: 22767562 PMCID: PMC3027639 DOI: 10.1136/bcr.02.2010.2708] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The authors describe two cases that developed organizing pneumonia (OP) associated with novel influenza A(H1N1) virus. These patients were admitted to intensive care unit (ICU) because of severe respiratory failure. After initial clinical improvement, both patients worsened their condition during their second week of ICU stay, presenting fever, increasing in inflammatory parameters and worsening in oxygen exchange and respiratory mechanics. Chest x-rays and computed tomographies showed an increment on lung infiltrates, given by areas of consolidation and ground glass opacification. Although broad-spectrum antibiotics were administered, patients showed no improvement. All cultures, including bronchoalveolar lavage samples, were negative. In both cases, an open lung biopsy was performed, and histopathological examination of the specimen was compatible with OP. Both patients were successfully treated with high-dose corticoids. The aim of this report is to alert about the possibility of OP associated with novel influenza virus in patients with severe respiratory failure.
Collapse
Affiliation(s)
- Rodrigo Cornejo
- Medicine Department, Clinical Hospital Universidad de Chile, Santiago, Chile.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Harms PW, Schmidt LA, Smith LB, Newton DW, Pletneva MA, Walters LL, Tomlins SA, Fisher-Hubbard A, Napolitano LM, Park PK, Blaivas M, Fantone J, Myers JL, Jentzen JM. Autopsy findings in eight patients with fatal H1N1 influenza. Am J Clin Pathol 2010; 134:27-35. [PMID: 20551263 DOI: 10.1309/ajcp35kozsavnqzw] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A novel H1N1 influenza A virus emerged in April 2009, and rapidly reached pandemic proportions. We report a retrospective observational case study of pathologic findings in 8 patients with fatal novel H1N1 infection at the University of Michigan Health Systems (Ann Arbor) compared with 8 age-, sex-, body mass index-, and treatment-matched control subjects. Diffuse alveolar damage (DAD) in acute and organizing phases affected all patients with influenza and was accompanied by acute bronchopneumonia in 6 patients. Organizing DAD with established fibrosis was present in 1 patient with preexisting granulomatous lung disease. Only 50% of control subjects had DAD. Peripheral pulmonary vascular thrombosis occurred in 5 of 8 patients with influenza and 3 of 8 control subjects. Cytophagocytosis was seen in all influenza-related cases. The autopsy findings in our patients with novel H1N1 influenza resemble other influenza virus infections with the exception of prominent thrombosis and hemophagocytosis. The possibility of hemophagocytic syndrome should be investigated in severely ill patients with H1N1 infection.
Collapse
|
28
|
Busi Rizzi E, Schininà V, Ferraro F, Rovighi L, Cristoforo M, Chiappetta D, Lisena F, Lauria F, Bibbolino C. Radiological findings of pneumonia in patients with swine-origin influenza A virus (H1N1). LA RADIOLOGIA MEDICA 2010; 115:507-15. [PMID: 20526820 PMCID: PMC7101976 DOI: 10.1007/s11547-010-0553-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 01/13/2010] [Indexed: 01/15/2023]
Abstract
PURPOSE During spring 2009, a pandemic swine-origin influenza A (H1N1) virus (S-OIV) emerged and spread globally. We describe the chest X-ray and computed tomography (CT) findings of 40 patients with pneumonia due to S-OIV observed in our institution. MATERIAL AND METHODS Among 534 patients with S-OIV, according to the US Centers for Disease Control and Prevention case definition, seen between June and November 2009, 121 underwent chest X-ray and 40 (median age 44 years, range 16-79) had pneumonia. The initial chest radiographs were evaluated for pattern, distribution and extent of lung abnormalities. Unenhanced chest CT scans were performed in two patients and were reviewed for the same findings. Underlying medical conditions were present in 42% of patients (17/40). RESULTS Our patients had predominantly mild illness, and pneumonia was observed in 40 individuals (40/121 patients who had chest X-rays, 33%; and 40/534 patients with S-OIV, 7.5%). However, S-OIV can cause severe illness requiring admission to the intensive care unit for advanced mechanical ventilation and extracorporeal life support, including adult respiratory distress syndrome (ARDS) and death. The major radiological abnormalities observed were interstitial changes (60.0%), with (22.0%) or without patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones (7.5%). Extensive disease was seen in 37.5% (15/40), and ARDS was observed in three individuals (0.30%)with underlying medical conditions. Subtle pleural effusion was noted in four patients. CONCLUSIONS In our series, the most frequent pneumonia patterns observed during S-OIV (H1N1) virus were interstitial changes and patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones. CT, performed in severely ill patients, confirmed the ARDS identified with chest X-rays, better depicting the features and extent of lung abnormalities.
