Pathology and pathogenesis of bioterrorism-related inhalational anthrax
Pathology and pathogenesis of bioterrorism-related inhalational anthrax
复制标题
DOI：
10.1016/s0002-9440(10)63697-8
复制
发表时间：
2003-08-01
影响因子：
6
通讯作者：
Zaki, SR
中科院分区：
文献类型：
--
作者：
Guarner, J;Jernigan, JA;Zaki, SR
2001年10月和11月期间，公共卫生当局调查了11名与生物恐怖主义有关的吸入性炭疽病人。袭击发生在美国。采用针对炭疽芽孢杆菌细胞壁和荚膜的单克隆抗体对8例患者进行病理和免疫组化（IHC）研究。5例死亡患者有明显的浆液性胸腔积液和出血性纵隔炎。胸片上肺部浸润对应肺泡内水肿和透明膜。免疫组化检测显示，纵隔淋巴结、周围软组织和胸膜中有丰富的细胞内和细胞外杆菌、细菌片段和颗粒状抗原染色。肺、肝、脾和肠的免疫组化染色主要出现在血管和窦内。组织革兰氏染色不一致呈阳性。3例存活患者胸膜免疫组化染色显示丰富的颗粒状抗原染色和罕见的杆菌，而经支气管活检显示间质细胞颗粒状抗原染色。存活患者革兰氏染色未见杆菌。死于生物恐怖素相关吸入性炭疽的患者的病理和免疫组化研究证实了感染途径。免疫组化是诊断幸存炭疽病例不可或缺的手段。胸膜中炭疽杆菌抗原的存在可以解释突出和持续的出血性胸膜积液。
During October and November 2001, public health authorities investigated 11 patients with inhalational anthrax related to a bioterrorism. attack in the United States. Formalin-fixed samples from 8 patients were available for pathological and immunohistochemical (IHC) study using monoclonal antibodies against the Bacillus anthracis cell wall and capsule. Prominent serosanguinous pleural effusions and hemorrhagic mediastinitis were found in 5 patients who died. Pulmonary infiltrates seen on chest radiographs corresponded to intraalveolar edema and hyaline membranes. IHC assays demonstrated abundant intra and extracellular bacilli, bacillary fragments, and granular antigen-staining in mediastinal lymph nodes, surrounding soft tissues, and pleura. IHC staining in lung, liver, spleen, and intestine was present primarily inside blood vessels and sinusoids. Gram's staining of tissues was not consistently positive. In 3 surviving patients, IHC of pleural samples demonstrated abundant granular antigen-staining and rare bacilli while transbronchial biopsies showed granular antigen-staining in interstitial cells. in surviving patients, bacilli were not observed with gram's stains. Pathological and IHC studies of patients who died of bioterrorisin related inhalational anthrax confirmed the route of infection. IHC was indispensable for diagnosis of surviving anthrax cases. The presence of B. anthracis antigens in the pleurae could explain the prominent and persistent hemorrhagic pleural effusions.