{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:59:38Z","timestamp":1791583178369,"version":"4.3.4"},"reference-count":74,"publisher":"Archives of Pathology and Laboratory Medicine","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2010,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>In March 2009, a novel swine-origin influenza A\/H1N1 virus was identified. After global spread, the World Health Organization in June declared the first influenza pandemic in 41 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the clinicopathologic characteristics of 34 people who died following confirmed A\/H1N1 infection with emphasis on the pulmonary pathology findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>We reviewed medical records, autopsy reports, microbiologic studies, and microscopic slides of 34 people who died between May 15 and July 9, 2009, and were investigated either by the New York City Office of Chief Medical Examiner (32 deaths) or through the consultation service of a coauthor (2 deaths).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most of the 34 decedents (62%) were between 25 and 49 years old (median, 41.5 years). Tracheitis, bronchiolitis, and diffuse alveolar damage were noted in most cases. Influenza viral antigen was observed most commonly in the epithelium of the tracheobronchial tree but also in alveolar epithelial cells and macrophages. Most cases were reverse transcription\u2013polymerase chain reaction positive for influenza. Histologic and microbiologic autopsy evidence of bacterial pneumonia was detected in 55% of cases. Underlying medical conditions including cardiorespiratory diseases and immunosuppression were present in 91% of cases. Obesity (body mass index, &gt;30) was noted in 72% of adult and adolescent cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The pulmonary pathologic findings in fatal disease caused by the novel pandemic influenza virus are similar to findings identified in past pandemics. Superimposed bacterial infections of the respiratory tract were common. Preexisting obesity, cardiorespiratory diseases, and other comorbidities also were prominent findings among the decedents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5858\/134.2.235","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T12:05:22Z","timestamp":1613131522000},"page":"235-243","source":"Crossref","is-referenced-by-count":333,"title":["Pulmonary Pathologic Findings of Fatal 2009 Pandemic Influenza A\/H1N1 Viral Infections"],"prefix":"10.5858","volume":"134","author":[{"given":"James R.","family":"Gill","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zong-Mei","family":"Sheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan F.","family":"Ely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald G.","family":"Guinee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary B.","family":"Beasley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charuhas","family":"Deshpande","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Mollura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Morens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"Bray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Travis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery K.","family":"Taubenberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3906","reference":[{"issue":"2","key":"i1543-2165-134-2-235-b01","series-title":"JAMA","first-page":"179","article-title":"Mortality associated with influenza and respiratory syncytial virus in the United States.","volume":"289","author":"Thompson, W. W.","year":"2003","unstructured":"Thompson, W. W., D. K.Shay, E.Weintraub, et al. Mortality associated with influenza and respiratory syncytial virus in the United States.JAMA2003. 289 (2):179\u2013186."},{"issue":"3","key":"i1543-2165-134-2-235-b02","series-title":"N Engl J Med","first-page":"225","article-title":"The persistent legacy of the 1918 influenza virus.","volume":"361","author":"Morens, D. M.","year":"2009","unstructured":"Morens, D. M., J. K.Taubenberger, and A. S.Fauci. The persistent legacy of the 1918 influenza virus.N Engl J Med2009. 