Understanding yellow fever-associated myocardial injury: an autopsy study

Imagem de Miniatura
Arquivos
art_GIUGNI_Understanding_yellow_feverassociated_myocardial_injury_an_autopsy_study_2023.PDF (5.87 MB)
Citações na Scopus
0
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER
Autores
POUR, Shahab Zaki
CUNHA, Marielton dos Passos
Citação
EBIOMEDICINE, v.96, article ID 104810, 15p, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background Yellow fever (YF) is a viral hemorrhagic fever, endemic in parts of South America and Africa. There is scarce evidence about the pathogenesis of the myocardial injury. The objective of this study is to evaluate the cardiac pathology in fatal cases of YF.Methods This retrospective autopsy study included cases from the Sao Paulo (Brazil) epidemic of 2017-2019. We reviewed medical records and performed cardiac tissue histopathological evaluation, electron microscopy, immunohistochemical assays, RT-qPCR for YF virus (YFV)-RNA, and proteomics analysis on inflammatory and endothelial biomarkers.Findings Seventy-three confirmed YF cases with a median age of 48 (34-60) years were included. We observed myocardial fibrosis in 68 (93.2%) patients; cardiomyocyte hypertrophy in 68 (93.2%); endothelial alterations in 67 (91.8%); fiber necrosis in 50 (68.5%); viral myocarditis in 9 (12.3%); and secondary myocarditis in 5 (6.8%). Four out of five patients with 17DD vaccine-associated viscerotropic disease presented with myocarditis. The cardiac conduction system showed edema, hemorrhages and endothelial fibrinoid necrosis. Immunohistochemistry detected CD68-positive inflammatory interstitial cells and YFV antigens in endothelial and inflammatory cells. YFV-RNA was detected positive in 95.7% of the cardiac samples. The proteomics analysis demonstrated that YF patients had higher levels of multiple inflammatory and endothelial biomarkers in comparison to cardiovascular controls, and higher levels of interferon gamma-induced protein 10 (IP-10) in comparison to sepsis (p = 0.01) and cardiovascular controls (p < 0.001) in Dunn test.Interpretation Myocardial injury is frequent in severe YF, due to multifactorial mechanisms, including direct YFV-mediated damage, endothelial cell injury, and inflammatory response, with a possible prominent role for IP-10.
Palavras-chave
Yellow fever, 17DD, YEL-AVD, Myocarditis, Heart conduction system, Vascular endothelium, Cytokines, Chemokines, IP-10, Autopsy
URI
https://observatorio.fm.usp.br/handle/OPI/57527
Referências
  1. Akwii RG, 2019, CELLS-BASEL, V8, DOI 10.3390/cells8050471
  2. Alvarez Maria Fernanda, 2017, F1000Res, V6, P390, DOI 10.12688/f1000research.11078.1
  3. Amalakuhan B, 2016, CYTOKINE, V88, P267, DOI 10.1016/j.cyto.2016.08.028
  4. [Anonymous], 2017, Wkly Epidemiol Rec, V92, P193
  5. [Anonymous], SINANWEB-Febre Amarela
  6. [Anonymous], Dados Estatisticos-Secretaria da Saude-Governo do Estado de Sao Paulo
  7. Barreto-Vieira DF, 2020, MEM I OSWALDO CRUZ, V115, DOI 10.1590/0074-02760200278
