Infectious Pathology of the Respiratory Tract

256 Pages·2021·50.498 MB·English

by  Vsevolod Zinserling

Infectious Pathology
of the Respiratory
Tract
Vsevolod Zinserling
123
Infectious Pathology of the Respiratory
Tract
Vsevolod Zinserling
Infectious Pathology
of the Respiratory Tract
With Contributions by
Yulia R. Zyuzya
Vladimir V. Svistunov
Valery V. Varyasin
Vsevolod Zinserling
Pathomorphology
Institute of Experimental Medicine at V.A. Almazov Research Center
Saint Petersburg
Russia
ISBN 978-3-030-66324-7 ISBN 978-3-030-66325-4 (eBook)
https://doi.org/10.1007/978-3-030-66325-4
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Preface
The importance of respiratory infectious pathology is obvious. Several manu-
als discuss the fundamental aspects of the pathogenesis of infections [1, 2],
and many issues of its diagnostics in routine work of clinical pathologists are
excellently presented as well [3–6]. Especially informative are the chapters
devoted to tropical infections. Due to quite objective reasons, there are practi-
cally no modern publications founded upon autopsy studies. The only excep-
tion is a review based upon a limited number of cases including SARS,
MERS, pandemic influenza, and Legionella [7]. In 2020, numerous publica-
tions appeared presenting autopsy series in COVID-19 (see Chap. 6). Several
infections (mycoplasmosis, chlamydiosis, etc.) appeared to lie outside the
focus of attention of a majority of pathologists. In Russia, especially in
Leningrad/Saint Petersburg, different variants of infectious pathology, includ-
ing pneumonia, influenza, mycoplasmosis, HIV, and intrauterine infections,
have been successfully studied in children, adults, and on experimental mod-
els for fast a century in the scientific school of Vsevolod D. and Alexander
V. Zinserling [8, 9]. Russian pathology has also outstanding experience in
investigating tuberculosis [10, 11]. For certain reasons, having no relation to
the professional work, these results were published in English only in a lim-
ited number of contributions. In this book, we summarize the experience of
our scientific schools presenting the results, which have been achieved in
previous decades in comparison with the modern data and literature. It
appears necessary to cite Russian publications of the former century, espe-
cially when they present reliable results, the topic remains actual, and there
are no modern contributions at all. We paid more attention to diseases that are
less known and we had the opportunity to study thoroughly. We considered it
very important to present a set of numerous original illustrations, mostly
demonstrating our own observations. We found it unnecessary to try to per-
form a complete review of the literature; unfortunately the majority of mod-
ern publications do not discuss lifetime and postmortem morphological
diagnostics of infectious lung lesions—the main task that we put before us
while preparing the manual. Valuable contributions were made by Yulia R.
Zyuzya, Dr. Med. Sci. (Russia)—Chapters 7.3, 13, 14.2, 14.6, 15, 18;
Vladimir Svistunov, Dr. Med. Sci (Russia)—Chapters 10, 11.6; and Valery
Varjasin, Dr. Med. Sci. (Russia)—Chapter 5.3.
Saint Petersburg, Russia Prof. Vsevolod Zinserling
v
vi Preface
References
1. Mims CA, Dimmock NJ, Nash A, Stephen J. Mim’s pathogenesis of
infectious disease. 4th ed. Academic Press; 1995. 414 p.
2. Engleberg NG, Rita V, Dermody TS, editors. Shaechter’s mechanisms of
microbial disease. 4th ed. Lippincott Williams & Wilkins; 2007.
3. Kradin RL, editor. Diagnostic pathology of infectious diseases. Elsevier;
2018. 698 p.
4. Procop GW, Pritt BS, editors. Pathology of infectious diseases. Elsevier;
2015. 706 p.
5. Hofman P, editor. Infectious disease and parasites. Springer Reference;
2016. 343 p.
