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纽扣热“黑点”的组织学及其中康氏立克次体的免疫荧光显示

The histology of "taches noires" of boutonneuse fever and demonstration of Rickettsia conorii in them by immunofluorescence.

作者信息

Montenegro M R, Mansueto S, Hegarty B C, Walker D H

出版信息

Virchows Arch A Pathol Anat Histopathol. 1983;400(3):309-17. doi: 10.1007/BF00612192.

Abstract

The recent increase in the incidence of boutonneuse fever in Italy provided the opportunity to study the pathology of six "taches noires," the lesions at the site of tick bite. The center of the lesion has either an ulcer or an area of necrosis of the epidermis and superficial dermis; in some cases the epidermis is intact. The alterations are mainly in the dermis and subcutaneous tissues where the small vessels show endothelial swelling and intramural and perivascular oedema and inflammation with macrophages, lymphocytes and smaller numbers of plasma cells, PMNs and eosinophils. In a few small arteries and fewer veins there are either nonocclusive mural or occlusive thrombi; there is no spatial or quantitative correlation between thrombosis and necrosis. We propose that cutaneous necrosis results from severe injury to many small vessels. Rickettsiae which had not been previously observed in "taches noires" were demonstrated in blood vessels by immunofluorescence, a finding that may be used as a means for early aetiological diagnosis of the disease. The "tache noire" is an excellent human model for localized rickettsial injury.

摘要

近期意大利纽扣热发病率上升,这为研究6例“黑色斑疹”(蜱叮咬部位的皮损)的病理情况提供了契机。皮损中心有溃疡形成或表皮及浅表真皮坏死区;部分病例表皮完整。病变主要位于真皮和皮下组织,小血管内皮细胞肿胀,壁内及血管周围水肿,伴有巨噬细胞、淋巴细胞浸润,少量浆细胞、中性粒细胞及嗜酸性粒细胞浸润。少数小动脉及更少的静脉内有非阻塞性壁血栓或阻塞性血栓形成;血栓形成与坏死之间无空间或数量上的关联。我们认为皮肤坏死是由许多小血管的严重损伤所致。通过免疫荧光法在血管中发现了此前在“黑色斑疹”中未观察到的立克次体,这一发现可作为该病早期病因诊断的手段。“黑色斑疹”是局部立克次体损伤的理想人体模型。

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