肾脏受累的地中海斑疹热：临床和组织病理学数据。

Renal Involvement in Mediterranean Spotted Fever: Clinical and Histopathological Data.

机构信息

Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University and Infectious Disease Clinic, University Hospital St. George, Plovdiv, Bulgaria.

Department of General and Clinical Pathology, Faculty of Medicine, Medical University and General and Clinical Pathology Clinic, University Hospital St. George, Plovdiv, Bulgaria.

出版信息

Med Princ Pract. 2021;30(4):369-375. doi: 10.1159/000516167. Epub 2021 Mar 29.

DOI:10.1159/000516167

PMID:33780958

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8436609/

Abstract

OBJECTIVE

Mediterranean spotted fever (MSF) is a tick-borne rickettsial infection endemic to the Mediterranean coastline countries. As a result of growing tourism, imported cases have been registered in many nonendemic countries and regions. We present clinical laboratory parameters and histopathological data on renal impairment in patients with MSF. The study meets our goal of identifying kidney involvement and detecting renal damage in people with MSF.

SUBJECTS AND METHODS

Three hundred fifty patients with MSF with a diagnosis confirmed by immunofluorescence analysis were tested for serum urea, creatinine, and albumin. Fifty-five patients with malignant form of MSF were divided into 2 groups: 19 fatalities and 36 survivors. The percentage of patients with acute renal failure (ARF) was compared in both groups.

RESULTS

Subjects with elevated urea and creatinine levels increased from 5.21 to 3.47% in mild to 48.78 and 29.26% in severe MSF, respectively. Loss of serum albumin also increased from mild to severe MSF. Renal impairment comprised 60% of the cohort of 55 patients with malignant MSF: 89.4% in the group of deaths and almost twice less in the survivors. ARF developed in 84.2% of fatal cases and was >2 times less in survivors. Postmortem light microscopy of renal samples of 9 fatal cases revealed perivascular mononuclear inflammatory infiltrates, vasculitis with fibrinoid necrosis, acute tubular necrosis, interstitial edema, hemorrhage, and thrombosis.

CONCLUSION

Renal pathology associated with MSF rickettsial infection consists of systemic small vessel vasculitis and vascular injury, leading to ARF in the most severe cases.

摘要

目的

地中海斑疹热（MSF）是一种流行于地中海沿海国家的蜱传立克次体感染病。由于旅游业的发展，许多非流行地区和国家都有输入性病例的记录。我们介绍了 MSF 患者肾脏损害的临床实验室参数和组织病理学数据。本研究的目的是确定 MSF 患者的肾脏受累情况，并检测肾脏损害。

对象和方法

对 350 例经免疫荧光分析确诊为 MSF 的患者进行血清尿素、肌酐和白蛋白检测。55 例恶性 MSF 患者分为 2 组：19 例死亡和 36 例存活。比较两组急性肾衰竭（ARF）患者的比例。

结果

尿素和肌酐水平升高的患者比例从轻度 MSF 的 5.21%升至 48.78%，严重 MSF 升至 3.47%。血清白蛋白的丢失也从轻度 MSF 增加到严重 MSF。55 例恶性 MSF 患者中有 60%出现肾脏损害：死亡组为 89.4%，存活组为 60%。84.2%的死亡病例发生 ARF，存活组则不到一半。9 例死亡病例的肾脏样本光镜检查显示血管周围单核炎症浸润、伴纤维蛋白样坏死的血管炎、急性肾小管坏死、间质水肿、出血和血栓形成。