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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
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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
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“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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“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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“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
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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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“The predominant pathologic feature common to almost all case patients was inflammation of the trachea and bronchi (Table 2; Figure 1A).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“When case patients without a concomitant bacterial pneumonia were stratified by age group, those aged ,18 years were more likely to be IHC-positive for influenza B virus than were those aged $18 years (P 5 .03).”
§ 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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“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
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“Marked congestion of mural capillaries and edema of adjacent connective tissues were conspicuous and common features.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Pulmonary Pathology
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“At the CDC, influenza B viral nucleic acids were detected in formalin-fixed, paraffin-embedded samples of respiratory tissue from all case patients”
§ 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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“Among the adult case patients with influenza B virus infection, fatal disease occurred significantly more often in the context of a combined bacterial pneumonia: 82% of patients aged $18 years died with evidence of bacterial pneumonia, compared with only 24% of those patients #18 years of age.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
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“Of 28 case patients for whom heart tissue samples were available to detect C4d and C9 by IHC, 19 revealed multifocal cytoplasmic staining of contiguous intramural myocytes that stained reproducibly with both of the anticomplement antibodies.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
plainn = 28- Asserted: passes — The authors put it forward as true.
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“When patients with histological or IHC evidence of cardiac injury were compared with those without this evidence by various demographic, laboratory, and clinical features, only the frequency of bacterial pneumonia was identified as statistically significant (P , .01)(Table 3).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
plaincorrelationaln = 29 ·- Asserted: passes — The authors put it forward as true.
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“no viral antigens were identified in the damaged myocardium of any case patient”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
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“Among control tissues obtained from15 patients who died of an infectious process other than influenza B virus infection, focal staining of C4d and C9 was observed only in rare cardiac myocytes of a 6-year-old child with enteroviral meningoencephalitis and a 3-year-old child with pneumococcal pneumonia.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
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“Influenza B virus also infects acinar cells of the submucosal glands in the trachea and bronchi”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
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“In our evaluation, we identified a reproducible pattern of staining with both antibodies in cardiac tissues from the majority of case patients with fatal influenza B virus infection”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
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“Myocardial injury was identified by histological and IHC assessment in 20 (69%) of 29 case patients with cardiac tissue samples available.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
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“Conspicuous staining of C4d or C9 was not identified in any of the cardiac tissues from the 8 patients with sudden traumatic death.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
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“many of the case patients identified in our series had no recognized risk factor for severe influenza other than young age.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
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“indeed, 90% of the case patients in this series with myocardial injury were aged ,18 years.”
§ 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
“Nucleic acids of influenza B virus were amplified by rRT-PCR from formalin-fixed, paraffinembedded myocardium from only 1 case patient.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
plainSingle case- Asserted: passes — The authors put it forward as true.
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“viral nucleic acids were detected in the cardiac tissue from only one patient”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
plainSingle case- Asserted: passes — The authors put it forward as true.
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“Bacterial pneumonia in this cohort of case patients with fatal influenza B was represented predominantly by S. aureus”
§ 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
“Indeed, damage to cardiac muscle was evident in 85% of patients with myocardium for evaluation who did not have bacterial pneumonia.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“We identified a consistent pattern of IHC staining in the ciliated epithelium of the airways of case patients that closely approximated the cellular tropism exhibited in respiratory tissues from patients infected with seasonal human-adapted influenza A viruses”
§ 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
“The frequency of myocardial injury among the case patients with influenza B without histological evidence of myocarditis was statistically greater than observed among the patients who died of other infectious causes (P 5 .03)”
§ 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
“No viral antigens were detected by IHC stain in the myocardium of any patient.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Cardiac Pathology
plainn = 8- Asserted: passes — The authors put it forward as true.
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“Historical and contemporary descriptions of influenza pathology have characteristically focused, predominantly or exclusively, on disease caused by seasonal or pandemic influenza A viruses [2,3,[10][11][12][13][14][15].”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > Abstract
What the sources say
- Not checked yetcites [2] Taubenberger, 2008, The pathology of influenza virus infections, Annu Rev Pathol source
- Not checked yetcites [3] Morens, 2008, Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness, J Infect Dis 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 [11] Hers, 1958, Bacteriology and histopathology of the respiratory tract and lungs in fatal Asian influenza, Lancet source
- Not checked yetcites [12] Feldman, 1972, Fatal Hong Kong influenza: a clinical, microbiological and pathological analysis of nine cases, Yale J Biol Med
- Not checked yetcites [13] Lindsay, 1970, Hong Kong influenza: clinical, microbiologic, and pathologic features in 127 cases, JAMA 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
- 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.
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In the paper
“Histological descriptions of influenza B-associated skeletal myopathy are remarkably similar to the cardiac pathology identified in several of the case patients in our series”
§ 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 [43] Bove, 1983, Morphology of acute myopathy associated with influenza B infection, Pediatr Pathol source
- Not checked yetcites [44] Kelly, 1989, Fatal rhabdomyolysis following influenza infection in a girl with familial carnitine palmityl transferase deficiency, Pediatrics source
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In the paper
“Viral-mediated injury to these cells and to the epithelium lining large airways and ciliated ducts undoubtedly contributes to the evolution of influenza-associated bacterial pneumonia by compromising the mucus stream and hindering mucociliary clearance of bacteria from the respiratory tract”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
boosteddirect- Asserted: passes — The authors put it forward as true.
