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Pathological findings in swine flu deaths

Pulmonary Pathologic Findings of Fatal 2009 Pandemic Influenza A/H1N1 Viral Infections.

Posted 12/07/09. This article is scheduled to appear in the February 2010 print issue.

N Context.—In March 2009, a novel swine-origin influenza
A/H1N1 virus was identified. After global spread, the
World Health Organization in June declared the first
influenza pandemic in 41 years.
Objective.—To describe the clinicopathologic characteristics
of 34 people who died following confirmed A/
H1N1 infection with emphasis on the pulmonary pathology
Design.—We reviewed medical records, autopsy reports,
microbiologic studies, and microscopic slides of 34
people who died between May 15 and July 9, 2009, and
were investigated either by the New York City Office of
Chief Medical Examiner (32 deaths) or through the
consultation service of a coauthor (2 deaths).
Results.—Most of the 34 decedents (62%) were
between 25 and 49 years old (median, 41.5 years).
Tracheitis, bronchiolitis, and diffuse alveolar damage
were noted in most cases. Influenza viral antigen was
observed most commonly in the epithelium of the
tracheobronchial tree but also in alveolar epithelial cells
and macrophages. Most cases were reverse transcription–
polymerase chain reaction positive for influenza.
Histologic and microbiologic autopsy evidence of bacterial
pneumonia was detected in 55% of cases.
Underlying medical conditions including cardiorespiratory
diseases and immunosuppression were present in
91% of cases. Obesity (body mass index,>30) was noted
in 72% of adult and adolescent cases.
Conclusions.—The pulmonary pathologic findings in
fatal disease caused by the novel pandemic influenza virus
are similar to findings identified in past pandemics.
Superimposed bacterial infections of the respiratory tract
were common. Preexisting obesity, cardiorespiratory
diseases, and other comorbidities also were prominent
findings among the decedents.
(Arch Pathol Lab Med. 2010;134:E1–E9)




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