Cited by 95Influenza Virus Research StudiesRespiratory viral infections researchAutopsy Techniques and Outcomes

Histopathological and immunohistochemical findings of 20 autopsy cases with 2009 H1N1 virus infection

Open access
Nakajima, Noriko, Sato, Yuko, Katano, Harutaka, Hasegawa, Hideki, Kumasaka, Toshio, Hata, Satoru, Tanaka, Shinya, Amano, Tomonori +13 more·2012·Modern Pathology

Abstract

Twenty autopsy cases with 2009 pandemic influenza A (2009 H1N1) virus infection, performed between August 2009 and February 2010, were histopathologically analyzed. Hematoxylin-eosin staining, immunohistochemistry for type A influenza nucleoprotein antigen, and real-time reverse transcription-PCR assay for viral RNA were performed on formalin-fixed and paraffin-embedded specimens. In addition, the D222G amino acid substitution in influenza virus hemagglutinin, which binds to specific cell receptors, was analyzed in formalin-fixed and paraffin-embedded trachea and lung sections by direct sequencing of PCR-amplified products. There were several histopathological patterns in the lung according to the most remarkable findings in each case: acute diffuse alveolar damage (DAD) with a hyaline membrane (four cases), organized DAD (one case), acute massive intra-alveolar edema with variable degrees of hemorrhage (three cases), neutrophilic bronchopneumonia (five cases) and tracheobronchitis with limited histopathological changes in alveoli (four cases). In two cases, the main findings were due to preexisting disease. Influenza virus antigen was only detected in the respiratory tract in 10 cases by immunohistochemistry. The antigen was detected in type II pneumocytes (three cases) in the epithelial cells of the trachea, bronchi and glands (six cases), and in the epithelial cells in both of the above (one case). The four cases with acute DAD presented with antigen-positive type II pneumocytes. In one case, the D222G substitution was detected in the lung as a major sequence, although 222D was prominent in the trachea, suggesting that selection of the viral clones occurred in the respiratory tract. In five cases, the pathogenesis of 2009 H1N1 was confirmed to be viral infection in pneumocytes, which caused severe alveolar damage and fatal viral pneumonia. Further studies on both host and viral factors in autopsy or biopsy materials will be essential to elucidate the other pathogenic factors involved in influenza virus infection.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1038/modpathol.2011.125

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

1 of the 35 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Authors
Nakajima, N., Sato, Y., Katano, H., Hasegawa, H., Kumasaka, T., Hata, S., Tanaka, S., Amano, T., Kasai, T., Chong, J.-M., Iiduka, T., Nakazato, I., Hino, Y., Hamamatsu, A., Horiguchi, H., Tanaka, T., Hasagawa, A., Kanaya, Y., Oku, R., Oya, T., & Sata, T.
Affiliations
  • National Institute of Infectious Diseases (JP)
  • Japanese Red Cross Medical Center (JP)
  • Nagano Red Cross Hospital (JP)
  • Hokkaido University (JP)
  • Uji-Tokushukai Medical Center (JP)
  • Nara Medical University Hospital (JP)
  • Toshima Hospital (JP)
  • National Center for Global Health and Medicine (JP)
  • Okinawa Prefectural Nanbu Medical Center & Children's Medical Center (JP)
  • Kyoto City Hospital (JP)
  • Tokyo Medical Examiner's Office (JP)
  • Hitachinaka General Hospital (JP)
  • Sakai City Institute of Public Health (JP)
  • Odawara Municipal Hospital (JP)
  • Oita Prefectural Hospital (JP)
  • Japanese Red Cross Narita Hospital (JP)
  • Niigata Prefectural Central Hospital (JP)
Corresponding author
Nakajima, Noriko
Venue
Modern Pathology
Publisher
Elsevier BV
Published
2012-01
Volume
25
Issue
1
Pages
1-13
ISSN
0893-3952 (ISSN-L)
OpenAlex
W2071039804
Cited by
95
References
35
Citations by year
2026: 2 · 2025: 4 · 2024: 8 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 10 · 2019: 5 · 2018: 7 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 7 · 2013: 9 · 2012: 7
FWCI
5.76
Type
journal article
Language
en
Update notices
erratum (2012-03-01)
Open access
Locations
  • Modern Pathology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Ministry of Health, Labour and Welfare (Shinko-Ippan-014)
Topics
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Autopsy Techniques and Outcomes
Keywords
2009 H1N1 influenza, pandemic influenza A, lung histopathology, hyaline membranes, alveolar type II cells, viral pneumonia, tracheobronchitis, bronchopneumonia
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Antigens, Viral, Autopsy, Child, Child, Preschool, DNA Mutational Analysis, Female, Fixatives, Formaldehyde, Humans, Immunohistochemistry, Influenza, Human, Japan, Lung, Male, Middle Aged, Mutation, RNA, Viral, Time Factors, Paraffin Embedding, Tissue Fixation, Hemagglutinin Glycoproteins, Influenza Virus, Reverse Transcriptase Polymerase Chain Reaction, Influenza A Virus, H1N1 Subtype, Young Adult, Pandemics, Real-Time Polymerase Chain Reaction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review