Liver transplant after SARS-CoV-2 infection: A systematic review.

BACKGROUND: The Coronavirus 19 (COVID-19) pandemic has dramatically impacted liver organ transplantation. The American Society of Transplantation recommends a minimum of 28 days after symptom resolution for organ donation. However, the exact time for transplantation for recipients is unknown. Considering that mortality on the waiting list for patients with MELD >25 or fulminant hepatitis is higher than that of COVID-19, the best time for surgery after SARS-CoV-2 infection remains undetermined. This study aims to expand the current knowledge regarding the Liver Transplantation (LT) time for patients after COVID-19 and to provide transplant physicians with essential decision-making tools to manage these critically ill patients during the pandemic. METHODS: Systematic review of patients who underwent liver transplantation after diagnosis of COVID-19. The MEDLINE, PubMed, Cochrane, Lilacs, Embase, and Scielo databases were searched until June 20, 2021. The MESH terms used were "COVID-19" and "Liver transplantation". RESULTS: 558 articles were found; of these 13 articles and a total of 18 cases of COVID-19 prior to liver transplantation were reported. The mean age was 38.7±14.6, with male prevalence. Most had mild symptoms of COVID. Five patients have specific treatment for COVID-19 with convalescent plasm or remdesivir/oseltamivir, just one patient received hydroxychloroquine, and 12 patients received only symptomatic treatment. The median time between COVID-19 to LT was 19 days (13.5‒44.5). Deceased donor liver transplantation accounted for 61% of cases, while living donor transplantation was 39%. CONCLUSION: Despite the concerns regarding the postoperative evolution, the mortality of patients with high MELD or fulminant hepatitis transplanted shortly after COVID-19 diagnosis does not seem to be higher. (PROSPERO, registration number = CRD42021261790).

Disseminated Herpes Simplex Virus in an Immunocompetent Patient Without Presence of Epidermal or Mucosal Lesions.

ABSTRACT: Herpes simplex virus (HSV) is a disease usually characterized by lesions within the epidermis or mucosa of children and adults. However, this infection can also cause complications to many systems of the body, including the peripheral and central nervous system, respiratory system, and hepatobiliary system. In this case, we present a 43-year-old man with a history of substance abuse, who presented with fever, cough, and headache, and within days, progressed into fulminant hepatitis and hypoxic failure. Bacterial and fungal cultures were negative, as well as the workup for human immunodeficiency virus. However, the presence of HSV was detected in a bronchial lavage culture after the patients had expired. This result, along with the findings at autopsy, including viral cytopathic effect in the lung and liver, which were confirmed with immunohistochemical stains for HSV, strongly suggest that the cause of death is from disseminated herpes virus infection with hepatitis and viral pneumonitis. This disseminated infection occurred in an immunocompetent host without any evidence of mucocutaneous lesions.

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

AIMS: The clinical spectrum of yellow fever (YF) ranges from asymptomatic to fulminant hepatitis. During the sylvatic YF epidemic in the metropolitan area of São 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.

Intravascular and intraparenchymatous hepatic segmentary sclerosis

Purpose: To evaluate the morphological effects of injected sclerosing agents into the liver. Methods: This study was performed on twenty dogs, distributed into five groups: Group 1 (n = 5) - control, Group 2 (n = 5) - injection of 50% glucose solution inside hepatic parenchyma and animals followed during seven days, Group 3 (n = 10) - injection of ethanol inside hepatic parenchyma and animals distribution into two subgroups Subgroup 3A (n = 5) - followed during 24 hours and subgroup 3B (n = 5) - followed during seven days (group 3B), Group 4 (n = 5) - ethanol injection inside left portal vein branch and followed during 24 hours. Livers were macroscopically evaluated, submitted to hepatic arteriography and portography, then histology. Results: All animals in Group 4 died within 23 hours due to diffuse hepatic necrosis. The animals of groups 2 and 3 had a satisfactory evolution. Fibrosis formed in the segment reached by the sclerosant solution and interruption of the contrast flow injected into the portal system. Conclusion: Intrahepatic parenchymal ethanol injection is well tolerated and causes sclerosis restricted to a specific segment; however, intraportal ethanol injection causes massive hepatic necrosis and can lead to death.(AU)

Toxic myopathy and acute hepatic necrosis in cattle caused by ingestion of Senna obtusifolia (sicklepod; coffee senna) in Brazil.

