Patologia feto-placent??ria na infec????o pelo parvov??rus humano B19

Abstract

S??o escassas as refer??ncias aos dados histol??gicos relativos ?? infec????o cong??nita pelo parvov??rus humano B19.Apresentamos estudo morfol??gico de seis aut??psias em que o v??rus foi detectado por hibridiza????o DNA (HIS-HDB), PCR e microscopia eletr??nica (ME) em tecidos feto-placent??rios fixados em formol e inclu??dos em parafina. Estas aut??psias integravam um grupo de 86 Hidropisias Fetais n??o Imunol??gicas (HFNI) que apresentaram ?? microscopia ??ptica complexo lesional sist??mico inflamat??rio/degenerativo de causa indeterminada. Em uma crian??a detectou-se processo sifil??tico multivisceral com microorganismos, caracterizando infec????o dupla. Os fetos exibiram quadro semelhante: hidropisia, hepato-esplenomegalia, hipoplasia pulmonar e eritroblastemia. O dado histol??gico espec??fico consistiu em inclus??o nuclear em eritroblastos do sangue, do tecido visceral eritropoi??tico e medula ??ssea. Cardiopatia complexa, lobula????o pulmonar an??mala e poliesplenia foram observadas em um caso. Em dois cora????es evidenciou-se fibroelastose difusa. As les??es pulmonares se manifestaram por dismaturidade e processo cr??nico intersticial; as hep??ticas revelaram colestase, fibrose portal, prolifera????o canalicular, necroses hepatocit??rias focais irregularmente dispostas, transforma????o gigantocit??ria e hemossiderose. No sistema nervoso central predominaram as les??es an??xicas, embora a aut??lise n??o permitisse an??lise minuciosa.In view of the scarce references concerning the histological data in congenital parvovirus human B19 infection, we intend to provide a description of the pathological features observed in six autopsies.The virus was detected by DNA hybridization (ISH-H),PCR and electronmicroscopy (EM) in paraffin embedded feto-placentary tissues.These cases constitute a subset from 86 Non Immunologic Hydrops Fetalis (NIHF) cases, in which a systemic complex of inflammatory/degenerative lesions of unknown etiology was visualized by optical microscopy. In one case a syphilitic process was detected, typefying a double infection. All fetuses showed a similar pathology - hydrops, hepato-splenomegaly,lung hypoplasia and erythroblastemia, the specific histological feature being the presence of intranuclear inclusions in the erythroid progenitors, in the erythropoietic visceral tissue and in blood marrow. Complex cardiopathy allied to abnormal lung lobulation and polisplenia were observed once; in 2 cases endocardial fibroelastosis was diagnosed. The pulmonary lesions were represented by dysmaturity allied to interstitial mononuclear infiltration. The hepatic consisted of cholestasis, portal fibrosis, canalicular proliferation, hemossiderosis,focal necroses and giant cell transformation. The central nervous system lesions were predominantly anoxic although the autolysis impaired a correct diagnosis