Presencia de trombosis y hallazgos anatomopatológicos post mortem en 109 pacientes con COVID-19 / Presence of thrombosis and post-mortem pathological findings in 109 patients with COVID-19

INTRODUCCIÓN: En 6 meses se notificaron más de 400 mil fallecidos por COVID-19. Han surgido múltiples investigaciones para comprender su etiopatogenia, siendo la autopsia médica uno de los mejores procedimientos para obtener información. Presentamos una revisión respecto a hallazgos post mortem publicados hasta mayo, 2020. RESULTADOS: Se recolectaron 12 estudios, de un total de 109 pacientes cuyo deceso fue por complicación respiratoria, predominó el sexo masculino, edad avanzada y con múltiples comorbilidades. El estudio PCR se realizó principalmente para diagnóstico. Se demostró ARN viral en riñón, hígado, corazón, cerebro y otros órganos. Los autores relataron presencia de micro y/o macro trombosis, en 50 de 109 casos, sobre todo a nivel pulmonar y renal, de tipo microscópica y relacionados a signos de shock. Desde la perspectiva anatomopatológica, se centra en alteraciones pulmonares y renales: daño alveolar difuso, injuria tubular aguda, microtrombos y otros signos de alteración microcirculatoria. Los estudios inmunohistoquímicos, de inmunofluoresencia y microscopía electrónica sugieren tropismo del virus por células epiteliales y estromales a nivel pulmonar y renal. En otros órganos se encuentran elementos morfológicos inespecíficos, atribuibles a patologías de base o shock. CONCLUSIÓN: El patrón histopatológico de daño alveolar difuso es frecuente, principalmente en fase exudativa o temprana. En el tejido renal destaca la injuria tubular aguda y daño microcirculatorio. El número y la descripción de muestras en otros órganos es reducida, siendo necesaria mayor casuística. La trombosis, es un trastorno prevalente en pulmones y riñones de pacientes con signos de shock. El tipo de trombo con más frecuencia descrito, es el microtrombo. Si bien se puede explicar como gatillante del fenómeno trombótico la interacción entre agente y huésped, otros factores deben ser estudiados para dilucidar la patogenia.

Using immunoglobulin Y as an alternative antibody for the detection of hepatitis A virus in frozen liver sections

An increasing amount of research has been conducted on immunoglobulin Y (IgY) because the use of IgY offers several advantages with respect to diagnostic testing, including its easy accessibility, low cost and translatability to large-scale production, in addition to the fact that it can be ethically produced. In a previous work, immunoglobulin was produced and purified from egg yolks (IgY) reactive to hepatitis A virus (HAV) antigens. In the present work, this anti-HAV-specific IgY was used in an indirect immunofluorescence assay to detect viral antigens in liver biopsies that were obtained from experimentally infected cynomolgus monkeys. Fields that were positive for HAV antigen were detected in liver sections using confocal microscopy. In conclusion, egg yolks from immunised hens may be a reliable source for antibody production, which can be employed for immunological studies.

Detección de antígenos del virus del dengue en tejidos post mórtem / Detection of dengue virus antigen in post-mortem tissues

El panorama epidemiológico del dengue ha empeorado durante la última década. Las dificultades para prevenir su transmisión, así como la ausencia de una vacuna o tratamiento específico, lo convierten en un riesgo que desafía las medidas de salud pública y desborda la capacidad de los centros de salud y los sistemas de investigación a muchos niveles. Actualmente, la mayoría de los estudios sobre la patogenia de la infección centran su atención en la respuesta inmunitaria de las células T casi exclusivamente en infecciones secundarias y están dirigidos a identificar los mecanismos implicados en el desarrollo de la permeabilidad vascular y de los eventos hemorrágicos que lo acompañan. En este reporte se describe el caso de una menor de 45 días de edad con signos clínicos de dengue grave, cuyo diagnóstico se confirmó por reacción en cadena de la polimerasa de transcripción inversa en muestras de tejido post mórtem y por herramientas de apoyo diagnóstico de inmunohistoquímica, las cuales detectaron antígenos virales en todos los órganos obtenidos en la necropsia. Este caso subraya la importancia del estudio de las infecciones primarias asociadas a dengue grave, particularmente en niños, en quienes es más probable el desarrollo de la forma grave de la enfermedad sin una infección previa, y, además, pone de relieve la importancia de un diagnóstico que no se limite a las muestras de tejido hepático en el estudio de la patogenia de la infección viral.

