ClinicoPathologic correlation

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Clinico-Pathologic correlation

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Pathogenesis
Initial virus replication in the respiratory
tract.
Hypercytokinemia
sIL-2r, IL-6, IFN-?, IFN-a, IFN-d
SIRS, MODS, ARDS, reactive hemophagocytic syndrome
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H5N1 HAS BECOME HIGHLY PATHOGENIC

• The pathology of H5N1 avian influenza is
  completely different from traditional human
  influenza and much more serious.
• Typical human flu infects the respiratory tract
  and can lead to severe complications like
  pneumonia.
• In striking contrast, highly pathogenic H5N1
  avian influenza replicates both within and
  outside the respiratory tract in poultry and in
  humans, thereby causing damage in multiple
  organs, hemorrhage, pneumonia and death.

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Pathologic changes

• Oganizing diffuse alveolar damage with
  interstitial fibrosis
• Extensive hepatic central lobular necrosis
• Acute renal tubular necrosis
• Lymphoid depletion
• Reactive hemophagocytic syndrome

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LT.
RT.
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Liver
Centrilobular necrosis
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Laboratory diagnosis

• CBC - Leukopenia, Lymphopenia Thrombocytopenia
  Pancytopenia
• Liver enzyme slightly increase in the presence
  of ARDS
• Viral detection Rapid test and confirmatory test

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Rapid test

• Target - Influenza A or AB antigen detection
• Source of specimen - Nasopharyngeal swab or
  Aspiration
• Technique Immunochromatography or Enzyme immuno
  assay (EIA)
• Turn around time 15-30 min
• Report Positive/Negative

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Confirmatory test

• Target to specify whether it is Influenza A /H5
  or not
• 1. Reverse transcriptase - Polymerase chain
  reaction (RT-PCR) for influeuza A/H5
• Source of specimen Sputum, Nasopharyngeal swab
  or Aspiration
• Turn around time 48 hr
• Report Positive/Negative

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Confirmatory test (continue)

• 2. Immunofluorescence antibody (IFA) to H5
  antigen by using H5 monoclonal antibody
• Source of specimen Sputum
• Report Positive/Negative

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Confirmatory test (continue)

• 3. Serology 4 folds rising between 2 wks
• Source of specimen Blood
• Technique - Microneutralization test
• Report - H5 specific antibody titre

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Confirmatory test (continue)

• 4. Viral culture for influenza A/H5
• Source of specimen Sputum
• Technique in HeP-2, RD cells or MDCK cell
  lines
• Turn around time 5-10 d
• Report Positive/Negative