Pulmonary changes in Norwegian fatal cases of pandemic influenza H1N1 (2009) infection: a morphologic and molecular genetic study

Autor: Voltersvik, Pål, Aqrawi, Lara A., Dudman, Susanne, Hungnes, Olav, Bostad, Leif, Brokstad, Karl A., Cox, Rebecca J., Strøm, Erik Heyerdahl, Rognum, Torleiv O., Mæhlen, Jan, Alfsen, Glenny Cecilie, Viset, Trond, Kvelstad, Ingjerd Lien, Morild, Inge
Rok vydání: 2016
Předmět:
Male
0301 basic medicine
Pathology
Epidemiology
Influenza A Virus
H1N1 Subtype
0302 clinical medicine
Pandemic
Medicine
030212 general & internal medicine
Respiratory system
Child
Diffuse alveolar damage
Norway
High-Throughput Nucleotide Sequencing
Middle Aged
Immunohistochemistry
2009 pandemic
3. Good health
Hospitalization
Infectious Diseases
medicine.anatomical_structure
Host-Pathogen Interactions
immunohistochemistry
Human mortality from H5N1
RNA
Viral
Original Article
Female
HA pyrosequencing
influenza
Adult
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Adolescent
Real-Time Polymerase Chain Reaction
Virus
lung
Young Adult
03 medical and health sciences
Influenza
Human
Humans
Obesity
Pandemics
Aged
Lung
business.industry
Public Health
Environmental and Occupational Health
Outbreak
Original Articles
030104 developmental biology
Mutation
Immunology
business
Zdroj: Influenza and Other Respiratory Viruses
ISSN: 1750-2659
1750-2640
Popis: Background: During the pandemic outbreak of the 2009 swine influenza (A(H1N1) pdm09), 32 fatal cases occurred in Norway and 19 of these were included in this study. Objectives: We characterised pulmonary changes in these fatal Norwegian cases. Patients and Methods: Upon hospitalisation, detailed clinical information and specimens from the upper and lower respiratory pathways were collected. At post-mortem, lung tissue was collected, formalin-fixed and paraffin-embedded. Immunohistochemical and light microscopic examination was performed to visualise the local expression of the A(H1N1) pdm09 virus. Reverse transcription-polymerase chain reaction (RT-PCR) and pyrosequencing of the non-fixed specimens allowed the identification of mutations in the influenza virus surface glycoprotein (haemagglutinin gene) particularly at position 222. Results and Conclusions: The overall course of illness lasted from 2 to 40 days (median 9 days). Diffused alveolar damage (DAD) was evident in 11 cases, 4 of which had no apparent underlying illness. Obesity was prominent in 12 cases, where three individuals were classified as otherwise healthy. The HA D222G mutation was detected in six cases, 3 of which had no underlying illness. Immunohistochemistry showed the A(H1N1)pdm09 virus to be prominent at the site of inflammation both in close proximity to and inside alveolar structures in the lung tissue. In addition to a possible role for the HA D222G mutation, our findings indicate that host factors and underlying conditions in the infected individuals are fundamental for disease outcome in many cases. This study increases our understanding of determinants for the clinical outcome of pandemic influenza, which could guide future treatment. publishedVersion
Databáze: OpenAIRE
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