Emerging respiratory infections: The infectious disease pathology of SARS, MERS, pandemic influenza, and Legionella

Abstract

Lower respiratory infections remain one of the top global causes of death and the emergence of new diseases continues to be a concern. In the first two decades of the 21st century, we have born witness to the emergence of newly recognized coronaviruses that have rapidly spread around the globe, including severe acute respiratory syndrome virus (SARS) and Middle Eastern respiratory syndrome virus (MERS). We have also experienced the emergence of a novel H1N1 pandemic influenza strain in 2009 that caused substantial morbidity and mortality around the world and has transitioned into a seasonal strain. Although we perhaps most frequently think of viruses when discussing emerging respiratory infections, bacteria have not been left out of the mix, as we have witnessed an increase in the number of infections from Legionella spp. since the organisms' initial discovery in 1976. Here, we explore the basic epidemiology, clinical presentation, histopathology, and clinical laboratory diagnosis of these four pathogens and emphasize themes in humans' evolving relationship with our natural environment that have contributed to the infectious burden. Histology alone is rarely diagnostic for these infections, but has been crucial to bettering our understanding of these diseases. Together, we rely on the diagnostic acumen of pathologists to identify the clinicopathologic features that raise the suspicion of these diseases and lead to the early control of the spread in our populations.

Keywords: Influenza; Legionella; MERS; Pathology; SARS.

Fig. 1

Emerging and reemerging viral respiratory infections, examples: A) SARS gross pathology, B) SARS hyaline membranes, C) SARS intracytoplasmic inclusions, D) MERS pulmonary necrosis, E) H1N1pdm09 hyaline membranes, and F) H1N1pdm09 antigens in bronchiolar epithelial cells. All panel images ©John Wiley and Sons as cited.

Fig. 2

Legionella micdadei: A) Gross pathology, B) hematoxylin and eosin stain, C) faint Gram staining characteristic of Legionella species, and D) modified acid-fast staining characteristic of L. micdadei, but not other Legionella species. Prosector acknowledgement: Drs. Kelly Smith and Gregory Cheeney.