RESUMO
West Nile Virus (WNV) was identified by immunohistochemistry (IHC) and polymerase chain reaction (PCR) as the etiologic agent in 4 encephalitis fatalities in New York City in the late summer of 1999. The fatalities occurred in persons with a mean age of 81.5 years, each of whom had underlying medical problems. Cardinal clinical manifestations included fever and profound muscle weakness. Autopsy disclosed encephalitis in 2 instances and meningoencephalitis in the remaining 2. The inflammation was mostly mononuclear and formed microglial nodules and perivascular clusters in the white and gray matter. The brainstem, particularly the medulla, was involved most extensively. In 2 brains, cranial nerve roots had endoneural mononuclear inflammation. In addition, 1 person had acute pancreatitis. Based on our experience, we offer recommendations for the autopsy evaluation of suspected WNV fatalities.
Assuntos
Febre do Nilo Ocidental/patologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Linfócitos T CD4-Positivos/patologia , Linfócitos T CD8-Positivos/patologia , Nervos Cranianos/patologia , Encefalite/virologia , Evolução Fatal , Feminino , Febre/virologia , Humanos , Imuno-Histoquímica , Masculino , Meningoencefalite/virologia , Debilidade Muscular/virologia , Pancreatite/virologia , Febre do Nilo Ocidental/complicaçõesRESUMO
Forty-three pleural fluids from 30 patients with eosinophilic pleural effusion (EPE) were examined and correlated with biochemical and clinical findings. The percentage of eosinophiles ranged from 12% to 83%, averaged 38% and was accompanied by a high lymphocyte count, averaging 34%. The fluids were shown to be exudates. A history of allergy or immune disorders was elicited from seven patients and allergy to drug from one patient. Eight patients gave a history of thoracic trauma unrelated in time to the effusion. Three patients received transvenous pacemakers. In the remaining 11 patients the presence of the eosinophilic pleural effusion could not be correlated with any clinical data. Regardless of clinical setting, which in six patients included a past history of cancer, EPE proved to be a self-limiting disease with a favorable outcome. Thus, this diagnosis by cytologic examination of the sediment is of considerable prognostic significance even in patients with a history of other disorders that may give rise to effusions. Possibly the most significant observation recorded was the presence of a large population of lymphocytes in EPE. The role of these cells in the mechanism of EPE is discussed.