The epidemiological, clinical and pathological findings of field and experimental Senna obtusifolia (sicklepod; coffee senna) poisoning in cattle are described. The low availability of good quality forage and high rate of infestation of pastures by S. obtusifolia were the factors that led to poisonous plant ingestion. In this study, the morbidity ranged between 2% and 27.9%, and the lethality was 100%. For the experimental study, six cattle were fed with the aerial parts of S. obtusifolia collected in three different seasons at 9%-38% of the animal's body weight. The experimental and field diseases were similar. The main clinical signs were diarrhea, reluctance to move, muscular weakness and recumbency. The gross findings included pale discoloration of the skeletal muscle. Microscopically, the affected cattle showed degeneration and necrosis of the skeletal muscles and occasionally of the cardiac muscles. Additionally, two cattle showed centrilobular hepatic necrosis. In this study, S. obtusifolia collected from the same farm showed seasonal variation in toxicity. Poisoning by S. obtusifolia is an important cause of death of cattle in the Central Western region of Brazil. The toxicosis caused by this plant is similar to S. occidentalis poisoning; however, in S. obtusifolia poisoning, acute hepatic necrosis is sometimes present.

Perreyia flavipes larvae toxicity / Toxicidade das larvas de Perreyia flavipes

Fresh or thawed Perreyia flavipes larvae were ground and mixed with water and orally ad ministered to sheep. At 5mg/kg, neither clinical nor enzymatic changes were observed. Unique do ses of 7.5 and 10mg/kg induced characteristic clinical signs of Perreyia sp. larvae poisoning, increased GGT and AST values, and decreased glycemic curves. However, doses of 5, 10, and 15mg/kg repeated at 30 or 15 days intervals caused no disease and mild disease followed by death, respectively. These fin dings indicate that these animals probably developed some degree of tolerance to the toxins in P. flavipes larvae. Ultrastru ctural examination of liver revealed proliferation of the smooth endoplasmic reticulum in the hepatocytes, which may be associated with an increased ability to metabolize toxins and could consequently lead to the tolerance observed in the present study. Further investigations may elucidate whether such tolerance effects could be applied as a control measure for P. flavipes poioning or other hepatotoxic diseases. In addition, clinicopathological findings were discussed.

Larvas frescas ou descongeladas de Perreyia flavipes foram moídas e misturadas com água e administradas de forma oral a ovinos. Com 5mg/kg, não foram observados achados clínicos ou enzimáticos. Doses únicas de 7,5 e 10mg/kg induziram a sinais clínicos característicos de intoxicação pelas larvas de Perreyia sp., os níveis de GGT e AST estavam aumentados e as curvas glicêmicas estavam diminuídas. Entretanto, doses de 5, 10 e 15mg/kg repetidas em intervalos de 30 ou 15 dias não causou doença ou causou doença discreta seguida de morte, respectivamente. Estes achados indicam que estes animais provavelmente desenvolveram algum grau de tolerância para as toxinas presentes nas lar-Larvas frescas ou descongeladas de Perreyia flavipes foram vas de P. flavipes. O exame ultraestrutural do fígado revelou moídas e misturadas com água e administradas de forma proliferação do retículo endoplasmático liso de hepatócioral a ovinos. Com 5mg/kg, não foram observados acha-tos, o que pode ser associado a um aumento na capacidade dos clínicos ou enzimáticos. Doses únicas de 7,5 e 10mg/ de metabolizar toxinas e conseqüentemente levar à tolekg induziram a sinais clínicos característicos de intoxicação rância observada no presente estudo. Outras investigações pelas larvas de Perreyia sp., os níveis de GGT e AST estavam poderão esclarecer se os efeitos de tal tolerância poderiam aumentados e as curvas glicêmicas estavam diminuídas. ser aplicados como medida de controle da intoxicação por Entretanto, doses de 5, 10 e 15mg/kg repetidas em interva-P. flavipes ou outras doenças hepatotóxicas. Além disso, os los de 30 ou 15 dias não causou doença ou causou doença resultados clínico-patológicos foram discutidos.