The epidemiological situation of dengue has worsened over the last decade. The difficulties in preventing its transmission and the absence of a vaccine or specific treatment have made dengue a serious risk to public health, health centers and research systems at different levels. Currently, most studies on the pathogenesis of dengue infection focus on the T-cell immune response almost exclusively in secondary infections and are aimed at identifying the mechanisms involved in the development of vascular permeability and bleeding events that accompany the infection. This report describes the case of a baby girl less than 45 days of age with clinical signs of severe dengue, whose diagnosis was confirmed by reverse transcription polymerase chain reaction in post-mortem tissue samples and by the ancillary diagnostic use of immunohistochemistry, which detected viral antigens in all organs obtained at autopsy. This case highlights the importance of studying primary infections associated with severe dengue, particularly in children, who are more likely to develop the severe form of the disease without previous infection, and it further stresses the importance of a diagnosis that should not be based solely on the examination of liver tissue samples when studying the pathogenesis of the viral infection.

Anti-hepatitis C virus treatment may prevent the progression of liver fibrosis in non-responder human immunodeficiency virus/hepatitis C virus coinfected patients

AIM: To evaluate changes in liver histology in patients with human immunodeficiency virus/hepatitis C virus coinfection non-responders to a suboptimal Interferon+Ribavirine regimen. MATERIALS AND METHODS: We investigated 49 patients with two sequential liver biopsies: 18 were non-responders to Interferon+Ribavirine treatment (Group hepatitis C virus Rx) administered after the 1st liver biopsy who underwent a 2nd liver biopsy after a median period of 3.92 year and 31 were patients who remained untreated for hepatitis C virus disease (Group hepatitis C virus untreated) after the 1st liver biopsy because of refusal and underwent a 2nd liver biopsy after a median period of 5.05-years. Most patients in both groups were under highly active antiretroviral therapy. At the time of 1st liver biopsy similar degrees of necro-inflammation, fibrosis and steatosis were observed in both groups. Changes in liver lesions between 1st and 2nd liver biopsys were adjusted for different intervals between liver biopsys by a mathematic formula. RESULTS: Liver fibrosis did not change in 88.9% of patients in Group hepatitis C virus Rx and in 77.4% in Group hepatitis C virus untreated. A marked deterioration in liver fibrosis was observed in 5 (16%) patients in Group hepatitis C virus untreated and in none in Group hepatitis C virus treated. Necro-inflammation and steatosis remained substantially unchanged in both groups. CONCLUSION: Liver histology remained substantially unchanged in human immunodeficiency virus/hepatitis C virus patients non-responder to anti-hepatitis C virus therapy over 4 years observation, suggesting an effective anti-hepatitis C virus early treatment for all hepatitis C virus/human immunodeficiency virus coinfected patients who can reasonably tolerate therapy. .

Spontaneous HBsAg loss in Korean patients: relevance of viral genotypes, S gene mutations, and covalently closed circular DNA copy numbers

BACKGROUND/AIMS: Occult HBV infection can persist following HBsAg loss and be transmitted, but the virological features are not well defined. METHODS: Here we investigated 25 Korean patients who lost HBsAg during follow up, either spontaneously or subsequent to therapy. RESULTS: Whereas subtype adr (genotype C) was found in 96% of HBsAg positive patients, 75 % of patients who lost HBsAg spontaneously were seemed to be infected with the ayw subtype with sequence similar to genotype D. Mutations in the major hydrophilic region (MHR) of HBsAg were found in 7 patients who lost HBsAg spontaneously. The mutations include T123S, M125I/N, C139R, D144E, V177A, L192F, and W196L, some of which have not been reported before. Functional analysis via transfection experiments indicate that the C139R and D144E mutations drastically reduced HBsAg antigenicity, while the Y225del mutation found in one interferon-treated patient impaired HBsAg secretion. CONCLUSIONS: Lack of detectable HBsAg in patient serum could be explained by low level of ccc DNA in liver tissue, low antigenicity of the surface protein, or its secretion defect.

Occult Hepatitis B Virus Infection in Chronic Hepatitis C / 대한소화기학회지

Occult HBV infection is defined as the presence of HBV DNA in the liver (with or without detectable or undetectable HBV DNA in the serum) of individuals testing negative for HBsAg. Studies on occult HBV infection in hepatitis C patients have reported highly variable prevalence, because the prevalence of occult HBV infection varies depending on the hepatitis B risk factors and methodological approaches. The most reliable diagnostic approach for detecting occult HBV detection is through examination of liver DNA extracts. HCV has been suspected to strongly suppress HBV replication up to the point where it may be directly responsible for occult HBV infection development. However, more data are needed to arrive at a definitive conclusion regarding the role of HCV in inducing occult HBV infection. Occult HBV infection in chronic hepatitis C patients is a complex biological entity with possible relevant clinical implications. Influence of occult HBV infection on the clinical outcomes of chronic hepatitis C may be considered negative. However, recent studies have shown that occult HBV infection could be associated with the development of hepatocellular carcinoma and contribute to the worsening of the course of chronic liver disease over time in chronic hepatitis C patients. Nevertheless, the possible role of occult HBV infection in chronic hepatitis C is still unresolved and no firm conclusion has been made up until now. It still remains unclear how occult HBV infection affects the treatment of chronic hepatitis C. Therefore, in order to resolve current controversies and understand the pathogenic role and clinical impacts of occult HBV infection in chronic hepatitis C patients, well-designed clinical studies are needed.

