Svetlitskaya O.I.1, Yudina O.A.2, Kashanski R.V.2, Kanus I.I.1
The morphologic characteristic of the inner organs lesion in the acute respiratory distress syndrome of the viral and bacterial etiology
1Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
2City Clinical Pathologicoanatomic Bureau, Minsk, Republic of Belarus
Vestnik VGMU. 2018;17(2):55-62.
Objectives. To determine morphologic peculiarities of the respiratory system and other internals lesion in dead people with the acute respiratory distress syndrome (ARDS) of the viral and bacterial etiology.
Material and methods. The results of the pathologicoanatomic research of 151 dead persons with the community-acquired pneumonia that was complicated by the development of ARDS conducted in the City Clinical Pathologicoanatomic Bureau of Minsk were analyzed. Macroscopic and microscopic changes in internals: lungs, heart, brain, kidneys and adrenals were estimated. The histological research was done on paraffinic sections with staining by means of hematoxylin and eosin according to Gram MSB.
Results. Morphologic features of the lungs, heart, brain, kidneys and adrenals lesion in 151 dead persons with the severe course of extrahospital pneumonia that was complicated by the development of the acute respiratory distress syndrome were determined. Pathomorphologic signs of hemorrhagic and necrotic tracheobronchitis and acute diffuse alveolar injury of the lungs were found. Morphologic changes in other organs had nonspecific character and were caused by the development of the systemic inflammatory response of an organism.
Conclusions. In a pathomorphologic picture in influenza the lesions of the lungs associated with viral cytopathic action, that in the early period were characterized by acute alveolar damage, prevailed, they were replaced by fibrotic and sclerotic changes in the future. The microcirculation disorders caused by vasopathic action of a virus were revealed both in the lungs, and in all parenchymal organs. In the combined viral and bacterial damage of the lungs in morphology the manifestations of purulent inflammation prevailed.
Key words: acute respiratory distress syndrome, community-acquired pneumonia, respiratory infections, influenza virus, diffuse alveolar damage of the lungs.
1. Bonmarin I, Belchior E, Bergounioux J, Brun-Buisson C, Mégarbane B, Chappert JL, et al. Intensive care unit surveillance of influenza infection in France: the 2009/10 pandemic and the three subsequent seasons. Euro Surveill. 2015;20(46). doi: http://dx.doi.org/10.2807/1560-7917.ES.2015.20.46.30066
2. Minchole E, Figueredo AL, Omeñaca M, Panadero C, Royo L, Vengoechea JJ, et al. Seasonal influenza A H1N1pdm09 virus and severe outcomes: a reason for broader vaccination in non-elderly, at-risk people. PloS One. 2016 Nov;11(1):e0165711.
3. Sun Y, Wang Q, Yang G, Lin C, Zhang Y, Yang P. Weight and prognosis for influenza A(H1N1)pdm09 infection during the pandemic period between 2009 and 2011: a systematic review of observation studies with meta-analysis. Infect Dis. 2016;48(11-12):813-22. doi: http://dx.doi.org/10.1080/23744235.2016.1201721
4. Snacken R, Quinten C, Devaux I, Plata F, Broberg E, Zucs P, et al. Surveillance of hospitalized severe cases of influenza A(H1N1)pdm09 and related fatalities in nine EU countries in 2010-2011. Influenza Other Respir Viruses. 2012 Nov;6(6):e93-6. doi: http://dx.doi.org/10.1111/j.1750-2659.2012.00406.x
5. Mikić D, Nozić D, Kojić M, Popović S, Hristović D, Dimitrijević RR, et al. Clinical manifestations, therapy and outcome of pandemic influenza A (H1N1) 2009 in hospitalized patients. Vojnosanit Pregl. 2011 Mar;68(3):248-56.
6. Avdeev SN. Pneumonia and acute respiratory distress syndrome caused by influenza a (H1N1) virus). Pul'monologiia. 2010;(1):32-46. Pril: Gripp A/H1N1: uroki pandemii. (In Russ.)