361 (3):225\u2013229."},{"issue":"1","key":"i1543-2165-134-2-235-b03","series-title":"Rev Sci Tech","first-page":"187","article-title":"Pandemic influenza\u2014including a risk assessment of H5N1.","volume":"28","author":"Taubenberger, J. K.","year":"2009","unstructured":"Taubenberger, J. K. and D. M.Morens. Pandemic influenza\u2014including a risk assessment of H5N1.Rev Sci Tech2009. 28 (1):187\u2013202."},{"issue":"1","key":"i1543-2165-134-2-235-b04","series-title":"Bull Hist Med","first-page":"105","article-title":"Updating the accounts: global mortality of the 1918\u20131920 \u201cSpanish\u201d influenza pandemic.","volume":"76","author":"Johnson, N. P.","year":"2002","unstructured":"Johnson, N. P. and J.Mueller. Updating the accounts: global mortality of the 1918\u20131920 \u201cSpanish\u201d influenza pandemic.Bull Hist Med2002. 76 (1):105\u2013115."},{"issue":"1","key":"i1543-2165-134-2-235-b05","series-title":"Emerg Infect Dis","first-page":"15","article-title":"1918 Influenza: the mother of all pandemics.","volume":"12","author":"Taubenberger, J. K.","year":"2006","unstructured":"Taubenberger, J. K. and D. M.Morens. 1918 Influenza: the mother of all pandemics.Emerg Infect Dis2006. 12 (1):15\u201322."},{"issue":"5937","key":"i1543-2165-134-2-235-b06","series-title":"Science","first-page":"197","article-title":"Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans.","volume":"325","author":"Garten, R. J.","year":"2009","unstructured":"Garten, R. J., C. T.Davis, C. A.Russell, et al. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans.Science2009. 325 (5937):197\u2013201."},{"key":"i1543-2165-134-2-235-b07","article-title":"World now at the start of 2009 influenza pandemic.","author":"Chan, M.","unstructured":"Chan, M.\n          \n          World now at the start of 2009 influenza pandemic.\n          World Health Organization. http:\/\/www.who.int\/mediacentre\/news\/statements\/2009\/h1n1_pandemic_phase6_20090611\/en\/index.html. Accessed June 15, 2009."},{"key":"i1543-2165-134-2-235-b08","unstructured":"Pandemic (H1N1) 2009\u2014update 64\n          \n          World Health Organization. http:\/\/www.who.int\/csr\/don\/en\/index.html. Accessed November 17, 2009."},{"issue":"1","key":"i1543-2165-134-2-235-b09","series-title":"J Infect Dis","first-page":"53","article-title":"Pandemic versus epidemic influenza mortality: a pattern of changing age distribution.","volume":"178","author":"Simonsen, L.","year":"1998","unstructured":"Simonsen, L., M. J.Clarke, L. B.Schonberger, N. H.Arden, N. J.Cox, and K.Fukuda. 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Epidemiological characteristics of pandemic influenza H1N1 2009 and seasonal influenza infection.Med J Aust2009. 191 (3):146\u2013149."},{"issue":"34","key":"i1543-2165-134-2-235-b12","series-title":"Euro Surveill","first-page":"1","article-title":"Pandemic influenza A(H1N1)v in New Zealand: the experience from April to August 2009.","volume":"14","author":"Baker, M. G.","year":"2009","unstructured":"Baker, M. G., N.Wilson, Q. S.Huang, et al. Pandemic influenza A(H1N1)v in New Zealand: the experience from April to August 2009.Euro Surveill2009. 14 (34):1\u20136."},{"issue":"33","key":"i1543-2165-134-2-235-b13","series-title":"Euro Surveill","first-page":"1","article-title":"Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009.","volume":"14","author":"Vaillant, L.","year":"2009","unstructured":"Vaillant, L., G.La Ruche, A.Tarantola, and P.Barboza. Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009.Euro Surveill2009. 14 (33):1\u20136."},{"key":"i1543-2165-134-2-235-b14","article-title":"H1N1 flu (swine flu): resources for laboratories.","unstructured":"Centers for Disease Control and Prevention\n          \n          H1N1 flu (swine flu): resources for laboratories.