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Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection
Abstract
BACKGROUND: Influenza B virus infection causes rates of hospitalization and influenza-associated pneumonia similar to seasonal influenza A virus infection and accounts for a substantial percentage of all influenza-related hospitalizations and deaths among those aged <18 years; however, the pathogenesis of fatal influenza B virus infection is poorly described. METHODS: Tissue samples obtained at autopsy from 45 case patients with fatal influenza B virus infection were evaluated by light microscopy and immunohistochemical assays for influenza B virus, various bacterial pathogens, and complement components C4d and C9, to identify the cellular tropism of influenza B virus, characterize concomitant bacterial pneumonia, and describe the spectrum of cardiopulmonary injury. RESULTS: Viral antigens were localized to ciliated respiratory epithelium and cells of submucosal glands and ducts. Concomitant bacterial pneumonia, caused predominantly by Staphylococcus aureus, was identified in 38% of case patients and occurred with significantly greater frequency in those aged >18 years. Pathologic evidence of myocardial injury was identified in 69% of case patients for whom cardiac tissue samples were available for examination, predominantly in case patients aged <18 years. CONCLUSIONS: Our findings suggest that bacterial pneumonia and cardiac injury contribute to fatal outcomes after infection with influenza B virus and that the frequency of these manifestations may be age related.
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TL;DR
In a 45-patient autopsy series of fatal influenza B virus infection, death was often rapid and was frequently accompanied by bacterial pneumonia or myocardial injury. Cardiac injury and/or bacterial pneumonia were identified in 90% of case patients for whom these features could be assessed.
Key findings
- Among 45 case patients, median age at death was 11 years (range, 10 months–55 years), and 34 (76%) were aged <18 years; median time from illness onset to death was 3 days (range, 1–22 days), with 24 of 35 (69%) dying within 4 days.
- Pathologic evidence of concomitant bacterial pneumonia was present in 17 (38%) case patients; among those with bacterial pneumonia, *Staphylococcus aureus* was confirmed in 13 (76%), including 7 with methicillin-resistance markers and 11 with Panton-Valentine leukocidin markers.
- Myocardial injury was identified in 20 of 29 (69%) case patients with cardiac tissue available; 10 had unequivocal myocarditis, and C4d/C9 IHC staining was seen in 19 of 28 (68%) tested.
- Cardiac injury and bacterial pneumonia were prominent: one or both features were identified in 90% of case patients for whom these pathologic characteristics could be assessed, and cardiac muscle damage was evident in 85% of evaluated patients without bacterial pneumonia.
Methods
- Retrospective autopsy case series of tissue samples submitted to the CDC from patients with suspected infectious cause of death during May 2000–February 2010; 45 patients with confirmed influenza B virus infection were examined.
- Histopathology and immunohistochemistry assessed airway, lung, cardiac, and lymph node tissues; influenza B viral antigens were detected with pooled monoclonal antibodies against nucleocapsid and hemagglutinin, and bacterial coinfection was assessed with tissue Gram/silver stains plus IHC for selected bacterial antigens.
- Molecular analysis used real-time RT-PCR for influenza B hemagglutinin and lineage-specific probes, plus multiplex real-time PCR for *S. aureus* *nuc*, PVL, and *mecA* genes; categorical features were compared with two-sided Fisher’s exact test and continuous data with Wilcoxon rank-sum test.
Limitations
- The paper states that the study was limited by restricted analysis of case patients for whom an autopsy was performed and tissue samples were sent to the CDC, and by qualitative and quantitative differences among submitted tissue samples.
- The text also makes evident that this is a selected autopsy cohort with missing data for some clinical and pathologic features, so frequencies may not represent all fatal influenza B infections.
- The paper notes uncertainty about pathogenic mechanisms, including that no viral antigens were detected in damaged myocardium and influenza B nucleic acids were amplified from myocardium in only 1 case patient, leaving the relative contributions of viral-mediated injury and ischemia unresolved.
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54 Own result · 24 Not checked yet · 4 Own method · 3 Own interpretation
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“Age .18years was the only feature that differed significantly between case patients with and without evidence of histologically confirmed bacterial pneumonia (P , .001) (Table 1).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
plaincorrelationaln = 45 ·- Asserted: passes — The authors put it forward as true.
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“Other pulmonary lesions, including intraalveolar hemorrhage and edema, interstitial pneumonia (Figure 1F), and alveolitis were observed in #50% of case patients without evidence of bacterial pneumonia (Table 2).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“All of the case patients with pneumonia due to infection with S. aureus and 1 due to S. pyogenes showed diffusely necrotizing pulmonary lesions, accompanied by abundant hemorrhage and edema, distinguished by coalesced areas of necrosis and hemorrhage that destroyed the normal architecture of the lungs (Figure 1E).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“Seventeen (38%) case patients had pathologic evidence of a concomitant bacterial pneumonia.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
plainn = 45- Asserted: passes — The authors put it forward as true.
