University of Washington, Department of Laboratory Medicine, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195-7110, United States.
University of Washington, Department of Laboratory Medicine, Box 357110, 1959 NE Pacific Street, NW120, Seattle, WA 98195-7110, United States.
Semin Diagn Pathol. 2019 May;36(3):152-159. doi: 10.1053/j.semdp.2019.04.006. Epub 2019 Apr 17.
Lower respiratory infections remain one of the top global causes of death and the emergence of new diseases continues to be a concern. In the first two decades of the 21st century, we have born witness to the emergence of newly recognized coronaviruses that have rapidly spread around the globe, including severe acute respiratory syndrome virus (SARS) and Middle Eastern respiratory syndrome virus (MERS). We have also experienced the emergence of a novel H1N1 pandemic influenza strain in 2009 that caused substantial morbidity and mortality around the world and has transitioned into a seasonal strain. Although we perhaps most frequently think of viruses when discussing emerging respiratory infections, bacteria have not been left out of the mix, as we have witnessed an increase in the number of infections from Legionella spp. since the organisms' initial discovery in 1976. Here, we explore the basic epidemiology, clinical presentation, histopathology, and clinical laboratory diagnosis of these four pathogens and emphasize themes in humans' evolving relationship with our natural environment that have contributed to the infectious burden. Histology alone is rarely diagnostic for these infections, but has been crucial to bettering our understanding of these diseases. Together, we rely on the diagnostic acumen of pathologists to identify the clinicopathologic features that raise the suspicion of these diseases and lead to the early control of the spread in our populations.
下呼吸道感染仍然是全球主要死因之一，新疾病的出现仍然令人担忧。在 21 世纪的头二十年，我们见证了新出现的冠状病毒在全球迅速传播，包括严重急性呼吸综合征病毒（SARS）和中东呼吸综合征病毒（MERS）。我们还经历了 2009 年新型 H1N1 大流行性流感株的出现，该流感株在全球造成了大量发病率和死亡率，并已转变为季节性流感株。尽管在讨论新出现的呼吸道感染时，我们通常首先想到的是病毒，但细菌也没有被排除在外，因为自 1976 年首次发现军团菌属以来，我们已经观察到该菌引起的感染数量有所增加。在这里，我们探讨了这四种病原体的基本流行病学、临床表现、组织病理学和临床实验室诊断，并强调了人类与自然环境不断变化的关系中导致感染负担的主题。这些感染仅凭组织学很少能做出诊断，但对加深我们对这些疾病的认识至关重要。我们共同依赖病理学家的诊断敏锐度来识别出引起这些疾病怀疑的临床病理特征，并导致早期控制人群中的传播。