Collapse
Affiliation(s)
- E Busi Rizzi
- Diagnostic Department, Radiology, National Institute for Infectious Diseases L. Spallanzani, Via Portuense 292, 00149, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Mukhopadhyay S, Philip AT, Stoppacher R. Pathologic findings in novel influenza A (H1N1) virus ("Swine Flu") infection: contrasting clinical manifestations and lung pathology in two fatal cases. Am J Clin Pathol 2010; 133:380-7. [PMID: 20154276 PMCID: PMC7109771 DOI: 10.1309/ajcpxy17sulqkswk] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although novel influenza A (H1N1) virus infection has assumed pandemic proportions, there are few reports of the pathologic findings. Herein we describe the pathologic findings of novel influenza A (H1N1) infection based on findings in 2 autopsy cases. The first patient, a 36-year-old man, had flu-like symptoms; oseltamivir (Tamiflu) therapy was started 8 days after onset of symptoms, and he died on day 15 of his illness. At autopsy, the main finding was diffuse alveolar damage with extensive fresh intra-alveolar hemorrhage. The second patient, a 46-year-old woman with alcoholism, was found unresponsive in a basement and brought to the hospital intoxicated and confused. Her condition deteriorated rapidly, and she died 4 days after admission. The main autopsy finding was acute bronchopneumonia with gram-positive cocci, intermixed with diffuse alveolar damage. The pathologic findings in these contrasting cases of novel influenza A (H1N1) infection are similar to those previously described for seasonal influenza. The main pathologic abnormality in fatal cases is diffuse alveolar damage, but it may be overshadowed by an acute bacterial bronchopneumonia.
Collapse
|
30
|
Wang J, Oberley-Deegan R, Wang S, Nikrad M, Funk CJ, Hartshorn KL, Mason RJ. Differentiated human alveolar type II cells secrete antiviral IL-29 (IFN-lambda 1) in response to influenza A infection. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2009; 182:1296-304. [PMID: 19155475 PMCID: PMC4041086 DOI: 10.4049/jimmunol.182.3.1296] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Alveolar type II epithelial cells (ATIIs) are one of the primary targets for influenza A pneumonia. The lack of a culture system for maintaining differentiated ATIIs hinders our understanding of pulmonary innate immunity during viral infection. We studied influenza A virus (IAV)-induced innate immune responses in differentiated primary human ATIIs and alveolar macrophages (AMs). Our results indicate that ATIIs, but not AMs, support productive IAV infection. Viral infection elicited strong inflammatory chemokine and cytokine responses in ATIIs, including secretion of IL-8, IL-6, MCP-1, RANTES, and MIP-1beta, but not TNF-alpha, whereas AMs secreted TNF-alpha as well as other cytokines in response to infection. Wild-type virus A/PR/8/34 induced a greater cytokine response than reassortant PR/8 virus, A/Phil/82, despite similar levels of replication. IAV infection increased mRNA expression of IFN genes IFN-beta, IL-29 (IFN-lambda1), and IL-28A (IFN-lambda2). The major IFN protein secreted by type II cells was IL-29 and ATIIs appear to be a major resource for production of IL-29. Administration of IL-29 and IFN-beta before infection significantly reduced the release of infectious viral particles and CXC and CC chemokines. IL-29 treatment of type II cells induced mRNA expression of antiviral genes MX1, OAS, and ISG56 but not IFN-beta. IL-29 induced a dose-dependent decrease of viral nucleoprotein and an increase of antiviral genes but not IFN-beta. These results suggest that IL-29 exerts IFN-beta-independent protection in type II cells through direct activation of antiviral genes during IAV infection.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Animals
- Antiviral Agents/metabolism
- Cell Differentiation/genetics
- Cell Differentiation/immunology
- Cells, Cultured
- Chickens
- Female
- Gene Expression Regulation, Viral/immunology
- Humans
- Influenza A Virus, H1N1 Subtype/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H3N2 Subtype/genetics
- Influenza A Virus, H3N2 Subtype/immunology
- Interferon-beta/genetics
- Interferon-beta/metabolism
- Interferons
- Interleukins/genetics
- Interleukins/metabolism
- Macrophages, Alveolar/cytology
- Macrophages, Alveolar/immunology
- Macrophages, Alveolar/metabolism
- Macrophages, Alveolar/virology
- Male
- Middle Aged
- Pulmonary Alveoli/cytology
- Pulmonary Alveoli/immunology
- Pulmonary Alveoli/metabolism
- Pulmonary Alveoli/virology
Collapse
Affiliation(s)
- Jieru Wang
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206
| | | | - Shuanglin Wang
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206
| | - Mrinalini Nikrad
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206
| | - C. Joel Funk
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206
| | - Kevan L. Hartshorn
- Department of Hematology/Oncology, Boston University School of Medicine, Boston, MA 02118
| | - Robert J. Mason
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206
| |
Collapse
|
31
|
Taubenberger JK, Morens DM. The pathology of influenza virus infections. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2008; 3:499-522. [PMID: 18039138 DOI: 10.1146/annurev.pathmechdis.3.121806.154316] [Citation(s) in RCA: 751] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Influenza viruses are significant human respiratory pathogens that cause both seasonal, endemic infections and periodic, unpredictable pandemics. The worst pandemic on record, in 1918, killed approximately 50 million people worldwide. Human infections caused by H5N1 highly pathogenic avian influenza viruses have raised concern about the emergence of another pandemic. The histopathology of fatal influenza virus pneumonias as documented over the past 120 years is reviewed here. Strikingly, the spectrum of pathologic changes described in the 1918 influenza pandemic is not significantly different from the histopathology observed in other less lethal pandemics or even in deaths occurring during seasonal influenza outbreaks.