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“Bronchiolitis was observed in 40% of case patients without a superimposed bacterial infection (Figure 1C).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“Viral antigens were detected by IHC staining of respiratory tissues from 28 case patients.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Laboratory Confirmation of Influenza B Virus Infection
plainn = 28- Asserted: passes — The authors put it forward as true.
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In the paper
“For 17 (38%) case patients, intraalveolar collections of neutrophils and macrophages containing intracellular bacteria were identified by using tissue Gram or silver techniques (Table 1).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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In the paper
“Antigens of influenza B virus were detected predominantly in the nuclei of ciliated columnar epithelium of the trachea and proximal bronchi and less frequently in cells lining the bronchioles (Table 2; Figure 2A and 2B).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Distribution of Viral Antigens
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In the paper
“Tissue samples from case-patients without bacterial pneumonia were more likely to be IHC positive for viral antigens than those from case patients with evidence of bacterial coinfection (P , .001) (Table 1).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Laboratory Confirmation of Influenza B Virus Infection
plaincorrelationaln = 28 ·- Asserted: passes — The authors put it forward as true.
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“Inflammatory cell infiltrates were characterized predominantly by lymphocytes, plasma cells, and macrophages that infiltrated the lamina propria and often extended into the submucosa to involve seromucinous glands and ciliated ducts (Figure 1B).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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In the paper
“IHC and PCR assays confirmed coinfection with S. aureus in 13 (76%) of the patients with bacterial pneumonia, of whom 7 had genetic markers for methicillin resistance and 11 for Panton-Valentine leukocidin.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“Erythrophagocytosis was identified in lymph nodes adjacent to trachea and bronchi of 10 (34%) of the 29 case patients for whom these tissues were available (Figure 1D).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“The epithelial surfaces of these airways were often denuded and associated with necrosis and hemorrhage; however, in most cases, the basal layer of epithelium and basement membrane were preserved (Figure 1A).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“All other years were represented by 1 influenza B virus lineage or a combination of Yamagata-like and Victoria-like strains.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Laboratory Confirmation of Influenza B Virus Infection
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In the paper
“Illnesses occurred during December-April among the 44 case patients for whom this information was recorded.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
plainn = 44- Asserted: passes — The authors put it forward as true.
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In the paper
“Only Yamagata-like strains were identified from 2008 (n 5 11), whereas Victoria-like strains were identified in all tissues from case patients from 2003 (n 5 4), 2007 (n 5 9), and 2009 (n 5 9).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Laboratory Confirmation of Influenza B Virus Infection
plainn = 11- Asserted: passes — The authors put it forward as true.
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In the paper
“Of case patients for whom antigens could be detected and a duration of illness was available, 13 (72%) died within 4 days after illness onset and only 2 (11%) survived for .7 days, including a 13-year-old child with acute myeloblastic leukemia in whom viral antigens were detected by IHC at 22 days.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Distribution of Viral Antigens
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In the paper
“The median age of death for case patients was 11 years (range, 10 months to 55 years); 34 (76%) case patients were aged ,18 years.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
plainn = 45- Asserted: passes — The authors put it forward as true.
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In the paper
“Tissue samples from 45 case patients (29 female and 16 male patients) with influenza B virus infection were examined (Table 1).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
plainn = 45- Asserted: passes — The authors put it forward as true.
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“Place of death was recorded for 42 case patients; of these, 11 (26%) died at home, 3 (7%) died en route to a hospital, 9 (21%) died at a clinic or shortly after arrival at an emergency department, and 19 (45%) died during hospitalization.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
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In the paper
“Pre-existing medical conditions considered to be high risk for severe influenza, other than young age, were identified in 13 (43%) of the case patients for whom these data were available.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
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In the paper
“The median number of days from illness onset until death was 3 (range, 1-22 days) among the 35 patients for whom this information was available; 24 (69%) of these case patients died within 4 days after illness onset.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Patient Characteristics
plainn = 35- Asserted: passes — The authors put it forward as true.
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In the paper
“of the influenza B viruses that could be characterized, 25 were Victoria-like and 17 Yamagata-like strains (Table 1).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Laboratory Confirmation of Influenza B Virus Infection
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In the paper
“Close inspection of glandular epithelium occasionally revealed focal necrosis.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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In the paper
“Antigens were also identified in the epithelium of submucosal glands and ciliated ducts of the trachea and bronchi (Figure 2C and 2D) and uncommonly in airspaces, comprising predominantly detached strips of ciliated airway epithelium, or single cells, situated freely within the alveoli.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Distribution of Viral Antigens
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In the paper
“Viral antigens were detected infrequently in respiratory tissues from most IHC-positive patients, and extensive staining was relatively unusual.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Distribution of Viral Antigens
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In the paper
“Histological evidence of myocardial injury was characterized in 1 case patient by a small acute myocardial infarct and, in 6 others, by variably sized foci of shrunken or hypereosinophilc myocytes lacking cross-striations and nuclei (Figure 3B).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
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In the paper
“For most case patients in this series, death followed a remarkably rapid clinical progression, regardless of demonstrable bacterial pneumonia: 50% of all case patients died within 3 days after illness onset, and 70% died within 4 days.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
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In the paper
“Histological features of myocarditis were apparent in 50% of these patients; of surprise, the cardiac tissue samples from the other 50% demonstrated multifocal IHC evidence of damage that was histologically compatible with ischemic necrosis in the absence of conspicuous inflammatory cell infiltrates.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
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In the paper
“For 17 case patients, there was histological evidence of myocyte damage, including 10 with unequivocal myocarditis, characterized by multiple discrete foci of myocyte necrosis accompanied by clusters of interstitial lymphocytes, macrophages, and occasional neutrophils (Figure 3A).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
plainn = 17- Asserted: passes — The authors put it forward as true.
