Section 2 -

Diagnosis of Emerging Pulmonary Infections Sherif R. Zaki Chief, Infectious Disease Pathology Activity National Center for Infectious Diseases Centers for Disease Control and Prevention

Contrary to predictions made in the later half of the 20th century, infectious diseases remain the leading cause of death worldwide. Infectious disease pathologists have a longstanding history of contributing to the diagnosis and identification of infectious disease agents. Pathologists are characteristically among the first health care workers involved in recognizing infectious disease outbreaks and hence are in an excellent position to discover new zoonotic diseases and other emerging infectious disease syndromes. Pulmonary infections in man are caused by a variety of organisms including viruses, bacteria, fungi, rickettsia, parasites and other microbes. Lung may also be involved as part of systemic infection as seen for example with parvoviridae and viral hemorrhagic fevers. The diagnosis of pneumonia, suspected by history and clinical manifestations, also can be supported histopathologically, and the overall pattern of histopathologic lesions may suggest a specific diagnosis. In addition to histologic pattern recognition, immunohistochemistry (IHC), and in situ hybridization (ISH) in tissue, several other diagnostic tests are available to aid the pathologist in microbial identification. Cell culture techniques, serology, polymerase chain reaction (PCR), and electron microscopy (EM) all play vital roles in the diagnosis of these infections. These powerful techniques continue to provide excellent tools for the pathologist in addressing pathogenesis research, consultation cases, and moreover, the recent challenges posed by new, emerging, and reemerging diseases. Table 1. Recent Outbreaks of Emerging Pulmonary Infections Year Pathogen References 93 Hantavirus 1-3 95 Leptospirosis 20-22 97 H5N1 Avian Influenza 17 99 Nipah virus 18 01 Anthrax 19 03 SARS 4-13 03-04 Influenza (including pediatric deaths and avian influenza) 14-16 The presentation will provide an overview of the common pathologic findings present in pneumonias and other pulmonary infections along with discussion of current diagnostic testing modalities to detect pulmonary pathogens. Outbreaks of emerging and re-emerging pulmonary diseases that CDC investigated during recent years including hantavirus, sudden acute respiratory syndrome (SARS), leptospirosis, anthrax, and influenza (including avian influenza) will also be presented. The differential diagnosis of these entities as well as systematic and syndromic pathologic approaches to achieve an etiologic diagnosis will also be discussed. 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