Coronary artery disease · 2001
On the wide spectrum of abnormalities in the coronary arteries of Whipple's disease.
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James T N
Аннотация
BACKGROUND: There is growing interest in the role of microbes in the pathogenesis of coronary atherosclerosis but most of the evidence has been seroepidemiologic. It would be useful to know more about the cytology and histology of coronary lesions containing clearly depicted microbes.
OBJECTIVE: To define carefully the assorted abnormalities apparent in the coronary arteries of individuals dying with Whipple's disease.
METHODS: Myocardial tissue from 12 cases of Whipple's disease was studied by light microscopy. Slides were stained routinely (in sequence) with either the periodic-acid-Schiff (PAS) or Goldner-trichrome method and some with Gomori methenimine silver. Cardiac slides with PAS-positive bacilli were compared to lesions in jejunal lamina propria.
RESULTS: There were abundant sites of coronary arterial damage associated with presence of Whipple bacilli, more in the tunica media than in intima and adventitia. Bacilli in the arterial lesions were identical to those in lamina propria. Medial lesions were often associated with a fibroproliferative 'atheroma'. Both intracellular and extracellular bacilli were found. Most lesions were devoid of inflammation, but some sites exhibited either florid arteritis or dense scarring. Arteries that were scarred or inflamed exhibited only a few bacilli. There was an apparent affinity of bacilli for the nuclei in medial smooth muscle cells and in nearby ventricular myocytes. Apoptosis (TUNEL-positive) was present in medial smooth muscle cells, endothelial cells, and ventricular myocytes.
CONCLUSIONS: There is a wide spectrum of coronary abnormalities in Whipple's disease. It would be useful to know how often the Whipple bacillus is a part of the total pathogen burden in coronary disease.
OBJECTIVE: To define carefully the assorted abnormalities apparent in the coronary arteries of individuals dying with Whipple's disease.
METHODS: Myocardial tissue from 12 cases of Whipple's disease was studied by light microscopy. Slides were stained routinely (in sequence) with either the periodic-acid-Schiff (PAS) or Goldner-trichrome method and some with Gomori methenimine silver. Cardiac slides with PAS-positive bacilli were compared to lesions in jejunal lamina propria.
RESULTS: There were abundant sites of coronary arterial damage associated with presence of Whipple bacilli, more in the tunica media than in intima and adventitia. Bacilli in the arterial lesions were identical to those in lamina propria. Medial lesions were often associated with a fibroproliferative 'atheroma'. Both intracellular and extracellular bacilli were found. Most lesions were devoid of inflammation, but some sites exhibited either florid arteritis or dense scarring. Arteries that were scarred or inflamed exhibited only a few bacilli. There was an apparent affinity of bacilli for the nuclei in medial smooth muscle cells and in nearby ventricular myocytes. Apoptosis (TUNEL-positive) was present in medial smooth muscle cells, endothelial cells, and ventricular myocytes.
CONCLUSIONS: There is a wide spectrum of coronary abnormalities in Whipple's disease. It would be useful to know how often the Whipple bacillus is a part of the total pathogen burden in coronary disease.