title: 2009 H1N1 fatalities: the New Mexico experience.
abstract: Histopathologic features of New Mexico 2009 H1N1 fatalities have not been representative of those reported nationwide. We retrospectively reviewed medical records of all New Mexico 2009 pandemic influenza A (pH1N1) fatalities (n = 50). In cases in which autopsy was performed (n = 12), histologic sections and culture results were examined. In contrast to previously published studies, the majority of our fatalities did not have diffuse alveolar damage (DAD) (2/12; 16.7%). Common findings included pulmonary interstitial inflammation and edema, tracheobronchitis, and pneumonia. Two cases had significant extra-pulmonary manifestations: myocarditis and cerebral edema with herniation. The majority had a rapid disease course: range from 1 to 12 days (median, 2 days), and Native Americans were disproportionately represented among fatalities. These findings suggest that New Mexico H1N1 fatalities generally did not survive long enough to develop the classic picture of DAD. Pathologists should be aware that H1N1 may cause extra-pulmonary pathology and perform postmortem cultures and histologic sampling accordingly.
authors.affiliation: New Mexico Office of the Medical Investigator, The University of New Mexico, Albuquerque, NM 87102, USA. erinbrooks1@hotmail.com
authors.forename: Erin G
authors.initials: EG
authors.lastname: Brooks
authors.forename: Clare H
authors.initials: CH
authors.lastname: Bryce
authors.forename: Catherine
authors.initials: C
authors.lastname: Avery
authors.forename: Chad
authors.initials: C
authors.lastname: Smelser
authors.forename: Deborah
authors.initials: D
authors.lastname: Thompson
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Nolte
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000473:pathology / Q000821:virology; D001991:Bronchitis / Q000473:pathology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004677:Encephalocele / Q000473:pathology / Q000821:virology; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000473:pathology / Q000821:virology; D009516:New Mexico / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D058873:Pandemics; D011024:Pneumonia, Viral / Q000473:pathology; D011654:Pulmonary Edema / Q000473:pathology / Q000821:virology; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D014136:Tracheitis / Q000473:pathology / Q000821:virology; D055815:Young Adult