tetano
Editor, Senior Moderator
Jpn. J. Infect. Dis., 63 (1), 67-71, 2010
Short Communication
The First Autopsy Case of Pandemic Influenza (A/H1N1pdm) Virus Infection in Japan: Detection of a High Copy Number of the Virus in Type II Alveolar Epithelial Cells by Pathological and Virological Examination
Noriko Nakajima1, Satoru Hata2, Yuko Sato1, Minoru Tobiume1, Harutaka Katano1, Keiko Kaneko1, Noriyo Nagata1, Michiyo Kataoka1, Akira Ainai3, Hideki Hasegawa1,3, Masato Tashiro3, Makoto Kuroda4, Tamami Odai5, Nobuyuki Urasawa5, Tomoyoshi Ogino6, Hiroaki Hanaoka6, Masahide Watanabe6, and Tetsutaro Sata1*
1Department of Pathology, 3Influenza Virus Research Center, and 4Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo 162-8640; and 2Department of Clinical Laboratory, 5Department of Cardiology, and 6Department of Pathology, Nagano Red Cross Hospital, Nagano 380-8582, Japan
(Received December 15, 2009. Accepted January 5, 2010)
*Corresponding author: Mailing address: Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. Tel: +81-3-5285-1111, Fax: +81-3-5285-1189, E-mail: tsata@nih.go.jp
SUMMARY: We report the pathological and virological findings of the first autopsy case of the 2009 pandemic influenza (A/H1N1pdm) virus infection in Japan. A man aged 33 years with chronic heart failure due to dilated cardiomyopathy, mild diabetes mellitus, atopic dermatitis, bronchial asthma, and obesity died of respiratory failure and multiple organ dysfunction syndrome. Macroscopic examination showed severe plumonary edema and microscopically the lung sections showed very early exudative-stage diffuse alveolar damage (DAD). Immunohistochemistry revealed proliferation of the influenza (A/H1N1pdm) virus in alveolar epithelial cells, some of which expressed SAα2-3Gal on the cell surface. Influenza (A/H1N1pdm) virus genomic RNA and mRNA were also detected in alveolar epithelial cells. Real-time PCR revealed 723 copies/cell in the left lower lung section from which the influenza (A/H1N1pdm) virus was isolated. Electron microscopic analysis revealed filamentous viral particles in the lung tissue. The concentrations of various cytokines/chemokines in the serum and the autopsied lung tissue were measured. IL-2R, IL-6, IL-8, IL-10, IFN-α, MCP-1, and MIG levels were elevated in both. These findings indicated a case of viral pneumonia caused by influenza (A/H1N1pdm) virus infection, showing characteristic pathological findings of the early stage of DAD.
http://www.nih.go.jp/JJID/63/67.pdf
Short Communication
The First Autopsy Case of Pandemic Influenza (A/H1N1pdm) Virus Infection in Japan: Detection of a High Copy Number of the Virus in Type II Alveolar Epithelial Cells by Pathological and Virological Examination
Noriko Nakajima1, Satoru Hata2, Yuko Sato1, Minoru Tobiume1, Harutaka Katano1, Keiko Kaneko1, Noriyo Nagata1, Michiyo Kataoka1, Akira Ainai3, Hideki Hasegawa1,3, Masato Tashiro3, Makoto Kuroda4, Tamami Odai5, Nobuyuki Urasawa5, Tomoyoshi Ogino6, Hiroaki Hanaoka6, Masahide Watanabe6, and Tetsutaro Sata1*
1Department of Pathology, 3Influenza Virus Research Center, and 4Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo 162-8640; and 2Department of Clinical Laboratory, 5Department of Cardiology, and 6Department of Pathology, Nagano Red Cross Hospital, Nagano 380-8582, Japan
(Received December 15, 2009. Accepted January 5, 2010)
*Corresponding author: Mailing address: Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan. Tel: +81-3-5285-1111, Fax: +81-3-5285-1189, E-mail: tsata@nih.go.jp
SUMMARY: We report the pathological and virological findings of the first autopsy case of the 2009 pandemic influenza (A/H1N1pdm) virus infection in Japan. A man aged 33 years with chronic heart failure due to dilated cardiomyopathy, mild diabetes mellitus, atopic dermatitis, bronchial asthma, and obesity died of respiratory failure and multiple organ dysfunction syndrome. Macroscopic examination showed severe plumonary edema and microscopically the lung sections showed very early exudative-stage diffuse alveolar damage (DAD). Immunohistochemistry revealed proliferation of the influenza (A/H1N1pdm) virus in alveolar epithelial cells, some of which expressed SAα2-3Gal on the cell surface. Influenza (A/H1N1pdm) virus genomic RNA and mRNA were also detected in alveolar epithelial cells. Real-time PCR revealed 723 copies/cell in the left lower lung section from which the influenza (A/H1N1pdm) virus was isolated. Electron microscopic analysis revealed filamentous viral particles in the lung tissue. The concentrations of various cytokines/chemokines in the serum and the autopsied lung tissue were measured. IL-2R, IL-6, IL-8, IL-10, IFN-α, MCP-1, and MIG levels were elevated in both. These findings indicated a case of viral pneumonia caused by influenza (A/H1N1pdm) virus infection, showing characteristic pathological findings of the early stage of DAD.
http://www.nih.go.jp/JJID/63/67.pdf