Histopathological Features and Viral Antigen Distribution in the Lung of Fatal Patients with <Emphasis Type="Italic">Enterovirus</Emphasis> 71 Infection

Enterovirus 71 (EV71) infection causes hand-foot-and-mouth disease (HFMD) in children and might be accompanied by severe neurological complications. It has become one of the most important pathogens of central nervous system infection. To explore the causes of lung injury by EV71, the distribution of EV71 receptors, SCARB2 and PSGL-1, in human lung tissues was examined. Our results revealed that SCARB2 was positively distributed in the bronchial and bronchiolar epithelial cells, alveolar cells and macrophages, while PSGL-1 was positively scattered in bronchial and bronchiolar epithelial cells and macrophages, and negatively distributed in alveolar cells. The pathological changes of fatal lung with EV71 infection demonstrated intrapulmonary bronchitis and bronchiolitis, diffuse or focal infiltration of inflammatory cells, such as T cells and B cells in the wall and surrounding tissues, widened alveolar septum, capillaries in the septum with highly dilated and congested, and infiltrated inflammatory cells, showing different degrees of protein edema with fibrin exudation in the alveolar cavity, as well as obvious hyaline membrane formation in some alveolar cavities. The EV71 antigen in lung tissues was detected, and the viral antigen was positive in lung bronchial and bronchiolar epithelial cells, and positively scattered in the alveolar cells and macrophages. Therefore, in addition to the complications of central nervous system injury, the lung remains the main target organ for virus attack in severe EV71 infected patients. Lung injury was mainly caused by neurogenic damage and/or direct invasion of the virus into the lungs in critically serious children, and the lesions were mainly pulmonary edema and interstitial pneumonia.