Histopathology of the human liver in yellow fever with special emphasis on the diagnostic role of the Councilman body

Abstract

Liver specimens from 10 cases of yellow fever (YF) were studied by light and four by electron microscopy to review morphological aspects of the disease relevant to its diagnosis, with special emphasis on acidophilic bodies (AB) and on the possible presence of the virus within infected cells. The AB were compared with those found in 22 out of 69 liver specimens with other pathological processes. In YF the typical alteration was an acidophilic hepatocellular necrosis with a preferential midzonal distribution. Ceroid pigment was abundant, its amount was proportional to the degree of liver cell damage and it was found in altered hepatocytes and Kupffer cells in the most damaged areas. The inflammatory infiltrate was scanty, not only in portal tracts but also within the lobules. Electron microscopically, no viral particles were found in liver cells or AB. The latter appeared as round or elliptical cytoplasmic masses, surrounded by a conspicuous cellular membrane and densely packed with organelles, fat vacuoles and residual bodies. They differed from AB in other liver diseases by the presence of fat vacuoles and ceroid pigment. Some peculiarities of AB in other liver diseases such as presence of bile pigment and iron, would depend upon the presence of these pigments in the hepatocytes which originated them.

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

“…This is the first study, to our knowledge, to describe hepatic and systemic pathological findings in autopsies of YF‐related OLT patients. The diagnosis of infection of the engrafted liver by YFV in all four autopsies using histopathology, immunohistochemistry and molecular methods further reinforces previous studies on YF pathology . Moreover, major lesions were found in other organs, confirming that YFV causes systemic disease, with a biological behaviour different from the classic hepatotropic virus.…”

Host-cell interaction of attenuated and wild-type strains of yellow fever virus can be differentiated at early stages of hepatocyte infection

“…Induction of apoptosis of hepatic cells found in this in vitro model may therefore be an important marker of the attenuated 17D strain. However, it should be noted that in vivo, in the liver of YF fatal cases, some Councilman bodies were observed and described as apoptotic hepatocytes [17,18]. Therefore, infection of hepatic cells by a YF wild-type strain could be associated with an apoptotic process in vivo.…”

“…Viral antigens and histopathological alterations identified in liver samples of YF fatal cases are preferentially observed in the midzone area. The hepatocellular changes mainly described are hepatocytic steatosis, focal areas of necrosis and the presence of Councilman bodies, which are typical of YF infection and might coincide with apoptotic cells [17,18]. Due to the liver tropism of the YF virus in vivo, we used a human hepatic cell line to compare in vitro the cellular responses to infection by the YF attenuated 17D and parental Asibi strains.…”

Outbreak of Yellow Fever among Nonhuman Primates, Espirito Santo, Brazil, 2017

“…We observed classic histopathologic commonalities with yellow fever–associated disease in humans (midzonal lytic necrosis, apoptotic bodies, steatosis, and scarce paucicellular inflammation) ( 10 , 11 ). The severity and extent of these lesions probably accounted for severe hepatic failure and death of the animals.…”