\n          Centers for Disease Control and Prevention Web site. http:\/\/www.cdc.gov\/h1n1flu\/lab\/. Accessed June 2, 2009."},{"issue":"3","key":"i1543-2165-134-2-235-b15","series-title":"Mol Diagn","first-page":"217","article-title":"Optimization of the isolation and amplification of RNA from formalin-fixed, paraffin-embedded tissue: the Armed Forces Institute of Pathology experience and literature review.","volume":"2","author":"Krafft, A. E.","year":"1997","unstructured":"Krafft, A. E., B. W.Duncan, K. E.Bijwaard, J. K.Taubenberger, and J. H.Lichy. 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Evaluation of PCR testing of ethanol-fixed nasal swab specimens as an augmented surveillance strategy for influenza virus and adenovirus identification.J Clin Microbiol2005. 43 (4):1768\u20131775."},{"issue":"10","key":"i1543-2165-134-2-235-b17","series-title":"Arch Virol","first-page":"1901","article-title":"Using RRT-PCR analysis and virus isolation to determine the prevalence of avian influenza virus infections in ducks at Minto Flats State Game Refuge, Alaska, during August 2005.","volume":"152","author":"Runstadler, J. A.","year":"2007","unstructured":"Runstadler, J. A., G. M.Happ, R. D.Slemons, et al. Using RRT-PCR analysis and virus isolation to determine the prevalence of avian influenza virus infections in ducks at Minto Flats State Game Refuge, Alaska, during August 2005.Arch Virol2007. 152 (10):1901\u20131910."},{"issue":"8","key":"i1543-2165-134-2-235-b18","series-title":"J Clin Microbiol","first-page":"2675","article-title":"Detection of novel (swine origin) H1N1 influenza A virus by quantitative real-time RT-PCR.","volume":"47","author":"Wang, R.","year":"2009","unstructured":"Wang, R., Z. M.Sheng, and J. K.Taubenberger. Detection of novel (swine origin) H1N1 influenza A virus by quantitative real-time RT-PCR.J Clin Microbiol2009. 47 (8):2675\u20132677."},{"issue":"8","key":"i1543-2165-134-2-235-b19","series-title":"J Virol","first-page":"3754","article-title":"Role of sialic acid binding specificity of the 1918 influenza virus hemagglutinin protein in virulence and pathogenesis for mice.","volume":"83","author":"Qi, L.","year":"2009","unstructured":"Qi, L., J. C.Kash, V. G.Dugan, et al. Role of sialic acid binding specificity of the 1918 influenza virus hemagglutinin protein in virulence and pathogenesis for mice.J Virol2009. 83 (8):3754\u20133761."},{"issue":"21","key":"i1543-2165-134-2-235-b20","series-title":"JAMA","first-page":"1519","article-title":"Disseminated necrosis of the pulmonary capillaries in influenzal pneumonia.","volume":"72","author":"LeCount, E. R.","year":"1919","unstructured":"LeCount, E. R.\n          \n          Disseminated necrosis of the pulmonary capillaries in influenzal pneumonia.\n          JAMA\n          1919. 72 (21):1519\u20131520."},{"key":"i1543-2165-134-2-235-b21","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"1","article-title":"Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1)\u2014United States, May\u2013August 2009.","volume":"58","year":"2009","unstructured":"Centers for Disease Control and Prevention\n          \n          Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (H1N1)\u2014United States, May\u2013August 2009.\n          MMWR Morb Mortal Wkly Rep\n          2009. 58:1\u20134."},{"issue":"4","key":"i1543-2165-134-2-235-b22","series-title":"Am J Clin Pathol","first-page":"612","article-title":"Usefulness of immunohistochemical diagnosis of streptococcus pneumoniae in formalin-fixed, paraffin-embedded specimens compared with culture and gram stain techniques.","volume":"127","author":"Guarner, J.","year":"2007","unstructured":"Guarner, J., M. M.Packard, K. B.Nolte, et al. Usefulness of immunohistochemical diagnosis of streptococcus pneumoniae in formalin-fixed, paraffin-embedded specimens compared with culture and gram stain techniques.Am J Clin Pathol2007. 127 (4):612\u2013618."