MORPHOGENESIS OF DIFFUSE ALVEOLAR HEMORRHAGE IN SEVERE INFLUENZA A VIRUS PNEUMONIA
DOI:
https://doi.org/10.11603/1681-2727.2025.2.15269Keywords:
influenza A, viral hemorrhagic pneumonia, cytokine storm, diffuse alveolar hemorrhage, diffuse alveolar injuryAbstract
SUMMARY. Over the past hundred years, 12 severe pandemics of viral respiratory infections have occurred on planet Earth. All of them (with the exception of the latest COVID-19 pandemic) were caused by the influenza A virus. It is known that severe influenza A is characterized by an unpredictable course and possible life-threatening complications that develop quite rapidly in time: (acute respiratory distress syndrome, diffuse alveolar hemorrhage/bleeding, acute respiratory failure, infectious toxic shock, cerebral edema, etc.).
Progressive structural and functional damage to the lung parenchyma tissue, which is the main morphological sign of deterioration in patients, and the still limited effectiveness of general methods of treating these complications remain poorly understood and require further study.
The aim of our study was to obtain and analyze information on the pathogenetic/morphogenetic features of lung parenchyma aerosol barrier lesions directly or indirectly associated with severe influenza A viral hemorrhagic pneumonia.
To achieve this goal, we searched the literature in the scientometric databases Web of Science, Google Scholar, Scopus, Science Direct, Clinical Key Elsevier, PubMed, using the following keywords: “influenza A”, “viral hemorrhagic pneumonia”, “cytokine storm”, “diffuse alveolar hemorrhage”, “diffuse alveolar injury”. After processing and analyzing the publications, only professional sources that met the conditions of the request and the purpose of the study were selected for review.
The results of the study have shown that the pathogenetic features of the development of critical conditions in patients with severe influenza A are due to bilateral diffuse hemorrhagic pneumonia. Regardless of which general pathological process (according to the literature – inflammation, bleeding or hemorrhage) underlies the morphogenesis of this critical condition, the dominant and ultimately determining clinical and morphological factor in the severity of this form of influenza A is diffuse hemorrhagic pneumonia with the presence of a massive intra-alveolar hemorrhagic exudate in the lungs. The development of pulmonary diffuse alveolar hemorrhage in influenza virus infection occurs through activation and damage to endothelial cells (ECs) by several mechanisms, including direct injury, loss of tight junctions and capillary hyperpermeability due to inflammatory factors and, ultimately, due to EC apoptosis.
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