Perreyia flavipes larvae toxicity / Toxicidade das larvas de Perreyia flavipes

Fresh or thawed Perreyia flavipes larvae were ground and mixed with water and orally ad ministered to sheep. At 5mg/kg, neither clinical nor enzymatic changes were observed. Unique do ses of 7.5 and 10mg/kg induced characteristic clinical signs of Perreyia sp. larvae poisoning, increased GGT and AST values, and decreased glycemic curves. However, doses of 5, 10, and 15mg/kg repeated at 30 or 15 days intervals caused no disease and mild disease followed by death, respectively. These fin dings indicate that these animals probably developed some degree of tolerance to the toxins in P. flavipes larvae. Ultrastru ctural examination of liver revealed proliferation of the smooth endoplasmic reticulum in the hepatocytes, which may be associated with an increased ability to metabolize toxins and could consequently lead to the tolerance observed in the present study. Further investigations may elucidate whether such tolerance effects could be applied as a control measure for P. flavipes poioning or other hepatotoxic diseases. In addition, clinicopathological findings were discussed.(AU)

Larvas frescas ou descongeladas de Perreyia flavipes foram moídas e misturadas com água e administradas de forma oral a ovinos. Com 5mg/kg, não foram observados achados clínicos ou enzimáticos. Doses únicas de 7,5 e 10mg/kg induziram a sinais clínicos característicos de intoxicação pelas larvas de Perreyia sp., os níveis de GGT e AST estavam aumentados e as curvas glicêmicas estavam diminuídas. Entretanto, doses de 5, 10 e 15mg/kg repetidas em intervalos de 30 ou 15 dias não causou doença ou causou doença discreta seguida de morte, respectivamente. Estes achados indicam que estes animais provavelmente desenvolveram algum grau de tolerância para as toxinas presentes nas lar-Larvas frescas ou descongeladas de Perreyia flavipes foram vas de P. flavipes. O exame ultraestrutural do fígado revelou moídas e misturadas com água e administradas de forma proliferação do retículo endoplasmático liso de hepatócioral a ovinos. Com 5mg/kg, não foram observados acha-tos, o que pode ser associado a um aumento na capacidade dos clínicos ou enzimáticos. Doses únicas de 7,5 e 10mg/ de metabolizar toxinas e conseqüentemente levar à tolekg induziram a sinais clínicos característicos de intoxicação rância observada no presente estudo. Outras investigações pelas larvas de Perreyia sp., os níveis de GGT e AST estavam poderão esclarecer se os efeitos de tal tolerância poderiam aumentados e as curvas glicêmicas estavam diminuídas. ser aplicados como medida de controle da intoxicação por Entretanto, doses de 5, 10 e 15mg/kg repetidas em interva-P. flavipes ou outras doenças hepatotóxicas. Além disso, os los de 30 ou 15 dias não causou doença ou causou doença resultados clínico-patológicos foram discutidos.(AU)

Transplantation of bone marrow cells decreases tumor necrosis factor-α production and blood-brain barrier permeability and improves survival in a mouse model of acetaminophen-induced acute liver disease.

BACKGROUND AIMS: Acute liver failure (ALF), although rare, remains a rapidly progressive and frequently fatal condition. Acetaminophen (APAP) poisoning induces a massive hepatic necrosis and often leads to death as a result of cerebral edema. Cell-based therapies are currently being investigated for liver injuries. We evaluated the therapeutic potential of transplantation of bone marrow mononuclear cells (BMC) in a mouse model of acute liver injury. METHODS: ALF was induced in C57Bl/6 mice submitted to an alcoholic diet followed by fasting and injection of APAP. Mice were transplanted with 10(7) BMC obtained from enhanced green fluorescent protein (GFP) transgenic mice. RESULTS: BMC transplantation caused a significant reduction in APAP-induced mortality. However, no significant differences in serum aminotransferase concentrations, extension of liver necrosis, number of inflammatory cells and levels of cytokines in the liver were found when BMC- and saline-injected groups were compared. Moreover, recruitment of transplanted cells to the liver was very low and no donor-derived hepatocytes were observed. Mice submitted to BMC therapy had some protection against disruption of the blood-brain barrier, despite their hyperammonemia, and serum metalloproteinase (MMP)-9 activity similar to the saline-injected group. Tumor necrosis factor (TNF)-α concentrations were decreased in the serum of BMC-treated mice. This reduction was associated with an early increase in interleukin (IL)-10 mRNA expression in the spleen and bone marrow after BMC treatment. CONCLUSIONS: BMC transplantation protects mice submitted to high doses of APAP and is a potential candidate for ALF treatment, probably via an immunomodulatory effect on TNF-α production.