Hepatitis E virus in liver and bile samples from slaughtered pigs of Brazil

The objective of this study was to detect and identify hepatitis E virus (HEV) strains in liver and bile samples from slaughtered pigs in the state of Paraná, Brazil. Liver and bile samples were collected from 118 asymptomatic adult pigs at a slaughterhouse in a major Brazilian pork production area. The samples were assayed using a nested reverse transcription-polymerase chain reaction protocol with primer sets targeting open reading frames (ORF)1 and 2 of the HEV genome. HEV RNA was detected in two (1.7%) liver samples and one (0.84%) bile sample using both primers sets. The HEV strains were classified as genotype 3b on the basis of their nucleotide sequences. These data suggest that healthy pigs may be a source of HEV infection for consumers of pig liver and slaughterhouse workers in Brazil.

[Investigating the presence of different hepatitis C virus genotypes in serum, peripheral blood mononuclear cells, and liver biopsy specimens of patients with hepatitis C virus infection]

Hepatitis C virus [HCV] is essentially considered as hepatotropic, but virus sequences have also been found in other important extrahepatic sites, including peripheral blood mononuclear cells [PBMCs]. This study was done to investigate the presence of mixed infection and the differences between hepatitis C virus genotypes in plasma, peripheral blood mononuclear cells, and liver biopsy specimens in patients with hepatitis C virus infection. One hundred and fifty two patients with established chronic hepatitis C infection attending Firouzgar Hospital, affiliated to Tehran University of Medical Sciences, from September 2008 to April 2010 were enrolled in the present study. After collecting plasma, peripheral blood mononuclear cell, and liver biopsy specimens, RNA was extracted from the samples and hepatitis C virus genotyping was performed using INNO-LiPATM HCV II kit. The hepatitis C virus genotyping was confirmed by sequencing the RT-nested PCR product of 5'-UTR fragments. The mean age of the participants was 31.2 +/- 16.9 years. Multiple hepatitis C virus genotypes were detected in 4 [2.6%] out of 152 plasma samples, 10 [6.6%] out of 152 peripheral blood mononuclear cell samples, and 9 [18.8%] out of 48 liver biopsy specimens. Hepatitis C virus genotypes were different in the plasma, PBMC, and liver biopsy specimens of 21 [13.8%] patients. The present study shows that a significant proportion of patients with chronic hepatitis C infection are infected by multiple hepatitis C virus genotypes which may not be detectable in their plasma specimens

Development and characterization of a potential diagnostic monoclonal antibody against capsid protein VP1 of the chicken anemia virus

Chicken anemia virus (CAV) is an important viral pathogen that causes anemia and severe immunodeficiency syndrome in chickens worldwide. In this study, a potential diagnostic monoclonal antibody against the CAV VP1 protein was developed which can precisely recognize the CAV antigen for diagnostic and virus recovery purposes. The VP1 gene of CAV encoding the N-terminus-deleted VP1 protein, VP1Nd129, was cloned into an Escherichia (E.) coli expression vector. After isopropyl-beta-D-thiogalactopyronoside induction, VP1Nd129 protein was shown to be successfully expressed in the E. coli. By performing an enzyme-linked immunoabsorbent assay using two coating antigens, purified VP1Nd129 and CAV-infected liver tissue lysate, E3 monoclonal antibody (mAb) was found to have higher reactivity against VP1 protein than the other positive clones according to the result of limiting dilution method from 64 clones. Using immunohistochemistry, the presence of the VP1-specific mAb, E3, was confirmed using CAV-infected liver and thymus tissues as positive-infected samples. Additionally, CAV particle purification was also performed using an immunoaffinity column containing E3 mAb. The monoclonal E3 mAb developed in this study will not only be very useful for detecting CAV infection and performing histopathology studies of infected chickens, but may also be used to purify CAV particles in the future.