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“Myocarditis or myocardial necrosis without inflammatory cell infiltrates have been described sporadically in patients with severe influenza B [35][36][37]”
§ 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 [35][36][37]
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In the paper
“The time from onset to death observed with fatal influenza B was more rapid than the duration of fatal illness described for pandemic 1918 A(H1N1), pandemic 1957 A(H2N2), pandemic 1968 A(H3N2), pandemic 2009 H1N1, and seasonal A(H3N2) viruses [3, 10-13, 4).”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
What the sources say
- Not checked yetcites [3] Morens, 2008, Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness, J Infect Dis 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 [11] Hers, 1958, Bacteriology and histopathology of the respiratory tract and lungs in fatal Asian influenza, Lancet source
- Not checked yetcites [12] Feldman, 1972, Fatal Hong Kong influenza: a clinical, microbiological and pathological analysis of nine cases, Yale J Biol Med
- Not checked yetcites [13] Lindsay, 1970, Hong Kong influenza: clinical, microbiologic, and pathologic features in 127 cases, JAMA source
- Not checked yetcites [4] Rota, 1990, Cocirculation of two distinct evolutionary lineages of influenza type B virus since 1983, Virology source
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“there are a few reports of sudden unexpected cardiac arrest or rapidly developing manifestations suggestive of myocardial ischemia in previously healthy children infected with influenza B virus [38,39]”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“many of these patients also present with elevated levels of cardiac muscle creatine phosphokinase [42]”
§ 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 [42] Farrell, 1980, Epidemic influenza myopathy in Cincinnati in 1977, J Pediatr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the histological similarity with fatal seasonal influenza A virus infection”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > DISCUSSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“include randomly distributed foci of segmental hyaline degeneration and necrosis of individual fibers, often in the absence of any inflammatory infiltrates [43,44]”
§ 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 [43] Bove, 1983, Morphology of acute myopathy associated with influenza B infection, Pediatr Pathol source
- Not checked yetcites [44] Kelly, 1989, Fatal rhabdomyolysis following influenza infection in a girl with familial carnitine palmityl transferase deficiency, Pediatrics source
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“suggesting that cardiac injury, directly or indirectly associated with influenza B virus infection, contributed prominently to the deaths of many of the case patients who we studied.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“in this context, our data support the hypothesis that (SAa2, 6Gal) is the preferred receptor for influenza B virus.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Nonetheless, our findings and others [24,34] indicate that fatal disease in children can occur in the absence of concomitant bacterial pneumonia.”
§ Myocardial Injury and Bacterial Pneumonia Contribute to the Pathogenesis of Fatal Influenza B Virus Infection > 30, 31] (Table
What the sources say
hedged- Asserted: passes — The authors put it forward as true.
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In the paper
“Influenza B virus can replicate in regenerating human muscle cell cultures”
§ 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 [45] Servidei, 1987, Infectivity of influenza B virus in cultured human muscle, Acta Neuropathol source
plain- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 21
- Probably not a substantial claim. 25
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plainn = 29- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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
plainn = 42- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
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.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
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.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
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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It may state two separate claims as one.
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
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.
None of the sources cited for this claim have been checked yet.
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
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.
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
“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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Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
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.
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- 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.
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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
Morens, D. M., Taubenberger, J. K., & Fauci, A. S. (2008) · The Journal of Infectious Diseases · doi:10.1086/591708 · Cited by 1,625 · cited 2×
“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
Knowles, M. R., & Boucher, R. C. (2002) · Journal of Clinical Investigation · doi:10.1172/jci0215217 · Cited by 1,054
Estimates of deaths associated with seasonal influenza --- United States, 1976-2007.
Thompson, M. G., Shay, D. K., Zhou, H., Bridges, C. B., Cheng, P. Y., Burns, E. M., Bresee, J., & Cox, N. J. (2010) · PubMed · Cited by 760
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
2009 Pandemic Influenza A (H1N1)
Shieh, W.-J., Blau, D. M., Denison, A. M., DeLeon-Carnes, M., Adem, P., Bhatnagar, J., Sumner, J., Liu, L., Patel, M., Batten, B., et al. (2010) · The American Journal of Pathology · doi:10.2353/ajpath.2010.100115 · Cited by 429
Self-citationOsterhaus, A. D. M. E., Rimmelzwaan, G. F., Martina, B. E. E., Bestebroer, T. M., & Fouchier, R. A. M. (2000) · Science · doi:10.1126/science.288.5468.1051 · Cited by 415
Finelli, L., Fiore, A., Dhara, R., Brammer, L., Shay, D. K., Kamimoto, L., Fry, A., Hageman, J., Gorwitz, R., Bresee, J., et al. (2008) · PEDIATRICS · doi:10.1542/peds.2008-1336 · Cited by 312
Self-citation
Research works printed but not linked: 1
- Emery, 2009, Multiplex BHQplus™ hydrolysis probe rRT-PCR assay for discrimination of current Yamagata-like and Victoria-like influenza B viruses [abstract M13]
Cited by
Sorted by citations
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., et al. (2019) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201908-1581st · Cited by 3,657
The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis.
Klein, E. Y., Monteforte, B., Gupta, A., Jiang, W., May, L., Hsieh, Y., & Dugas, A. (2016) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12398 · Cited by 574
Rapkiewicz, A., Mai, X., Carsons, S. E., Pittaluga, S., Kleiner, D. E., Berger, J. S., Thomas, S., Adler, N., Charytan, D. M., Gasmi, B., et al. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2020.100434 · Cited by 535
“No evidence of complementmediated myocardial damage was present in our cohort, though we and others have demonstrated this previously in the setting of influenza [29,30].”
Influenza virus-related critical illness: pathophysiology and epidemiology
Kalil, A. C., & Thomas, P. G. (2019) · Critical Care · doi:10.1186/s13054-019-2539-x · Cited by 524
The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection
Sellers, S. A., Hagan, R. S., Hayden, F. G., & Fischer, W. A. (2017) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12470 · Cited by 455
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
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.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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.
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