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In the paper
“Indeed, cardiac injury and bacterial pneumonia were prominent findings in this cohort, and one or both features were identified in 90% of the case patients for whom these pathologic characteristics could be assessed.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
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In the paper
“This pattern of staining was observed in the myocardium of each case patient with abnormal histological findings for whom tissues remained for testing (Figures 3C-3F) and in cardiac tissues of 3 other case patients lacking specific histological evidence of myocyte injury.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
plainn = 3- Asserted: passes — The authors put it forward as true.
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In the paper
“Only 2 distinct lineages of influenza B viruses, comprising the Victoria-like and Yamagata-like strains, currently circulate among human populations [4]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Abstract
What the sources say
- Not checked yetcites [4] Rota, 1990, Cocirculation of two distinct evolutionary lineages of influenza type B virus since 1983, Virology source
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In the paper
“Influenza B viruses seldom predominate during seasonal influenza epidemics, but when this occurs, mortality statistics are generally intermediate to those attributable to the influenza A virus subtypes [6][7][8][9].”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Abstract
What the sources say
- Not checked yetcites [6] Nolan, 1980, Morbidity and mortality associated with influenza B in the United States, 1979–1980. A report from the Center for Disease Control, J Infect Dis source
- Not checked yetcites [7] Glezen, 1980, Epidemiologic observations of influenza B virus infections in Houston, Texas, 1976–1977, Am J Epidemiol source
- Not checked yetcites [8] Simmerman, 2009, Incidence, seasonality and mortality associated with influenza pneumonia in Thailand: 2005–2008, PLoS One source
- Not checked yetcites [9] Centers for Disease Control and Prevention, 2010, Estimates of deaths associated with seasonal influenza—United States, 1976–2007, MMWR Morb Mortal Wkly Rep
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In the paper
“Negative controls included cardiac tissues with no histologic evidence of inflammation or myocyte injury, obtained at autopsy from 8 patients who died suddenly of a noninfectious cause and from 15 patients who died of confirmed viral or bacterial infections other than influenza B virus infection.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Histopathology and Immunohistochemistry
plainn = 15- Asserted: passes — The authors put it forward as true.
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In the paper
“Skeletal myopathy is described in 14%-48% of children infected with influenza B virus [26,40,41]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [26] Peltola, 2003, Influenza A and B infections in children, Clin Infect Dis source
- Not checked yetcites [40] Wang, 2009, Clinical and laboratory analysis of influenza B infection in children in Taichung, Taiwan during the 2006–2007 flu season, Pediatr Neonatol source
- Not checked yetcites [41] Chi, 2008, Clinical features of children infected with different strains of influenza B in southern Taiwan, Pediatr Infect Dis J source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“which has been the most commonly identified etiology among US hospitalized pediatric patients with influenza-associated bacterial pneumonia since the 2003-2004 influenza season [16,32].”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [16] Finelli, 2008, Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection, Pediatrics source
- Not checked yetcites [32] Dawood, 2010, Influenza-associated pneumonia in children hospitalized with laboratory-confirmed influenza, 2003–2008, Pediatr Infect Dis J source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Of note, 34% of the 309 seasonal influenza-associated deaths in children reported to the CDC during 2004-2008 were attributed to influenza B [16] (CDC, unpublished data)”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
What the sources say
- Not checked yetcites [16] Finelli, 2008, Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection, Pediatrics source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“of the 115 pediatric influenza-associated deaths in the United States reported to the CDC during the 2010-2011 influenza season, 44 (38%) involved influenza B virus infection [49]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [49] Centers for Disease Control and Prevention, 2011, Influenza-associated pediatric deaths—United States, September 2010–August 2011, MMWR Morb Mortal Wkly Rep
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study was limited by its restricted analysis of case patients for whom an autopsy was performed and tissue samples sent to the CDC and by qualitative and quantitative differences among case patient tissue samples submitted for evaluation.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“contemporary studies indicate that influenza B is clinically indistinguishable from seasonal influenza A, causes similar rates of hospitalization and influenzaassociated pneumonia, and accounts for a substantial percentage of all influenza-related hospitalizations and deaths in patients aged ,18 years [6,8,[24][25][26][27].”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
What the sources say
- Not checked yetcites [6] Nolan, 1980, Morbidity and mortality associated with influenza B in the United States, 1979–1980. A report from the Center for Disease Control, J Infect Dis source
- Not checked yetcites [8] Simmerman, 2009, Incidence, seasonality and mortality associated with influenza pneumonia in Thailand: 2005–2008, PLoS One source
- Not checked yetcites [24] Liou, 1987, Children hospitalized with influenza B infection, Pediatr Infect Dis J source
- Not checked yetcites [25] Hite, 2007, Medically attended pediatric influenza during the resurgence of the Victoria lineage of influenza B virus, Int J Infect Dis source
- Not checked yetcites [26] Peltola, 2003, Influenza A and B infections in children, Clin Infect Dis source