Ultrastructural Identification of Circovirus in the Liver of Saffron Finch (Sicalis flaveola spp. ) / Identificación Ultrastructural de circovirus en el Hígado de Canarios Venezolanos (Sicalis flaveola spp. )

Circovirus are viral agents that cause disease in avian species. The main clinical symptoms of the disease are immunosuppression and, in young birds feather disorders. In neonates, the disease is known as "black spot" and characterized by abdominal enlargement, hepatobiliar congestion and failure to thrive. Also, it wasobserved in adult infected birds with other symptoms and clinical signs, such as enteritis, sinusitis, rhinitis, tracheitis, bronchopneumonia, myocarditis, nephritis, splenitis, dyspnea, anorexia, depression leading to high mortality. In April 2008, 317 saffron finch were apprehended during an illegal commercialization and were forwarded to the Wild Animals Recovery Center of the Tiete Ecological Park. Subsequently, 101 (31.66 percent) died and 20 of these were selected and sent to the Laboratory of Electron Microscopy, Biological Institute of São Paulo, Brazil to investigate possible etiological agents. After necropsy of these animals fragments of lung, liver and small intestine were processed using negative staining and resin embedding techniques. On the transmission electron microscopy, the negative staining technique allowed observation in 20 (100 percent) samples of liver suspension, a great number of particles with morphology similar to the circovirus, spherical, non-enveloped, isometric, characterized as "complete" and "empty ", measuring between 17 and 20 nm in diameter. By the resin embedding technique, oval or rounded viral intracytoplasmatic inclusion bodies, containing viral particles disposed in paracrystalline arrays or loose arrangements were observed in ultrathin sections on the 20 (100 percent) samples of liver suspension. This is the first report on the presence of circovirus in saffron finch (Sicalis flaveola spp.).

Circovirus son agentes virales que causan enfermedad en las aves. Los principales síntomas clínicos de la enfermedad son la inmunosupresión y desórdenes en las plumas de aves jóvenes. En los recién nacidos la enfermedad se conoce como "punto negro" y se caracteriza por distensión abdominal, congestión hepatobiliar y falla en el desarrollo. También se han observado en las aves adultas infectadas, otros síntomas y signos clínicos, tales como la enteritis, sinusitis, rinitis, traqueitis, bronconeumonía, miocarditis, nefritis, esplenitis, disnea, anorexia, depresión llevando también a alta mortalidad. En abril de 2008, durante una comercialización ilegal, fueron confiscados 317 canarios venezolanos, siendo llevados al Centro de Rehabilitación de Animales Silvestres del Parque Ecológico de Tietê. Posteriormente, 101 (31,66 por ciento) aves murieron y entre éstas fueron seleccionadas 20 y enviadas al Laboratorio de Microscopía Electrónica, Instituto Biológico de São Paulo, para identificar el posible agente etiológico. Después de la necropsia, fragmentos de pulmón, hígado e intestino delgado se procesaron mediante las técnicas de tinción negativa y de inclusión en resina. A través de microscopía electrónica de transmisión, la técnica de tinción negativa permitió visualizar en las 20 muestras (100 por ciento) de suspensión del hígado, un gran número de partículas con morfología similar al circovirus, esférico, sin envoltura, isométrico, que se caracteriza como "completa" y "vacío", que miden entre 17 y 20 nm de diámetro. Mediante la técnica de cuerpos de inclusión en resina se observó en el 100 por ciento de las muestras de suspensión de hígado, cuerpos de inclusión virales intracitoplasmáticos, redondeadas u ovales, con partículas de virus dispuestos en matrices paracristalinas o sueltas en los cortes ultrafinos. Este es el primer reporte de la presencia de circovirus en canarios Venezolanos (Sicalis flaveola spp.).

The Gut and Lung Morphometry in Experimental and Natural Lineage 1 Variant of Peste des Petits Ruminants Virus Infection in Nigerian Goats / Morfometría Intestinal y Pulmonar en la Infección Natural y Experimental del Virus Peste des petits ruminants del linaje 1 en Cabras de Nigeria

The lung and gut morphometry in both natural and experimental Peste de petit ruminant (PPR) virus which are scanty in literature hence the need for this study. The goats that were submitted for necropsy in the Department of Veterinary Pathology University of Ibadan between 2009 and 2010 and the gross pathological diagnosis were PPR were enrolled in this study. The degree of pneumonia as a percentage of the total lung volume was estimated using standard methods. The gut morphometry of goats experimentally infected with PPR virus was also used. Student "T" test was used for the test of significance in evaluating the effect of age, sex and the lung consolidation pattern in natural PPR and analysis of the gut morphometry. Complicated PPR had significant higher pulmonary consolidation when compared with the uncomplicated PPR (p< 0.05). The pulmonary consolidation was significantly higher on the right lung with a mean percentage value of 6.54 than the left lung (p< 0.05). The caudal lobe was more consolidated than the cranial and middle lobes in natural PPR. The pulmonary consolidation was more in goats less than a year, while the buck had a significantly higher pulmonary consolidation than the does (p< 0.05). There was no significant difference in the mean length of the villi and width of the villi of PPR virus infected goats when compared to the control, however a significant difference was observed in the cryptal depth (p< 0.05). There was a significant difference in the mean villi length and cryptal depth of goats with complicated PPR (Mannheimia hemolytica) infected goats (p< 0.05) relative to the control. From this study, it showed that most natural PPR were complicated with bacteria and this complication may have contributed to the fatality associated with PPR especially those caused by lineage 1 viruses. This study also showed that secondary bacterial involvement in course of PPR affect the gut morphometry and that could account for the severity of intestinal lesion commonly observed with field PPR in Nigerian goats.

