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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Vydáno v:	Critical care (London, England) Ročník 24; číslo 1; s. 495 - 10
Hlavní autoři:	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
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	London BioMed Central 12.08.2020 BioMed Central Ltd Springer Nature B.V BMC
Témata:	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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Shrnutí:	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.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	1364-8535 1466-609X 1364-8535 1466-609X 1366-609X
DOI:	10.1186/s13054-020-03218-5