- Not checked yetcites [27] Dawood, 2010, Burden of seasonal influenza hospitalization in children, United States, 2003 to 2008, J Pediatr source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A cardiac tissue sample from a patient with Coxsackie B1 viral myocarditis was used as a positive control.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Histopathology and Immunohistochemistry
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Its specificity was assessed by evaluating its reactivity with formalin-fixed, paraffin-embedded Madin-Darby canine kidney cells infected with influenza B virus strains Beijing/243/97 and HK/16/03 and with influenza A virus subtypes H1N1, H3N2, and H5N1.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Histopathology and Immunohistochemistry
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Fatal influenza B virus infection occurs most frequently among pediatric patients; however, influenza B is also associated with lethal outcomes and substantial seasonal morbidity among adults [28,29].”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Preferential binding of influenza B viruses to receptors represented by sialic acid connected to galactose by a a-2, 6 linkage (SAa2, 6Gal) has been identified in vitro and is predicted from a structural analysis of the influenza B hemagglutinin molecule [46]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [46] Wang, 2007, Structural basis for receptor specificity of influenza B virus hemagglutinin, Proc Nat Acad Sci U S A source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“the life-threatening consequences exacted by coinfections with influenza B virus and S. aureus or S. pyogenes are increasingly described [16,29,50]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [16] Finelli, 2008, Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection, Pediatrics source
- Not checked yetcites [29] Aebi, 2010, Co-infection of influenza B and streptococci causing severe pneumonia and septic shock in healthy women, BMC Infect Dis source
- Not checked yetcites [50] Scaber, 2011, Group A streptococcal infections during the seasonal influenza outbreak 2010/11 in South East England, Euro Surveill source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Myocarditis is also reported occasionally among patients with fatal influenza A virus infection [2,10,14]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [2] Taubenberger, 2008, The pathology of influenza virus infections, Annu Rev Pathol source
- Not checked yetcites [10] Martin, 1959, Asian influenza A in Boston, 1957–1958. I. Observations in thirty-two influenza-associated fatal cases, AMA Arch Intern Med source
- Not checked yetcites [14] Guarner, 2006, Histopathologic and immunohistochemical features of fatal influenza A virus infection in children during the 2003–2004 season, Clin Infect Dis source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The few studies to describe in vivo distribution of influenza virus antigens in respiratory tissues from deceased patients have focused specifically on influenza A viruses [14,15]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [14] Guarner, 2006, Histopathologic and immunohistochemical features of fatal influenza A virus infection in children during the 2003–2004 season, Clin Infect Dis source
- Not checked yetcites [15] Shieh, 2010, 2009 pandemic influenza A (H1N1): pathology and pathogenesis of 100 fatal cases in the United States, Am J Pathol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“IHC stains for C4d and C9 have been used to identify early myocardial infarcts in patients who die before an influx of leukocytes can occur [18]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
- Not checked yetcites [18] Jenkins, 2010, The utility of C4d, C9, and troponin T immunohistochemistry in acute myocardial infarction, Arch Pathol Lab Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The authors state this as an assumption.
No comprehensive studies describe the pathology of influenza B virus infection in a large series of patients with fatal disease or distinguish the pathology of disease with and without concomitant bacterial pneumonia.
“To our knowledge, there are no comprehensive studies to describe the pathology of influenza B virus infection in a large series of patients with fatal disease or to distinguish the pathology of disease with and without concomitant bacterial pneumonia.”
The paper relies on this without support.
No large studies have specifically identified cardiac injury as a frequent manifestation of fatal influenza B.
“however, we are not aware of any large studies that specifically identify cardiac injury as a frequent manifestation of fatal influenza B.”
The paper relies on this without support.
The pathogenic mechanisms that lead to injury to striated fibers in the heart and skeletal muscles are unknown.
“The pathogenic mechanisms that lead to injury to striated fibers in the heart and skeletal muscles remain unknown.”
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?
In the citing paper
“In seasonal epidemics, influenza bacterial coinfection is associated with increases in hospital admissions,4, 5 more severe symptoms,6 and increases in mortality.7”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [7]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Infection with influenza B virus was identified in 36 (82%) of the case patients by at least 1 assay before submission to the CDC.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Laboratory Confirmation of Influenza B Virus Infection
Reported 82 · recomputed 80
Citations
Cites
Methicillin-Resistant S. aureus Infections among Patients in the Emergency Department
Moran, G. J., Krishnadasan, A., Gorwitz, R. J., Fosheim, G. E., McDougal, L. K., Carey, R. B., & Talan, D. A. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa055356 · Cited by 2,285
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“Pandemic A (H1N1) 1918–1919 10 (NR) 93 Streptococcus pneumoniae [3]”
BackgroundThe Pathology of Influenza Virus Infections
Taubenberger, J. K., & Morens, D. M. (2008) · Annual Review of Pathology: Mechanisms of Disease · doi:10.1146/annurev.pathmechdis.3.121806.154316 · Cited by 1,111
Mucus clearance as a primary innate defense mechanism for mammalian airways
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Estimates of deaths associated with seasonal influenza --- United States, 1976-2007.
