Posted on 12/07/2009 1:01:54 PM PST by decimon
In fatal cases of 2009 H1N1 influenza, the virus can damage cells throughout the respiratory airway, much like the viruses that caused the 1918 and 1957 influenza pandemics, report researchers from the National Institutes of Health (NIH) and the New York City Office of Chief Medical Examiner. The scientists reviewed autopsy reports, hospital records and other clinical data from 34 people who died of 2009 H1N1 influenza infection between May 15 and July 9, 2009. All but two of the deaths occurred in New York City. A microscopic examination of tissues throughout the airways revealed that the virus caused damage primarily to the upper airway—the trachea and bronchial tubes—but tissue damage in the lower airway, including deep in the lungs, was present as well. Evidence of secondary bacterial infection was seen in more than half of the victims.
The team was led by James R. Gill, M.D., of the New York City Office of Chief Medical Examiner and New York University School of Medicine, and Jeffery K. Taubenberger, M.D., Ph.D., of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH. The findings are reported in the Archives of Pathology & Laboratory Medicine, now available online and scheduled to appear in the February 2010 print issue.
"This study provides clinicians with a clear and detailed picture of the disease caused by 2009 H1N1 influenza virus that will help inform patient management," says NIAID Director Anthony S. Fauci, M.D. "In fatal cases of 2009 H1N1 influenza, it appears the novel pandemic influenza virus produces pulmonary damage that looks very much like that seen in earlier influenza pandemics."
The new report also underscores the impact 2009 H1N1 influenza is having on younger people. While most deaths from seasonal influenza occur in adults over 65 years old, deaths from 2009 H1N1 influenza occur predominately among younger people. The majority of deaths (62 percent) in the 34 cases studied were among those 25 to 49 years old; two infants were also among the fatal cases.
Ninety-one percent of those autopsied had underlying medical conditions, such as heart disease or respiratory disease, including asthma, before becoming ill with 2009 H1N1 influenza. Seventy-two percent of the adults and adolescents who died were obese. This finding agrees with earlier reports, based on hospital records, linking obesity with an increased risk of death from 2009 H1N1 influenza.
The researchers examined tissue samples from the 34 deceased individuals to assess how 2009 H1N1 influenza virus damaged various parts of the respiratory system. "We saw a spectrum of damage to tissue in both the upper and lower respiratory tracts," says Dr. Taubenberger. In all cases, the uppermost regions of the respiratory tract—the trachea and bronchial tubes—were inflamed, with severe damage in some cases. In 18 cases, evidence of damage lower down in the finer branches of the bronchial tubes, or bronchioles, was noted. In 25 cases, the researchers found damage to the small globular air sacs, or alveoli, of the lungs.
"This pattern of pathology in the airway tissues is similar to that reported in autopsy findings of victims of both the 1918 and 1957 influenza pandemics," notes Dr. Taubenberger.
The researchers also examined 33 of the 34 cases for evidence of pulmonary bacterial infections. Of these cases, 18 (55 percent) were positive for such infections. Not all of those individuals who had bacterial pneumonia along with 2009 H1N1 virus infection had been hospitalized, however, indicating that some had acquired their bacterial infections outside of a health-care setting. This raises the possibility, say the authors, that community-acquired bacterial pneumonia is playing a role in the current pandemic. "Even in an era of widespread and early antibiotic use," write the authors, "bacterial pneumonia remains an important factor for severe or fatal influenza."
Computerized tomography (CT) lung images were available in four cases of pulmonary bacterial infection. In all four cases, the CT scans showed an abnormality known as ground-glass opacity, which are patches of rounded haze not seen in normal lung images. It is not known, say the researchers, whether the abnormalities detected by CT in the four cases also occur in people who have milder H1N1 infections. They call for additional investigation into the utility of CT scans as a tool to help clinicians identify and better treat severe H1N1 infections.
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Visit www.flu.gov for one-stop access to U.S. government information on avian and pandemic influenza. Also, visit NIAID's flu Web portal at http://www3.niaid.nih.gov/topics/Flu/.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov .
The National Institutes of Health (NIH)—The Nation's Medical Research Agency—includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.
Reference: JR Gill et al. Pulmonary pathological findings of fatal 2009 pandemic influenza A/H1N1 viral infections. Archives of Pathology & Laboratory Medicine. Published online Dec. 7, 2009. {Note: Full text of the paper is available at www.archivesofpathology.org}
If you investigate a group that died from any disease, it is expected that the damage will be severe. So this article seems to say nothing unusual, although it is useful for those who want to alarm the public.
I don't know what that means.
Anyway, I got something about 2-1/2 weeks ago. Went to the doc, and found I was running a mild fever. Symptoms weren't like the normal flu either more like bronchitis or sinus infection.
I've developed a cough that won't go away. It's like when I was an asthmatic kid.
Maybe there's something too this. (cough..)
RE: “Anyway, I got something about 2-1/2 weeks ago. Went to the doc, and found I was running a mild fever. Symptoms weren’t like the normal flu either more like bronchitis or sinus infection. “
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I have something similar - day 9 and counting - still very sick and major sinus headache today. Started with scratchy throat and nagging cough. Next day, mild chills and fever of 100 plus worsening throat. Three nights of coughing and excruciating throat sent me to the doc. He said “bronchitis” and prescribed antibiotic.
