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			PubMed Journals: Lancet

  Source:		PMID: 12781536
  Download:	https://www.thelancet.com/action/showPdf?pii=S0140-6736%2803%2913413-7

    		Lancet. 2003 May 24;361(9371):1773-8.
     
			Lung pathology of fatal
			severe acute respiratory syndrome.

			Nicholls JM(1), Poon LL, Lee KC, Ng WF,
			Lai ST, Leung CY, Chu CM, Hui PK, Mak KL,
			Lim W, Yan KW, Chan KH, Tsang NC, Guan Y,
			Yuen KY, Peiris JS.

			Author Information
			(1) Department of Pathology, University
			of Hong Kong, Hong Kong Special Administrative
			Region, China.

			BACKGROUND: Severe acute respiratory syndrome
			(SARS) is a novel infectious disease with
			global impact. A virus from the family Coronaviridae
			has been identified as the cause, but the
			pathogenesis is still unclear. METHODS: Post-mortem
			tissue samples from six patients who died
			from SARS in February and March, 2003, and
			an open lung biopsy from one of these patients
			were studied by histology and virology.
			Only one full autopsy was done. Evidence
			of infection with the SARS-associated coronavirus
			(SARS-CoV) and human metapneumovirus was
			sought by reverse-transcriptase PCR and
			serology. Pathological samples were examined
			by light and electron microscopy and
			immunohistochemistry. FINDINGS: All six
			patients had serological evidence of recent
			infection with SARS-CoV. Diffuse alveolar
			damage was common but not universal. Morphological
			changes identified were bronchial epithelial
			denudation, loss of cilia, and squamous
			metaplasia. Secondary bacterial pneumonia
			was present in one case. A giant-cell infiltrate
			was seen in four patients, with a pronounced
			increase in macrophages in the alveoli and
			the interstitium of the lung. Haemophagocytosis
			was present in two patients. The alveolar
			pneumocytes also showed cytomegaly with
			granular amphophilic cytoplasm. The patient
			for whom full autopsy was done had atrophy
			of the white pulp of the spleen. Electron
			microscopy revealed viral particles in the
			cytoplasm of epithelial cells corresponding
			to coronavirus. INTERPRETATION: SARS is associated with
			epithelial-cell proliferation and an increase
			in macrophages in the lung. The presence
			of haemophagocytosis supports the contention
			that cytokine dysregulation may account,
			at least partly, for the severity of the
			clinical disease. The case definition of
			SARS should acknowledge the range of lung
			pathology associated with this disease.

			PMID: 12781536 [Indexed for MEDLINE]

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