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Influenza-Associated Deaths among Children in the United States, 2003–2004
Bhat, N., Wright, J. G., Broder, K. R., Murray, E. L., Greenberg, M. E., Glover, M. J., Likos, A. M., Posey, D. L., Klimov, A., Lindstrom, S. E., et al. (2005) · New England Journal of Medicine · doi:10.1056/nejmoa051721 · Cited by 648
Self-citationCocirculation of two distinct evolutionary lineages of influenza type B virus since 1983
Rota, P. A., Wallis, T. R., Harmon, M. W., Rota, J. S., Kendal, A. P., & Nerome, K. (1990) · Virology · doi:10.1016/0042-6822(90)90186-u · Cited by 539
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Self-citation
Research works printed but not linked: 1
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Cited by
Sorted by citations
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Clinical Characteristics and Predictors of Mortality in Critically Ill Influenza Adult Patients
Hsu, J.-C., Lee, I., Huang, W.-C., Chen, Y., & Tsai, C.-Y. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9041073 · Cited by 14
Chiu, S., Lin, J., Wang, H.-C., Wu, H.-S., Chang, H., Lin, Y.-C., & Liu, H. (2014) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2014.02.017 · Cited by 13
Severe respiratory failure associated with influenza B virus infection
Kato, S., Fujisawa, T., Enomoto, N., Inui, N., Nakamura, Y., & Suda, T. (2015) · Respirology Case Reports · doi:10.1002/rcr2.107 · Cited by 11
Siskin, M., Rao, S. D., Rapkiewicz, A., Bangalore, S., & Garshick, M. S. (2017) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2017.06.006 · Cited by 11
Cardiac Troponin-I Concentration In Weaned Calves With Bovine Respiratory Disease
Hanedan, B., Kirbaş, A., Dorman, E., Mehmet, O. T., Kandemır, F. M., & Alkan, Ö. (2015) · Acta veterinaria · doi:10.1515/acve-2015-0038 · Cited by 12
Lapinscki, B. A., Pereira, L. A., Nogueira, M. B., Vidal, L. R., Riediger, I. N., Debur, M. C., Presibella, M. M., & Raboni, S. M. (2017) · Vaccine · doi:10.1016/j.vaccine.2017.11.033 · Cited by 10
Change in patterns of hospitalization for influenza during COVID‐19 surges
Venkatram, S. K., Alapati, A., Dileep, A., & Diaz‐Fuentes, G. (2021) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12900 · Cited by 9
Hydroquinone exposure alters the morphology of lymphoid organs in vaccinated C57Bl/6 mice
Fábris, A. L. D. S., Nunes, A. V., Schuch, V., de Paula-Silva, M., da Rocha, G. H. O., Nakaya, H. I., Ho, P. L., Silveira, E. L. V., & Farsky, S. H. P. (2019) · Environmental Pollution · doi:10.1016/j.envpol.2019.113554 · Cited by 10
Next-Generation Sequencing Analysis of Cellular Response to Influenza B Virus Infection
Sheng, Z., Huang, C., Liu, R., Guo, Y., Ran, Z., Li, F., & Wang, D. (2020) · Viruses · doi:10.3390/v12040383 · Cited by 10
“The global burden of annual influenza epidemics involving IBV, coupled with the increasing strong links between IBV and fatal infections in humans [21,22], calls for an urgent need for more basic and clinical investigations of IBV.”
BackgroundBai, B., Wang, H., Li, M., Ma, X., Zheng, J., Deng, Q., & Yu, Z. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00121 · Cited by 9
“(T cells)-mediated cell immunity may aggravate the acute lung injury caused by influenza B virus infection and facilitate the occurrence of the secondary bacterial invasion (3, 10, 11).”
BackgroundLakhan, N., Clarke, M. F., Mathew, S. M., & Marshall, H. S. (2016) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12403 · Cited by 10
Pascua, P. N. Q., Jones, J. C., Marathe, B. M., Seiler, P., Caufield, W. V., Freeman, B. B., Webby, R. J., & Govorkova, E. A. (2021) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01137-21 · Cited by 9
“cations, including encephalitis and myositis (3, 5, 6).”
