A study of human myocardial tissue in Chagas' disease: distribution and frequency of inflammatory cell types

Although many reports have described the presence of inflammatory cells in chagasic lesions, the precise role(s) of these cells and whether their numbers in the lesions correlate with lesion severity are not known. In this work, we determined the numbers of mononuclear cells, neutrophils and eosinophils present in lesion sites of heart tissue sections from one acute and nine chronic chagasic patients. These numbers were independently recorded for five types of histologic patterns (HP) defined by the following characteristics: interstitial myocarditis with degeneration and necrosis of muscle fibers (HP I), interstitial myocarditis with preservation of muscle fibers (HP II), minimal or absent myocarditis with essentially preserved myocardium (HP III), interstitial fibrosis (HP IV), and myocytolysis (HP V). The largest numbers of inflammatory cells were found in HP I where substantial numbers of eosinophils were found. Eosinophils were frequently seen in areas showing HP I in the tissue sections from the patients with the most severe myocarditis (in terms of the high frequency of necrotic areas in HP I). Eosinophils were also seen in areas of HP III, i.e. in relatively preserved areas of tissue sections from patients displaying the most severe myocarditis, although in lesser numbers than found in HP I. The smallest numbers of inflammatory cells were seen in HP III, where the myocardium was essentially intact. Although significant numbers of inflammatory cells were seen in HP II and IV, eosinophils were either present in small numbers or absent, and there was no obvious correlation between the content of any of the monitored cell types and the overall intensity of myocarditis. The presence of relatively large proportions of eosinophils in tissue areas with HP I type of lesions would appear to implicate these cells in the production of chagasic heart lesions.