Prasad H B, Puranik S C, Kadam D B, Sangle S A, Borse R T, Basavraj A, Umarji P B, Mave Vidya, Ghorpade S V, Bharadwaj R, Jamkar A V, Mishra A C
B.J. Medical College Clinical Research Site, Pune.
J Assoc Physicians India. 2011 Aug;59:498-500.
India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough, and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage. The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage (DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had either polymorphonuclear or mononuclear infiltrate. Furthermore, necrotizing pneumonitis pattern seen on these patients is the likely cause of mortality in these patients. Although clinical ARDS pattern was noted in all these patients, it was well correlated in lung pathology in all these cases.
2009年7月，印度在浦那报告了首例甲型H1N1流感病例，自那时起，印度报告的病例数和死亡人数激增。由于关于印度甲型H1N1流感死亡病例的组织病理学发现的数据非常少，因此对2009年15例甲型H1N1流感死亡病例的尸检结果进行了回顾性图表分析。常见的临床特征为发热、咳嗽和呼吸急促，其次是喉咙痛和流鼻涕。常见的肺部表现为单核细胞浸润、肺泡间隔增厚、肺泡内出血。其他表现为肺血管充血、肺水肿、细胞肿大、纤维蛋白积聚和嗜酸性膜形成。这些发现提示弥漫性肺泡损伤（DAD）和出血性DAD。所有接受尸检的患者的影像学表现均提示单叶或多叶肺炎。这一临床发现可以在这些患者中得到病理学上的关联，因为他们所有人都有中性粒细胞或单核细胞浸润。此外，这些患者出现的坏死性肺炎模式可能是其死亡原因。尽管所有这些患者都出现了临床急性呼吸窘迫综合征（ARDS）模式，但在所有这些病例中，其与肺部病理学表现密切相关。
