Department of Microbiology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India.
Indian J Med Res. 2010 May;131:702-10.
Gangrene of stomach or intestines owing to non-occlusive bowel infarction (NOBI) is a rare event with unknown etiology. Since B19 may cause vasculitis, arteritis, angiopathy and more importantly, localized microvascular thrombi formation hence patients with bowel gangrene were investigated for B19 infection.
Twelve patients (8 male and 4 females; median age 40 yr) of ischemic unexplained gangrene of bowel underwent emergency laparotomy. Eight cases had NOBI while four had occlusive bowel infarction (OBI). Anti-B19 antibodies in sera by ELISA and Western-blot and B19 DNA by PCR in sera and resected tissues were analysed.
All patients underwent resection of gangrenous bowel; with exteriorization followed by restoration wherever appropriate. Histopathology showed loss of bowel mucosa and crypts with inflammatory cell infiltration besides fibrin thrombus in gastric vessels. Sera of all 8 patents of NOBI had B19 genome by nested-PCR (VP1 unique) and in 6 by PCR (VP1-VP2). In three patients resected bowel tissues also had B19 DNA besides anti-B19 IgM and IgG antibodies. NOBI patients were reticulocytopenic and anaemic while one had necrotizing vasculitis of skin a year ago. No IgM antibodies to agents causing vasculitis (HTLV-I, HIV-1+2, CMV, HSV1+2, mumps virus and Mycobacterium tuberculosis) nor any abnormality in coagulation profiles were detected. In four OBI cases's sera and resected bowel tissues and in control bowel tissues (n=36) no anti-B19 IgM antibodies or B19 DNA were detected.
Novel finding of active B19 infection in non-occlusive gangrene of the bowel may be causal rather than casual.
非闭塞性肠梗死（NOBI）引起的胃或肠坏疽是一种罕见的病因不明的疾病。由于 B19 可能引起脉管炎、动脉炎、血管病，更重要的是，局部微血栓形成，因此对患有肠坏疽的患者进行了 B19 感染的调查。
12 例（8 例男性和 4 例女性；中位年龄 40 岁）缺血性不明原因肠坏疽患者接受了紧急剖腹手术。8 例为 NOBI，4 例为闭塞性肠梗死（OBI）。通过 ELISA 和 Western-blot 检测血清中的抗 B19 抗体，通过 PCR 检测血清和切除组织中的 B19 DNA。
所有患者均接受了坏疽肠的切除术；在适当的情况下进行了外置和修复。组织病理学显示胃血管中有黏膜和隐窝丧失，炎症细胞浸润，以及纤维蛋白血栓。8 例 NOBI 患者的血清通过巢式-PCR（VP1 独特）和 6 例患者的 PCR（VP1-VP2）均有 B19 基因组。在 3 例患者的切除肠组织中，除了抗 B19 IgM 和 IgG 抗体外，还存在 B19 DNA。NOBI 患者出现网织红细胞减少和贫血，而 1 例患者在 1 年前患有坏死性血管炎。未检测到引起血管炎的病原体（HTLV-I、HIV-1+2、CMV、HSV1+2、腮腺炎病毒和结核分枝杆菌）的 IgM 抗体，也未检测到凝血谱的任何异常。在 4 例 OBI 病例的血清和切除肠组织以及对照组肠组织（n=36）中，均未检测到抗 B19 IgM 抗体或 B19 DNA。
新型非闭塞性肠坏疽中 B19 感染的发现可能是因果关系而非偶然关系。
