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Yellow fever and orthotopic liver transplantation: new insights from the autopsy room for an old but re-emerging disease

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Autor(es):
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Duarte-Neto, Amaro N. [1] ; Cunha, Marielton dos P. [2] ; Marcilio, Izabel [3] ; Song, Alice T. W. [4] ; de Martino, Rodrigo B. [4] ; Ho, Yeh-Li [5] ; Pour, Shahab Z. [2] ; Dolhnikoff, Marisa [1] ; Saldiva, Paulo H. N. [1] ; Duarte, Maria I. S. [1] ; Takakura, Cleusa F. [1] ; Lima, Fabiana R. [1] ; Tanigawa, Ryan Y. [1] ; Iglezias, Silvia D'A [6] ; Kanamura, Cristina T. [6] ; dos Santos, Angela B. G. [1] ; Perondi, Beatriz [7] ; Zanotto, Paolo M. de A. [2] ; D'Albuquerque, Luiz A. C. [4] ; Alves, Venancio A. F. [1]
Número total de Autores: 20
Afiliação do(s) autor(es):
[1] Univ Sao Paulo, Fac Med, Dept Patol, Ave Dr Arnaldo 455 Sala 1161, BR-01246903 Sao Paulo - Brazil
[2] Univ Sao Paulo, ICB, LEMB, Sao Paulo - Brazil
[3] Univ Sao Paulo, Hosp Clin, Fac Med, Nucleo Vigilancia Epidemiol, Sao Paulo - Brazil
[4] Univ Sao Paulo, Div Transplante Figado & Orgaos Aparelho Digest, Fac Med, Hosp Clin HCFMUSP, Sao Paulo - Brazil
[5] Univ Sao Paulo, Div Clin Molestias Infecciosas & Parasitarias, Unidade Terapia Intens, Hosp Clin, Fac Med, Sao Paulo - Brazil
[6] Univ Sao Paulo, Nucleo Anat Patol, Inst Adolfo Lutz, Sao Paulo - Brazil
[7] Univ Sao Paulo, Com Crise Febre Amarela, Hosp Clin HCFMUSP, Diretoria Clin, Fac Med, Sao Paulo - Brazil
Número total de Afiliações: 7
Tipo de documento: Artigo Científico
Fonte: Histopathology; v. 75, n. 5, p. 638-648, NOV 2019.
Citações Web of Science: 5
Resumo

Aims The clinical spectrum of yellow fever (YF) ranges from asymptomatic to fulminant hepatitis. During the sylvatic YF epidemic in the metropolitan area of Sao Paulo, Brazil in 2018, seven orthotopic liver transplantations (OLTs) were performed in our institution to treat fulminant YF hepatitis. Three patients recovered, while four patients died following OLT. The autopsy findings of all these cases are presented herein as the first description of YF in transplanted patients. Methods and results All patients were men, aged 16-40 years, without vaccination to YF virus (YFV). All organs were examined, with tissue sampling for histopathological analysis. Detection of YF virus antigens (YFV Ag) was performed with two primary antibodies (mouse polyclonal anti-YFV antibody directed to wild strain and a goat anti-YF virus antibody), and RT-PCR assays were utilised to detect YFV-RNA. All the cases depicted typical findings of YF hepatitis in the engrafted liver. The main extrahepatic findings were cerebral oedema, pulmonary haemorrhage, pneumonia, acute tubular necrosis and ischaemic/reperfusion pancreatitis. Of the four cases, the YVF Ag was detected in the heart in one case, liver and testis in three cases, and the kidney and spleen in all four cases. All four cases had YF virus RNA detected by RT-PCR in the liver and in other organs. Conclusions Infection of the engrafted liver and other organs by YFV, possibly combined with major ischaemic systemic lesions, may have led to the death of four of the seven patients undergoing OLT. (AU)

Processo FAPESP: 16/08204-2 - Diversidade genética e filodinâmica dos arbovírus emergentes e reemergentes (DENV, ZIKV e CHIKV) nas regiões Nordeste e Sudeste do Brasil, 2014-2016
Beneficiário:Marielton dos Passos Cunha
Modalidade de apoio: Bolsas no Brasil - Doutorado