Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 3, 499-522

The Pathology of Influenza Virus Infections

Affiliations
Review

The Pathology of Influenza Virus Infections

Jeffery K Taubenberger et al. Annu Rev Pathol.

Abstract

Influenza viruses are significant human respiratory pathogens that cause both seasonal, endemic infections and periodic, unpredictable pandemics. The worst pandemic on record, in 1918, killed approximately 50 million people worldwide. Human infections caused by H5N1 highly pathogenic avian influenza viruses have raised concern about the emergence of another pandemic. The histopathology of fatal influenza virus pneumonias as documented over the past 120 years is reviewed here. Strikingly, the spectrum of pathologic changes described in the 1918 influenza pandemic is not significantly different from the histopathology observed in other less lethal pandemics or even in deaths occurring during seasonal influenza outbreaks.

Figures

Figure 1
Figure 1
H&E-stained section of the lung from a 1918 influenza victim showing necrotizing bronchiolitis. There is necrosis of the bronchiolar wall, with submucosal edema and vascular congestion. The epithelial layer is desquamating, and necrotic epithelial cells are present in the lumen. A mixed inflammatory cell infiltrate is present throughout (original magnification 40×).
Figure 2
Figure 2
H&E-stained section of the lung from a 1918 influenza victim showing necrotizing bronchiolitis. There is necrosis of the bronchiolar wall. The epithelial layer is desquamating, and necrotic epithelial cells are present in the lumen. A mixed inflammatory cell infiltrate is present throughout (original magnification 200×).
Figure 3
Figure 3
H&E-stained section of the lung from a 1918 influenza victim showing a massive infiltrate of neutrophils that fills the alveolar air spaces in early bacterial bronchopneumonia. Alveolar capillary congestion is prominent (original magnification 200×).
Figure 4
Figure 4
H&E-stained section of the lung from a 1918 influenza victim showing a pattern of necrotizing alveolitis. The alveolar walls are necrotic, and alveolar air spaces contain edema fluid, desquamated epithelial cells, and inflammatory cells (original magnification 200×).
Figure 5
Figure 5
H&E-stained section of the lung from a 1918 influenza victim showing hyaline membranes lining an alveolar duct and adjacent alveoli. The alveolar air spaces contain edema fluid, strands of fibrin, desquamated epithelial cells, and inflammatory cells (original magnification 200×).
Figure 6
Figure 6
H&E-stained section of the lung from a 1918 influenza victim showing massive pulmonary edema. The alveolar air spaces contain edema fluid. A mild interstitial inflammatory cell infiltrate is also present (original magnification 40×).
Figure 7
Figure 7
H&E-stained section of the lung from a 1918 influenza victim showing massive pulmonary hemorrhage. The alveolar air spaces contain erythrocytes. Interstitial edema and a mild interstitial inflammatory cell infiltrate are also present (original magnification 40×).
Figure 8
Figure 8
H&E-stained section of the lung from a 1957 influenza victim showing massive pulmonary edema and hemorrhage in early bronchopneumonia. The alveolar air spaces contain edema fluid and erythrocytes. A bronchiole shows necrotizing bronchiolitis with epithelial desquamation and necrotic epithelial cells in the bronchiolar lumen (original magnification 20×).
Figure 9
Figure 9
H&E-stained section of the lung from a 1918 influenza victim showing bronchiolitis obliterans. The surrounding alveoli show edema and hemorrhage. There is interstitial capillary congestion, and a peribronchiolar vessel shows a thrombus (original magnification 40×).

Similar articles

  • H5N1 Influenza Viruses: Outbreaks and Biological Properties
    G Neumann et al. Cell Res 20 (1), 51-61. PMID 19884910. - Review
    All known subtypes of influenza A viruses are maintained in wild waterfowl, the natural reservoir of these viruses. Influenza A viruses are isolated from a variety of ani …
  • Pandemic Influenza--Including a Risk Assessment of H5N1
    JK Taubenberger et al. Rev Sci Tech 28 (1), 187-202. PMID 19618626.
    Influenza pandemics and epidemics have apparently occurred since at least the Middle Ages. When pandemics appear, 50% or more of an affected population can be infected in …
  • Pathology of Human Influenza Revisited
    T Kuiken et al. Vaccine 26 Suppl 4 (Suppl 4), D59-66. PMID 19230162. - Review
    The pathology of human influenza has been studied most intensively during the three pandemics of the last century, the last of which occurred in 1968. It is important to …
  • Avian Influenza Virus (H5N1): A Threat to Human Health
    JS Peiris et al. Clin Microbiol Rev 20 (2), 243-67. PMID 17428885. - Review
    Pandemic influenza virus has its origins in avian influenza viruses. The highly pathogenic avian influenza virus subtype H5N1 is already panzootic in poultry, with attend …
  • Comparison of the Pathology Caused by H1N1, H5N1, and H3N2 Influenza Viruses
    J Guarner et al. Arch Med Res 40 (8), 655-61. PMID 20304252. - Review
    The spectrum of morbidity and mortality of H1N1, H5N1, and H3N2 influenza A viruses relates to the pathology they produce. In this review, we describe and compare the pat …
See all similar articles

Cited by 286 PubMed Central articles

See all "Cited by" articles

Publication types

MeSH terms

LinkOut - more resources

Feedback