Collapse
Affiliation(s)
- Jeffery K Taubenberger
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
| | | |
Collapse
|
32
|
Seki M, Suyama N, Hashiguchi K, Hara A, Kosai K, Kurihara S, Nakamura S, Yamamoto K, Imamura Y, Izumikawa K, Kakaya H, Yanagihara K, Yamamoto Y, Mukae H, Tashiro T, Kohno S. A patient with fulminant influenza-related bacterial pneumonia due to Streptococcus pneumoniae followed by Mycobacterium tuberculosis infection. Intern Med 2008; 47:2043-7. [PMID: 19043258 DOI: 10.2169/internalmedicine.47.1473] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 74-year-old man with poorly controlled diabetes mellitus was admitted to our hospital because of severe respiratory disturbance, fever, and sputum. We found massive consolidation of the right lung and nodular shadows on the left lung on chest X-ray, and detected influenza virus and Streptococcus pneumoniae antigen from a nasopharyngeal swab and urine sample, respectively. Co-infection with influenza virus and bacteria was suspected, and oseltamivir and biapenem were prescribed. Laboratory data improved after the addition of sivelestat sodium hydrate, an inhibitor of neutrophil-derived elastase; however, chest X-ray findings became worse on Day 8, and we administered 1 g methylprednisolone intravenously for two days. On Day 12, we detected Mycobacterium tuberculosis in the sputum, even though we did not previously detect any acid-fast bacilli, and started anti-tuberculosis drugs, such as isoniazid, rifampicin, ethambutol hydrochloride, and pyrazinamide; however, the patient died 12 days later. Severe influenza-related bacterial pneumonia with Streptococcus pneumoniae and subsequently secondary tuberculosis infection were finally suspected in this case. This was a very rare case in which additional tuberculosis infection was found in a patient with fulminant pneumonia due to co-infection of influenza virus and bacteria. It is necessary to observe patients with influenza carefully, especially when steroids are used, even if antibiotics are also administered.
Collapse
Affiliation(s)
- Masafumi Seki
- Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Abstract
The lungs are among the most vulnerable to microbial assault of all organs in the body. From a contemporary vantage, lower respiratory tract infections are the greatest cause of infection-related mortality in the United States, and rank seventh among all causes of deaths in the United States.2,3 From a global and historic perspective, the scope and scale of lower respiratory tract infection is greater than any other infectious syndrome, and viral pneumonias have proven to be some of the most lethal and dramatic of human diseases. The 1918–1919 influenza pandemic, perhaps the most devastating infectious disease pandemic in recorded history, resulted in an estimated 40 million deaths worldwide, including 700,000 deaths in the U.S.4 The global outbreak of severe acute respiratory syndrome (SARS) during 2003, although considerably smaller in scale, resulted in 8098 cases and 774 deaths5 and is a dramatic contemporary example of the ability of viral pneumonias to rapidly disseminate and cause severe disease in human populations.
Collapse
|
35
|
Kanne JP, Godwin JD, Franquet T, Escuissato DL, Müller NL. Viral pneumonia after hematopoietic stem cell transplantation: high-resolution CT findings. J Thorac Imaging 2007; 22:292-9. [PMID: 17721347 DOI: 10.1097/rti.0b013e31805467f4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for many hematologic malignancies and nonmalignant disorders of bone marrow function. Pulmonary infections from bacterial, fungal, and viral organisms are a major cause of morbidity and mortality in patients after HSCT. The radiographic and high-resolution computed tomography (HRCT) findings of the different lower respiratory tract viral infections are quite similar. Findings of viral pneumonia on HRCT include small poorly defined centrilobular nodules and patchy, often bilateral, areas of peribronchial ground-glass opacity and consolidation. Air trapping may be present because of associated bronchiolitis. Interlobular septal thickening, bronchial wall thickening, and tree-in-bud opacities may also be present. Advanced viral pneumonia with diffuse alveolar damage is characterized by patchy or confluent consolidation and ground-glass opacities. Although nonspecific, in the correct clinical setting, these HRCT findings can help suggest the diagnosis of viral pneumonia in recipients of HSCT.
