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: | , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
BioMed Central
12.08.2020
BioMed Central Ltd Springer Nature B.V BMC |
| Subjects: | |
| ISSN: | 1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X |
| Online Access: | Get full text |
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| Abstract | 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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| AbstractList | 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. Keywords: COVID-19, SARS-CoV-2, Autopsy, RT-PCR, Immunohistochemistry Abstract 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. 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. 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. 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). 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. 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. 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. 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. 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). 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. 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.BACKGROUNDPost-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients.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.METHODSWe 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.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).RESULTSPulmonary 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).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.CONCLUSIONSIn 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. 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. |
| ArticleNumber | 495 |
| Audience | Academic |
| Author | Peluso, Lorenzo Taccone, Fabio Silvio Trépant, Anne-Laure De Mendonça, Ricardo Remmelink, Myriam De Clercq, Sarah De Witte, Olivier Verocq, Camille Goffard, Jean-Christophe D’Haene, Nicky Salmon, Isabelle Maris, Calliope Vincent, Jean-Louis Racu, Marie-Lucie Rorive, Sandrine Lebrun, Laetitia Decaestecker, Christine Lavis, Philomène |
| Author_xml | – sequence: 1 givenname: Myriam surname: Remmelink fullname: Remmelink, Myriam organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 2 givenname: Ricardo surname: De Mendonça fullname: De Mendonça, Ricardo organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 3 givenname: Nicky surname: D’Haene fullname: D’Haene, Nicky organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 4 givenname: Sarah surname: De Clercq fullname: De Clercq, Sarah organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 5 givenname: Camille surname: Verocq fullname: Verocq, Camille organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 6 givenname: Laetitia surname: Lebrun fullname: Lebrun, Laetitia organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 7 givenname: Philomène surname: Lavis fullname: Lavis, Philomène organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 8 givenname: Marie-Lucie surname: Racu fullname: Racu, Marie-Lucie organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 9 givenname: Anne-Laure surname: Trépant fullname: Trépant, Anne-Laure organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Centre Universitaire inter Régional d’expertise en Anatomie Pathologique Hospitalière (CurePath, CHIREC, CHU Tivoli, ULB) – sequence: 10 givenname: Calliope surname: Maris fullname: Maris, Calliope organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 11 givenname: Sandrine surname: Rorive fullname: Rorive, Sandrine organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Centre Universitaire inter Régional d’expertise en Anatomie Pathologique Hospitalière (CurePath, CHIREC, CHU Tivoli, ULB) – sequence: 12 givenname: Jean-Christophe surname: Goffard fullname: Goffard, Jean-Christophe organization: Immunodeficiency Treatment Unit, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 13 givenname: Olivier surname: De Witte fullname: De Witte, Olivier organization: Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 14 givenname: Lorenzo surname: Peluso fullname: Peluso, Lorenzo organization: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 15 givenname: Jean-Louis surname: Vincent fullname: Vincent, Jean-Louis organization: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 16 givenname: Christine surname: Decaestecker fullname: Decaestecker, Christine organization: Laboratory of Image Synthesis and Analysis (LISA), Université Libre de Bruxelles (ULB), CPI 165/57, DIAPath, Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles (ULB), CPI 305/1 – sequence: 17 givenname: Fabio Silvio surname: Taccone fullname: Taccone, Fabio Silvio organization: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB) – sequence: 18 givenname: Isabelle orcidid: 0000-0002-7732-2863 surname: Salmon fullname: Salmon, Isabelle email: Isabelle.Salmon@erasme.ulb.ac.be organization: Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Centre Universitaire inter Régional d’expertise en Anatomie Pathologique Hospitalière (CurePath, CHIREC, CHU Tivoli, ULB), DIAPath, Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles (ULB), CPI 305/1 |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32787909$$D View this record in MEDLINE/PubMed |
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Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different... Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in... Background Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different... Abstract Background Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported... |
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| SubjectTerms | 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 |
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