de Brito T, Morais C F, Yasuda P H, Lancellotti C P, Hoshino-Shimizu S, Yamashiro E, Alves V A
Faculty of Medicine, Department of Pathology, University of São Paulo, Brazil.
Ann Trop Med Parasitol. 1987 Jun;81(3):207-14. doi: 10.1080/00034983.1987.11812114.
Twenty hearts from patients dying of leptospirosis were studied. Interstitial myocarditis was found in 50% of the cases, and a significant statistical correlation was observed between myocarditis and the inflammatory involvement of the conduction tissue. Acute coronary arteritis, affecting the main branches of the coronary arteries, was observed in 70% of the cases, and this finding also correlates significantly with interstitial myocarditis. Aortitis was found in 57.8% of the cases. When serum against L. interrogans serovar icterohaemorrhagiae was used, focal IP antigen deposits were observed in the coronary arteries and in the aorta. Experimental data from 12 guinea-pigs inoculated with L. interrogans serovar icterohaemorrhagiae showed a focal myocarditis involving mainly the subendocardial and pericoronary heart tissue, with IP antigen deposits in the same sites. Leptospirosis might be visualized as a generalized illness resembling other infectious vasculitides. The heart and main vessels are involved during the septicaemic phase of the disease, and bacterial migration, toxin(s), enzymes and/or antigenic products liberated by bacterial lysis might account for the increased endothelial permeability with antigen deposits and inflammation.
对20例死于钩端螺旋体病患者的心脏进行了研究。50%的病例发现有间质性心肌炎，并且心肌炎与传导组织的炎症累及之间存在显著的统计学相关性。70%的病例观察到急性冠状动脉炎，累及冠状动脉的主要分支，这一发现也与间质性心肌炎显著相关。57.8%的病例发现有主动脉炎。当使用抗黄疸出血型钩端螺旋体血清时，在冠状动脉和主动脉中观察到局灶性IP抗原沉积。对12只接种黄疸出血型钩端螺旋体的豚鼠的实验数据显示，局灶性心肌炎主要累及心内膜下和冠状动脉周围心肌组织，且在相同部位有IP抗原沉积。钩端螺旋体病可被视为一种类似于其他感染性血管炎的全身性疾病。在疾病的败血症期，心脏和主要血管会受累，细菌迁移、毒素、酶和/或细菌裂解释放的抗原性产物可能是抗原沉积和炎症导致内皮通透性增加的原因。
