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van Dam LF, Kroft LJM, van der Wal LI, Cannegieter SC, Eikenboom J, de Jonge E, Huisman MV, Klok FA. Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: A different phenotype of thrombotic disease? Thromb Res 2020; 193:86-89. [PMID: 32531548 PMCID: PMC7274953 DOI: 10.1016/j.thromres.2020.06.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 infections are associated with a high prevalence of venous thromboembolism, particularly pulmonary embolism (PE). It is suggested that COVID-19 associated PE represents in situ immunothrombosis rather than venous thromboembolism, although the origin of thrombotic lesions in COVID-19 patients remains largely unknown. METHODS In this study, we assessed the clinical and computed tomography (CT) characteristics of PE in 23 consecutive patients with COVID-19 pneumonia and compared these to those of 100 consecutive control patients diagnosed with acute PE before the COVID-19 outbreak. Specifically, RV/LV diameter ratio, pulmonary artery trunk diameter and total thrombus load (according to Qanadli score) were measured and compared. RESULTS We observed that all thrombotic lesions in COVID-19 patients were found to be in lung parenchyma affected by COVID-19. Also, the thrombus load was lower in COVID-19 patients (Qanadli score -8%, 95% confidence interval [95%CI] -16 to -0.36%) as was the prevalence of the most proximal PE in the main/lobar pulmonary artery (17% versus 47%; -30%, 95%CI -44% to -8.2). Moreover, the mean RV/LV ratio (mean difference -0.23, 95%CI -0.39 to -0.07) and the prevalence of RV/LV ratio >1.0 (prevalence difference -23%, 95%CI -41 to -0.86%) were lower in the COVID-19 patients. CONCLUSION Our findings therefore suggest that the phenotype of COVID-19 associated PE indeed differs from PE in patients without COVID-19, fuelling the discussion on its pathophysiology.
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Affiliation(s)
- L F van Dam
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - L J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - L I van der Wal
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - S C Cannegieter
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Eikenboom
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - E de Jonge
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
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Mejido DCP, de Oliveira JM, Gaspar AMC, Gardinali NR, Bottino FDO, de Carvalho LG, Lopes dos Santos DR, Kevorkian YB, Xavier LL, Moran J, Pelajo-Machado M, Marchevsky RS, Pinto MA. Evidences of HEV genotype 3 persistence and reactivity in liver parenchyma from experimentally infected cynomolgus monkeys (Macaca fascicularis). PLoS One 2019; 14:e0218472. [PMID: 31211801 PMCID: PMC6581283 DOI: 10.1371/journal.pone.0218472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
Hepatitis E virus genotype 3 (HEV-3) is an emerging zoonotic pathogen, responsible for sporadic cases of acute hepatitis E worldwide. Primate models have proven to be an essential tool for the study of HEV pathogenesis. Here we describe the outcomes of HEV infection in Macaca fascicularis (cynomolgus) inoculated experimentally with genotype 3. Eight adult cynomolgus macaques were inoculated intravenously with HEV-3 viral particles isolated from swine and human samples. Liver, spleen, duodenum, gallbladder and bile were sequential assessed up to the end-point of this study, 67 days post-inoculation (dpi). Our previously published findings showed that biochemical parameters return gradually to baseline levels at 55 dpi, whereas anti-HEV IgM and HEV RNA become undetectable in the serum and feces of all animals, indicating a non-viremic phase of recovery. Nevertheless, at a later stage during convalescence (67 dpi), the presence of HEV-3 RNA and antigen persist in central organs, even after peripheral viral clearance. Our results show that two cynomolgus inoculated with swine HEV-3 (animals I3 and O1) presented persistence of HEV RNA low titers in liver, gallbladder and bile. At this same stage of infection, HEV antigen (HEV Ag) could be detected in all infected animals, predominantly in non-reactive Kupffer cells (CD68+iNOS-) and sinusoidal lining cells. Simultaneously, CD4+, CD3+CD4+, and CD3+CD8+ immune cells were identified in hepatic sinusoids and small inflammatory clusters of lobular mononuclear cells, at the end-point of this study. Inability of HEV clearance in humans can result in chronic hepatitis, liver cirrhosis, with subsequent liver failure requiring transplantation. The results of our study support the persistence of HEV-3 during convalescence at 67 dpi, with active immune response in NHP. We alert to the inherent risk of viral transmission through liver transplantation, even in the absence of clinical and biochemical signs of acute infection. Thus, besides checking conventional serological markers of HEV infection, we strongly recommend HEV-3 RNA and antigen detection in liver explants as public health measure to prevent donor-recipient transmission and spread of hepatitis E.
