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Severe Leptospirosis Features in the Spleen Indicate Cellular Immunosuppression Similar to That Found in Septic Shock.
Duarte-Neto, Amaro Nunes; Croda, Julio; Pagliari, Carla; Soriano, Francisco Garcia; Nicodemo, Antonio Carlos; Duarte, Maria Irma Seixas.
Afiliación
  • Duarte-Neto AN; Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Croda J; Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Pagliari C; Faculdade de Medicina, Universidade Federal do Mato Grosso do Sul e Fundação Oswaldo Cruz, Campo Grande, Brazil.
  • Soriano FG; Departamento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Nicodemo AC; Disciplina de Emergências Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
  • Duarte MIS; Unidade de Terapia Intensiva - Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.
Front Immunol ; 10: 920, 2019.
Article en En | MEDLINE | ID: mdl-31114579
Objectives: To compare microscopic and immunologic features in the spleens of patients who died of pulmonary hemorrhage and shock caused by leptospirosis (11 cases) or Gram-positive/-negative bacterial septic shock (10 cases) to those from control spleens (12 cases from splenectomy). Methodology: Histological features in the red pulp and white pulp were analyzed using archived samples by a semi quantitative score. Immunohistochemistry was used for the recognition of immune cell markers, cytokines, caspase-3 and Leptospira antigens. Results: The control group differed significantly from the leptospirosis and septic shock patients which demonstrate strong similarities: diffuse congestion in the red pulp with a moderate to intense infiltration of plasma cells and polymorphonuclear cells; follicles with marked atrophy; high density of CD20+ cells; low density of NK, TCD4+ and active caspase-3 positive cells and strong expression of IL-10; leptospirosis patients had higher S100 and TNF-α positive cells in the spleen than the other groups. Conclusion: The results suggest that an immunosuppressive state develops at the terminal stage of severe leptospirosis with pulmonary hemorrhage and shock similar to that of patients with septic shock, with diffuse endothelial activation in the spleen, splenitis, and signs of disturbance in the innate and adaptive immunity in the spleen. The presence of leptospiral antigens in 73% of the spleens of the leptospirosis patients suggests the etiological agent contributes directly to the pathogenesis of the lesions. Our results support therapeutic approaches involving antibiotic and immunomodulatory treatments for leptospirosis patients and suggest that leptospirosis patients, which are usually young men with no co-morbidities, form a good group for studying sepsis and septic shock.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Séptico / Bazo / Tolerancia Inmunológica / Leptospira / Leptospirosis / Antígenos Bacterianos Tipo de estudio: Observational_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Front Immunol Año: 2019 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Suiza

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Séptico / Bazo / Tolerancia Inmunológica / Leptospira / Leptospirosis / Antígenos Bacterianos Tipo de estudio: Observational_studies Límite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Front Immunol Año: 2019 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Suiza