First autopsies show pattern of lung injury causing H1N1 deaths
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Researchers from Brazil have performed the first autopsies, finding a pattern associated with H1N1 flu deaths from pneumonia. The findings are hoped to lead clinicians to better management of H1N1 flu and pneumonia by providing clues about the need for antibacterial and antiviral medications to limit lungdamage and deaths from the pandemic flu.
"The lack of information on the pathophysiology of this novel disease is a limitation that prevents better clinical management and hinders the development of a therapeutic strategy," said lead author, Thais Mauad, M.D., Ph.D., associate professor of the Department of Pathology at São Paulo University, in Brazil.
The study, due for publication January 1 in the American Journal of Respiratory and Critical Care Medicine, found that 75 percent of 21 patients autopsied who died from H1N1 influenza had underlying medical conditions such as cancer or heart disease. The patients died in São Paulo with confirmed H1N1 infection in July and August, 2009.
One fourth of those autopsied with H1N1 flu had no underlying medical condition. All of the H1N1 patients who died experienced rapid progression of flu symptoms that lead to death, and were between age 39 to 50.
四分之一帶有H1N1豬流感病毒被解剖的屍體並沒有潛藏的醫療情况。所有的H1N1病人死於導致死亡的急速進展流感症狀，是39歲至50歲之間。
According to Dr. Mauad, body aches and fever were less frequently present in patients who died from rapid progression of respiratory symptoms associated with H1N1 flu. "Most patients with a fatal form of the disease presented with difficulty breathing (dyspnea), with fever and myalgia being less frequently present."
根據Mauad博士，死於與H1N1豬流感病毒有關的急速進展呼吸系統症狀的病人， 身體疼痛和發燒並不出現頻繁，“大部分患者有呼吸困（呼吸困難）形式作為致命疾病，發燒和肌肉疼痛是不經常存在。”
All of the patients who died from H1N1 flu had acute lung injury that followed three distinct patterns. “All patients have a picture of acute lung injury," said Dr. Mauad. "In some patients this is the predominant pattern; in others, acute lung injury is associated with necrotizing bronchiolitis (NB); and in others there is a hemorrhagic pattern." Bronchiolitis is an inflammation of the small airways in the lung. Necrotizing refers to destruction of the lung tissue.
Patients with underlying medical conditions such as heart disease and cancer who died from H1N1 flu were more likely to have a hemorrhagic lung condition. Bacterial co-infections were associated with necrotizing bronchiolitis (NB).
“It is important to bear in mind that patients with underlying medical conditions must be adequately monitored, since they are at greater risk of developing a severe H1N1 infection," said Dr. Mauad. In these patients, H1N1 infection may present as a potential fatal disease, requiring early and prompt intensive care management, including protective ventilation strategies and adequate hemodynamic management. "We found that 38 percent of these patients had a bacterial infection (bronchopneumonia). This has important consequences because these patients need to receive antibiotic therapy, in addition to antiviral therapy."
Cytokine storm was also found to play a role in deaths from H1N1 influenza. Cytokine storm leading to H1N1 flu deaths is the result of an overly vigorous inflammatory response that causes acute lung injury.
在H1N1豬流感病毒死亡中細胞素風暴被發現亦有扮演一個角色，細胞素風暴導致H1N1豬流感死亡是由於強有力的發炎反應引致急性肺損傷。
The scientists say the first autopsies uncovering distinct patterns of infection from H1N1 flu in the lungs should lay some groundwork for a better understanding of the disease. "We would like to deepen our efforts into the understanding of the immune responses in cases of severe infection," said Dr. Mauad. "This could ultimately lead to new therapeutic approaches”.
doi: 10.1164/rccm.200909-1420OC
http://www.examiner.com/x-14041-Charlotte-Health-and-Happiness-Examiner~y2009m12d23-First-autopsies-show-pattern-of-lung-injury-causing-H1N1-deaths
台灣仔細考慮強制將懷疑流感疫苗死亡屍體解剖
Taiwan mulls compulsory autopsies in suspected flu-vaccine deaths
Posted : Wed, 23 Dec 2009 09:03:58 GMT
By : dpa
Category : Health
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Taipei - Taiwan plans to perform compulsory autopsies on people suspected of dying from the swine-flu vaccine, an official said Wednesday. "Currently, the families of some people who are suspected to have died from the H1N1 vaccine do not allow us to perform an autopsy," said Chou Chih-hao, deputy director of the Centres for Disease Control (CDC).
"To clear up public concern about the safety of the vaccine, we plan to ask the authorities to amend the law, so that we can perform autopsies on the bodies of people who are suspected of having died from the H1N1 vaccine," he said.
Since Taiwan began vaccinations against swine flu on November 1, 787 people have been hospitalized for symptoms associated with the shots and 35 of them have died.
There have been legal disputes because some families insisted their relatives died from the vaccine while the hospitals giving the shots and the CDC insisted the deaths were unrelated to the vaccine.
So far, 4.8 million Taiwanese have been vaccinated against the H1N1 virus.
The vaccines used in Taiwan are AdimFlu-S, developed by Taiwan's Adimmune Corp, and Focetria, developed by the Swiss pharmaceutical company Novartis AG.
http://www.earthtimes.org/articles/show/300730,taiwan-mulls-compulsory-autopsies-in-suspected-flu-vaccine-deaths.html
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