Collapse
Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, Vancouver General Hospital, Vancouver BC, Canada.
| | | | | | | | | |
Collapse
|
36
|
Longhi MP, Williams A, Wise M, Morgan BP, Gallimore A. CD59a deficiency exacerbates influenza-induced lung inflammation through complement-dependent and -independent mechanisms. Eur J Immunol 2007; 37:1266-74. [PMID: 17429844 PMCID: PMC2435422 DOI: 10.1002/eji.200636755] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Influenza-specific immune activity not only promotes virus clearance but also causes immunopathology, thereby underlining the importance of mounting a measured anti-viral immune response. Since complement bridges both the innate and adaptive immune systems and has been implicated in defence against influenza, the role of the complement regulator CD59a in modulating the response to influenza was explored. For this purpose, immune responses to influenza virus, strain E61-13-H17, in mice deficient in the complement regulator protein CD59a (Cd59a–/– mice) were compared to those in wild-type mice. The severity of lung inflammation was significantly enhanced in the lungs of Cd59a–/– mice with increased numbers of infiltrating neutrophils and CD4+ T cells. When complement was inhibited using soluble complement receptor1, the frequency of lung-infiltrating neutrophils in influenza-infected Cd59a–/– mice was much reduced whilst numbers of CD4+ T cells remained unchanged. These results demonstrate that CD59a, previously defined as a complement regulator, modulates both the innate and adaptive immune response to influenza virus by both complement-dependent and-independent mechanisms.
Collapse
Affiliation(s)
- M Paula Longhi
- Department of Medical Biochemistry and Immunology, School of Medicine, Cardiff University, Cardiff, UK.
| | | | | | | | | |
Collapse
|
37
|
Humphreys IR, Edwards L, Snelgrove RJ, Rae AJ, Coyle AJ, Hussell T. A critical role for ICOS co-stimulation in immune containment of pulmonary influenza virus infection. Eur J Immunol 2007; 36:2928-38. [PMID: 17039567 DOI: 10.1002/eji.200636155] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lung pathology observed during influenza infection is due to direct damage resulting from viral replication and bystander damage caused by overly exuberant antiviral immune mechanisms. In the absence of universally effective vaccines and antiviral therapies, knowledge of the cellular components required for immune containment of influenza is essential. ICOS is a late co-stimulatory molecule expressed by T cells 12-24 h after activation. We show for the first time that inhibition of ICOS with a monoclonal antibody reduces pulmonary T cell inflammation and associated cytokine expression. Surprisingly however, this reduction in T cells was not accompanied by an alleviation of weight loss and illness. Furthermore, lung viral titres were elevated following anti-ICOS treatment, suggesting that the beneficial outcome of reducing T cell pathology was masked by enhanced virus-induced damage and innate inflammation. This study demonstrates the delicate balance that exists between pathogen burden and pulmonary T cell inflammation during influenza infection and highlights the critical role of ICOS in this response.
Collapse
MESH Headings
- Animals
- Antibodies, Monoclonal/pharmacology
- Antigens, Differentiation, T-Lymphocyte/analysis
- Antigens, Differentiation, T-Lymphocyte/drug effects
- Antigens, Differentiation, T-Lymphocyte/physiology
- Cytokines/metabolism
- Female
- Inducible T-Cell Co-Stimulator Protein
- Influenza A virus/drug effects
- Mice
- Mice, Inbred BALB C
- Orthomyxoviridae Infections/immunology
- Orthomyxoviridae Infections/pathology
- Pneumonia, Viral/immunology
- Pneumonia, Viral/pathology
- T-Lymphocytes/immunology
- Virus Replication/drug effects
Collapse
Affiliation(s)
- Ian R Humphreys
- Centre for Molecular Microbiology and Infection, Department of Biochemistry, Imperial College, London, UK
| | | | | | | | | | | |
Collapse
|
38
|
Robertson SJ, Hasenkrug KJ. The role of virus-induced regulatory T cells in immunopathology. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 2006; 28:51-62. [PMID: 16841143 PMCID: PMC7079961 DOI: 10.1007/s00281-006-0019-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 05/17/2006] [Indexed: 12/14/2022]
Abstract
In recent years, regulatory T cells have received increased attention for their role in immune responses to microbial infections. The list of microbial pathogens associated with regulatory T cell responses is growing rapidly and includes bacteria, viruses, parasites, and fungi. As the biology of regulatory T cells is revealed, we are discovering that their induction during infection is a normal aspect of immunity, necessary to limit collateral damage from inflammatory responses and aggressive immunological effectors. Thus, these cells play a critical role in maintaining the delicate balance between preventing immunopathology and allowing the immune response to clear infections. While generally successful, there are notable exceptions where regulatory T cell-mediated suppression appears to be responsible for allowing certain viruses to establish and maintain a persistent state. In this review, we will discuss our current understanding of what virus-induced regulatory T cells are, how they are induced, and what mechanisms they use to suppress immunity. The complex role of Tregs in regulating immunity to viral infections, and the consequences their activity has on disease is illustrated by a review of specific viral infections including hepatitis C virus and human immunodeficiency virus.