Renal cortex copper concentration in acute copper poisoning in calves / Concentração de cobre no córtex renal na intoxicação aguda de cobre em bezerros

The aim of this study was to estimate the diagnostic value of renal cortex copper (Cu) concentration in clinical cases of acute copper poisoning (ACP). A total of 97 calves that died due to subcutaneous copper administration were compiled in eleven farms. At least, one necropsy was conducted on each farm and samples for complementary analysis were taken. The degree of autolysis in each necropsy was evaluated. The cases appeared on extensive grazing calf breeding and intensive feedlot farms, in calves of 60 to 200 kg body weight. Mortality varied from 0.86 to 6.96 percent, on the farms studied. The first succumbed calf was found on the farms between 6 and 72 hours after the susbcutaneous Cu administration. As discrepancies regarding the reference value arose, the local value (19.9 parts per million) was used, confirming the diagnosis of acute copper poisoning in 93 percent of the analyzed kidney samples. These results confirm the value of analysis of the cortical kidney Cu concentration for the diagnosis of acute copper poisoning.

O objetivo deste trabalho foi estimar o valor diagnóstico de concentração de cobre (Cu) no córtex do rim em casos clínicos da intoxicação cobre aguda (ACP). Um total de 97 bezerros foi compilado em onze fazendas. Pelo menos, uma necropsia foi realizada em cada caso e foram colhidas amostras para análise complementar. O grau de autólise em cada necropsia foi avaliado. Os casos aparecem em criação extensiva e também em fazendas de confinamento intensivo. Os pesos dos animais variavam de 60 até 200 kg. Mortalidade variou entre 0,86 e 6,96 por cento, em todas as fazendas estudadas, o primeiro animal morto foi observado entre 6 e 72 horas após à administração parenteral de Cu. Surgirem discrepâncias em relação ao valor de referência a ser usado. O valor local (19. 9 partes por milhão) foi usado, confirmando o diagnóstico de intoxicação aguda de cobre em 93 por cento das amostras analisadas nos rins. Estes resultados confirmam o valor diagnóstico da concentração de Cu no rim córtex para o diagnóstico de ACP.

Renal cortex copper concentration in acute copper poisoning in calves / Concentração de cobre no córtex renal na intoxicação aguda de cobre em bezerros

The aim of this study was to estimate the diagnostic value of renal cortex copper (Cu) concentration in clinical cases of acute copper poisoning (ACP). A total of 97 calves that died due to subcutaneous copper administration were compiled in eleven farms. At least, one necropsy was conducted on each farm and samples for complementary analysis were taken. The degree of autolysis in each necropsy was evaluated. The cases appeared on extensive grazing calf breeding and intensive feedlot farms, in calves of 60 to 200 kg body weight. Mortality varied from 0.86 to 6.96 percent, on the farms studied. The first succumbed calf was found on the farms between 6 and 72 hours after the susbcutaneous Cu administration. As discrepancies regarding the reference value arose, the local value (19.9 parts per million) was used, confirming the diagnosis of acute copper poisoning in 93 percent of the analyzed kidney samples. These results confirm the value of analysis of the cortical kidney Cu concentration for the diagnosis of acute copper poisoning.(AU)

O objetivo deste trabalho foi estimar o valor diagnóstico de concentração de cobre (Cu) no córtex do rim em casos clínicos da intoxicação cobre aguda (ACP). Um total de 97 bezerros foi compilado em onze fazendas. Pelo menos, uma necropsia foi realizada em cada caso e foram colhidas amostras para análise complementar. O grau de autólise em cada necropsia foi avaliado. Os casos aparecem em criação extensiva e também em fazendas de confinamento intensivo. Os pesos dos animais variavam de 60 até 200 kg. Mortalidade variou entre 0,86 e 6,96 por cento, em todas as fazendas estudadas, o primeiro animal morto foi observado entre 6 e 72 horas após à administração parenteral de Cu. Surgirem discrepâncias em relação ao valor de referência a ser usado. O valor local (19. 9 partes por milhão) foi usado, confirmando o diagnóstico de intoxicação aguda de cobre em 93 por cento das amostras analisadas nos rins. Estes resultados confirmam o valor diagnóstico da concentração de Cu no rim córtex para o diagnóstico de ACP.(AU)

Intoxicação experimental por Trema micrantha em equinos / Experimental Trema micrantha poisoning in horses