},{"key":"i1543-2165-134-2-235-b23","series-title":"Influenza","first-page":"287","author":"Mulder, J.","year":"1972","unstructured":"Mulder, J. and J. F. P.Hers. Influenza. Groningen, the NetherlandsWolters-Noordhoff Publishing. 1972. 287."},{"issue":"7","key":"i1543-2165-134-2-235-b24","series-title":"J Infect Dis","first-page":"962","article-title":"Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness.","volume":"198","author":"Morens, D. M.","year":"2008","unstructured":"Morens, D. M., J. K.Taubenberger, and A. S.Fauci. 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The pathology of human influenza revisited.Vaccine2008. 26 (suppl 4):D59\u2013D66."},{"issue":"7","key":"i1543-2165-134-2-235-b31","series-title":"J Infect Dis","first-page":"945","article-title":"Planning for an influenza pandemic: thinking beyond the virus.","volume":"198","author":"McCullers, J. A.","year":"2008","unstructured":"McCullers, J. A.\n          \n          Planning for an influenza pandemic: thinking beyond the virus.\n          J Infect Dis\n          2008. 198 (7):945\u2013947."},{"issue":"suppl 3","key":"i1543-2165-134-2-235-b32","series-title":"Vaccine","first-page":"C9","article-title":"Pneumococcal pneumonia and influenza: a deadly combination.","volume":"27","author":"Klugman, K. P.","year":"2009","unstructured":"Klugman, K. P., Y. W.Chien, and S. A.Madhi. Pneumococcal pneumonia and influenza: a deadly combination.Vaccine2009. 27 (suppl 3):C9\u2013C14."},{"issue":"7111","key":"i1543-2165-134-2-235-b33","series-title":"Nature","first-page":"578","article-title":"Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus.","volume":"443","author":"Kash, J. C.","year":"2006","unstructured":"Kash, J. C., T. M.Tumpey, S. C.Proll, et al. Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus.Nature2006. 443 (7111):578\u2013581."},{"issue":"10","key":"i1543-2165-134-2-235-b34","series-title":"Nat Med","first-page":"1203","article-title":"Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia.","volume":"12","author":"de Jong, M. D.","year":"2006","unstructured":"de Jong, M. D., C. P.Simmons, T. T.Thanh, et al. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia.Nat Med2006. 12 (10):1203\u20131207."},{"issue":"27","key":"i1543-2165-134-2-235-b35","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"749","article-title":"Intensive-care patients with severe novel influenza A (H1N1) virus infection\u2014Michigan, June 2009.","volume":"58","year":"2009","unstructured":"Centers for Disease Control and Prevention\n          \n          Intensive-care patients with severe novel influenza A (H1N1) virus infection\u2014Michigan, June 2009.\n          MMWR Morb Mortal Wkly Rep\n          2009. 58 (27):749\u2013752."},{"issue":"9","key":"i1543-2165-134-2-235-b36","series-title":"Arch Pathol Lab Med","first-page":"1397","article-title":"Pulmonary and cardiovascular complications of obesity: an autopsy study of 76 obese subjects.","volume":"132","author":"Haque, A. K.","year":"2008","unstructured":"Haque, A. K., S.Gadre, J.Taylor, S. A.Haque, D.Freeman, and A.Duarte. Pulmonary and cardiovascular complications of obesity: an autopsy study of 76 obese subjects.Arch Pathol Lab Med2008. 132 (9):1397\u20131404."},{"issue":"19","key":"i1543-2165-134-2-235-b37","series-title":"MMWR Morb Mortal Wkly Rep","first-page":"521","article-title":"Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine.","volume":"58","year":"2009","unstructured":"Centers for Disease Control and Prevention\n          \n          Serum cross-reactive antibody response to a novel influenza A (H1N1) virus after vaccination with seasonal influenza vaccine.\n          MMWR Morb Mortal Wkly Rep\n          2009. 58 (19):521\u2013524."},{"issue":"2","key":"i1543-2165-134-2-235-b01","series-title":"JAMA","first-page":"179","article-title":"Mortality associated with influenza and respiratory syncytial virus in the United States.","volume":"289","author":"Thompson, W. W.","year":"2003","unstructured":"Thompson, W. W., D. K.Shay, E.Weintraub, et al. Mortality associated with influenza and respiratory syncytial virus in the United States.JAMA2003. 