Collapse
Affiliation(s)
- Shelly J. Robertson
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 903 South 4th St., Hamilton, MT 59840 USA
| | - Kim J. Hasenkrug
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 903 South 4th St., Hamilton, MT 59840 USA
| |
Collapse
|
39
|
Guarner J, Paddock CD, Shieh WJ, Packard MM, Patel M, Montague JL, Uyeki TM, Bhat N, Balish A, Lindstrom S, Klimov A, Zaki SR. Histopathologic and immunohistochemical features of fatal influenza virus infection in children during the 2003-2004 season. Clin Infect Dis 2006; 43:132-40. [PMID: 16779738 DOI: 10.1086/505122] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 03/27/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Centers for Disease Control and Prevention enhanced national surveillance for influenza-associated deaths among children because of early reports of pediatric deaths during the 2003-2004 influenza season. METHODS We studied lung and upper airway specimens from 47 case patients who died who had at least 1 positive result for influenza virus tests using hematoxylin and eosin, special stains for bacteria and fungi, and immunohistochemical (IHC) assays for influenza A and B viruses and other potential viral and bacterial respiratory pathogens. RESULTS Nineteen (40%) of the 47 patients were <or=2 years old, and 26 (55%) were female. Influenza IHC testing identified type A antigens in 26 patients and type B antigens in 1 patient. Influenza antigens were observed focally in bronchoepithelial cells and mucous glands of trachea, bronchi, and larger bronchioli, showing submucosal mononuclear inflammatory infiltrates. IHC assays were the only confirmatory diagnostic test for 5 patients (11%). Significant life-threatening pathological conditions that could be considered the cause of death were present in 36 patients (77%) and included diffuse alveolar damage (12 cases), extensive secondary pneumonia (11 cases), extensive intraalveolar hemorrhage (10 cases), viral pneumonitis (10 cases), myocarditis (6 cases), and meningoencephalitis (1 case). For 9 patients with bronchopneumonia, a bacterial or fungal etiology was determined with IHC assay (3 Staphylococcus infections, 3 group A streptococci infections, 1 Streptococcus pneumoniae infection, 1 Bordetella pertussis infection, and 1 Aspergillus infection). CONCLUSIONS IHC assays are useful for the diagnosis of influenza and bacterial pneumonia. This study underscores the importance of performing autopsies to identify the causes of death in patients with influenza infection.
Collapse
Affiliation(s)
- Jeannette Guarner
- Infectious Disease Pathology Activity, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Cheung OY, Chan JWM, Ng CK, Koo CK. The spectrum of pathological changes in severe acute respiratory syndrome (SARS). Histopathology 2005; 45:119-24. [PMID: 15279629 PMCID: PMC7194176 DOI: 10.1111/j.1365-2559.2004.01926.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aims: To analyse the lung pathology of severe acute respiratory syndrome (SARS) and correlate the findings with the time sequence of the disease. Methods and results: Ten patients with a clinical diagnosis of SARS, and virological confirmation of SARS coronavirus infection were identified. Histology in most cases showed diffuse alveolar damage, from early to late phases, and the changes corresponded to the time sequence. Other variable features include multinucleated giant cells, pneumocytes with cytomegaly and variable amounts of inflammatory cells and foamy macrophages. One case showed superimposed bronchopneumonia. No viral inclusions were found. Coronavirus particles were identified in pneumocytes by electron microscopy. Conclusions: The predominant pathological process of SARS is diffuse alveolar damage and, in patients who die from the disease, there is evidence of organization and fibrosis. There are apparently no histological features specific for this disease, and the aetiological diagnosis depends on virological and ultrastructural studies.
Collapse
Affiliation(s)
- O Y Cheung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong.
| | | | | | | |
Collapse
|
41
|
Xu L, Yoon H, Zhao MQ, Liu J, Ramana CV, Enelow RI. Cutting edge: pulmonary immunopathology mediated by antigen-specific expression of TNF-alpha by antiviral CD8+ T cells. THE JOURNAL OF IMMUNOLOGY 2004; 173:721-5. [PMID: 15240656 DOI: 10.4049/jimmunol.173.2.721] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Respiratory virus infection results in considerable pulmonary immunopathology, a component of which results from the host immune responses. We have developed a murine model to specifically examine the lung injury due to CD8(+) T cell recognition of an influenza hemagglutinin (HA) transgene on lung epithelium in the absence of replicating virus, after adoptive transfer. Lung injury is largely mediated by chemokines expressed by the epithelial cells upon T cell recognition mediated by TNF-alpha. To determine the critical source of TNF-alpha, HA-specific TNF(-/-) CD8(+) T cells were transferred into HA transgenic animals, and lung injury was not observed, though these T cells exhibited no defect in antiviral activity in vivo. This indicates that the initiating event in the injury process is Ag-specific expression of TNF-alpha by antiviral CD8(+) T cells upon recognition of alveolar epithelial Ag, and that the effector activities responsible for viral clearance may be dissociable from those resulting in immunopathology.