La morfometría del pulmón y el intestino en la infección del virus Peste des petits ruminants (PRR) de forma natural así como experimental es escaza en la literatura, de ahí la necesidad de este estudio. Fueron incluidas en este estudio las cabras que fueron sometidas a autopsia en el Departamento de Patología Veterinaria de la Universidad de Ibadan entre 2009 y 2010, con diagnóstico patológico macroscópico de PPR. El grado de neumonía como porcentaje del volumen pulmonar total fue estimado mediante los métodos estándar. También fue determinada la morfometría del intestino de las cabras infectadas experimentalmente con el virus PPR. Se utilizó la prueba "T" de Student para determinar la significancia en la evaluación de los efectos de edad, sexo, patrón de consolidación pulmonar en PPR natural y análisis de la morfometría intestinal. La PPR complicada tuvo una consolidación pulmonar altamente significativa en comparación con la PPR no complicada (p <0,05). La consolidación pulmonar fue significativamente mayor en el pulmón derecho, con un valor porcentaje promedio de 6,54 en comparación al pulmón izquierdo (p <0,05). El lóbulo caudal fue más consolidado que los lóbulos craneal y medio en presencia del PPR natural. La consolidación pulmonar fue más frecuente en caprinos menores de un año, mientras que los machos cabríos tuvieron una consolidación pulmonar significativamente más alta (p <0,05). No hubo diferencias significativas en la longitud y ancho promedio de las vellosidades en cabras infectadas con PPR en comparación con el control, pero se observó una diferencia significativa en la profundidad de las criptas (p <0,05). Hubo diferencia significativa en la longitud de las vellosidades y la profundidad media de las criptas en las cabras infectadas con PPR complicada (Mannheimia haemolytica) (p <0,05) en relación al control. A partir de este estudio, se demostró que las infecciones con PPR natural se complicaron con bacterias, y estas complicaciones pueden haber contribuido a la mortalidad asociada el PPR, especialmente las causadas por el virus del linaje 1. Este estudio también mostró que la participación bacteriana secundaria en el curso de la PPR afecta la morfometría intestinal y que podría dar cuenta de la gravedad de la lesión intestinal observada comúnmente en la infección de PPR en cabras de Nigeria.

Clinical significance of occult hepatitis B virus infection in chronic hepatitis C patients / 대한간학회지

BACKGROUND/AIMS: We investigated the frequency of occult hepatitis B virus (HBV) infection in anti-hepatitis C virus (HCV)-positive individuals and the effects of occult HBV infection on the severity of liver disease. METHODS: Seventy-one hepatitis B virus surface-antigen (HBsAg)-negative patients were divided according to their HBV serological status into groups A (anti-HBc positive, anti-HBs negative; n=18), B (anti-HBc positive, anti-HBs positive; n=34), and C (anti-HBc negative, anti-HBs positive/negative; n=19), and by anti-HCV positivity (anti-HCV positive; n=32 vs. anti-HCV negative; n=39). Liver biopsy samples were taken, and HBV DNA was quantified by real-time PCR. RESULTS: Intrahepatic HBV DNA was detected in 32.4% (23/71) of the entire cohort, and HBV DNA levels were invariably low in the different groups. Occult HBV infection was detected more frequently in the anti-HBc-positive patients. Intrahepatic HBV DNA was detected in 28.1% (9/32) of the anti-HCV-positive and 35.9% (14/39) of the anti-HCV-negative subjects. The HCV genotype did not affect the detection rate of intrahepatic HBV DNA. In anti-HCV-positive cases, occult HBV infection did not affect liver disease severity. CONCLUSIONS: Low levels of intrahepatic HBV DNA were detected frequently in both HBsAg-negative and anti-HCV-positive cases. However, the frequency of occult HBV infection was not affected by the presence of hepatitis C, and occult HBV infection did not have a significant effect on the disease severity of hepatitis C.

