NIH - NEW YORK AUTOPSIES SHOW 2009 H1N1 INFLUENZA VIRUS DAMAGES ENTIRE AIRWAY

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This article is from the US National Institutes of Health.  I think the findings

are interesting - particularly with regard to the high number of H1N1-related

fatalities associated with pre-existing lung or heart disease, and obesity.

 

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NEW YORK AUTOPSIES SHOW 2009 H1N1 INFLUENZA VIRUS DAMAGES ENTIRE AIRWAY

Monday, December 7, 2009 1:48 PM

 

 

 

  " NIH OLIB (NIH/OD) " <olib

 

 

To:  NIHPRESS

 

U.S. Department of Health and Human Services

NATIONAL INSTITUTES OF HEALTH NIH News

National Institute of Allergy and Infectious Diseases (NIAID)

<http://www.niaid.nih.gov/>

For Immediate Release: Monday, December 07, 2009

CONTACT: Anne A. Oplinger, 301-402-1663, <e-mail: aoplinger

 

NEW YORK AUTOPSIES SHOW 2009 H1N1 INFLUENZA VIRUS DAMAGES ENTIRE AIRWAY

 

In

fatal cases of 2009 H1N1 influenza, the virus can damage cells

throughout the respiratory airway, much like the viruses that caused

the 1918 and 1957 influenza pandemics, report researchers from the

National Institutes of Health (NIH) and the New York City Office of

Chief Medical Examiner.

The scientists reviewed autopsy reports, hospital records and other

clinical data from 34 people who died of 2009 H1N1 influenza infection

between May 15 and July 9, 2009. All but two of the deaths occurred in

New York City. A microscopic examination of tissues throughout the

airways revealed that the virus caused damage primarily to the upper

airway -- the trachea and bronchial tubes -- but tissue damage in the lower

airway, including deep in the lungs, was present as well. Evidence of secondary

bacterial infection was seen in more than half of the victims.

 

The team was led by James R. Gill, M.D., of the New York City Office of Chief

Medical Examiner and New York University School of Medicine,

and Jeffery K. Taubenberger, M.D., Ph.D., of the National Institute of

Allergy and Infectious Diseases (NIAID) at NIH. The findings are

reported in the Archives of Pathology & Laboratory Medicine, now

available online and scheduled to appear in the February 2010 print

issue.

 

" This study provides clinicians with a clear and detailed

picture of the disease caused by 2009 H1N1 influenza virus that will

help inform patient management, " says NIAID Director Anthony S. Fauci,

M.D. " In fatal cases of 2009 H1N1 influenza, it appears the novel pandemic

influenza

virus produces pulmonary damage that looks very much like that seen in

earlier influenza pandemics. "       The new report also underscores the

impact 2009 H1N1 influenza is having on younger people. While most

deaths from seasonal influenza occur in adults over 65 years old,

deaths from 2009 H1N1 influenza occur predominately among younger

people. The majority of deaths (62 percent) in the 34 cases studied

were among those 25 to 49 years old; two infants were also among the

fatal cases.

 

Ninety-one percent of those autopsied had underlying medical conditions, such as

heart disease or respiratory disease, including asthma,

before becoming ill with 2009 H1N1 influenza. Seventy-two percent of

the adults and adolescents who died were obese. This finding agrees

with earlier reports, based on hospital records, linking obesity with

an increased risk of death from 2009 H1N1 influenza.

 

The

researchers examined tissue samples from the 34 deceased individuals to

assess how 2009 H1N1 influenza virus damaged various parts of the respiratory

system. " We saw a spectrum of damage to tissue in both the upper and lower

respiratory tracts, " says Dr. Taubenberger. In all cases, the uppermost regions

of the respiratory tract

-- the trachea and bronchial tubes -- were inflamed, with severe damage

in some cases. In 18 cases, evidence of damage lower down in the finer

branches of the bronchial tubes, or bronchioles, was noted. In 25

cases, the researchers found damage to the small globular air sacs, or

alveoli, of the lungs.

 

" This pattern of pathology in the

airway tissues is similar to that reported in autopsy findings of

victims of both the 1918 and 1957 influenza pandemics, " notes Dr.

Taubenberger.

 

The researchers also examined 33 of the 34 cases for evidence of pulmonary

bacterial infections. Of these cases, 18 (55 percent) were positive for such

infections. Not all of those individuals who had bacterial pneumonia along with

2009 H1N1 virus infection

had been hospitalized, however, indicating that some had acquired their

bacterial infections outside of a health-care setting.  This raises the

possibility, say the authors, that community-acquired bacterial

pneumonia is playing a role in the current pandemic.

" Even in an era of widespread and early antibiotic use, " write the

authors, " bacterial pneumonia remains an important factor for severe or

fatal influenza. "

 

Computerized tomography

(CT) lung images were available in four cases of pulmonary bacterial

infection. In all four cases, the CT scans showed an abnormality known

as ground-glass opacity, which are patches of rounded haze not seen in

normal lung images. It is not known, say the researchers, whether the

abnormalities detected by CT in the four cases also occur in people who

have milder H1N1 infections. They call for additional investigation

into the utility of CT scans as a tool to help clinicians identify and

better treat severe H1N1 infections.

 

Visit <www.flu.gov>

for one-stop access to U.S. government information on avian and

pandemic influenza. Also, visit NIAID's flu Web portal at

<http://www3.niaid.nih.gov/topics/Flu/>.           

 

NIAID conducts and supports research -- at NIH,

throughout the United States, and worldwide -- to study the causes of

infectious and immune-mediated diseases, and to develop better means of

preventing, diagnosing and treating these illnesses. News releases, fact sheets

and other NIAID-related materials are available on the NIAID Web site at

<http://www.niaid.nih.gov>.

 

The

National Institutes of Health (NIH) -- The Nation's Medical Research

Agency -- includes 27 Institutes and Centers and is a component of the U.S.

Department of Health and Human Services.

It is the primary federal agency for conducting and supporting basic,

clinical and translational medical research, and it investigates the

causes, treatments, and cures for both common and rare diseases. For more

information about NIH and its programs, visit <www.nih.gov>.

------------------------

REFERENCE: JR Gill et al. Pulmonary pathological findings of fatal 2009 pandemic

influenza A/H1N1 viral infections.

Archives of Pathology & Laboratory Medicine. Published online Dec.

7, 2009. {Note: Full text of the paper is available at

<www.archivesofpathology.org>}

 

##

 

This NIH News Release is available online at:

<http://www.nih.gov/news/health/dec2009/niaid-07.htm>.

 

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