6. Schmitt BH, editor. Atlas of infectious pathology. Springer; 2017. 255 p.
7. Bradley BT, Bryan A. Emerging respiratory infections: the infectious
disease pathology of SARS, MERS, pandemic influenza and Legionella.
Semin Diagn Pathol 2019;36:152–9. https://doi.org/10.1053/j.
semdp.2019.04.06.
8. Zinserling VD, Zinserling AV. Pathological anatomy of acute pneumonia
of different etiology. Gos Izd Med Lit. Leningrad; 1963. 175 p. (In
Russian).
9. Zinserling AV, Zinserling VA. Modern infections: pathologic anatomy
and issues of pathogenesis: a guide. SPb: Sotis; 2002. 346 p. (In Russian).
10. Strukov AI. Forms of pulmonary tuberculosis in morphological light.
M.: Publishing House of the USSR Academy of Medical Sciences; 1948.
160 p. (In Russian).
11. Puzik VI, Uvarova OA, Averbakh MM. Pathomorphology of modern
forms of pulmonary tuberculosis. -M.: Medicine; 1973. 215 p. (In
Russian).
Contents
1 General Aspects of Infectious Pathology . . . . . . . . . . . . . . . . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 Microbiology, Molecular Biology, Immunology,
and Microscopy in Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3 Local Immunity of Respiratory Tract in Different
Age Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4 Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4.1 Etiology, Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4.2 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
4.3 Own Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
5 Paramyxovirus and other RNA virus infections . . . . . . . . . . . . . 35
5.1 Parainfluenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
5.2 Respiratory Syncytial Infection . . . . . . . . . . . . . . . . . . . . . . . . 36
5.3 Metapneumovirus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
5.4 Measles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
5.5 Lung Lesions Due to Other RNA–Viruses . . . . . . . . . . . . . . . 44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
6 Infections Due to Coronaviruses . . . . . . . . . . . . . . . . . . . . . . . . . . 47
6.1 COVID-19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
7 Respiratory Infections Due to DNA Viruses . . . . . . . . . . . . . . . . . 53
7.1 Adenovirus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
7.2 Respiratory Herpes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
7.3 Lung Lesions in Cytomegalovirus in Adults
with HIV Infection in AIDS Stage . . . . . . . . . . . . . . . . . . . . . . 57
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
vii
viii Contents
8 Pneumonias. General Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
9 Atypical Pneumonias Due to Chlamydia and Mycoplasma . . . . 67
9.1 Respiratory Chlamydiosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
9.2 Respiratory Mycoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
9.2.1 Microbiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
9.2.2 Clinical Picture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
9.2.3 Laboratory Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . 71
9.2.4 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
9.2.5 Experimental Models . . . . . . . . . . . . . . . . . . . . . . . . . . 73
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
10 Lobar Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
10.1 General Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
10.2 Views Upon Pathology in a Historical Aspect . . . . . . . . . . . . 82
10.3 Clinical Manifestations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
10.3.1 Own Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
10.4 Pathology. Own Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
10.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
11 Other Community-Acquired Pneumonia . . . . . . . . . . . . . . . . . . . 89
11.1 Focal Pneumococcal Pneumonia . . . . . . . . . . . . . . . . . . . . . . 89
11.2 Pneumonia Caused by a Hemophilic Bacillus
(Hist. Afanasyev–Pfeifer Rod) . . . . . . . . . . . . . . . . . . . . . . . . 90
11.3 Pneumonia Caused by Klebsiella
(Hist. Fridländer Pneumonia) . . . . . . . . . . . . . . . . . . . . . . . . . 91
11.4 Streptococcal Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
11.5 Staphylococcal Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . 93
11.6 Legionellosis of the Lungs
(Syn. Disease of Legionnaires) . . . . . . . . . . . . . . . . . . . . . . . 95
11.7 Plague . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
11.8 Anthrax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
11.9 Actinomycosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
11.10 Whooping Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
12 Nosocomial Pneumonias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
12.1 Pseudomonas Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
12.2 Hospital Pneumonia Due to Klebsiella . . . . . . . . . . . . . . . . . 102
12.3 Proteus Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
12.4 Pneumonia Caused by Pathogenic Escherichia . . . . . . . . . . . 103
