H1N1 Lung pathology
發表在元月號的The American respiratory and critical care medicine:Lung Pathology in Fatal Novel Human Influenza A (H1N1) Infection.Am. J. Respir. Crit. Care Med. 2010; 181: 72-79
特點是單獨的肺臟侵犯，肺外器官的變化為繼發性，有三種特異性的病理發現，
1.diffuse alveolar damage (DAD)
2 necrotizing bronchiolitis
3. DAD with intense alveolar hemorrhage.
而免疫學上的描述，有講等於沒說：There is also evidence of ongoing pulmonary aberrant immune response.
對臨床治療有何提示呢？好像沒有，它的病理變化與其他流感肺炎或禽流感引起的ARDS沒有什麼差異性。而唯一一位孕婦，它的病理變化特別嚴重，原因不明。necrotizing bronchitis 與同時或合併細菌性感染有關，約有38％有細菌感染證據，與現有的cohort資料29% 大略相等，菌種以S. pneumoniae為大宗，因為它與inflenza virus有共通的 the pathways and intermediate signaling molecules are similar in both infections, creating an opportunity for either interference with or augmentation of the immune response during dual or sequential infection. 其他菌種： (10 cases with S. pneumoniae, 6 with Streptococcus pyogenes, and 7 with Staphylococcus aureus)
(A) Condensed, diffusely edematous and hemorrhagic lung. Inset, a thrombus in a middle-sized artery (arrow).
(B) Large cartilaginous airway showing intense epithelial squamous metaplasia, better visualized in the inset. SM = squamous metaplasia.
(C) Exudative diffuse alveolar damage with numerous hyaline membranes within alveolar spaces (arrowheads).
(D) Extensive lung hemorrhage as the predominant pattern of acute lung injury.
(E) Necrotizing bronchiolitis. The bronchiole (Br) is filled with necrotic epithelial and inflammatory cells. The adjacent alveoli (Alv) show fibrinous exudate rich in inflammatory cells.
(F) Necrotizing bronchiolitis, same bronchiole as in E, Verhoeff staining. With the elastic staining in dark gray, one can better appreciate the extensive destruction of the airway wall.
(G) Necrotizing bronchiolitis (Br) with evident granulation tissue (Gt) in the adjacent alveolar tissue indicating exudate organization.
(H) Cytopathic effect in alveolar epithelial cells (arrow). Scale bars B–G: 100 µm; H: 25 µm.
中文翻譯摘要：
發表文章
