How H1N1 kills
Brazilian doctors have found new clues to how the H1N1 virus kills its victims.
While the swine flu causes either no disease or relatively mild illness in most people, it can be deadly. It has taken an unusually heavy toll on children and young adults, who are usually largely spared by influenza.
Thais Mauad of the Sao Paulo University and colleagues conducted autopsies on 21 Brazilian patients who died from acute respiratory failure caused by the virus earlier this year. Detailed examination and testing of the victims' lungs found three distinct patterns of damage, the researchers report in the American Thoracis Society's American Journal of Respiratory and Critical Care Medicine.
All the patients had evidence of acute lung damage, and in some this was the main reason they appear to have died. But in others, the acute lung damage is associated with "necrotizing bronchiolitis," a destructive inflammation of the lung tissue. In others, the doctors found a "hemorraghic pattern" of damage to the lung.
Those with necrotizing bronchiolitis were more likely to have developed a bacterial infection along with the H1N1 infection. They might have benefited from quicker use of antibiotics along with antiviral drugs, the researchers say.
Those with heart disease and cancer were more likely to have the hemorraghic condtiion. These patients could have benefited from other types of aggressive treatment, such as being put on a vetilator more quickly.
In addition, the researchers found evidence of a "cytokine storm," which is an unusual immune response, in the lungs. Doctors think this occurs when the immune system responds too strongly to the infection, causing what turns out to be fatal lung damage.
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