title: Diagnosis of influenza from respiratory autopsy tissues: detection of virus by real-time reverse transcription-PCR in 222 cases.
abstract: The recent influenza pandemic, caused by a novel H1N1 influenza A virus, as well as the seasonal influenza outbreaks caused by varieties of influenza A and B viruses, are responsible for hundreds of thousands of deaths worldwide. Few studies have evaluated the utility of real-time reverse transcription-PCR to detect influenza virus RNA from formalin-fixed, paraffin-embedded tissues obtained at autopsy. In this work, respiratory autopsy tissues from 442 suspect influenza cases were tested by real-time reverse transcription-PCR for seasonal influenza A and B and 2009 pandemic influenza A (H1N1) viruses and the results were compared to those obtained by immunohistochemistry. In total, 222 cases were positive by real-time reverse transcription-PCR, and of 218 real-time, reverse transcription-PCR-positive cases also tested by immunohistochemistry, only 107 were positive. Although formalin-fixed, paraffin-embedded tissues can be used for diagnosis, frozen tissues offer the best chance to make a postmortem diagnosis of influenza because these tissues possess nucleic acids that are less degraded and, as a consequence, provide longer sequence information than that obtained from fixed tissues. We also determined that testing of all available respiratory tissues is critical for optimal detection of influenza virus in postmortem tissues.
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. ADenison@cdc.gov
authors.forename: Amy M
authors.initials: AM
authors.lastname: Denison
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Blau
authors.forename: Heather A
authors.initials: HA
authors.lastname: Jost
authors.forename: Tara
authors.initials: T
authors.lastname: Jones
authors.forename: Dominique
authors.initials: D
authors.lastname: Rollin
authors.forename: Rongbao
authors.initials: R
authors.lastname: Gao
authors.forename: Lindy
authors.initials: L
authors.lastname: Liu
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.forename: Marlene
authors.initials: M
authors.lastname: Deleon-Carnes
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.forename: Clifton
authors.initials: C
authors.lastname: Drew
authors.forename: Patricia
authors.initials: P
authors.lastname: Adem
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Emery
authors.forename: Bo
authors.initials: B
authors.lastname: Shu
authors.forename: Kai-Hui
authors.initials: KH
authors.lastname: Wu
authors.forename: Brigid
authors.initials: B
authors.lastname: Batten
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Greer
authors.forename: Chalanda S
authors.initials: CS
authors.lastname: Smith
authors.forename: Jeanine
authors.initials: J
authors.lastname: Bartlett
authors.forename: Jeltley L
authors.initials: JL
authors.lastname: Montague
authors.forename: Mitesh
authors.initials: M
authors.lastname: Patel
authors.forename: Xiyan
authors.initials: X
authors.lastname: Xu
authors.forename: Stephen
authors.initials: S
authors.lastname: Lindstrom
authors.forename: Alexander I
authors.initials: AI
authors.lastname: Klimov
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D001344:Autopsy; D006801:Humans; D007150:Immunohistochemistry; D009980:Influenza A virus / Q000235:genetics*; D009981:Influenza B virus / Q000235:genetics*; D007251:Influenza, Human / Q000175:diagnosis* / Q000821:virology; D012367:RNA, Viral / Q000032:analysis*; D012137:Respiratory System / Q000033:anatomy & histology / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods
chemical_list: D012367:RNA, Viral