O objetivo desse estudo foi confirmar a toxidez e caracterizar os aspectos clínicos e patológicos da intoxicação por Trema micrantha em equinos. Três equinos, pôneis, com idade entre 2 e 7 anos consumiram espontaneamente folhas de T. micrantha em doses únicas de 30g/kg, 25g/ kg e 20g/kg. Os três animais adoeceram e evoluíram para morte. Outro equino recebeu 15 e 25g/kg da planta com intervalo de 30 dias entre as doses e não apresentou alteração clínica. Coletas diárias de sangue foram realizadas para análises bioquímicas. Os principais sinais clínicos apresentados foram apatia, desequilíbrios, dificuldade de deglutição, decúbito esternal, decúbito lateral, movimentos de pedalagem, coma e morte. Os três equinos afetados apresentaram elevação da atividade sérica de gama-glutamil transferase, dos níveis séricos de amônia e diminuição da glicemia. Esses animais foram necropsiados e fragmentos de diversos órgãos foram coletados para análise histopatológica e imuno-histoquímica. Os principais achados patológicos foram encontrados no fígado e no encéfalo dos três animais. O fígado apresentava, macroscopicamente, acentuação do padrão lobular; enquanto que, no encéfalo havia áreas amareladas na superfície de corte, mais evidentes na substância branca do cerebelo. Microscopicamente, o fígado apresentava tumefação hepatocelular, necrose de coagulação predominantemente centrolobular e hemorragia associada. No encéfalo, havia edema perivascular generalizado e astrócitos Alzheimer tipo II na substância cinzenta. Esses astrócitos apresentaram marcação fraca ou negativa na imuno-histoquímica anti-GFAP e marcação positiva do antígeno S-100. A dose letal mínima de folhas de T. micrantha estabelecida nesse experimento foi de 20g/kg. A ampla distribuição e palatabilidade desta planta, associadas à alta sensibilidade da espécie equina, constatada nesse experimento, reforçam a importância da planta em casos acidentais de intoxicação em equinos.(AU)

The aim of this study was to confirm the toxicity and characterize the clinical and pathological aspects of poisoning by Trema micrantha in horses. The green leaves of the plant were spontaneously consumed by three ponies at single doses of 20, 25, and 30g/kg. The three ponies developed clinical disease characterized by apathy, equilibrium deficit, deglutition difficulty, sternal or lateral recumbency, paddling, coma and death. Affected ponies had also enhanced seric activity of gamma-glutamyl transferase, seric ammonia apart of diminished glycemia. An additional pony, that received 15 and 25g/kg of T. micrantha with a 30 day interval between the two doses, showed no clinical disease. The three ponies were necropsied and fragments from organs were collected for histology and immunostaining (IS) procedures. The main pathological findings were in the liver and encephalon. There were enhanced lobular pattern of the liver and yellowish areas in the cut surface of the encephalon, especially visualized in the cerebellar white matter. Microscopically, there was hepatocellular swelling and coagulative hepatic necrosis predominantly centrilobular with hemorrhages. Generalized perivascular edema and Alzheimer type II astrocytes were observed in the encephalon. The Alzheimer type II astrocytes showed weak or absent anti-glial fibrillar acid protein IS associated with positive IS for S-100 protein. The minimal lethal dose of Trema micrantha leaves was established at 20g/kg. The sensibility of horses to this plant, its wide distribution and high palatability reinforces the importance of Trema micrantha in accidental poisoning of horses.(AU)

Intoxicação aguda com sementes de Crotalaria spectabilis (Leg. Papilionoideae) em suínos / Acute poisoning with Crotalaria spectabilis (Leg. Papilionoideae) seeds in pigs

Relata-se necrose hepatocelular em suínos após consumo de ração que continha grãos de sorgo-granífero (Sorghum bicolor) acidentalmente contaminado com sementes de Crotalaria spectabilis. Morreram 76 suínos em quatro propriedades no município de Juscimeira, MT. Os sinais clínicos iniciaram-se 24-48 horas após o consumo da ração contaminada e foram caracterizados por depressão, letargia, apatia, inapetência, vômito, mucosas ictéricas ou pálidas, ascite, decúbito esternal, decúbito lateral com movimentos de pedalagem e convulsões, a evolução clínica foi de 48-60 horas seguida de morte. As Principais alterações macroscópicas foram fígado aumentado de tamanho com evidenciação do padrão lobular, ascite e hidrotórax com líquido de coloração amarelo avermelhado contendo filamentos com aspecto de fibrina, linfonodos aumentados e edema pulmonar interlobular. A doença foi reproduzida utilizando-se 16 suínos divididos em seis grupos que receberam sementes de C. spectabilis em diferentes doses. Necrose hepatocelular ocorreu em sete suínos, sendo dois que receberam doses diárias 2,5g/kg e cinco que receberam doses únicas de 5,0 e 9,5g/kg. Dez doses diárias de 0,5 e 1,25g/kg causaram fibrose hepática.

