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Rivas-Castro A, Salinas-Lara C, Sánchez Garibay C, Abarca-Rojano E, Hernández-Pando R, Marquina-Castillo B, Flores Barrada MA, Peralta-Díaz Y, León-Marroquín EY, Tena Suck ML, Medina Mendoza J, Sánchez Gama Y, Soto Rojas LO, Choreño Parra JA, Romero-López JP. The role of TNF receptors as mediators of chronic vasculitis in possible milder forms of the CNS tuberculosis. J Infect Dev Ctries 2023; 17:1458-1465. [PMID: 37956380 DOI: 10.3855/jidc.17544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/07/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Central nervous system (CNS) tuberculosis (TB) is the most severe form of TB due to its high mortality and functional sequelae. There are several differential diagnoses for TB; and, it can also cause secondary conditions, such as vasculitis. METHODOLOGY 155 biopsies, corresponding to 155 different patients out of 5,386 registered biopsies from 2008-2013, met the criteria of unknown etiology vasculitis and evidence of cerebral vascular disease. These were analyzed to assess the presence of central nervous system TB. The selected cases were assessed with Suzaan Marais (SM) criteria for clinical tuberculosis. After that, Ziehl-Neelsen (ZN) staining and polymerase chain reaction (PCR) were performed to amplify a fragment of the insertion sequence IS6110 of M. tuberculosis. 21 patients met the criteria for definitive tuberculosis by ZN staining and PCR, and 2 met the criteria for possible tuberculosis. Tumor necrosis factor (TNF)-α, TNF-R1, and TNF-R2 were determined by immunohistochemistry in histological sections from formalin-fixed paraffin-embedded (FF-PE) tissues in the 23 selected patients. RESULTS Granulomatous TB was present in almost half of the cases. TNF-R1 and TNF-R2 were expressed mainly in blood vessels, histiocytes, and macrophages. TNF-R2 expression was higher than the other markers, which suggests an anti-inflammatory response against M. tuberculosis. CONCLUSIONS The histopathological presentation of TB is not always limited to granulomas, abscesses, or meningitis; there are also clinical presentations characterized only with chronic inflammation of nervous and vascular tissue.
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Affiliation(s)
- Alejandro Rivas-Castro
- Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Citlaltepetl Salinas-Lara
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, Mexico
| | - Carlos Sánchez Garibay
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, Mexico
| | - Edgar Abarca-Rojano
- Sección de Estudios de Pogrado e Investigacion, Escuela Superior de Medicina Instituto Politécnico Nacional, Mexico City, Mexico
| | - Rogelio Hernández-Pando
- Experimental Pathology Section. Department of Pathology. National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | | | - Manuel Alejandro Flores Barrada
- Profesor investigador de la universidad Juárez Autónoma de Tabasco de la división académica multidisciplinaria Comalcalco, Tabasco, Mexico
| | - Yazmín Peralta-Díaz
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, Mexico
| | - Elsa Yazmín León-Marroquín
- Departamento de Física Médica, Hospital de Oncología Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México
| | - Martha Lilia Tena Suck
- Departamento de Neuropatología, Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez", Mexico City, Mexico
| | | | | | - Luis O Soto Rojas
- Laboratorio de Patogénesis Molecular, Laboratorio 4, Edificio A4, Carrera Médico Cirujano, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, Edomex, Mexico
| | - José Alberto Choreño Parra
- Departamento de Enseñanza, Instituto Nacional de Enfermedades Respiratorias Isanel Cosío Villegas, Mexico City, Mexico
| | - José Pablo Romero-López
- Red MEDICI, Carrera médico cirujano, Facultad de Estudios Superiores Iztacala UNAM, Mexico, Mexico
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