289 (2):179\u2013186."},{"issue":"3","key":"i1543-2165-134-2-235-b02","series-title":"N Engl J Med","first-page":"225","article-title":"The persistent legacy of the 1918 influenza virus.","volume":"361","author":"Morens, D. M.","year":"2009","unstructured":"Morens, D. M., J. K.Taubenberger, and A. S.Fauci. The persistent legacy of the 1918 influenza virus.N Engl J Med2009. 361 (3):225\u2013229."},{"issue":"1","key":"i1543-2165-134-2-235-b03","series-title":"Rev Sci Tech","first-page":"187","article-title":"Pandemic influenza\u2014including a risk assessment of H5N1.","volume":"28","author":"Taubenberger, J. K.","year":"2009","unstructured":"Taubenberger, J. K. and D. M.Morens. Pandemic influenza\u2014including a risk assessment of H5N1.Rev Sci Tech2009. 28 (1):187\u2013202."},{"issue":"1","key":"i1543-2165-134-2-235-b04","series-title":"Bull Hist Med","first-page":"105","article-title":"Updating the accounts: global mortality of the 1918\u20131920 \u201cSpanish\u201d influenza pandemic.","volume":"76","author":"Johnson, N. P.","year":"2002","unstructured":"Johnson, N. P. and J.Mueller. Updating the accounts: global mortality of the 1918\u20131920 \u201cSpanish\u201d influenza pandemic.Bull Hist Med2002. 76 (1):105\u2013115."},{"issue":"1","key":"i1543-2165-134-2-235-b05","series-title":"Emerg Infect Dis","first-page":"15","article-title":"1918 Influenza: the mother of all pandemics.","volume":"12","author":"Taubenberger, J. K.","year":"2006","unstructured":"Taubenberger, J. K. and D. M.Morens. 1918 Influenza: the mother of all pandemics.Emerg Infect Dis2006. 12 (1):15\u201322."},{"issue":"5937","key":"i1543-2165-134-2-235-b06","series-title":"Science","first-page":"197","article-title":"Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans.","volume":"325","author":"Garten, R. J.","year":"2009","unstructured":"Garten, R. J., C. T.Davis, C. A.Russell, et al. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans.Science2009. 325 (5937):197\u2013201."},{"key":"i1543-2165-134-2-235-b07","article-title":"World now at the start of 2009 influenza pandemic.","author":"Chan, M.","unstructured":"Chan, M.\n          \n          World now at the start of 2009 influenza pandemic.\n          World Health Organization. http:\/\/www.who.int\/mediacentre\/news\/statements\/2009\/h1n1_pandemic_phase6_20090611\/en\/index.html. Accessed June 15, 2009."},{"key":"i1543-2165-134-2-235-b08","unstructured":"Pandemic (H1N1) 2009\u2014update 64\n          \n          World Health Organization. http:\/\/www.who.int\/csr\/don\/en\/index.html. Accessed November 17, 2009."},{"issue":"1","key":"i1543-2165-134-2-235-b09","series-title":"J Infect Dis","first-page":"53","article-title":"Pandemic versus epidemic influenza mortality: a pattern of changing age distribution.","volume":"178","author":"Simonsen, L.","year":"1998","unstructured":"Simonsen, L., M. J.Clarke, L. B.Schonberger, N. H.Arden, N. J.Cox, and K.Fukuda. 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Epidemiological characteristics of pandemic influenza H1N1 2009 and seasonal influenza infection.Med J Aust2009. 191 (3):146\u2013149."},{"issue":"34","key":"i1543-2165-134-2-235-b12","series-title":"Euro Surveill","first-page":"1","article-title":"Pandemic influenza A(H1N1)v in New Zealand: the experience from April to August 2009.","volume":"14","author":"Baker, M. G.","year":"2009","unstructured":"Baker, M. G., N.Wilson, Q. S.Huang, et al. Pandemic influenza A(H1N1)v in New Zealand: the experience from April to August 2009.Euro Surveill2009. 14 (34):1\u20136."},{"issue":"33","key":"i1543-2165-134-2-235-b13","series-title":"Euro Surveill","first-page":"1","article-title":"Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009.","volume":"14","author":"Vaillant, L.","year":"2009","unstructured":"Vaillant, L., G.La Ruche, A.Tarantola, and P.Barboza. 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