Collapse
Affiliation(s)
- Lumei Xu
- Department of Medicine, Yale University School of Medicine, New Haven, CT 06516, USA
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
Influenza remains an important epidemic viral infection. Thousands of deaths occur and billions of dollars are spent each year with influenza-related illnesses. Morbidity and mortality are largely attributed to respiratory complications that may require intensive care unit (ICU) admission. Medical and neonatal ICUs, transplant units, chronic-care wards, and nursing homes are at increased risk for nosocomial outbreaks of influenza, which are characterized by abrupt onset and rapid spread. In this article, the authors review the current concepts, recent advances, and management strategies in influenza-associated pneumonia. Pertinent issues to the critical care practitioner are discussed in detail.
Collapse
Affiliation(s)
- Eduardo C Oliveira
- Division of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, USA.
| | | | | |
Collapse
|
43
|
Gerberding JL, Morgan JG, Shepard JAO, Kradin RL. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 9-2004. An 18-year-old man with respiratory symptoms and shock. N Engl J Med 2004; 350:1236-47. [PMID: 15028828 DOI: 10.1056/nejmcpc049006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
44
|
Chong PY, Chui P, Ling AE, Franks TJ, Tai DYH, Leo YS, Kaw GJL, Wansaicheong G, Chan KP, Ean Oon LL, Teo ES, Tan KB, Nakajima N, Sata T, Travis WD. Analysis of deaths during the severe acute respiratory syndrome (SARS) epidemic in Singapore: challenges in determining a SARS diagnosis. Arch Pathol Lab Med 2004; 128:195-204. [PMID: 14736283 DOI: 10.5858/2004-128-195-aoddts] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT An outbreak of severe acute respiratory syndrome (SARS), an infectious disease attributed to a novel coronavirus, occurred in Singapore during the first quarter of 2003 and led to 204 patients with diagnosed illnesses and 26 deaths by May 2, 2003. Twenty-one percent of these patients required admission to the medical intensive care unit. During this period, the Center for Forensic Medicine, Health Sciences Authority, Singapore, performed a total of 14 postmortem examinations for probable and suspected SARS. Of these, a total of 8 were later confirmed as SARS infections. OBJECTIVE Our series documents the difficulties encountered at autopsy during the initial phases of the SARS epidemic, when the pattern of infection and definitive diagnostic laboratory criteria were yet to be established. DESIGN Autopsies were performed by pathologists affiliated with the Center for Forensic Medicine, Health Sciences Authority, Singapore. Tissue was accessed and read at the Tan Tock Seng Hospital, Singapore, and at the Armed Forces Institute of Pathology, Washington, DC. Autopsy tissue was submitted to the Virology Department, Singapore General Hospital, for analysis, and in situ hybridization for the SARS coronavirus was carried out at the National Institute of Infectious Diseases, Tokyo, Japan. RESULTS Thirteen of 14 patients showed features of diffuse alveolar damage. In 8 patients, no precipitating etiology was identified, and in all of these patients, we now have laboratory confirmation of coronavirus infection. Two of the 8 patients presented at autopsy as sudden unexpected deaths, while the remaining 6 patients had been hospitalized with varying lengths of stay in the intensive care unit. In 3 patients, including the 2 sudden unexpected deaths, in situ hybridization showed the presence of virally infected cells within the lung. In 4 of the 8 SARS patients, pulmonary thromboemboli were also recognized on gross examination, while one patient had marantic cardiac valvular vegetations. CONCLUSIONS It is unfortunate that the term atypical pneumonia has been used in conjunction with SARS. Although nonspecific by itself, the term does not accurately reflect the underlying dangers of viral pneumonia, which may progress rapidly to acute respiratory distress syndrome. We observed that the clinical spectrum of disease as seen in our autopsy series included sudden deaths. This is a worrisome finding that illustrates that viral diseases will have a spectrum of clinical presentations and that the diagnoses made for such patients must incorporate laboratory as well as clinical data.
