Neuropathology of Yellow Fever Autopsy Cases

Abstract Objective: We analyzed morphologically and immunohistochemically the brains of yellow fever patients who underwent autopsy, in order to identify and characterize neuropathological changes, which have few descriptions in the literature. The data were compared with brains collected from individuals without the disease, as a control group. Both cases and controls were subdivided according to the presence or absence of co-concurrent septic shock, in order to exclude changes of the sepsis associated encephalopathy.Results: All cases and controls presented, at least focally, neuropathological changes, which included edema, meningeal and parenchymal inflammatory infiltrate and hemorrhages, and perivascular inflammatory infiltrate. We did not find an unequivocal aspect of encephalitis. The only parameter that, after statistical analysis, can be attributed to the presence of yellow fever, was the perivascular inflammatory infiltrate. Since most of the parameters evaluated did not show statistically significant differences between cases and controls, an explanation for the presence of neuropathological findings may be the vascular changes, consequent to shock induced endotheliopathy, associated with stimulation of the immune system inherent to systemic infectious processes.