Fazeli Bahare, Ravari Hassan, Farzadnia Mahdi
Immunology Department, Immunology Research Centre, Avicenna (Bu-Ali) Research Institute, Bu-Ali Sq, Ferdosi Sq, Mashhad 91967-73117, Iran.
Vascular. 2012 Dec;20(6):334-6. doi: 10.1258/vasc.2011.cr0271. Epub 2011 Jul 29.
Rickettsia is an intracellular pathogen that attaches to vascular endothelial cell membranes and its genome integrates into the DNA of the host and thereby inhibits apoptosis of the endothelial cells. Rickettsia can infect the body following a flea/louse bite. Rickettsia was suggested as one etiology of Buerger's disease long ago. We report a patient with Buerger's disease for whom a left below-knee amputation was done. Twenty-five biopsies for DNA extraction were obtained from the arteries, veins and microvasculature of the amputated limb. Three samples were positive for Rickettsia. The finding may explain the proliferation of endothelial cells in the pathology of Buerger's disease, segmental nature of the disease, involving small- and medium-sized vessels, and the prevalence of Buerger's disease among the low socioeconomic class of the society. Understanding the infectious etiology of Buerger's disease would be invaluable, since early antibiotic therapy or even vaccination might have prevented the limb loss in the current and other cases of Buerger's disease. The authors suggest that paraffin blocks of Buerger's disease biopsies be investigated for Rickettsia infection, focusing specifically on the area of endothelial cell proliferation for DNA extraction. These results should be compared with other biopsies from a variety of other peripheral vascular diseases.
立克次体是一种细胞内病原体，它附着于血管内皮细胞膜，其基因组整合到宿主的DNA中，从而抑制内皮细胞的凋亡。立克次体可在跳蚤/虱子叮咬后感染人体。很久以前就有人提出立克次体是血栓闭塞性脉管炎的病因之一。我们报告了一名接受左膝下截肢手术的血栓闭塞性脉管炎患者。从截肢肢体的动脉、静脉和微血管中获取了25份用于DNA提取的活检样本。其中三份样本立克次体呈阳性。这一发现可能解释了血栓闭塞性脉管炎病理学中内皮细胞的增殖、该疾病累及中小血管的节段性特点以及血栓闭塞性脉管炎在社会经济地位较低阶层中的患病率。了解血栓闭塞性脉管炎的感染病因将非常宝贵，因为早期抗生素治疗甚至疫苗接种可能会防止当前及其他血栓闭塞性脉管炎病例出现肢体缺失。作者建议对血栓闭塞性脉管炎活检的石蜡块进行立克次体感染调查，特别关注用于DNA提取的内皮细胞增殖区域。这些结果应与来自其他各种周围血管疾病的其他活检结果进行比较。