Hepatitis viruses: Not always what it seems to be / Los virus de las hepatitis no siempre son habituales

The classic hepatotropic viruses, hepatitis A through E, are not the only viral agents able to infect the liver. Other systemic viruses may cause hepatic injury that can range from mild and transient elevation of aminotransferases to acute hepatitis and occasionally acute liver failure and fulminant hepatitis. The clinical presentation may be indistinguishable from that associated with classic hepatotropic viruses. These agents include cytomegalovirus; Epstein-Barr virus; herpes simplex virus; varicella-zoster virus; human herpesvirus 6, 7, and 8; human parvovirus B19; adenoviruses among others. Wide spectrums of clinical syndromes are associated with cytomegalovirus disease. Unique clinical syndromes may present in neonates, young adults and immunocompromised hosts infected with cytomegalovirus. Cases of fulminant hepatitis have been reported in both immunocompromised and immunocompetent hosts infected with Epstein Barr virus. Occasionally, these patients with acute hepatic failure may need liver transplantation. Herpes simplex viruses may involve the liver in neonatal infections, pregnancy, immunocompromised hosts and occasionally, immunocompetent adults. Varicella-Zoster virus has also been associated with severe acute hepatitis and fulminant hepatitis in adults. The drug of choice for these conditions is intravenous acyclovir. These may also need liver transplantation in the more severe forms of clinical presentation. Typical liver biopsy findings can be useful in determining the diagnosis of these viral infections. Human herpesviruses 6, 7, and 8, human parvovirus B19, and adenoviruses can also be present with features of acute liver injury and occasionally as fulminant hepatitis. The clinical syndromes are less well delineated than those associated with herpesviruses. It is important to consider these viruses as possible etiologic agents in patients who have acute liver injury and their serologic markers for the classic hepatotropic viruses are not indicative of an active infection.

Los agentes de la hepatitis viral A, B, C, D y E no son los únicos virus que pueden causar un síndrome de daño hepático agudo. Agentes virales como el citomegalovirus, Epstein-Barr, herpes simplex 1 y 2, Varicella-Zoster, virus herpes humano 6, 7, y 8, parvovirus B19 y adenovirus pueden causar daño hepático agudo e inclusive presentarse como hepatitis fulminante. Los cuadros clínicos de daño hepático agudo por citomegalovirus, Epstein Barr y herpes simplex 1 y 2 han sido caracterizado mejor. Se ha intentado el uso de drogas antivirales específicas como el uso intravenoso de aciclovir. Ocasionalmente, se ha requerido el trasplante hepático para rescatar pacientes con hepatitis fulminantes por estos agentes virales. La biopsia hepática puede ser de utilidad en estos casos puesto que los hallazgos son bastante característicos. La expresión clínica asociada a infecciones por virus herpes humano 6, 7 y 8, parvovirus B19 y adenovirus son menos características. Ha habido varios casos de hepatitis fulminante causada por estos agentes virales. Estos agentes virales deben ser considerados en el diagnóstico de casos de daño hepático agudo e inclusive hepatitis fulminante cuando los marcadores virales para los virus de hepatitis A-E son negativos.

Micronuclei formation in liver fibrosis samples from patients infected by hepatitis C virus

Genetic research on fibrosis outset and its progression in chronic hepatitis (CH) by hepatitis C virus (HCV) are limited. The lack of cytogenetic data led us to investigate the presence of micronuclei (MNi), as a sign of genomic damage. Hepatocytes of hepatic parenchyma from 62 cases diagnosed with CH associated with HCV and displaying different degrees of fibrosis (F1-F4) were analyzed. These data were compared to 15 cases without fibrosis (F0). Twelve healthy liver parenchyma samples were included as control. All samples were obtained from paraffin-embedded archival material. Micronucleated hepatocytes (MN-Heps) were analyzed through Feulgen/Fastgreen staining. Results showed that the rates of MN-Heps in the F4 group were statistically significant (p < 0.05) and higher than those in the control group. Like results were also obtained on comparing F4 with F0, F1, F2 and F3 cases. Conversely, differences were not significant (p > 0.05) on comparing F0, F1, F2, F3, one against the other, as well as individual versus control. Although chromosomal losses in CH were detected, it was shown that liver parenchyma with fibrosis in the initial stages (F1-F3) cannot be considered cytogenetically abnormal.

HCV virological response during treatment of chronic hepatitis C is associated with liver histological Improvement in patients with HCV/HIV co-infection

Liver histological improvement after treatment for chronic hepatitis C in patients co-infected with human immunodeficiency virus-1 (HIV-1) has been described. Paired liver biopsies in twenty six HCV/HIV co-infected patients were compared to determine factors possibly associated with histological improvement. The patients were submitted to a liver biopsy before treatment for hepatitis C and 25 months after the end of treatment. Fragments of the liver biopsy obtained before and after treatment were compared regarding the following parameters: histological activity index (HAI) and degree of fibrosis (Knodell); intensity of collagen deposits (Sirius Red staining) and degree of stellate cell activation (alpha-smooth muscle actin labeling). The ratios of the post and pre-treatment variables were related through logistic regression to body mass index (BMI), alcohol ingestion, HCV genotype, HCV viremia, presence of hepatic iron and pre-treatment hepatic steatosis. A negative RNA test in the 24th week of treatment was associated with improvement in fibrosis, collagen deposits and stellate cell numbers. The other variables analyzed did not correlate to an improvement in hepatic histology after hepatitis C treatment. Reduction in HCV viremia during treatment may result in reduced hepatic fibrosis even in patients without a sustained virological response.

