Severe Leptospirosis Features in the Spleen Indicate Cellular Immunosuppression Similar to That Found in Septic Shock

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art_DUARTE-NETO_Severe_Leptospirosis_Features_in_the_Spleen_Indicate_Cellular_2019.PDF (7 MB)
Citações na Scopus
5
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
Título da Revista
ISSN da Revista
Título do Volume
Editora
FRONTIERS MEDIA SA
Autores
CRODA, Julio
Citação
FRONTIERS IN IMMUNOLOGY, v.10, article ID 920, 15p, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objectives: To compare microscopic and immunologic features in the spleens of patients who died of pulmonary hemorrhage and shock caused by leptospirosis (11 cases) or Gram-positive/-negative bacterial septic shock (10 cases) to those from control spleens (12 cases from splenectomy). Methodology: Histological features in the red pulp and white pulp were analyzed using archived samples by a semi quantitative score. Immunohistochemistry was used for the recognition of immune cell markers, cytokines, caspase-3 and Leptospira antigens. Results: The control group differed significantly from the leptospirosis and septic shock patients which demonstrate strong similarities: diffuse congestion in the red pulp with a moderate to intense infiltration of plasma cells and polymorphonuclear cells; follicles with marked atrophy; high density of CD20(+) cells; low density of NK, TCD4(+) and active caspase-3 positive cells and strong expression of IL-10; leptospirosis patients had higher S100 and TNF-alpha positive cells in the spleen than the other groups. Conclusion: The results suggest that an immunosuppressive state develops at the terminal stage of severe leptospirosis with pulmonary hemorrhage and shock similar to that of patients with septic shock, with diffuse endothelial activation in the spleen, splenitis, and signs of disturbance in the innate and adaptive immunity in the spleen. The presence of leptospiral antigens in 73% of the spleens of the leptospirosis patients suggests the etiological agent contributes directly to the pathogenesis of the lesions. Our results support therapeutic approaches involving antibiotic and immunomodulatory treatments for leptospirosis patients and suggest that leptospirosis patients, which are usually young men with no co-morbidities, form a good group for studying sepsis and septic shock.
Palavras-chave
leptospirosis, Weil's disease, severe pulmonary hemorrhage syndrome, intensive care, spleen, sepsis-related immunosuppression
URI
https://observatorio.fm.usp.br/handle/OPI/32039
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - FM/MIP
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/06
Artigos e Materiais de Revistas Científicas - LIM/46
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