Pathology of enterovirus 71 infection: an autopsy study of 5 cases
Pathology of enterovirus 71 infection: an autopsy study of 5 cases
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DOI：
10.3760/cma.j.issn.0529-5807.2009.02.004
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发表时间：
2009-02-01
影响因子：
--
通讯作者：
Gao Zi-fen
中科院分区：
文献类型：
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作者：
Lu Min;Meng Gang;Gao Zi-fen
目的探讨致死性肠道病毒71型（EV 71）感染的临床病理特征。方法对5例EV 71感染死亡的新生儿进行尸检。采集主要器官的组织样本，福尔马林固定并在光学显微镜下检查。在选定的例子进行免疫组织化学研究。结果5例中4例以中枢神经系统病变为主，脑炎和脑脊髓炎主要累及脑干和上颈段脊髓。组织学检查结果包括神经元变性和坏死、神经元吞噬、血管周围袖套和巨噬细胞/小胶质细胞弥漫性或结节性增生。还观察到脑水肿、脑疝和无菌性脑膜炎。肺部主要表现为肺充血、神经源性肺水肿和局灶性出血。肠上皮有极轻微变化。肠淋巴组织增生，并伴有滤泡中心细胞凋亡。其余病例有脑水肿和轻度脑膜炎。肺泡间隔增厚，淋巴细胞浸润。一些肺泡细胞增生，并伴有弥漫性透明膜形成。未发现胃肠道特异性异常。5例均可见肺门及肠淋巴结肿大，伴滤泡中心细胞凋亡。一般而言，在心脏、肝脏和肾脏中未发现显著的病理变化。结论EV 71致死性感染的主要病理改变是中枢神经系统。肺部病变主要是继发性的。通常的死因是脑水肿并发脑疝和肺水肿。还值得注意的是，一些病例仅显示肺损伤，而没有典型的神经系统改变。
Objective To study the clinicopathologic features of fatal enterovirus 71 (EV71) infection. Methods Autopsy was performed in 5 neonates died of EV71 infection. Tissue samples from major organs were collected, formalin-fixed and examined under light microscopy. Immunohistochemical study was carried out in selected examples. Results Four of the 5 cases showed predominant changes in central nervous system, with encephalitis and encephalomyelitis identified mainly in brainstem and upper cervical spinal cord. Histologic findings included neuronal degeneration and necrosis, neuronophagia, perivascular cuffing and diffuse or nodular hyperplasia of macrophages/microglia. Cerebral edema, brain herniation and aseptic meningitis were also noted. The lungs showed mainly pulmonary congestion, neurogenic pulmonary edema and focal hemorrhage. There were minimal changes in the intestinal epithelium. The intestinal lymphoid tissue however was hyperplastic and associated with apoptosis of follicular center cells. The remaining case had cerebral edema and mild meningitis. The lung alveolar septa were thickened with lymphocytic infiltrates. Some alveolar cells were hyperplastic and associated with diffuse hyaline membrane formation. No specific abnormalities were identified in gastrointestinal tract. In all the 5 cases studied, there was enlargement of lung hilar and inesenteric lymph nodes, coupled with apoptosis of follicular center cells. In general, no significant pathologic changes were demonstrated in heart, liver and kidneys. Conclusions In fatal EV71 infection, the major pathologic changes lie in the central nervous system. The pulmonary lesions are mainly secondary in nature. The usual cause of death is cerebral edema complicated by brain herniation and pulmonary edema. It is also noteworthy that some cases show only lung damages, without classic neurologic changes.