Collapse
|
45
|
Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS, Suh GY, Kwon OJ, Han J. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 2002; 22 Spec No:S137-49. [PMID: 12376607 DOI: 10.1148/radiographics.22.suppl_1.g02oc15s137] [Citation(s) in RCA: 210] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Numerous viruses, including influenza virus, measles virus, Hantavirus, adenovirus, herpesviruses, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Influenza virus types A and B cause most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus, herpesviruses, measles virus, and adenovirus. The radiographic findings, which consist mainly of patchy or diffuse ground-glass opacity with or without consolidation and reticular areas of increased opacity, are variable and overlapping. Computed tomographic findings, which are also overlapping, consist of poorly defined centrilobular nodules, ground-glass attenuation with a lobular distribution, segmental consolidation, or diffuse ground-glass attenuation with thickened interlobular septa. The radiologic findings reflect the variable extents of the histopathologic features: diffuse alveolar damage (intraalveolar edema, fibrin, and variable cellular infiltrates with a hyaline membrane), intraalveolar hemorrhage, and interstitial (intrapulmonary or airway) inflammatory cell infiltration. Clinical information such as patient age, immune status, community outbreaks, symptom onset and duration, and presence of a rash remain important aids in diagnosis of viral causes.
Collapse
Affiliation(s)
- Eun A Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 36-2001. Acute febrile respiratory illness in a 57-year-old man with recurrent pulmonary disorders. N Engl J Med 2001; 345:1558-65. [PMID: 11794224 DOI: 10.1056/nejmcpc010036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
47
|
Abstract
OBJECTIVE To describe the clinical features and complications of patients hospitalized with influenza during the 1999-2000 influenza season. METHODS We reviewed all cases of patients with influenza admitted to a large metropolitan referral hospital during the 1999-2000 season. RESULTS Thirty-five adult patients (15 men and 20 women) tested positive for influenza A by direct enzyme immunoassay. A fourfold to sevenfold increase in the number of influenza cases was observed over previous years. Most patients had serious comorbid illnesses (88%), such as diabetes and chronic respiratory and heart disease. Seventeen patients developed pneumonia; these patients tended to be older (mean +/- SD, 63 +/- 13 years vs 51 +/- 19 years, respectively; p = 0.04) and had a higher incidence of chronic lung disease (41% vs 6%, respectively; p = 0.02) than the patients without pneumonia. Shortness of breath was the only symptom that distinguished patients with pneumonia from those with an upper respiratory tract illness alone. Antiviral treatment was begun 4 +/- 3 days from initiation of symptoms in patients with pneumonia and consisted of oseltamivir (35.2%), rimantadine (5.8%), or a combination of both (17.6%). Respiratory and/or blood culture results were positive in five patients (29%), Staphylococcus aureus was isolated in five patients, and Streptococcus pneumoniae was isolated in one patient. Ten of the patients with pneumonia (58.8%) were admitted to the ICU, and 5 patients (29%) died. The length of ICU stay and mechanical ventilation were 28 +/- 26 days and 21.5 +/- 20.5 days, respectively. Death in most pneumonia patients was attributed to respiratory failure. CONCLUSION The recognized number of hospital admissions for influenza increased fourfold to sevenfold over previous years, most likely due to the implementation of rapid diagnostic tests for influenza. Patients with signs and symptoms of influenza and shortness of breath should undergo chest radiography. Hospitalization of patients with influenza pneumonia occurred in both previously healthy and immunocompromised patients and had a high mortality. S aureus was the most common bacterial isolate in patients with influenza pneumonia. Empiric antibiotics with staphylococcal activity should be used pending culture results in patients with influenza pneumonia. The effectiveness of oseltamivir and rimantadine in treating patients with influenza pneumonia remains to be determined.
Collapse
Affiliation(s)
- E C Oliveira
- Division of Critical Care Medicine, Washington Hospital Center, Washington, DC, USA
| | | | | |
Collapse
|
48
|
Guarner J, Shieh WJ, Dawson J, Subbarao K, Shaw M, Ferebee T, Morken T, Nolte KB, Freifeld A, Cox N, Zaki SR. Immunohistochemical and in situ hybridization studies of influenza A virus infection in human lungs. Am J Clin Pathol 2000; 114:227-33. [PMID: 10941338 DOI: 10.1309/hv74-n24t-2k2c-3e8q] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Influenza viruses are responsible for acute febrile respiratory disease. When deaths occur, definitive diagnosis requires viral isolation because no characteristic viral inclusions are seen. We examined the distribution of influenza A virus in tissues from 8 patients with fatal infection using 2 immunohistochemical assays (monoclonal antibodies to nucleoprotein [NP] and hemagglutinin [HA]) and 2 in situ hybridization (ISH) assays (digoxigenin-labeled probes that hybridized to HA and NP genes). Five patients had prominent bronchitis; by immunohistochemical assay, influenza A staining was present focally in the epithelium of larger bronchi (intact and detached necrotic cells) and in rare interstitial cells. The anti-NP antibody stained primarily cell nuclei, and the anti-HA antibody stained mainly the cytoplasm. In 4 of these cases, nucleic acids (ISH) were identified in the same areas. Three patients had lymphohistiocytic alveolitis and showed no immunohistochemical or ISH staining. Both techniques were useful for detection of influenza virus antigens and nucleic acids in formalin-fixed paraffin-embedded tissues and can enable further understanding of fatal influenza A virus infections in humans.
