1 / 44

SARS 2003 Hong Kong

SARS 2003 Hong Kong. SARS : Severe Acute Respiratory Syndrome.

yanka
Download Presentation

SARS 2003 Hong Kong

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SARS 2003 Hong Kong

  2. SARS: Severe Acute Respiratory Syndrome

  3. Objectives: To pool images of SARS and help pathologists worldwide to quickly learn the spectrum of changes of SARS 2003 Hong Kong. In  case this disease occurs in countries outside Hong Kong, pathologists can compare their materials with index cases worked up in Hong Kong.   This site is not-for-profit

  4. Update(1):We are now pretty familiar with the pathology of SARS 2003 Hong Kong. Common Pathological Parameters are: • Lymphopenia, hyponatremia; note that these two parameters can also occur in Legionella pneumonia but in SARS investigations for Legionella pneumonia will be negative. • Patchy lung involvement; patchy lung firmness at autopsy; in fatal cases the firm areas are large and extensive. • Lung firmness represents organizing pneumonitis (not pneumonic consolidation)

  5. Update(2): • Granular or vacuolated pulmonary edema with low inflammatory cell content; (edema pattern is similar to that seen in pneumocystis carinii infection but such organisms are not found) • Pneumocytes in alveoli; many multinucleated syncytial pneumocytes (cytokeratin positive) • Oragnizing pneumonitis; when organizing pneumonitis involves an alveolus - resembles a glomerulus hence glomeruloid organizing pneumonitis, within the substance of organizing pneumonitis there are cytokeratin positive pneumocytes - hence some degree of desquamative pneumonitis should have occurred before death.

  6. Update(3): • Desquamated pneumoncytes often show vacuolated cytoplasm and may show clear nuclei; these do not necessarily indicate presence of virus particles but more likely represent cytopathic effect of the pathogen • Electron microscopy is helpful - it shows cytopathic effects and it is the only way to visualize any viral particles in pneumocytes

  7. Previously posted updatesIn all three fatal cases from one hospital there was lymphopenia on admissionCase 1 HB=12.1 WBC=8.2 Absolute lymphocyte count=0.7 x 10^9/L (normal 1-3.8)Case 2 HB=12.5 WBC=10.8 Absolute lymphcyte count=0.6 x 10^9/L (normal 1-3.8)Case 3 HB=9.9 WBC=11.2 Absolute lymphocyte count=0.6 x 10^9/L (normal 1-3.8)

  8. Lymphopenia: One more fatal case had lymphopenia on admission. Now four out of four fatal cases had lymphopenia

  9. Hyponatremia: In three fatal cases from one hospital, all had mild hyponatremia in the first electrolyte profile (respectively 128, 135, 135 - normal 136-148 mmol/L)

  10. Hyponatremia: One more fatal case had hyponatremia on admission. Now 4/4 fatal cases had hyponatremia

  11. Electron microscopy is useful !!: Viral particles can be seen in cytoplasm of pneumocytes. Cytopathic changes of nuclei are also shown. Pictures will be posted soon. Keep surfing here.

  12. X-ray

  13. Gross picture of right lung: close up

  14. Granular or vocuolated edema

  15. Granular (or vacuolated) edema fluid There is no iflammatory cells in the fluid. Desquamated syncytial pneumocytes are present

  16. Desquamated syncytial pneumocytes They have vesicular nuclei but no cytoplasmic inclusion

  17. SARS Image Lung SARS patient. Point: Desquamated syncytial pneumocytes

  18. Multinucleated cells in alveoli

  19. Hyaline cytoplasm in desquamated pneumocytes. Pending viral studies

  20. Desquamative pneumonitis

  21. Syncytium of Type II pneumocytes with one smudged nucleus

  22. Foamy mcrophages and pneumocytes

  23. Desquamated pneumocytes Inclusion like material

  24. Organizing diffuse alveolar damage

  25. Squamous metaplasia of terminal bonchiolar epithelium

  26. Glomeruloid organizing lesions

  27. Glomeruloid organizing lesions comprise perivascular proliferation of young fibroblasts and cuff of T-lymphocytes CD3

  28. Neutrophils are scant in alveolar spaces but may be abundant within the pulmonary or septal vessels. Margination is not prominent.

  29. Organizing pneumonitis

  30. Glomeruloid organizing pneumonia

  31. Organizing cell groups in alveoli The cell groups contain desquamated pneumocytes, fibrin and edema fluid

  32. Early honey comb changes

  33. Cytology

  34. Sputum sample from a SARS patientPoint:Cluster of cells with cytoplasmic vocuoles

  35. Bronchial lavage from a SARS patientPoint: Pneumocytes with cytoplasmic vocuoles

  36. Tracheal aspirate from a SARS patientPoint: Large cells (probably pneumocytes) with cytoplasmic vocuoles

  37. Tracheal aspirate from a SARS patientPoint: Groups of pneumocytes

  38. Apoptosis is prominent in renal tubules and focally in the liver

  39. Apoptosis is prominent in lamina propria of small bowel.

  40. Lung from a SARS patient(case 4): Electron microscopy • Point: Viral pericles in cytoplasm of pneumocytes

  41. Roundish bodies of unknown nature are found within the cytoplasm of a pneumocyte. The diameter of the larger one is 220nm

More Related