12.5 Lung Gangrene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
12.6 Other Pathogens Producing Pneumonia Especially
in Immunosuppressed Host . . . . . . . . . . . . . . . . . . . . . . . . . . 106
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Contents ix
13 Tuberculosis and Other Mycobacteriosis . . . . . . . . . . . . . . . . . . . 107
13.1 General Considerations. The Role of Pathology
in the Study of Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . 107
13.2 Pathology of Lung Tuberculosis
Without Immunodeficiency . . . . . . . . . . . . . . . . . . . . . . . . . . 110
13.3 Peculiarities of Tuberculosis in Combination
with HIV in AIDS Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
13.4 Lung Lesions Due to Nontuberculous Mycobacteria
Myc. Avium (Mac) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
14 Respiratory Mycosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
14.1 Candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
14.2 Cryptococcosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
14.3 Histoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
14.4 Aspergillosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
14.5 Mucormycosis (Former Zygomycosis, Phycomycosis) . . . . . 173
14.6 Pneumocystosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
14.6.1 The Causative Agent . . . . . . . . . . . . . . . . . . . . . . . . . 173
14.6.2 Clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
14.6.3 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
14.7 Other Mycoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
15 Lesions Due to Protozoa and Helminthes . . . . . . . . . . . . . . . . . . . 185
15.1 Echinococcosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
15.1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
15.1.2 Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
15.2 Lung Lesions by Toxoplasma in HIV in AIDS Stage . . . . . . 188
15.3 Other Parasites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
16 Mixed Infectious Lesions. Pathogenesis
and Morphological Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
17 Lung Lesions in Intrauterine Infections . . . . . . . . . . . . . . . . . . . . 197
17.1 General Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
17.2 Intrauterine Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
17.3 Intrauterine Parainfluenza . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
17.4 Intrauterine RS Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
17.5 Intrauterine Herpes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
17.6 Intrauterine Cytomegaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200
17.7 Intrauterine Mycoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . 201
17.8 Intrauterine Chlamydiosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
17.9 Intrauterine Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
17.10 Intrauterine Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
x Contents
18 Morphological Differential Diagnosis of Some Focal
and Diffuse Granulomatous and Necrotic Processes
in the Lungs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
18.1 General Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
18.2 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
18.2.1 Tuberculosis in Immunocompetent Individuals . . . . . 206
18.2.2 Peculiarities of Tuberculosis Associated
with HIV Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
18.3 Mycobacteriosis Caused by Nontuberculous
Mycobacteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
18.4 HIV-Associated Nontuberculous Mycobacteriosis
M. avium, M. avium Intracellulare
(M. avium Complex, MAC) . . . . . . . . . . . . . . . . . . . . . . . . . . 213
18.5 Sarcoidosis—A Chronic Multisystem Disease
Belonging to the Group of Granulomatous
Diseases of an Unknown Nature . . . . . . . . . . . . . . . . . . . . . . 215
18.6 Necrotizing Sarcoid Granulomatosis (NSH) . . . . . . . . . . . . . 218
18.7 Hypersensitive Pneumonitis
(Exogenous Allergic Alveolitis) . . . . . . . . . . . . . . . . . . . . . . . 220
18.8 Mycotic Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
18.9 Actinomycosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
18.10 Tularemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
18.11 Granulomatosis of Chlamydial and Mycoplasma Etiology . . . 232
18.12 Bronchocentric Granulomatosis . . . . . . . . . . . . . . . . . . . . . . . 237
18.13 Granulomatosis with Polyangiitis . . . . . . . . . . . . . . . . . . . . . 239
18.14 Histiocytosis X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
18.15 Rheumatoid Damage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
18.16 Helminthiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
18.17 Granulomatous Inflammation of Foreign Bodies . . . . . . . . . 251
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
19 Conclusion. Questions Stay To Be Investigated . . . . . . . . . . . . . . 257
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259