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Lung pathology of fatal severe acute respiratory syndrome.
Lancet. 2003 May 24; 361(9371):1773-8.Lct

Abstract

BACKGROUND

Severe acute respiratory syndrome (SARS) is a novel infectious disease with global impact. A virus from the family Coronaviridae has been identified as the cause, but the pathogenesis is still unclear.

METHODS

Post-mortem tissue samples from six patients who died from SARS in February and March, 2003, and an open lung biopsy from one of these patients were studied by histology and virology. Only one full autopsy was done. Evidence of infection with the SARS-associated coronavirus (SARS-CoV) and human metapneumovirus was sought by reverse-transcriptase PCR and serology. Pathological samples were examined by light and electron microscopy and immunohistochemistry.

FINDINGS

All six patients had serological evidence of recent infection with SARS-CoV. Diffuse alveolar damage was common but not universal. Morphological changes identified were bronchial epithelial denudation, loss of cilia, and squamous metaplasia. Secondary bacterial pneumonia was present in one case. A giant-cell infiltrate was seen in four patients, with a pronounced increase in macrophages in the alveoli and the interstitium of the lung. Haemophagocytosis was present in two patients. The alveolar pneumocytes also showed cytomegaly with granular amphophilic cytoplasm. The patient for whom full autopsy was done had atrophy of the white pulp of the spleen. Electron microscopy revealed viral particles in the cytoplasm of epithelial cells corresponding to coronavirus.

INTERPRETATION

SARS is associated with epithelial-cell proliferation and an increase in macrophages in the lung. The presence of haemophagocytosis supports the contention that cytokine dysregulation may account, at least partly, for the severity of the clinical disease. The case definition of SARS should acknowledge the range of lung pathology associated with this disease.

Authors+Show Affiliations

Department of Pathology, University of Hong Kong, Hong Kong Special Administrative Region, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12781536

Citation

Nicholls, John M., et al. "Lung Pathology of Fatal Severe Acute Respiratory Syndrome." Lancet (London, England), vol. 361, no. 9371, 2003, pp. 1773-8.
Nicholls JM, Poon LL, Lee KC, et al. Lung pathology of fatal severe acute respiratory syndrome. Lancet. 2003;361(9371):1773-8.
Nicholls, J. M., Poon, L. L., Lee, K. C., Ng, W. F., Lai, S. T., Leung, C. Y., Chu, C. M., Hui, P. K., Mak, K. L., Lim, W., Yan, K. W., Chan, K. H., Tsang, N. C., Guan, Y., Yuen, K. Y., & Peiris, J. S. (2003). Lung pathology of fatal severe acute respiratory syndrome. Lancet (London, England), 361(9371), 1773-8.
Nicholls JM, et al. Lung Pathology of Fatal Severe Acute Respiratory Syndrome. Lancet. 2003 May 24;361(9371):1773-8. PubMed PMID: 12781536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lung pathology of fatal severe acute respiratory syndrome. AU - Nicholls,John M, AU - Poon,Leo L M, AU - Lee,Kam C, AU - Ng,Wai F, AU - Lai,Sik T, AU - Leung,Chung Y, AU - Chu,Chung M, AU - Hui,Pak K, AU - Mak,Kong L, AU - Lim,Wilina, AU - Yan,Kin W, AU - Chan,Kwok H, AU - Tsang,Ngai C, AU - Guan,Yi, AU - Yuen,Kwok Y, AU - Peiris,J S Malik, PY - 2003/6/5/pubmed PY - 2003/6/14/medline PY - 2003/6/5/entrez SP - 1773 EP - 8 JF - Lancet (London, England) JO - Lancet VL - 361 IS - 9371 N2 - BACKGROUND: Severe acute respiratory syndrome (SARS) is a novel infectious disease with global impact. A virus from the family Coronaviridae has been identified as the cause, but the pathogenesis is still unclear. METHODS: Post-mortem tissue samples from six patients who died from SARS in February and March, 2003, and an open lung biopsy from one of these patients were studied by histology and virology. Only one full autopsy was done. Evidence of infection with the SARS-associated coronavirus (SARS-CoV) and human metapneumovirus was sought by reverse-transcriptase PCR and serology. Pathological samples were examined by light and electron microscopy and immunohistochemistry. FINDINGS: All six patients had serological evidence of recent infection with SARS-CoV. Diffuse alveolar damage was common but not universal. Morphological changes identified were bronchial epithelial denudation, loss of cilia, and squamous metaplasia. Secondary bacterial pneumonia was present in one case. A giant-cell infiltrate was seen in four patients, with a pronounced increase in macrophages in the alveoli and the interstitium of the lung. Haemophagocytosis was present in two patients. The alveolar pneumocytes also showed cytomegaly with granular amphophilic cytoplasm. The patient for whom full autopsy was done had atrophy of the white pulp of the spleen. Electron microscopy revealed viral particles in the cytoplasm of epithelial cells corresponding to coronavirus. INTERPRETATION: SARS is associated with epithelial-cell proliferation and an increase in macrophages in the lung. The presence of haemophagocytosis supports the contention that cytokine dysregulation may account, at least partly, for the severity of the clinical disease. The case definition of SARS should acknowledge the range of lung pathology associated with this disease. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/12781536/Lung_pathology_of_fatal_severe_acute_respiratory_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140673603134137 DB - PRIME DP - Unbound Medicine ER -