Portal cd4+ and cd8+ t lymphocyte correlate to intensity of interface hepatitis in chronic hepatitis C

BACKGROUND: The pathogenesis of chronic hepatitis C is still a matter of debate. CD4+ and CD8+ T lymphocytes (TL) are typically observed within the portal and periportal spaces of affected livers, but their functional role in hepatitis C progression has not been fully elucidated. METHODS: CD4+ and CD8+ TL were quantified by immunohistochemistry in portal and periportal spaces of 39 liver biopsies from patients with chronic hepatitis C. They were associated to demographic data, histological parameters, laboratory findings of patients and hepatitis C genotypes. RESULTS: There was high numbers of CD4+ and CD8+ TL from which the density of CD4+ T was higher than CD8+ TL in portal and periportal spaces. CD4+ and CD8+ TL were directly correlated to intensity of interface hepatitis. CD8+ TL correlated to serum enzyme levels. CONCLUSION: The high numbers of CD4+ and CD8+ TL in portal and periportal spaces and their correlation to interface hepatitis suggest that hepatitis C evolution depends on the action of intrahepatic T lymphocytes, lending support to the notion of an immune-mediated mechanism in the pathogenesis of chronic hepatitis C.

INTRODUÇÃO: A patogênese da hepatite C crônica ainda está em discussão. Sabe-se que linfócitos T (LT) CD4+ e CD8+ são tipicamente observados no espaço portal e peri-portal de pacientes com hepatite C crônica, mas o conhecimento exato de suas ações no fígado, bem como sua influência na progressão da doença hepática ainda estão em discussão. MÉTODOS: Os LT CD4+ e T CD8+ foram quantificados por imunohistoquímica nos espaços porta e peri-portais em 39 biópsias hepáticas de pacientes cronicamente infectados pelo vírus da hepatite C. Esses dados foram associados com os dados demográficos, as alterações histológicas, os achados laboratoriais dos pacientes com hepatite C e com os genótipos do vírus da hepatite C. RESULTADOS: Houve grande quantidade tanto de LT CD4+ como de CD8+, sendo que houve maior densidade de LTCD4+ do que CD8+ nos espaços portal e peri-portal. Tanto o número de linfócitos T CD4+ como de CD8+ foram diretamente relacionados com a intensidade da hepatite de interface. Os linfócitos T CD8+ foram estatisticamente relacionados às enzimas hepáticas. CONCLUSÃO: O encontro de numerosos linfócitos T CD4+ e linfócitos T CD8+ no espaço-portal e peri-portal e sua correlação com a hepatite de interface sugerem que a evolução da hepatite C dependa da ação dos linfócitos T intra-hepáticos, ou seja, há um mecanismo imuno-mediado na patogênese da hepatite C crônica.

Envolvimento hepático em pacientes com dengue hemorrágico: manifestação rara? / Liver involvement in patients with dengue hemorrhagic fever: a rare phenomenon?

As manifestações hepáticas são descritas como não usuais no dengue e podem evoluir com quadros graves e potencialmente letais. Avaliamos as alterações hepáticas em 41 pacientes com dengue hemorrágico com confirmação laboratorial (ELISA IgM positivo) em Campo Grande, Mato Grosso do Sul, Brasil e observamos 61 por cento (25/41) de alteração na alanina aminotransferase e 80,5 por cento (33/41) na aspartato aminotransferase, sendo que não houve diferenças estatisticamente significativas quando comparamos as várias formas clínicas. A variação nos valores de ALT foi de 14-547U/l, nos valores da AST foi de 11-298U/l. Náuseas e/ou vômitos foram referidos por 90 por cento (37/41) dos pacientes, 46,3 por cento (19/41) referiram dor abdominal e 10 por cento (3/29) apresentavam hepatomegalia ao exame físico. A idade variou de 18 a 88 anos, 23 (56 por cento) eram mulheres e 18 (44 por cento) homens.

Hepatic manifestations are described as unusual complications of dengue and may lead to severe and potentially lethal conditions. Liver abnormalities in 41 patients diagnosed with dengue hemorrhagic fever in Campo Grande, Mato Grosso do Sul, Brazil, between January 1 and March 31, 2002, were evaluated. All were serologically positive for dengue in laboratory tests (IgM ELISA). ALT alterations were observed in 61 percent (25/41) and AST alterations in 80.5 percent (33/41), but there were no statistically significant differences between the various clinical forms. The range in ALT levels was 14-547U/l and in AST levels was 11-298U/l. Nausea and/or vomiting were reported by 90 percent (37/41) of the patients; 46.3 percent (19/41) had abdominal pain and 10 percent (3/29) presented hepatomegaly at clinical examination. The patients' ages ranged from 18 to 88 years; 23 (56 percent) were female and 18 (44 percent) were male.