BackgroundHu, J., Zhu, L., Wu, S.-T., & Ding, S. (2024) · Chemosensors · doi:10.3390/chemosensors12040068 · Cited by 8
Wang, S., Liu, S., Chu, K., Zhao, Y., Zhu, F., Hu, Y., Meng, F., Li, J., Luo, L., Yang, J., et al. (2017) · Expert Review of Vaccines · doi:10.1080/14760584.2017.1374181 · Cited by 8
Influenza B viruses: underestimated and overlooked
Koutsakos, M., & Kent, S. J. (2021) · Microbiology Australia · doi:10.1071/ma21033 · Cited by 8
Eşki, A., Öztürk, G. K., Çiçek, C., Gülen, F., & Demir, E. (2024) · Turkish Archives of Pediatrics · doi:10.5152/turkarchpediatr.2024.23286 · Cited by 7
Salatzki, J., Ochs, A. G., Weberling, L. D., Heins, J., Zahlten, M., Whayne, J. G., Stehning, C., Giannitsis, E., Denkinger, C. M., Merle, U., et al. (2024) · Journal of Cardiovascular Magnetic Resonance · doi:10.1016/j.jocmr.2024.101124 · Cited by 7
Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020–2021
Newell, K., Fischer, M., Massey, S., Orell, L., Steinberg, J., Tompkins, M. L., Castrodale, L. J., & McLaughlin, J. K. (2023) · Emerging infectious diseases · doi:10.3201/eid2909.230080 · Cited by 7
“70 Anchorage 28 (51) 111 (51) Interior 7 (13) 31 (14) Gulf 4 (7) 16 (7) Matanuska-Susitna 5 (9) 15 (7) Northern 2 (4) 20 (9) Southeast 2 (4) 7(3) Southwest 7 (13) 16 (7) Underlying medical condition 1.”
Death of Woman with Peripartum Influenza B Virus Infection and Necrotizing Pneumonia
Rein, J. L., Etra, A. M., Patel, J., Stein, J. L., Rivers, A. L., Gershengorn, H. B., Awerbuch, E., Kreiswirth, B. N., & Koshy, S. C. (2014) · Emerging infectious diseases · doi:10.3201/eid2007.140230 · Cited by 7
Autopsies in pandemics – a perspective on barriers and benefits. Is it time for a revival?
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“of autopsied influenza-related deaths have histopathological signs of myocarditis, although the importance of bacterial co-infection in this manifestation is undetermined (45, 46).”
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Cardiac Manifestations of Viral Infections, Including COVID-19: A Review
Weisleder, H., Jacobson, E., Frishman, W. H., & Dhand, A. (2022) · Cardiology in Review · doi:10.1097/crd.0000000000000481 · Cited by 6
“38 Viral entry into host cells is mediated by the binding of the viral S (spike) protein to angiotensin-converting enzyme 2 (ACE2) as an entry surface receptor.”
BackgroundShen, C., Ho, T., Wang, S.-M., Liao, Y.-T., Hu, Y.-S., Tsai, H., & Chen, S. (2020) · Clinical Immunology · doi:10.1016/j.clim.2020.108548 · Cited by 6
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“observed in adult fatal cases of influenza B infected patients [23].”
BackgroundLiu, D., Xu, J., Yu, X., Tong, F., Walline, J. H., Fu, Y., & Zhao, K. (2019) · BioMed Research International · doi:10.1155/2019/8756563 · Cited by 6
“Paddock suggested in 2012 that coinfection and cardiac injury contributed to fatal outcomes in influenza B infection [8], while Cohen found in 2014 that HIV infection was associated with IBV-related hospitalization [35].”
BackgroundRobinson, C. C., Loeffelholz, M. J., & Pinsky, B. A. (2016) · ASM Press eBooks · doi:10.1128/9781555819156.ch19 · Cited by 6
Fatal Influenza B Myocarditis in a 34-Year-Old Female
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Procalcitonin to Distinguish Viral From Bacterial Origin of Pneumonia: No Premature Conclusion!
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Puzelli, S., Facchini, M., Piacentini, S., Mario, G. D., Colucci, M. E., Calzoletti, L., Fabiani, C., Martino, A. D., Veronesi, L., Biasucci, G., et al. (2023) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2023.12.018 · Cited by 5
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Alessandri, F., Bilotta, F., Ceccarelli, G., Ruberto, F., Araimo, F., Imperiale, C., Pugliese, F. R., & for the PolU COVID-19 Team (2020) · Journal of Neuroanaesthesiology and Critical Care · doi:10.1055/s-0040-1713016 · Cited by 3
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Self-citationNLRP6 Induces Lung Injury and Inflammation Early in Brucella and Influenza Coinfection
Shi, B., Han, H., Li, H., Tan, L., Li, X., Wang, K., Li, B., He, W., Tian, C., Fang, Y., et al. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12122063 · Cited by 3
A New Master Donor Virus for the Development of Live-Attenuated Influenza B Virus Vaccines
White, C. L., Chiem, K., Perez, D. R., Santos, J. J. D. S., Garcia, S. C., Nogales, A., & Martínez‐Sobrido, L. (2021) · Viruses · doi:10.3390/v13071278 · Cited by 3
Zhao, T., Liu, Y., Jia, H., Wang, D., Du, M., & Wang, W. (2024) · Journal of Medical Biochemistry · doi:10.5937/jomb0-51197 · Cited by 2
“Therefore, effective prevention and treatment of severe pneumonia complicated with myocardial damage is of great significance in advancing children’s therapeutic effect and mass of life (3, 4).”
