Rivera Jorge, Sarmiento Ladys, Parra Edgar, Toro Gabriel, Neira Marcela, Méndez Jairo, Barbosa Juliana, Caldas María Leonor
Grupo de Morfología Celular, Instituto Nacional de Salud, Bogotá, D.C, Colombia.
Biomedica. 2011 Jul-Sep;31(3):372-80. doi: 10.1590/S0120-41572011000300009.
Influenza is an acute respiratory infection that may be seasonal or pandemic. In 2009 The World Health Organization (WHO) declared an influenza pandemia; 3,876 cases and 239 deaths were reported in Colombia.
The morphological changes in lung tissues associated with virus infection H1N1/v09 were described from autopsied victims. Materials and methods. Seventy-five cases were diagnosed by RT-PCR for influenza A H1N1/v09, of which the lungs of 20 were selected for morphological study by light microscopy, optical microscopy, high-resolution transmission electron microscopy and immunohistochemistry.
Of the 75 cases, 83% had viral pneumonitis and 17% alveolitis. Complications included intra-alveolar hemorrhage (66%), edema (89%), diffuse alveolar damage (2%), and bacterial co-infection (32%). Morphological changes were as follows: destruction of the alveolar epithelium and interstitium, edema, macrophages with vacuolated cytoplasm,and infiltration of polymorphonuclear leukocytes in the alveolar lumen and interstitium, vacuolization cytoplasmic type I pneumocytes and electronedense bodies in cellular debris in the alveolar lumen, and immunoreactivity of viral antigens in bronchiolar epithelial cells and alveolar infiltrate.
The low percentage of bacterial co-infection observed in these cases was a prominent feature, and suggested that the fatal result was probably not associated with secondary bacterial disease (Indicated by previous reports). The tissue lesions were attributed to tissue damage due to viral lesion, as well as the cellular and humoral inflammatory response associated with infiltration by polymorphonucleocytes and macrophages in the interstitium and alveolar lumen.
流感是一种急性呼吸道感染疾病，可呈季节性或大流行。2009年，世界卫生组织（WHO）宣布发生流感大流行；哥伦比亚报告了3876例病例和239例死亡。
描述从尸检受害者肺部组织中观察到的与H1N1/v09病毒感染相关的形态学变化。材料与方法。通过逆转录聚合酶链反应（RT-PCR）诊断出75例甲型H1N1/v09流感病例，从中选取20例的肺部组织进行光镜、光学显微镜、高分辨率透射电子显微镜和免疫组织化学检查以进行形态学研究。
在这75例病例中，83%患有病毒性肺炎，17%患有肺泡炎。并发症包括肺泡内出血（66%）、水肿（89%）、弥漫性肺泡损伤（2%）和细菌合并感染（32%）。形态学变化如下：肺泡上皮和间质破坏、水肿、细胞质有空泡的巨噬细胞、肺泡腔和间质中多形核白细胞浸润、I型肺泡上皮细胞细胞质空泡化以及肺泡腔内细胞碎片中的电子致密体，支气管上皮细胞和肺泡浸润中病毒抗原的免疫反应性。
这些病例中观察到的细菌合并感染比例较低是一个突出特征，这表明致命结果可能与继发性细菌疾病无关（先前报告表明）。组织损伤归因于病毒损伤导致的组织破坏，以及与间质和肺泡腔中多形核白细胞和巨噬细胞浸润相关的细胞和体液炎症反应。
