Garcia A G, Pegado C S, Cubel R de C, Fonseca M E, Sloboda I, Nascimento J P
Departamento de Anatomia Patológica do Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, RJ, Brasil.
Rev Inst Med Trop Sao Paulo. 1998 May-Jun;40(3):145-50. doi: 10.1590/s0036-46651998000300003.
In view of the scarce references concerning the histological data in congenital parvovirus human B19 infection, we intend to provide a description of the pathological features observed in six autopsies. The virus was detected by DNA hybridization (ISH-DBH), PCR and electronmicroscopy (EM) in paraffin-embedded feto-placentary tissues. These cases constitute a subset from 86 Non Immunologic Hydrops Fetalis (NIHF) cases, in which a systemic complex of inflammatory/degenerative lesions of unknown etiology was visualized by optical microscopy. In one case a syphilitic process was detected, typefying a double infection. All fetuses showed a similar pathology--hydrops, hepato-splenomegaly, lung hypoplasia and erythroblastemia, the specific histological feature being the presence of intranuclear inclusions in the erythroid progenitors, in the erythropoietic visceral tissue and in blood marrow. Complex cardiopathy allied to abnormal lung lobulation and polisplenia were observed once; in 2 cases endocardial fibroelastosis was diagnosed. The pulmonary lesions were represented by dysmaturity allied to interstitial mononuclear infiltration. The hepatic consisted of cholestasis, portal fibrosis, canalicular proliferation, hemossiderosis, focal necroses and giant cell transformation. The central nervous system lesions were predominantly anoxic although the autolysis impaired a correct diagnosis.
鉴于关于先天性人细小病毒B19感染的组织学数据的参考文献稀缺,我们打算描述在六例尸检中观察到的病理特征。通过DNA杂交(ISH-DBH)、聚合酶链反应(PCR)和电子显微镜(EM)在石蜡包埋的胎儿-胎盘组织中检测到该病毒。这些病例构成了86例非免疫性胎儿水肿(NIHF)病例的一个子集,在这些病例中,通过光学显微镜观察到了病因不明的全身性炎症/退行性病变复合体。在一例中检测到梅毒感染过程,确定为双重感染。所有胎儿均表现出相似的病理特征——水肿、肝脾肿大、肺发育不全和有核红细胞增多症,其特异性组织学特征是在红系祖细胞、造血内脏组织和骨髓中存在核内包涵体。曾观察到一例合并异常肺小叶形成和多脾的复杂心脏病;诊断出2例心内膜弹力纤维增生症。肺部病变表现为与间质性单核细胞浸润相关的发育不成熟。肝脏病变包括胆汁淤积、门脉纤维化、胆小管增生、含铁血黄素沉着、局灶性坏死和巨细胞转化。尽管自溶影响了正确诊断,但中枢神经系统病变主要为缺氧性病变。