Histopathologic and Immunohistochemical Features of Fatal Influenza Virus Infection in Children during the 2003–2004 Season
Identifieur interne : 001518 ( Main/Exploration ); précédent : 001517; suivant : 001519Histopathologic and Immunohistochemical Features of Fatal Influenza Virus Infection in Children during the 2003–2004 Season
Auteurs : Jeannette Guarner [Géorgie (pays), États-Unis] ; Christopher D. Paddock [Géorgie (pays)] ; Wun-Ju Shieh [Géorgie (pays)] ; Michelle M. Packard [Géorgie (pays)] ; Mitesh Patel [Géorgie (pays)] ; Jeltley L. Montague [Géorgie (pays)] ; Timothy M. Uyeki [Géorgie (pays)] ; Niranjan Bhat [Géorgie (pays)] ; Amanda Balish [Géorgie (pays)] ; Stephen Lindstrom [Géorgie (pays)] ; Alexander Klimov [Géorgie (pays)] ; Sherif R. Zaki [Géorgie (pays)]Source :
- Clinical Infectious Diseases [ 1058-4838 ] ; 2006.
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 ⩽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.
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DOI: 10.1086/505122
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Packard</name></author><author><name sortKey="Patel, Mitesh" sort="Patel, Mitesh" uniqKey="Patel M" first="Mitesh" last="Patel">Mitesh Patel</name></author><author><name sortKey="Montague, Jeltley L" sort="Montague, Jeltley L" uniqKey="Montague J" first="Jeltley L." last="Montague">Jeltley L. Montague</name></author><author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M." last="Uyeki">Timothy M. 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NE</wicri:cityArea></affiliation></author><author><name sortKey="Paddock, Christopher D" sort="Paddock, Christopher D" uniqKey="Paddock C" first="Christopher D." last="Paddock">Christopher D. Paddock</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Infectious Disease Pathology Activity, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Shieh, Wun Ju" sort="Shieh, Wun Ju" uniqKey="Shieh W" first="Wun-Ju" last="Shieh">Wun-Ju Shieh</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Infectious Disease Pathology Activity, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Packard, Michelle M" sort="Packard, Michelle M" uniqKey="Packard M" first="Michelle M." last="Packard">Michelle M. Packard</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Infectious Disease Pathology Activity, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Patel, Mitesh" sort="Patel, Mitesh" uniqKey="Patel M" first="Mitesh" last="Patel">Mitesh Patel</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Infectious Disease Pathology Activity, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Montague, Jeltley L" sort="Montague, Jeltley L" uniqKey="Montague J" first="Jeltley L." last="Montague">Jeltley L. Montague</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Influenza Branch, Division of Viral Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M." last="Uyeki">Timothy M. Uyeki</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Influenza Branch, Division of Viral Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Bhat, Niranjan" sort="Bhat, Niranjan" uniqKey="Bhat N" first="Niranjan" last="Bhat">Niranjan Bhat</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Influenza Branch, Division of Viral Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Balish, Amanda" sort="Balish, Amanda" uniqKey="Balish A" first="Amanda" last="Balish">Amanda Balish</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Influenza Branch, Division of Viral Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Lindstrom, Stephen" sort="Lindstrom, Stephen" uniqKey="Lindstrom S" first="Stephen" last="Lindstrom">Stephen Lindstrom</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Influenza Branch, Division of Viral Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Klimov, Alexander" sort="Klimov, Alexander" uniqKey="Klimov A" first="Alexander" last="Klimov">Alexander Klimov</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Influenza Branch, Division of Viral Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author><author><name sortKey="Zaki, Sherif R" sort="Zaki, Sherif R" uniqKey="Zaki S" first="Sherif R." last="Zaki">Sherif R. Zaki</name><affiliation wicri:level="1"><country xml:lang="fr">Géorgie (pays)</country><wicri:regionArea>Infectious Disease Pathology Activity, Atlanta</wicri:regionArea><wicri:noRegion>Atlanta</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Clinical Infectious Diseases</title><title level="j" type="abbrev">Clinical Infectious Diseases</title><idno type="ISSN">1058-4838</idno><idno type="eISSN">1537-6591</idno><imprint><publisher>The University of Chicago Press</publisher><date when="2006-07-15">2006</date><biblScope unit="vol">43</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="132">132</biblScope><biblScope unit="page" to="140">140</biblScope></imprint><idno type="ISSN">1058-4838</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1058-4838</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="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 ⩽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.</div></front></TEI><affiliations><list><country><li>Géorgie (pays)</li><li>États-Unis</li></country><region><li>Géorgie (États-Unis)</li></region></list><tree><country name="Géorgie (pays)"><noRegion><name sortKey="Guarner, Jeannette" sort="Guarner, Jeannette" uniqKey="Guarner J" first="Jeannette" last="Guarner">Jeannette Guarner</name></noRegion><name sortKey="Balish, Amanda" sort="Balish, Amanda" uniqKey="Balish A" first="Amanda" last="Balish">Amanda Balish</name><name sortKey="Bhat, Niranjan" sort="Bhat, Niranjan" uniqKey="Bhat N" first="Niranjan" last="Bhat">Niranjan Bhat</name><name sortKey="Klimov, Alexander" sort="Klimov, Alexander" uniqKey="Klimov A" first="Alexander" last="Klimov">Alexander Klimov</name><name sortKey="Lindstrom, Stephen" sort="Lindstrom, Stephen" uniqKey="Lindstrom S" first="Stephen" last="Lindstrom">Stephen Lindstrom</name><name sortKey="Montague, Jeltley L" sort="Montague, Jeltley L" uniqKey="Montague J" first="Jeltley L." last="Montague">Jeltley L. Montague</name><name sortKey="Packard, Michelle M" sort="Packard, Michelle M" uniqKey="Packard M" first="Michelle M." last="Packard">Michelle M. Packard</name><name sortKey="Paddock, Christopher D" sort="Paddock, Christopher D" uniqKey="Paddock C" first="Christopher D." last="Paddock">Christopher D. Paddock</name><name sortKey="Patel, Mitesh" sort="Patel, Mitesh" uniqKey="Patel M" first="Mitesh" last="Patel">Mitesh Patel</name><name sortKey="Shieh, Wun Ju" sort="Shieh, Wun Ju" uniqKey="Shieh W" first="Wun-Ju" last="Shieh">Wun-Ju Shieh</name><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M." last="Uyeki">Timothy M. Uyeki</name><name sortKey="Zaki, Sherif R" sort="Zaki, Sherif R" uniqKey="Zaki S" first="Sherif R." last="Zaki">Sherif R. Zaki</name></country><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Guarner, Jeannette" sort="Guarner, Jeannette" uniqKey="Guarner J" first="Jeannette" last="Guarner">Jeannette Guarner</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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