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Affiliation(s)
- Diana Chaves Pereira Mejido
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | - Jaqueline Mendes de Oliveira
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | - Ana Maria Coimbra Gaspar
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | - Noemi Rovaris Gardinali
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | - Fernanda de Oliveira Bottino
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | | | - Debora Regina Lopes dos Santos
- Departament of Veterinary Microbiology and Immunology, Federal Rural University of Rio De Janeiro, Rio de Janeiro, Brasil
| | - Yohan Brito Kevorkian
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | - Leandro Layter Xavier
- Laboratory of Morphometry, Institute of Biology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brasil
| | - Julio Moran
- Laboratory of Pathology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
| | | | - Renato Sergio Marchevsky
- Laboratory of Control of Neurovirulence, Bio-Manguinhos, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Marcelo Alves Pinto
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil
- * E-mail:
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de Sousa JR, Azevedo RSS, Martins Filho AJ, Araujo MTF, Moutinho ERC, Baldez Vasconcelos BC, Cruz ACR, Oliveira CS, Martins LC, Baldez Vasconcelos BH, Casseb LMN, Chiang JO, Quaresma JAS, Vasconcelos PFC. Correlation between Apoptosis and in Situ Immune Response in Fatal Cases of Microcephaly Caused by Zika Virus. Am J Pathol 2018; 188:2644-2652. [PMID: 30121258 DOI: 10.1016/j.ajpath.2018.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/12/2018] [Accepted: 07/16/2018] [Indexed: 12/27/2022]
Abstract
Zika virus (ZIKV) is a single-stranded positive-sense RNA flavivirus that possesses a genome approximately 10.7 Kb in length. Although pro-inflammatory and anti-inflammatory cytokines and apoptotic markers belonging to the extrinsic and intrinsic pathways are suggested to be involved in fatal cases of ZIKV-induced microcephaly, their exact roles and associations are unclear. To address this, brain tissue samples were collected from 10 individuals, five of whom were diagnosed as ZIKV positive with microcephaly and a further five were flavivirus-negative controls that died because of other causes. Examination of material from the fatal cases of microcephaly revealed lesions in the cerebral cortex, edema, vascular proliferation, neuronal necrosis, gliosis, neuronophagy, calcifications, apoptosis, and neuron loss. The expression of various apoptosis markers in the neural parenchyma, including FasL, FAS, BAX, BCL2, and caspase 3 differed between ZIKV-positive cases and controls. Further investigation of type 1 and 2 helper T-cell cytokines confirmed a greater anti-inflammatory response in fatal ZIKV-associated microcephaly cases. Finally, an analysis of the linear correlation between tumor necrosis factor-α, IL-1β, IL-4, IL-10, transforming growth factor-β, and IL-33 expression and various apoptotic markers suggested that the immune response may be associated with the apoptotic phenomenon observed in ZIKV-induced microcephaly.
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Affiliation(s)
- Jorge R de Sousa
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | - Raimunda S S Azevedo
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | | | - Marialva T F Araujo
- Department of Pathology, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | - Ermelinda R C Moutinho
- Department of Pathology, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | | | - Ana C R Cruz
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil; Center of Biological and Health Sciences, State University of Pará, Belém, Brazil
| | - Consuelo S Oliveira
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | - Lívia C Martins
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | | | - Livia M N Casseb
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | - Jannifer O Chiang
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil
| | - Juarez A S Quaresma
- Department of Pathology, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil; Center of Biological and Health Sciences, State University of Pará, Belém, Brazil; Tropical Medicine Center, Federal University of Pará, Belém, Brazil.
| | - Pedro F C Vasconcelos
- Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute, Ministry of Health, Ananindeua, Brazil; Center of Biological and Health Sciences, State University of Pará, Belém, Brazil.
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Schwartzmann PV, Ramalho LNZ, Neder L, Vilar FC, Ayub-Ferreira SM, Romeiro MF, Takayanagui OM, Dos Santos AC, Schmidt A, Figueiredo LTM, Arena R, Simões MV. Zika Virus Meningoencephalitis in an Immunocompromised Patient. Mayo Clin Proc 2017; 92:460-466. [PMID: 28259231 DOI: 10.1016/j.mayocp.2016.12.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/02/2016] [Accepted: 12/22/2016] [Indexed: 11/24/2022]
Abstract
The World Health Organization considers the Zika virus (ZIKV) outbreak in the Americas a global public health emergency. The neurologic complications due to ZIKV infection comprise microcephaly, meningoencephalitis, and Guillain-Barré syndrome. We describe a fatal case of an adult patient receiving an immunosuppressive regimen following heart transplant. The patient was admitted with acute neurologic impairment and experienced progressive hemodynamic instability and mental deterioration that finally culminated in death. At autopsy, a pseudotumoral form of ZIKV meningoencephalitis was confirmed. Zika virus infection was documented by reverse trancriptase-polymerase chain reaction, immunohistochemistry, and immunofluorescence and electron microscopy of the brain parenchyma and cerebral spinal fluid. The sequencing of the viral genome in this patient confirmed a Brazilian ZIKV strain. In this case, central nervous system involvement and ZIKV propagation to other organs in a disseminated pattern is quite similar to that observed in other fatal Flaviviridae viral infections.
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Affiliation(s)
- Pedro V Schwartzmann
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
| | - Leandra N Z Ramalho
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Luciano Neder
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Fernando C Vilar
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Sílvia M Ayub-Ferreira
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Marília F Romeiro
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Osvaldo M Takayanagui
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Antonio C Dos Santos
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - André Schmidt
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Luiz T M Figueiredo
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Marcus V Simões
- Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil
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