Brooks Erin G, Bryce Clare H, Avery Catherine, Smelser Chad, Thompson Deborah, Nolte Kurt B
New Mexico Office of the Medical Investigator, The University of New Mexico, Albuquerque, NM 87102, USA.
J Forensic Sci. 2012 Nov;57(6):1512-8. doi: 10.1111/j.1556-4029.2012.02163.x. Epub 2012 May 9.
Histopathologic features of New Mexico 2009 H1N1 fatalities have not been representative of those reported nationwide. We retrospectively reviewed medical records of all New Mexico 2009 pandemic influenza A (pH1N1) fatalities (n = 50). In cases in which autopsy was performed (n = 12), histologic sections and culture results were examined. In contrast to previously published studies, the majority of our fatalities did not have diffuse alveolar damage (DAD) (2/12; 16.7%). Common findings included pulmonary interstitial inflammation and edema, tracheobronchitis, and pneumonia. Two cases had significant extra-pulmonary manifestations: myocarditis and cerebral edema with herniation. The majority had a rapid disease course: range from 1 to 12 days (median, 2 days), and Native Americans were disproportionately represented among fatalities. These findings suggest that New Mexico H1N1 fatalities generally did not survive long enough to develop the classic picture of DAD. Pathologists should be aware that H1N1 may cause extra-pulmonary pathology and perform postmortem cultures and histologic sampling accordingly.
2009年新墨西哥州甲型H1N1流感死亡病例的组织病理学特征并不代表全国报告的特征。我们回顾性审查了新墨西哥州2009年甲型H1N1流感大流行所有死亡病例（n = 50）的医疗记录。在进行尸检的病例（n = 12）中，检查了组织切片和培养结果。与先前发表的研究不同，我们的大多数死亡病例没有弥漫性肺泡损伤（DAD）（2/12；16.7%）。常见的发现包括肺间质炎症和水肿、气管支气管炎和肺炎。两例有明显的肺外表现：心肌炎和伴有脑疝的脑水肿。大多数病例病程迅速：1至12天（中位数为2天），死亡病例中美洲原住民的比例过高。这些发现表明，新墨西哥州甲型H1N1流感死亡病例通常存活时间不足以发展为典型的DAD表现。病理学家应意识到甲型H1N1流感可能导致肺外病变，并相应地进行尸检培养和组织学取样。
