Fulminant hepatic failure in northern Brazil: morphological, immunohistochemical and pathogenic aspects of Lábrea hepatitis and yellow fever

Abstract

A morphological evaluation of histopathological liver samples from 42 fulminant hepatic failure cases from the Amazon Basin was undertaken in order to differentiate yellow fever (YF) from Lábrea hepatitis (LH) and other entities. The pattern and distribution of liver cell death as well as ballooning degeneration and midzonal apoptotic bodies were the most distinctive features of YF, whereas morula cells were the major finding for LH. Nineteen well characterised cases were further submitted to immunohistochemical studies for expression of YF antigen, hepatitis B surface antigen (HBsAg) and delta virus antigen. In both diseases, but particularly in LH, portal vein branch phlebitis was evident and might have played a role in the pathogenesis of hepatic injury, leading to hepatic extinction and portal tract approximation. The regeneration pattern was remarkable: a high proliferative index was detected in YF, whereas in LH multinucleation and pseudoacinar transformation, associated with portal type I collagen deposition and portal elastic fibre proliferation, was seen. In conclusion, midzonal apoptosis, portal phlebitis and a high proliferative index in patients without evidence of previous liver injury was the dominant picture in YF. On the other hand, LH cases showed extensive, predominantly lytic hepatocytic necrosis, portal and hepatic vein phlebitis and morula cells in patients with a morphological background of chronic liver disease.

A non-hepatotropic parasite infection increases mortality in the acetaminophen-induced acute liver failure murine model: possible roles for IL-5 and IL-6

“…Usually, this involves little to no immune cell infiltration of the liver (Bernal et al 2015, Yoon et al 2016). In this study, we found that ballooning degeneration of hepatocytes (a well-established indicator of hepatic necrosis) (Dias et al 2007) was significantly increased, following simultaneous acetaminophen overdose and T. crassiceps infection. Interestingly, levels of serum ALT were higher in parasitised mice that received acetaminophen than in non-parasitised mice that received acetaminophen.…”

Dengue Virus and Yellow Fever Virus Damage the Liver: A Systematic Review About the Histopathological Profiles

“…The main histopathological changes are described in Table 1. Among the histological characteristics present in YFVinfected humans, hepatocellular balloonism, Councilman corpuscle and the presence of apoptotic acidophilic bodies are the most evident findings in these patients [14,20,21] . The approach of the histological alterations of YFV and DENV is of great importance for the differential diagnosis, mainly because both diseases cause clinical manifestations of similar acute phase, but the hepatic damages in YFV infections are more serious and with a higher mortality rate when compared to DENV [20] .…”

“…The approach of the histological alterations of YFV and DENV is of great importance for the differential diagnosis, mainly because both diseases cause clinical manifestations of similar acute phase, but the hepatic damages in YFV infections are more serious and with a higher mortality rate when compared to DENV [20] . Diagnosis based on the YFV morphological changes is currently the gold standard for identifying the infection, based on specific morphological characteristics of liver damage, as mentioned previously, and which are observed in almost all human cases [14,22] . It is worth mentioning that the severity of hepatic changes is associated with circulating virus strain and host susceptibility [23] .…”

“…The presence of hepatocellular balloonism can be attributed to interference with mechanisms of control of water and ion concentrations, which may result from direct action of the YFV virus on the cell membrane or as a consequence of the immune response generated by the host [14] . Another clear finding in the infection, called Councilman's corpuscles, is usually found in hepatocytes, secondary to the development of apoptosis, where degeneration of the nucleolus occurs and the protein resulting from the apoptotic process remains accumulated [20] .…”

“…This event usually occurs in severe forms of DENV, characterized as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) [4,13] . In YFV infection, the morphological diagnosis, based on alterations characteristic of liver damage, is one of the most important methods in the identification of the disease and its degree of impairment, so that there is correct management of the patient [14] .…”