Collapse
Affiliation(s)
- J Guarner
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Foss HD, Schmitt-Gräff A, Daum S, Anagnostopoulos I, Assaf C, Hummel M, Stein H. Origin of primary gastric T-cell lymphomas from intraepithelial T-lymphocytes: report of two cases. Histopathology 1999; 34:9-15. [PMID: 9934579 DOI: 10.1046/j.1365-2559.1999.00566.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS The classification of primary gastric T-cell lymphomas is uncertain due to the exceeding rarity of these tumours; many of the reported cases were felt to be similar to node-based lymphomas. We describe two cases of primary gastric T-cell lymphoma with evidence of origination from intraepithelial T-lymphocytes. METHODS AND RESULTS Both tumours were restricted to the stomach; one displaying a large ulcerated mass, the other a widespread superficial tumour manifestation. Histologically the first tumour was composed of sheets of medium-sized lymphoid cells showing marked epitheliotropism at the edge of the ulcer, and a CD3+, CD4-, CD8-, CD20-, CD56-, CD103+, beta F1+ phenotype. The second case differed histologically and immunophenotypically from the first case. In addition to lamina propria and submucosal infiltration, the lymphoma contained an extensive intraepithelial component even in large areas without other evidence of tumour. The neoplastic cells ranged in size from small to medium and large. Immunohistology disclosed a CD3+, CD4+, CD8-, CD20-, CD56-, beta F1+ phenotype. Staining for CD103 could not be performed in this case since frozen material was not available. CONCLUSIONS The prominent epitheliotropism, the marked intraepithelial growth and the expression of CD103 strongly imply a derivation of these primary gastric lymphomas from intraepithelial T-lymphocytes. Additional studies of larger series will clarify whether the findings described here are typical of primary gastric T-cell lymphomas.
Collapse
Affiliation(s)
- H D Foss
- Konsultations- und Referenzzentrum für Lymphknoten und Hämatopathologie, Free University of Berlin
| | | | | | | | | | | | | |
Collapse
|
50
|
Suarez DL, Perdue ML, Cox N, Rowe T, Bender C, Huang J, Swayne DE. Comparisons of highly virulent H5N1 influenza A viruses isolated from humans and chickens from Hong Kong. J Virol 1998; 72:6678-88. [PMID: 9658115 PMCID: PMC109865 DOI: 10.1128/jvi.72.8.6678-6688.1998] [Citation(s) in RCA: 253] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Genes of an influenza A (H5N1) virus from a human in Hong Kong isolated in May 1997 were sequenced and found to be all avian-like (K. Subbarao et al., Science 279:393-395, 1998). Gene sequences of this human isolate were compared to those of a highly pathogenic chicken H5N1 influenza virus isolated from Hong Kong in April 1997. Sequence comparisons of all eight RNA segments from the two viruses show greater than 99% sequence identity between them. However, neither isolate's gene sequence was closely (>95% sequence identity) related to any other gene sequences found in the GenBank database. Phylogenetic analysis demonstrated that the nucleotide sequences of at least four of the eight RNA segments clustered with Eurasian origin avian influenza viruses. The hemagglutinin gene phylogenetic analysis also included the sequences from an additional three human and two chicken H5N1 virus isolates from Hong Kong, and the isolates separated into two closely related groups. However, no single amino acid change separated the chicken origin and human origin isolates, but they all contained multiple basic amino acids at the hemagglutinin cleavage site, which is associated with a highly pathogenic phenotype in poultry. In experimental intravenous inoculation studies with chickens, all seven viruses were highly pathogenic, killing most birds within 24 h. All infected chickens had virtually identical pathologic lesions, including moderate to severe diffuse edema and interstitial pneumonitis. Viral nucleoprotein was most frequently demonstrated in vascular endothelium, macrophages, heterophils, and cardiac myocytes. Asphyxiation from pulmonary edema and generalized cardiovascular collapse were the most likely pathogenic mechanisms responsible for illness and death. In summary, a small number of changes in hemagglutinin gene sequences defined two closely related subgroups, with both subgroups having human and chicken members, among the seven viruses examined from Hong Kong, and all seven viruses were highly pathogenic in chickens and caused similar lesions in experimental inoculations.
Collapse
Affiliation(s)
- D L Suarez
- Southeast Poultry Research Laboratory, USDA, ARS, Athens, Georgia 30605, USA.
| | | | | | | | | | | | | |
Collapse
|