Longitudinal Landscape of Long Flu and Long COVID
Zheng, M. (2026) · COVID · doi:10.3390/covid6010021 · Cited by 3
“The association between influenza and cardiac dysfunction is not a modern observation; severe cardiac damage was documented in nearly all fatalities of the 1918 Spanish flu pandemic [9], and has been a consistent finding in autopsies of fatal seasonal influenza cases since [10,11].”
Zheng, M. (2026) · Cardiovascular Toxicology · doi:10.1007/s12012-025-10077-5 · Cited by 2
“…myocardial necrosis and myocarditis, along with histological evidence of ischemic damage, characterized by shrunken, hypereosinophilic myocytes [ 10]; (iii) a seasonal rise in cardiovascular events during influenza epidemics, particularly in unvaccinated individuals [ 11]; fre - quent…”
Research progress on the association between viruses and cardiac diseases
He-min, Y., Zhu, M.-L., Zhao, Y., Tan, J.-X., Luo, S.-C., Pang, P., & Zheng, C.-B. (2026) · Journal of Virology · doi:10.1128/jvi.00383-26 · Cited by 2
“Population-based studies further indicate that pre-existing cardiovascular diseases are associated with increased mortality during influenza infection, and that acute influenza illness is temporally linked to an increased risk of cardiovascular events (4, 47, 48).”
Inactivated and Recombinant Influenza Vaccines
Patel, M. M., Grohskopf, L. A., Sambhara, S. R., Belser, J. A., Katz, J. M., & Fry, A. M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-79058-1.00033-5 · Cited by 2
Prandoni, S. (2012) · Journal of Public Health Research · doi:10.4081/jphr.2012.e29 · Cited by 2
Owusu, D., Hand, J., Tenforde, M. W., Feldstein, L. R., DaSilva, J. C., Barnes, J., Lee, G., Tran, J., Sokol, T. M., Fry, A. M., et al. (2020) · American Journal of Transplantation · doi:10.1111/ajt.15782 · Cited by 2
Intensivpflichtige Virusinfektionen der unteren Atemwege
Drick, N., & Welte, T. (2016) · Intensivmedizin up2date · doi:10.1055/s-0041-110072 · Cited by 1
Influenza – jeder kennt die „Grippe“ und doch wird sie immer noch unterschätzt
Welte, T. (2019) · Der Pneumologe · doi:10.1007/s10405-019-0257-3 · Cited by 1
Complications and Image Findings
Shi, Y., Shi, X., Wang, L., Zhou, S., Shi, W., & Wu, J. (2021) · Springer eBooks · doi:10.1007/978-981-16-1429-3_8 · Cited by 1
Zhong, P., Zhang, H., Chen, X., Liang, Y., Lin, L., Yang, S.-Y., Sheng, J.-Y., & Li, C. (2016) · PubMed Central · doi:10.7499/j.issn.1008-8830.2016.02.005 · Cited by 1
Khalil, A., Elhadry, A., Talo, M., Elwakeel, M. M. H., Ahmed, T., Alshehail, S. M., Atteiya, M., Batal, F., Sakha, Z., Azzo, M., et al. (2019) · The Open Infectious Diseases Journal · doi:10.2174/1874279301911010043 · Cited by 1
Babon, J. A. B. (2012) · The Journal of the American Medical Association (JAMA) Network (American Medical Association) · doi:10.13028/xaap-nf51
“Further studies to determine the role of these memory T cell responses should be done since IBV contributes to the burden of influenza disease (133, 150) and is a major component of the influenza vaccination that is currently being administered.”
BackgroundAbeysekera, R., Imbulpitiya, I., Ponnamperuma, S., & Kularatne, S. (2013) · Sri Lankan Journal of Infectious Diseases · doi:10.4038/sljid.v3i1.4473
Influenza B virus: need for heightened surveillance and epidemiologic case studies
Rayamajhi, N., Joshi, A., Pangeni, R. P., Upadhyay, B. P., Shakya, G., Shah, J. N., Karki, A., & Baral, K. P. (2015) · Journal of Patan Academy of Health Sciences · doi:10.3126/jpahs.v1i2.20182
Dissecting the Novel Roles of TRIM56 in Antiviral Innate Immunity
Liu, B. (2016) · doi:10.21007/etd.cghs.2016.0394
“Classified within the family Orthomyxoviridae, influenza A and B viruses (IAV and IBV) are important respiratory pathogens responsible for significant morbidity and mortality worldwide (12-15).”
