Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients

Background Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients. Methods We evaluated whether some specific post-mortem features are observed in these patients and if these cha...

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Published in:Critical care (London, England) Vol. 24; no. 1; pp. 495 - 10
Main Authors: Remmelink, Myriam, De Mendonça, Ricardo, D’Haene, Nicky, De Clercq, Sarah, Verocq, Camille, Lebrun, Laetitia, Lavis, Philomène, Racu, Marie-Lucie, Trépant, Anne-Laure, Maris, Calliope, Rorive, Sandrine, Goffard, Jean-Christophe, De Witte, Olivier, Peluso, Lorenzo, Vincent, Jean-Louis, Decaestecker, Christine, Taccone, Fabio Silvio, Salmon, Isabelle
Format: Journal Article
Language:English
Published: London BioMed Central 12.08.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Aged
Autopsy
Betacoronavirus - isolation & purification
Brain - virology
Brain damage
Cardiovascular disease
Colon - virology
Coronavirus Infections - therapy
Coronavirus Infections - virology
Coronaviruses
COVID-19
Critical care
Critical Care Medicine
Emergency Medicine
Fatalities
Female
Health aspects
Heart - virology
Hemorrhage
Humans
Immunohistochemistry
Intensive
Kidney - virology
Kidneys
Laboratories
Liver - virology
Lung - virology
Lungs
Male
Medical research
Medicine
Medicine & Public Health
Methenamine
Middle Aged
Morphology
Mortality
Pandemics
Patients
Pneumonia
Pneumonia, Viral - therapy
Pneumonia, Viral - virology
Proteins
Pulmonary arteries
Respiratory diseases
Reverse Transcriptase Polymerase Chain Reaction
RT-PCR
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Spleen - virology
Viral infections
Viruses
United States > US
COVID-19
Immunohistochemistry
SARS-CoV-2
Autopsy
RT-PCR
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Summary:Background Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients. Methods We evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in the lung and other organs. Results Pulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes, and/or acute pneumonia were also observed. Four lung infarcts, two acute myocardial infarctions, and one ischemic enteritis were observed. There was no evidence of myocarditis, hepatitis, or encephalitis. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e., lung, heart, spleen, liver, colon, kidney, and brain). Conclusions In conclusion, autopsies revealed a great heterogeneity of COVID-19-associated organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-020-03218-5