7. Luk'yanov SA, Gorbunov VV, Govorin AV, Romanova EN, Gorbunova TV, Gergesova EE. Influenza a (H1N1), complicated by pneumonia: prognosis of course and outcome of the disease. Biul Fiziologii Patologii Dykhaniia. 2011;(4):17-22. (In Russ.)
8. Polushin YuS, Khrapov KN, Mayskaya MYu, Dikarev KV. Viral pneumonia influenza a (H1N1) complicated by acute respiratory distress syndrome. Obshchaia Reanimatologiia. 2010;6(3):15-22. (In Russ.)
9. Ramsey C, Kumar A. H1N1: viral pneumonia as a cause of acute respiratory distress syndrome. Curr Opin Crit Care. 2011 Feb;17(1):64-71. doi: http://dx.doi.org/10.1097/MCC.0b013e3283427259
10. Kassil' VL, Vyzhigina MA, Sviridov SV. Acute respiratory distress syndrome in modern concepts of acute respiratory failure. Anesteziologiia Reanimatologiia. 2013;(2):85-9. (In Russ.)
11. Moroz VV, Vlasenko AV, Golubev M. SDS – pathogenesis and therapeutic targets. Anesteziologiia Reanimatologiia. 2014;(4):45-52. (In Russ.)
12. Peresada OA, Barsukov AN. Modern approaches to treatment of influenza and pneumonia in pregnant women. Med Novosti. 2012;(2):19-26. (In Russ.)
13. Michaan N, Amzallag S, Laskov I, Cohen Y, Fried M, Lessing JB, et al. Maternal and neonatal outcome of pregnant women infected with H1N1 influenza virus (swine flu). J Matern Fetal Neonatal Med. 2012 Feb;25(2):130-2. doi: http://dx.doi.org/10.3109/14767058.2011.562569
14. Rush B, Martinka P, Kilb B, McDermid RC, Boyd JH, Celi LA. Acute respiratory distress syndrome in pregnant woman. Obstet Gynecol. 2017 Mar;129(3):530-535. doi: http://dx.doi.org/10.1097/AOG.0000000000001907
15. van der Sluijs KF, van der Poll T, Lutter R, Juffermans NP, Schultz MJ. Bench-to-bedside review: bacterial pneumonia with influenza – patoenesis and clinical implications/ Crit Care. 2010;14(2):219. doi: http://dx.doi.org/10.1186/cc8893
16. Metersky ML, Masterton RG, Lode H, File TM Jr, Babinchak T. Epidemiology, microbiology, and treatment considerations for bacterial pneumonia complicating influenza. Int J Infect Dis. 2012 May;16(5):e321-31. doi: http://dx.doi.org/10.1016/j.ijid.2012.01.003
17. Viasus D, Oteo Revuelta JA, Martínez-Montauti J, Carratalà J. Influenza A(H1N1)pdm09-related pneumonia and other complications. Enferm Infecc Microbiol Clin. 2012 Oct;30 Suppl 4:43-8. doi: http://dx.doi.org/10.1016/S0213-005X(12)70104-0
Information about authors:
Svetlitskaya O.I. – Candidate of Medical Sciences, associate professor of the Chair of Anesthesiology & Resuscitation, Belarusian Medical Academy of Post-Graduate Education;
Yudina O.A. – Candidate of Medical Sciences, head of the Pathologicoanatomic Department of General Pathology No.1, City Clinical Pathologicoanatomic Bureau;
Kashanski R.V. – pathologist of the Pathologicoanatomic Department of General Pathology No.1, City Clinical Pathologicoanatomic Bureau;
Kanus I.I. – Doctor of Medical Sciences, professor of the Chair of Anesthesiology & Resuscitation, Belarusian Medical Academy of Post-Graduate Education.