BackgroundMcManus, B. M., Seidman, M. A., Klingel, K., & Luo, H. (2016) · ASM Press eBooks · doi:10.1128/9781555819439.ch7
Investigation of a Trimeric Hemagglutinin Stem Domain from Influenza B for a Universal Vaccine
Duran, A. (2018) · uO Research (University of Ottawa) · doi:10.20381/ruor-22454
Clinical Utility of Viral Loads in Influenza Virus Infections
Granados, A. (2018) · TSpace (University of Toronto)
Fabris, A. L. (2019) · Digital Library of Theses and Dissertations (Universidade de São Paulo) · doi:10.11606/d.9.2019.tde-08052019-152805
Pericardial window in tamponade and sever LV systolic dysfunction after acute myocarditis
(2019) · Journal of Surgery and Trauma · doi:10.32592/jsurgery.2019.7.1.106
“Pericardial tamponade is one of the most common diseases with many etiologies (1-3).”
BackgroundSilveira, M. B., da Silva, N. M., Finotti, A., Pereira, L. A., & Manrique, E. J. C. (2021) · Diversitas Journal · doi:10.17648/diversitas-journal-v6i2-1720
Influenza and Covid-19 in Children: Time to Have a Close Watch!
Kori, A., Ratageri, V. H., & Mithra, C. A. G. (2022) · The Indian Journal of Pediatrics · doi:10.1007/s12098-022-04139-7
“Fatal influenza B virus infections are rare but are associated with bacterial pneumonia and cardiac injury [2].”
(2021) · Microbiology Australia · doi:10.1071/mav42n3
Bessis, S., & Matt, M. (2019) · Médecine et Maladies Infectieuses · doi:10.1016/s0399-077x(19)30803-0
Erben, A., Yan, C. L., Ruiz, F., & Rivera, N. T. (2023) · BMJ Case Reports · doi:10.1136/bcr-2023-255224
Efficacy and safety of pediatric flu vaccination: a systematic review
Rico, F. M. E., & Fernández, L. P. (2023) · Revista Española de Quimioterapia · doi:10.37201/req/101.2023
“Temas y evidencia relacionada con los estudios. infectan por virus influenza cada año [35].”
BackgroundVillalba, J. A., & Pritt, B. S. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-93548-7.00013-1
McCullers, J. A. (2025) · Elsevier eBooks · doi:10.1016/b978-0-323-82763-8.00191-6
Cardioprotective effects of AMPK activation in H1N1 influenza virus infectionPreprint
Leumi, S., McFadden, M. I., Kumar, N., Mattoo, S. S., Roettger, J. E., Speaks, S., Liu, B. D. X., Mohan, S., Reznik, B. M., Cable, J. M., et al. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.08.28.672931
“Signs of myocarditis at autopsy have been reported in up to 48% of fatal seasonal influenza cases 4, 8, 9, 10 and this association is further supported by large-scale epidemiologic studies showing increased cardiovascular events during influenza season, particularly among the unvaccinated 11, 12 .”
Haemagglutinin 162–164 deletions enhance influenza B/Victoria virus fitness and virulence in vivoPreprint
Ng, G. G. K., Cronin, P., Li, X., Victorio, C. B. L., Cheng, D.-Q., Zhang, R., Wong, F. Y., Ganasarajah, A., Chacko, A., Webby, R. J., et al. (2026) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.64898/2026.01.08.698527
Zhang, B., Wang, H., Wang, Y., Liu, X., Yan, W., Zhou, J., Zhang, L., Yankai, L., Chen, Y., Liang, C., et al. (2026) · Virus Genes · doi:10.1007/s11262-026-02226-x
Étude de la pathogénicité des virus Influenza A/H1N1
Casalegno, J. (2014) · theses.fr (ABES) · doi:10.70675/6988852bz540fz4f0ez994czda4634eeb623
Post-influenza syndromes: a hidden burden in clinical practice
Tsiodras, S. (2026) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2026.2736888
Metadata
- Authors
- Paddock, C. D., Liu, L., Denison, A. M., Bartlett, J. H., Holman, R. C., DeLeon-Carnes, M., Emery, S. L., Drew, C. P., Shieh, W.-J., Uyeki, T. M., & Zaki, S. R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Venue
- The Journal of Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-30
- Volume
- 205
- Issue
- 6
- Pages
- 895-905
- ISSN
- 0022-1899 (ISSN-L)
- 1537-6613
- OpenAlex
- W2162655125
- Semantic Scholar
- 18926c6c817df030b3a6b9a0e7687f3773df1a15
- Cited by
- 171
- References
- 50
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 7 · 2023: 8 · 2022: 6 · 2021: 10 · 2020: 23 · 2019: 24 · 2018: 12 · 2017: 15 · 2016: 19 · 2015: 10 · 2014: 9 · 2013: 10 · 2012: 9
- FWCI
- 9.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Keywords
- influenza B, fatal influenza, myocardial injury, bacterial pneumonia, Staphylococcus aureus, influenza-associated pneumonia, cell tropism, complement C4d, complement C9, age-related mortality, autopsy findings
- MeSH terms
- Adolescent, Adult, Antigens, Viral, Autopsy, Child, Child, Preschool, Female, Heart Injuries, Hospitalization, Humans, Infant, Infant, Newborn, Influenza, Human, Male, Middle Aged, Myocardium, Influenza B virus, Specimen Handling, Staphylococcus aureus, Cohort Studies, Pneumonia, Bacterial, Young Adult, Viral Tropism
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