Hepatocellular necrosis are reported in swine after consumption of diets containing grains of "sorgo-granífero" (Sorghum bicolor) accidentally contaminated with Crotalaria spectabilis seeds in the municipality of Juscimeira, MT. Clinical signs began 24-48 hours after consumption of contaminated ration and were characterized by depression, lethargy, apathy, loss of appetite, vomiting, pale or jaundiced mucous membranes, ascites, lateral recumbency, the lateral position with paddling and convulsions, clinical outcome was 48-60 hours followed by death. 76 pigs died in four properties. The main gross lesions were liver increased in size and lobular illustration with red-brown central areas interspersed with yellowish areas, ascites and hydrothorax with reddish-yellow liquid containing filaments with aspect of fibrin, enlarged lymph nodes and interlobular pulmonary edema. The disease was experimentally reproduced with 16 pigs divided into six groups that received seeds of C. spectabilis in different doses. Hepatocellular necrosis occurred in seven pigs, two of which received daily doses of 2.5g/kg and five who received single doses of 5 and 9.5g/ kg. Ten daily doses of 0.5 and 1.25g/kg caused liver fibrosis.

Intoxicação aguda com sementes de Crotalaria spectabilis (Leg. Papilionoideae) em suínos / Acute poisoning with Crotalaria spectabilis (Leg. Papilionoideae) seeds in pigs

Relata-se necrose hepatocelular em suínos após consumo de ração que continha grãos de sorgo-granífero (Sorghum bicolor) acidentalmente contaminado com sementes de Crotalaria spectabilis. Morreram 76 suínos em quatro propriedades no município de Juscimeira, MT. Os sinais clínicos iniciaram-se 24-48 horas após o consumo da ração contaminada e foram caracterizados por depressão, letargia, apatia, inapetência, vômito, mucosas ictéricas ou pálidas, ascite, decúbito esternal, decúbito lateral com movimentos de pedalagem e convulsões, a evolução clínica foi de 48-60 horas seguida de morte. As Principais alterações macroscópicas foram fígado aumentado de tamanho com evidenciação do padrão lobular, ascite e hidrotórax com líquido de coloração amarelo avermelhado contendo filamentos com aspecto de fibrina, linfonodos aumentados e edema pulmonar interlobular. A doença foi reproduzida utilizando-se 16 suínos divididos em seis grupos que receberam sementes de C. spectabilis em diferentes doses. Necrose hepatocelular ocorreu em sete suínos, sendo dois que receberam doses diárias 2,5g/kg e cinco que receberam doses únicas de 5,0 e 9,5g/kg. Dez doses diárias de 0,5 e 1,25g/kg causaram fibrose hepática.(AU)

Hepatocellular necrosis are reported in swine after consumption of diets containing grains of "sorgo-granífero" (Sorghum bicolor) accidentally contaminated with Crotalaria spectabilis seeds in the municipality of Juscimeira, MT. Clinical signs began 24-48 hours after consumption of contaminated ration and were characterized by depression, lethargy, apathy, loss of appetite, vomiting, pale or jaundiced mucous membranes, ascites, lateral recumbency, the lateral position with paddling and convulsions, clinical outcome was 48-60 hours followed by death. 76 pigs died in four properties. The main gross lesions were liver increased in size and lobular illustration with red-brown central areas interspersed with yellowish areas, ascites and hydrothorax with reddish-yellow liquid containing filaments with aspect of fibrin, enlarged lymph nodes and interlobular pulmonary edema. The disease was experimentally reproduced with 16 pigs divided into six groups that received seeds of C. spectabilis in different doses. Hepatocellular necrosis occurred in seven pigs, two of which received daily doses of 2.5g/kg and five who received single doses of 5 and 9.5g/ kg. Ten daily doses of 0.5 and 1.25g/kg caused liver fibrosis.(AU)

Síndrome HELLP com necrose hepática maciça: relato de caso / HELLP syndrome with massive hepatic necrosis: case report