  8. Basso C, 2020, EUR HEART J, V41, P3827, DOI 10.1093/eurheartj/ehaa664
  9. Bi CF, 2022, J INFLAMM RES, V15, P4275, DOI [10.2147/JIR.S374117, 10.2147/JIR.S374117Journalof]
  10. Chan RC, 2001, LANCET, V358, P121, DOI 10.1016/S0140-6736(01)05341-7
  11. Chen Y, 2020, MOL MED, V26, DOI 10.1186/s10020-020-00230-x
  12. Chung MK, 2021, CIRC RES, V128, P1214, DOI 10.1161/CIRCRESAHA.121.317997
  13. Cunha MD, 2019, SCI REP-UK, V9, DOI 10.1038/s41598-019-56650-1
  14. de Avila RE, 2020, INT J INFECT DIS, V93, P90, DOI 10.1016/j.ijid.2020.01.039
  15. de-Oliveira-Pinto LM, 2012, MEM I OSWALDO CRUZ, V107, P48, DOI 10.1590/S0074-02762012000100007
  16. DEBRITO T, 1992, PATHOL RES PRACT, V188, P177, DOI 10.1016/S0344-0338(11)81176-3
  17. DeSilva M, 2015, MMWR-MORBID MORTAL W, V64, P279
  18. Duarte-Neto AN, 2019, HISTOPATHOLOGY, V75, P638, DOI 10.1111/his.13904
  19. Duarte-Neto AN, 2019, PLOS NEGLECT TROP D, V13, DOI 10.1371/journal.pntd.0007625
  20. Elemam NM, 2022, VIRUSES-BASEL, V14, DOI 10.3390/v14112445
  21. Fabro AT, 2019, AM J RESP CRIT CARE, V200, P250, DOI 10.1164/rccm.201711-2267IM
  22. Fernandes EG, 2023, EMERG INFECT DIS, V29, P493, DOI 10.3201/eid2903.220989
  23. Habimana R, 2020, ACUTE CRIT CARE, V35, P57, DOI 10.4266/acc.2020.00248
  24. Ho YL, 2019, J TRAVEL MED, V26, DOI 10.1093/jtm/taz040
  25. Kallas EG, 2019, LANCET INFECT DIS, V19, P750, DOI 10.1016/S1473-3099(19)30125-2
  26. Khongphatthanayothin A, 2005, SHOCK, V24, P407, DOI 10.1097/01.shk.0000180981.70870.8c
  27. LaBeaud AD, 2010, PLOS NEGLECT TROP D, V4, DOI 10.1371/journal.pntd.0000847
  28. LaBeaud AD, 2008, PLOS NEGLECT TROP D, V2, DOI 10.1371/journal.pntd.0000247
  29. Lambden S, 2018, CRIT CARE, V22, DOI 10.1186/s13054-018-2102-1
  30. Li S, 2022, J Virol, V96
  31. Lloyd W, 1931, AM HEART J, V6, P504, DOI 10.1016/S0002-8703(31)90034-3
  32. Lloyd W, 1931, AM HEART J, V6, P483, DOI 10.1016/S0002-8703(31)90033-1
  33. Merx MW, 2007, CIRCULATION, V116, P793, DOI 10.1161/CIRCULATIONAHA.106.678359
  34. Minhas AM, 2017, CUREUS J MED SCIENCE, V9, DOI 10.7759/cureus.1399
  35. Miranda CH, 2013, EUR HEART J-ACUTE CA, V2, P127, DOI 10.1177/2048872613475889
  36. Monath TP, 2015, J CLIN VIROL, V64, P160, DOI 10.1016/j.jcv.2014.08.030
  37. Paixao GMM, 2019, AM J CARDIOL, V123, P833, DOI 10.1016/j.amjcard.2018.11.032
  38. Puerta-Guardo H, 2016, PLOS PATHOG, V12, DOI 10.1371/journal.ppat.1005738
  39. Rocha-Lima H, 1912, Verh dtsch path, V15, P163
  40. Semsarian C, 2016, J ARRYTHM, V32, P359, DOI 10.1016/j.joa.2015.09.010
  41. Sow A, 2016, MALARIA J, V15, DOI 10.1186/s12936-016-1100-5
  42. Sun T, 2022, FRONT PUBLIC HEALTH, V10, DOI 10.3389/fpubh.2022.870065
  43. Tuells J, 2022, ARCH MED RES, V53, P649, DOI 10.1016/j.arcmed.2022.10.005
  44. Vasconcelos PFC, 2001, LANCET, V358, P91, DOI 10.1016/S0140-6736(01)05326-0

Coleções
Artigos e Materiais de Revistas Científicas - FM/MPT
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/03
Artigos e Materiais de Revistas Científicas - LIM/05
Artigos e Materiais de Revistas Científicas - LIM/06
Carregar mais