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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the well-written manuscript by Nin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who described pathological changes in the lungs in fatal cases of influenza A &#40;H1N1&#41; viral pneumonia&#46; They concluded that diffuse alveolar damage was the predominant finding&#44; accompanied by alveolar hemorrhage and&#44; in some cases&#44; by bronchiolitis and microthrombi&#46; Patients who died within the first week after diagnosis presented signs of exudative acute respiratory distress syndrome &#40;ARDS&#41;&#44; whereas those who died after the first week presented signs of proliferative ARDS&#46; Also&#44; in a recent editorial&#44; L&#243;pez-Alonso and Albaiceta<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> emphasized the presence of mechanisms of tissue repair occurring in very early stages of injury&#44; and questioned the role of this inflammatory response in patients&#8217; recovery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to highlight another important pathological finding observed in these patients&#58; organizing pneumonia &#40;OP&#41;&#46; A recent study examining the correlation between computed tomographic &#40;CT&#41; features and pathological findings in fatal cases of H1N1 pneumonia described a patient who presented linear opacities on a follow-up CT scan performed 15 days after the first examination&#46; The patient died 28 days after the first hospitalization&#44; and histological examination showed typical elongated fibroblast plugs filling airspaces&#44; compatible with OP&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Other studies have also reported similar findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary fibrosis observed in the recovery phase may&#44; at least in part&#44; account for the respiratory symptoms observed in these patients&#46; CT may play a role in the detection and characterization of the disease&#44; in monitoring the disease progress and response to treatment&#44; and in the identification of complications&#46; Although pulmonary opacities secondary to H1N1 infection usually regress during convalescence&#44; consolidations may occasionally progress to linear or peripheral opacities&#46; Histopathological studies have shown that&#44; in most cases&#44; these later changes are due to secondary OP&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; pulmonary opacities observed in the recovery phase of H1N1 infection frequently represent OP&#46; The diagnosis of secondary OP after H1N1 infection is important because proper treatment of OP requires corticosteroid therapy&#46; Physicians should be aware that OP may complicate the recovery of patients with H1N1 infection&#44; and the development of late opacities on CT scans during recovery should suggest this diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p></span>"
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Letter to the Editor
Organizing pneumonia as another pathological finding in pandemic influenza A (H1N1)
Organización de la neumonía como otro hallazgo patológico en la gripe A pandémica (H1N1)
E. Marchiori
Autor para correspondencia
edmarchiori@gmail.com

Corresponding author.
, G. Zanetti, F.A. Ferreira Francisco, B. Hochhegger
Federal University, Rio de Janeiro, Brazil
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    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Organizing pneumonia as another pathological finding in pandemic influenza A &#40;H1N1&#41;"
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        "titulo" => "Organizaci&#243;n de la neumon&#237;a como otro hallazgo patol&#243;gico en la gripe A pand&#233;mica &#40;H1N1&#41;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the well-written manuscript by Nin et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> who described pathological changes in the lungs in fatal cases of influenza A &#40;H1N1&#41; viral pneumonia&#46; They concluded that diffuse alveolar damage was the predominant finding&#44; accompanied by alveolar hemorrhage and&#44; in some cases&#44; by bronchiolitis and microthrombi&#46; Patients who died within the first week after diagnosis presented signs of exudative acute respiratory distress syndrome &#40;ARDS&#41;&#44; whereas those who died after the first week presented signs of proliferative ARDS&#46; Also&#44; in a recent editorial&#44; L&#243;pez-Alonso and Albaiceta<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> emphasized the presence of mechanisms of tissue repair occurring in very early stages of injury&#44; and questioned the role of this inflammatory response in patients&#8217; recovery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We would like to highlight another important pathological finding observed in these patients&#58; organizing pneumonia &#40;OP&#41;&#46; A recent study examining the correlation between computed tomographic &#40;CT&#41; features and pathological findings in fatal cases of H1N1 pneumonia described a patient who presented linear opacities on a follow-up CT scan performed 15 days after the first examination&#46; The patient died 28 days after the first hospitalization&#44; and histological examination showed typical elongated fibroblast plugs filling airspaces&#44; compatible with OP&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Other studies have also reported similar findings&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Pulmonary fibrosis observed in the recovery phase may&#44; at least in part&#44; account for the respiratory symptoms observed in these patients&#46; CT may play a role in the detection and characterization of the disease&#44; in monitoring the disease progress and response to treatment&#44; and in the identification of complications&#46; Although pulmonary opacities secondary to H1N1 infection usually regress during convalescence&#44; consolidations may occasionally progress to linear or peripheral opacities&#46; Histopathological studies have shown that&#44; in most cases&#44; these later changes are due to secondary OP&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; pulmonary opacities observed in the recovery phase of H1N1 infection frequently represent OP&#46; The diagnosis of secondary OP after H1N1 infection is important because proper treatment of OP requires corticosteroid therapy&#46; Physicians should be aware that OP may complicate the recovery of patients with H1N1 infection&#44; and the development of late opacities on CT scans during recovery should suggest this diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a></p></span>"
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