Histopathological and immunohistochemical findings of 20 autopsy cases with 2009 H1N1 virus infection
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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.
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Bacterial infection complicating A(H1N1)pdm09 ranged from 5 to 14% of fatal cases in the four studies reporting data from clinical testing prior to death.
“On this basis, bacterial infection complicating A(H1N1)pdm09 ranged from 5 to 14% of fatal cases in the four studies [1, 17, 21, 22] reporting data from clinical testing prior to death”
From The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. (2018) · cites this paper as [21]
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- 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
- ORCID
- 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
- bronze
- doi.org
- Licence
- 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
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