Essa síndrome pode ocorrer em diferentes fases da gestação e no pós-parto, sendo mais comum no segundo ou terceiro trimestre. É caracterizada por hemólise, aumento das aminotransferases e plaquetopenia (HELLP: HEmolysis, Liver Ezimes, Low Platelets)1 .Representa alteração microangiopática no fígado, que ocorre na pré-eclâmpsia grave e na eclâmpsia com frequência de 2 a 12%. Seu risco está aumentado em pacientes com múltiplas gestações, associado à idade maior de 25 anos.1 A suspensão da gravidez interrompe o curso desse distúrbio e outras gestações podem novamente desencadeá-lo.2 A sintomatologia inicial caracteriza-se por: dor no andar superior do abdômen, especialmente no hipocôndrio direito, náuseas e vômitos.1 Pode evoluir com convulsões, sangramento gengival e hematúria.1,3 A abordagem ao paciente inclui internação em Centro de Terapia Intensiva para monitorização adequada; interrupção da gravidez, na possibilidade de viabilidade do feto; e cirurgia de urgência em caso de hemorragia intraperitoneal.2(AU)

This syndrome may occur at different stages of pregnancy and postpartum being more common in the second or third quarter. HELLP syndrome is characterized by a disorder during pregnancy, attending with hemolysis, increased aminotransferases and thrombocytopenia. Microangiopthy is a change occurs on the liver in pre-eclampsia serious and often eclâmpsia of 2 to 12%. Multiple pregnancies associated with an old age, over 25 years, increase the risk for HELLP syndrome.3 It is the acronym: HEmolysis, liver Ezimes, low platelets.3 Abortion interrupted the course of disease and other pregnancies unleash again syndrome.2 The original symptoms are: pain in the upper floor of the abdomen, especially in the right hypochondrium, nausea and vomiting.3 The symptoms may evolve with convulsions, bleeding edge and hematuria.1,3 The treatment requires monitoring, interruption of pregnancy in the possibility of fetal viability, emergency surgery in case of hospitalization and intraperitoneal hemorrhage in intensive care center.2(AUI)

Intoxicação por Trema micrantha (Ulmaceae) em caprinos no Estado de Santa Catarina / Poisoning by Trema micrantha (Ulmaceae) in goats in the State of Santa Catarina

Vinte e cinco caprinos, criados em piquetes, morreram nos cinco dias subsequentes ao fornecimento de folhas de Trema micrantha (fam.Ulmaceae), uma árvore com nome comum de grandiúva. Quatro caprinos foram necropsiados e amostras de vísceras foram coletadas para exame histológico. As principais alterações clínicas foram: apatia, anorexia, cabeça apoiada contra obstáculos, decúbito e morte. Achados macroscópicos incluíram sufusões no epicárdio e endocárdio; fígado levemente amarelado e com padrão lobular evidente e, em um caso, acompanhado de hemorragias multifocais. Na histologia observou-se necrose hepática, que variava de centrolobular a massiva, compatível com hepatopatia tóxica. No SNC havia satelitose, tumefação neuronal, edema periaxonal, perivascular. O diagnóstico de intoxicação por Trema micrantha foi baseado no quadro clínico e lesional de hepatite tóxica associado ao uso da planta para alimentação de caprinos.

Twenty five goats, maintained in paddocks, had died in five subsequent days after have been offered leaves, mixed in the ration, of Trema micrantha, a tree commonly called grandiúva. Four animals were necropsied and samples were collected for histopathology. Clinical signs included apathy, anorexia, head pressing against obstacles, decubitus and death. Macroscopic findings included suffusions in the epi- and endocardium, a yellowish liver with pronounced lobular pattern, in one goat, the liver presented additionally multiple visible hemorrhages. Histological examination revealed centrilobular to massive hepatic necrosis consistent with acute liver toxicosis. In the brain, satelitosis, neuronal swelling, and perineuronal and perivascular edema was found. The diagnosis of poisoning by Trema micrantha was based in the clinical picture characteristic of toxic hepatitis associated in the feeding of the plant to the goats.

Intoxicação por Trema micrantha (Ulmaceae) em caprinos no Estado de Santa Catarina / Poisoning by Trema micrantha (Ulmaceae) in goats in the State of Santa Catarina

Vinte e cinco caprinos, criados em piquetes, morreram nos cinco dias subsequentes ao fornecimento de folhas de Trema micrantha (fam.Ulmaceae), uma árvore com nome comum de grandiúva. Quatro caprinos foram necropsiados e amostras de vísceras foram coletadas para exame histológico. As principais alterações clínicas foram: apatia, anorexia, cabeça apoiada contra obstáculos, decúbito e morte. Achados macroscópicos incluíram sufusões no epicárdio e endocárdio; fígado levemente amarelado e com padrão lobular evidente e, em um caso, acompanhado de hemorragias multifocais. Na histologia observou-se necrose hepática, que variava de centrolobular a massiva, compatível com hepatopatia tóxica. No SNC havia satelitose, tumefação neuronal, edema periaxonal, perivascular. O diagnóstico de intoxicação por Trema micrantha foi baseado no quadro clínico e lesional de hepatite tóxica associado ao uso da planta para alimentação de caprinos.(AU)

