REATIVAÇÃO DA DOENÇA DE CHAGAS EM INDIVÍDUOS COINFECTADOS PELO HIV: ASPECTOS HISTOPATOLÓGICOS

Abstract

Introduction – Reactivation of Chagas disease (CD) has been described in severe immunocompromised patients by various etiologies, among them those due to coinfection with HIV. Objective – Perform histopathological and immunohistochemical evaluation of the brain, myocardium, esophagus and large bowel of autopsied patients with CD and/or Acquired Immunodeficiency Syndrome (AIDS) compared with control patients. Material and Methods – A survey of autopsy reports was conducted in the period from 1998 to 2012 and selected eight adult subjects who were divided into four groups: Reactivation of Chagas disease (RE) (n=2), Chagas disease (CH) (n=2), AIDS (AI) (n=2) and Control (CO) (n=2). From each subject were collected and processed fragments of brain, myocardium, esophagus and large bowel whose fragments were processed for histological and immunohistochemical analysis. The histological sections stained with hematoxylin and eosin, Giemsa and Picrossirius were used to quantify the density of inflammatory cells, the density of mast cells and the percentage of collagen, respectively. Immunohistochemical analysis was performed to IL17 and CD31. Results – In the myocardium the density of mast cells was significantly higher in the CH group when compared to other groups. In the esophagus and large intestine, the density of mast cells was significantly higher when compared to other groups. The percentage of collagen in the esophagus, heart and intestine in the RE group was significantly lower when compared to the CO group. The CH group had a higher percentage of collagen in the myocardium and in the large bowel when compared to other groups. The density of cells immunostained by anti-IL17 was significantly higher in the large bowel and myocardium in the CH group when compared to the CO group. The myocardium and esophagus AI group higher density of vessels immunostained by anti-CD31 when compared to the other groups found. No significant correlations as the density of mast cells and percentage of collagen in groups RE, CO, CH and AI. Conclusion – Brain lesions found in patients with reactivation of DC and the highest density of immunostained cells by anti-IL17 at these sites suggests that this cytokine was intensifying local inflammation with consequent tissue damage due to inflammation. In addition, in these subjects, the highest density of mast cells in the esophagus and intestine suggests that these cells would be exercising relevant activity in esophageal and intestinal inflammation..