Morphological studies in a model for dengue-2 virus infection in mice

One of the main difficulties in studying dengue virus infection in humans and in developing a vaccine is the absence of a suitable animal model which develops the full spectrum of dengue fever, dengue haemorrhagic fever, and dengue shock syndrome. It is our proposal to present morphological aspects of an animal model which shows many similarities with the dengue infection in humans. BALB/c mice were intraperitoneally infected with non-neuroadapted dengue virus serotype 2 (DENV-2). Histopathological and morphometrical analyses of liver tissue revealed focal alterations along the infection, reaching wide-ranging portal and centrolobular veins congestion and sinusoidal cell death. Additional ultrastructural observations demonstrated multifocal endothelial injury, platelet recruitment, and alterated hepatocytes. Dengue virus antigen was detected in hepatocytes and in the capillar endothelium of the central lobular vein area. Liver function tests showed high levels of aspartate transaminase and alanine transaminase enzyme activity. Lung tissue showed interstitial pneumonia and mononuclear cells, interseptal oedema, hyperplasia, and hypertrophy of the bronchiolar epithelial cells. DENV-2 led to a transient inflammatory process, but caused focal alterations of the blood-exchange barrier. Viremia was observed from 2nd to 11th day p.i. by isolation of DENV-2 in C6/36 mosquito cell line inoculated with the supernatant of macerated liver, lung, kidney, and cerebellum tissues of the infected mice.

Clinical Significance of Intrahepatic HCV RNA Level in Chronic HCV Infection / 대한간학회지

BACKGROUND/AIMS: This study was carried out to identify the correlation between the serum HCV RNA and the liver HCV RNA level in chronic hepatitis C patients and to evaluate the differences of biochemistry, histology, HCV genotype and their response to antiviral therapy according to intrahepatic HCV RNA levels. METHODS: For thirty-six chronic hepatitis C patients (M:F=22:14, CH:LC=27:9), percutaneous liver biopsy was performed, and serum and liver HCV RNA level were measured. Seventeen patients were treated with IFN-alpha and ribavirin. RESULTS: There was a significant correlation between intrahepatic and serum HCV RNA levels (intrahepatic HCV RNA: 1.9+/-3.1x10(7) copies/g vs. serum HCV RNA: 3.2+/-3.2x10(6) copies/mL)(r=0.538, P<0.01). Total histological activity score (r=0.346, P=0.04) and periportal inflammation (r=0.398, P=0.01) were correlated with intrahepatic HCV RNA level. However, serum HCV RNA level was not correlated with histological activity. Serum ALT was not correlated with intrahepatic HCV RNA level. Intrahepatic HCV RNA level was higher in genotype 1 than genotype 2 or 3 (P=0.07). Intrahepatic HCV RNA level was not correlated with response to anti-viral therapy. CONCLUSION: Intrahepatic HCV RNA level was correlated with serum HCV RNA level and periportal inflammation in patients with chronic hepatitis C. It seems that intrahepatic HCV RNA level is more closely related to histological features than serum HCV RNA level.

Change of Hepatitis B Virus DNA Status in Anti-HBc Positive Liver Graft / 대한간학회지

BACKGROUND/AIMS: Many patients with positive anti-HBc, but negative HBsAg, are known to harbor occult HBV infection, which may transmit the virus through the graft in liver transplantation. We examined the change of HBV DNA within the liver allograft tissue of the donor with positive anti-HBc, but negative HBsAg, before and after the transplantation and assessed its significance. METHODS: Twenty-eight patients with available posttransplant biopsies that received anti-HBc positive liver allografts between April 2000 and November 2003 were enrolled in the study. Intraoperative wedge biopsy of donor liver and needle biopsy of the recipient around the 12th postoperative day were used. HBV DNA within the liver tissue was identified by polymerase chain reaction technique using paraffin-embedded liver tissue. RESULTS: Among 13 patients that showed positive amplification before transplantation, 10 turned negative and 3 remained positive after transplantation. One patient, who was negative, became positive after transplantation. Three patients had recurrent HBV infection, but none had positive PCR before or after transplantation and recurrence was not associated with PCR results. Donors with low anti-HBs titer were more likely to be PCR positive compared to donors with high anti-HBs serology (P<0.05). CONCLUSIONS: Under adequate prophylactic measures, the presence of HBV DNA within the liver tissue does not affect recurrence and most allografts harboring HBV DNA before transplantation will eventually show viral clearance. However, many anti-HBc positive allografts are infected by HBV at subclinical level so vigilant surveillance is essential.