Slowly it evolved into a major cold type of thing — still bad and major sinus headaches off and on — friends said sounded familiar - suffered nearly three weeks.
I do not think this is ‘swine’ or other flu. Not enough hallmarks of flu —
The description of damaged airways is interesting vis a vis swine flu, but it sounds like those affected had those pre-existing conditions that could render airways damaged anyway. Winter is here — lots of ‘stuff’ out there — impossible to put a name to each malady.
Yeah and the peak season is over and cases are declining. Noe of this is a surprize. This came earlier than usual but CDC and WHO made it into something it wasn’t. It became like the SARS scare and bird flu and every other friggin disease they want to use to control us with.
The Southern Hemisphere experience said that this flu would hit early and hard. That it would peak rapidly, have a second wave, and then die out earlier than usual. That is exactly what has happened.
Influenza most often kills by the induction of ‘shock lung’. That isn’t new. It is a nasty way to die but not new
The Asian flu epidemic of 1957 coincided with the start of the space race. Paul Perryman made reference to both events in his rock and roll recording, “Satellite Fever and the Asiatic Flu” (Kix Records, 1958).
Hope you get well soon!
About 10 years ago I kept getting bronchitis and when I didn’t have it, I wheezed with a cough but had no other symptoms. They kept giving me stronger and stronger antibiotics but the cough remained. AFter a chest xray and pondering a move to extreme anti-biotics (similar to those given to Aids patients) I was referred to a pulmonary specialist. He was baffled to know why I had been given a chest xray and months of antibiotics because I didn’t have an infection. I had inflamed lungs. The lining was irritated (by then so was I) and sensistive and making me cough. He gave me and albuterol (sp) inhaler so my airways would open up (over the counter, hate the stuff -makes me tremble) so that I could then take an Advair (prescription) inhaler to soothe the inflamed lining. It worked. After a few weeks I discontinued both and I was fine. I do continue to have hypersensitive lungs to if I get a significant chest cough I get an inhaler to keep my lungs happy. This stops me from coming out of a flu and then going right into a secondary infection and inflammation. I don’t know if that has anything to do with your symptoms but I wanted to put it out there in case it was relevant.
This is the classic description of a rhinovirus. The thing you need to be most careful of is a sinus infection ( those can be very nasty) and then a later development of bronchitis. Steamy showers, lots of liquids, lots of rest still the best
RE: “This is the classic description of a rhinovirus. The thing you need to be most careful of is a sinus infection ( those can be very nasty) and then a later development of bronchitis. Steamy showers, lots of liquids, lots of rest still the best”
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This was a weird start to illness with bronchitis coming before, not after the cold. Oh, and bacterial conjunctivitis in both eyes past three days as well — big fun — at least I can ‘see’ out of both eyes today!
Gotta love that ‘eye cup’ for bathing the eyes. Works great.
You might try Quercetin and Bromelain. Quercetin is something found in pears and apples that may prevent mast cells from releasing histamine. Bromelain is supposted to be anti-inflamitory. Supplements, so no prescription needed. Research it yourself before you try it.
Hang in there. There is soooo much crap going around this year.....almost enough to make me believe in chem trails ( almost)
I was hospitalized with pneumonia in August , I work in hospitals so I had about a 100% chance of having being exposed to H1N1 at some time.. I tested negative for H1N1 when hospitalized but since Denver has reported a tripling in pneumonia admissions this year I’d say prior exposure sure looks like a contributing factor. The symptoms and severity described sound real familiar... This ( H1N1 ) could be a catalyst for the normal flu to do some real damage this year.
I understand that pertussis is making a comeback. Atypical pertussis may seem like a cold or a nagging cough in adults. Whether that is what you have you may want to see if its time for a DPT booster. (Once every 10 years.) If you do have it you don’t want to spread it.
ping
Thank you for the good suggestions!
Thanks — hanging in for sure — funny thing is that although I’ve gotten little sleep until last two nights, I never had the flu hallmarks of high fever and major chills and that ‘can’t drag self out of bed feeling.’ It has not been like that — Instead, an odd combo of symptoms appearing in bizarre order, unlike what I recall in the past.
My doc said (with a smile) “you’ll live” and cautioned me to avoid much talking — easy since I have laryngitis as well!!! To me, this is NOT flu.
The thing that bothers me is that I have been through every plague since 1946, polio, measles, chicken pox, and mumps, caught every thing but polio, are we by eliminating risk converting childhood illness to adult life threatening stuff?
Ninety-one percent of those autopsied had underlying medical conditions, such as heart disease or respiratory disease, including asthma, before becoming ill with 2009 H1N1 influenza. Seventy-two percent of the adults and adolescents who died were obese. This finding agrees with earlier reports, based on hospital records, linking obesity with an increased risk of death from 2009 H1N1 influenza.
Yes. It seems that factors in addition to having H1N1 doomed these people.
OTOH, they say the H1N1 virus did itself cause tissue damage as was the case with the 1918 and 1957 strains.
It's still not decided why the 1918 flu was so deadly. It could be due to that particular flu or to other factors.
Smokin’ Joe I pinged your list and some other freepers to a new H1N1 article thread :)
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