2009 대유행 인플루엔자 A/H1N1 바이러스 감염 사망자의 폐 병리학적 소견

2009년 5월 15일~7월 9일 미국에서 신종플루로 사망한 34명의 의료기록, 부검보고서, 미생물학적 연구결과, 현미경 소견을 검토하여 사망자들의 폐 병리학적 소견을 밝힌 논문입니다.

사망자의 62%는 25세~49세(평균 41.5세)의 젊은 층이었으며, 대부분의 사례에서 기관염(Tracheitis), 세관지염(bronchiolitis), 미만성폐포손상(diffuse alveolar damage)이 나타났습니다. 대부분의 사망자는 기관과 기관지 가지의 상피세포에서 인플루엔자 바이러스 항원이 관찰되었으나 폐포의 상피세포와 대식세포( macrophages)에서 관찰되는 경우도 있었습니다. 또한 대부분의 사망자의 경우 PCR 검사에서 양성진단을 받았습니다.

조직학 및 현미경 검사를 통해 사망자의 55%에서 세균성 폐렴을 확인했고, 사망자의 91%가 심혈관계 질환 및 면역억제제 투여자 등을 포함한 기저질환을 가지고 있었습니다. 성인 및 사춘기 청소년 사망자의 72%가 체질량지수(BMI) 30 이상의 비만이었습니다.

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Pulmonary Pathologic Findings of Fatal 2009 Pandemic Influenza A/H1N1 Viral Infections

James R. Gill, MD; Zong-Mei Sheng, MD, PhD; Susan F. Ely, MD, MPHTM; Donald G. Guinee Jr, MD; Mary B. Beasley, MD; James Suh, MD; Charuhas Deshpande, MD; Daniel J. Mollura, MD; David M. Morens, MD; Mike Bray, MD; William D. Travis, MD;Jeffery K. Taubenberger, MD, PhD

출처 : The Archives of Pathology & Laboratory Medicine, 12/07/09.( February 2010 print issue.)
http://arpa.allenpress.com/pdf/i1543-2165-134-2-1.pdf (원문 : 첨부파일)

 Context.—In March 2009, a novel swine-origin influenza A/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years.

Objective.—To describe the clinicopathologic characteristics of 34 people who died following confirmed A/H1N1 infection with emphasis on the pulmonary pathology findings.

Design.—We reviewed medical records, autopsy reports, microbiologic studies, and microscopic slides of 34 people who died between May 15 and July 9, 2009, and were investigated either by the New York City Office of Chief Medical Examiner (32 deaths) or through the consultation service of a coauthor (2 deaths).

Results.—Most of the 34 decedents (62%) were between 25 and 49 years old (median, 41.5 years). Tracheitis, bronchiolitis, and diffuse alveolar damage were noted in most cases. Influenza viral antigen was observed most commonly in the epithelium of the tracheobronchial tree but also in alveolar epithelial cells and macrophages. Most cases were reverse transcription–polymerase chain reaction positive for influenza.
Histologic and microbiologic autopsy evidence of bacterial pneumonia was detected in 55% of cases. Underlying medical conditions including cardiorespiratory diseases and immunosuppression were present in 91% of cases. Obesity (body mass index, 30) was noted in 72% of adult and adolescent cases.

Conclusions.—The pulmonary pathologic findings in fatal disease caused by the novel pandemic influenza virus are similar to findings identified in past pandemics.
Superimposed bacterial infections of the respiratory tract were common. Preexisting obesity, cardiorespiratory diseases, and other comorbidities also were prominent findings among the decedents. (Arch Pathol Lab Med. 2010;134:E1–E9)