Twenty five goats, maintained in paddocks, had died in five subsequent days after have been offered leaves, mixed in the ration, of Trema micrantha, a tree commonly called grandiúva. Four animals were necropsied and samples were collected for histopathology. Clinical signs included apathy, anorexia, head pressing against obstacles, decubitus and death. Macroscopic findings included suffusions in the epi- and endocardium, a yellowish liver with pronounced lobular pattern, in one goat, the liver presented additionally multiple visible hemorrhages. Histological examination revealed centrilobular to massive hepatic necrosis consistent with acute liver toxicosis. In the brain, satelitosis, neuronal swelling, and perineuronal and perivascular edema was found. The diagnosis of poisoning by Trema micrantha was based in the clinical picture characteristic of toxic hepatitis associated in the feeding of the plant to the goats.(AU)

Achados clínicos e patológicos em cães infectados naturalmente por herpesvírus canino / Clinical and pathological Findings in dogs infected naturally by canine herpes virus

Descrevem-se os achados clínicos e patológicos e os exames laboratoriais de filhotes de cães com diagnóstico post mortem de infecção por herpesvírus canino. Os casos ocorreram em duas propriedades da Cidade de Porto Alegre, Rio Grande do Sul, em abril de 2007 e julho de 2008. Clinicamente, os cães apresentaram anorexia, apatia, choro e dispneia. A morte dos cães ocorreu após 24-72 horas do início dos sinais clínicos. Na necropsia observaram-se hemorragia multifocal renal e hepatomegalia com petéquias e pontos brancos na superfície natural do fígado. Os pulmões se apresentaram não-colapsados e vermelhos. Havia esplenomegalia e, em alguns cães, petéquias na superfície capsular do baço. Aumento dos linfonodos mesentéricos e do timo foi observado. Lesões microscópicas incluíram hemorragia e necrose multifocal em células epiteliais tubulares renais, hepatócitos e tecidos linfoides. Nos pulmões, havia necrose alveolar multifocal acentuada com abundante material fibrinoso e infiltrado inflamatório misto de intensidade variada. Ocasionais corpúsculos de inclusão intranucleares em áreas periféricas à necrose foram identificados em hepatócitos, células epiteliais de túbulos renais e células alveolares. Amostras de fígado, rim e pulmão foram positivas na imunofluorescência direta para herpesvírus canino tipo 1 (CHV-1). O diagnóstico de infecção por herpesvírus foi baseado nos achados de necropsia, histológicos e de imunofluorescência positiva em tecidos usando anticorpo anti-CHV-1. De nosso conhecimento, este é o primeiro relato da identificação do CHV-1 no Brasil, embora achados clínico-patológicos anteriores já sugerissem a presença do agente na população canina do país.

The clinic and pathological findings and laboratorial testing of puppies with postmortem diagnosis of canine herpesvirus infection are described. The cases occurred in two households of Porto Alegre, RS, in April 2007 and July 2008. The puppies presented anorexia, depression, cry and dyspnea, followed by death about 24-72 hours after the onset of clinical signs. At necropsy multifocal pin point hemorrhages were observed in the kidneys. The liver was enlarged with petechiae and white foci on the surface. The lungs were red and did not collapse. The spleen was enlarged and, in some cases, with petechiae on the capsular surface. Mesenteric lymph nodes and thymus were enlarged. Microscopic lesions included hemorrhages and multifocal necrosis of the renal tubular epithelial cells, hepatocytes and lymphoid tissues. In the lungs there was severe multifocal alveolar necrosis with abundant fibrin deposits and a mixed inflammatory infiltrate of variable intensity. Intranuclear inclusion bodies were identified in the periphery of necrotic areas in hepatocytes, renal tubular epithelial cells and alveolar cells. Samples of liver, kidney and lung were positive in the direct immunofluorescence test for canine herpes virus type 1 (CHV-1). The diagnosis was based on epidemiological data, necropsy findings, histological lesions and positive immunofluorescence results using CHV-1 antibody in tissue samples. To our knowledge, this is the first report of the identification of CHV-1 in Brazil, although previous clinic and pathological findings already suggested the presence of the virus in Brazilian canine population.