CORRELATION OF THE DISTRIBUTION OF RICKETTSIA-CONORII, MICROSCOPIC LESIONS, AND CLINICAL-FEATURES IN SOUTH-AFRICAN TICK BITE FEVER
CORRELATION OF THE DISTRIBUTION OF RICKETTSIA-CONORII, MICROSCOPIC LESIONS, AND CLINICAL-FEATURES IN SOUTH-AFRICAN TICK BITE FEVER
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DOI：
10.4269/ajtmh.1985.34.361
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发表时间：
1985-01-01
影响因子：
3.3
通讯作者：
GEAR, JHS
中科院分区：
文献类型：
--
作者：
WALKER, DH;GEAR, JHS
3例南非重症R. 2例死亡，1例并发多指坏疽。免疫荧光菌R. Conorii在脑血管内皮、软脑膜、肾小球小动脉和毛细血管、肾动脉和静脉、心肌毛细血管和动脉、肺泡毛细血管、胰隔、脾小动脉和真皮中均有表达。在肝窦衬里细胞、脾和淋巴结巨噬细胞以及断指部分存活区的血管中也观察到立克次体。病理学病变包括大脑和小脑血管周围单核白细胞、轻度单核软脑膜炎、肾小球小动脉炎、肾脏、胰腺、皮肤和心肌中血管和血管周围富含单核细胞的炎性病灶、肝细胞坏死和肺水肿。病变部位与立克次体感染有较强的地形相关性。少数血管损伤部位发生血栓和出血。立克次体是脑膜脑炎、周围坏疽和其他血管损伤灶的明显直接原因。法塔河伴播散性器官受累的Conorii感染强调了这种疾病的致病潜力。
Three South African patients with severe R. conorii infection had complicated courses of illness with 2 fatal cases and 1 with gangrene of multiple digits. Immunofluorescent organisms of R. conorii were demonstrated in vascular endothelium of brain, leptomeninges, renal glomerular arterioles and capillaries, renal arteries and veins, myocardial capillaries and arteries, pulmonary alveolar capillaries, pancreatic septa, splenic arterioles, and dermis. Rickettsiae were also observed in hepatic sinusoidal lining cells, splenic and lymph node macrophages, and the blood vessels of the partially viable zone of the amputated digits. Pathologic lesions included cerebral and cerebellar perivascular mononuclear leukocytes, mild mononuclear leptomeningitis, glomerular arteriolitis, vascular and perivascular mononuclear cell-rich inflammatory foci in the kidney, pancreas, skin, and myocardium, hepatocellular necrosis, and pulmonary edema. The sites of lesions and rickettsiae showed strong topographical correlation. Thrombi and hemorrhage occurred in a minority of the sites of vascular injury. Rickettsiae were the apparent direct cause of meningoencephalitis, peripheral gangrene, and other foci of vascular injury. Fata R. conorii infection with disseminated organ involvement emphasizes the pathogenic potential of this disease.