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J Clin Pathol 23:7-18 doi:10.1136/jcp.23.1.7
  • Articles

Pathological changes in virus infections of the lower respiratory tract in children

  1. W. Aherne,
  2. T. Bird,
  3. S. D. M. Court,
  4. P. S. Gardner,
  5. Joyce McQuillin
  1. Department of Pathology in the University, the Royal Victoria Infirmary, the General Hospital, Newcastle upon Tyne
  2. Department of Virology in the University, the Royal Victoria Infirmary, the General Hospital, Newcastle upon Tyne
  3. Department of Child Health in the University, the Royal Victoria Infirmary, the General Hospital, Newcastle upon Tyne
  4. Institute of Pathology, Newcastle upon Tyne

      Abstract

      The pathological changes are described in 22 children with proven or suspected virus infection of the lower respiratory tract. Two main patterns of disease were found: acute bronchiolitis and interstitial pneumonia. Particular viruses were not specifically associated with particular histological changes. The prime importance of the respiratory syncytial virus (RSV) as a cause of disease and death in young infants is again shown. Structural lesions and clinical dysfunction correlate fairly well; in acute bronchiolitis the main lesion is epithelial necrosis when a dense plug is formed in the bronchiolar lumen leading to trapping air and other mechanical interference with ventilation: in interstitial pneumonia there is widespread inflammation and necrosis of lung parenchyma, and severe lesions of the bronchial and bronchiolar mucosa as well. The implications of these structural changes for clinical management are discussed. The possibility of a hypersensitivity reaction in the cot death syndrome is raised, mediated by a serum antibody-antigen-complement reaction.