Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study
| العنوان: | Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study |
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| المؤلفون: | Wendy S. Barclay, Mark Thursz, Rebecca Penn, Justin Weir, Patrizia Viola, Graham S Cooke, Andrew G. Nicholson, Candice Roufosse, Richard Corbett, Pinelopi Manousou, Robert D. Goldin, Laury Baillon, Safa Al-Sarraj, Olivia C. Swann, Alireza Abdolrasouli, Kikkeri N. Naresh, Michael Osborn, Brian Hanley |
| المساهمون: | National Institute for Health Research |
| المصدر: | The Lancet Microbe e253 e245 The Lancet. Microbe The Lancet Microbe, Vol 1, Iss 6, Pp e245-e253 (2020) |
| بيانات النشر: | Elsevier BV, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Microbiology (medical), medicine.medical_specialty, lcsh:QR1-502, Autopsy, Nonbacterial thrombotic endocarditis, Microbiology, lcsh:Microbiology, Article, Pericarditis, Virology, Internal medicine, medicine, Humans, Mucormycosis, Diffuse alveolar damage, Lung, Cause of death, lcsh:R5-920, SARS-CoV-2, business.industry, COVID-19, Thrombosis, medicine.disease, United Kingdom, Viral Tropism, Infectious Diseases, medicine.anatomical_structure, Pancreatitis, Infarction, Acute Disease, Acute pancreatitis, lcsh:Medicine (General), business |
| الوصف: | Summary: Background: Severe COVID-19 has a high mortality rate. Comprehensive pathological descriptions of COVID-19 are scarce and limited in scope. We aimed to describe the histopathological findings and viral tropism in patients who died of severe COVID-19. Methods: In this case series, patients were considered eligible if they were older than 18 years, with premortem diagnosis of severe acute respiratory syndrome coronavirus 2 infection and COVID-19 listed clinically as the direct cause of death. Between March 1 and April 30, 2020, full post-mortem examinations were done on nine patients with confirmed COVID-19, including sampling of all major organs. A limited autopsy was done on one additional patient. Histochemical and immunohistochemical analyses were done, and histopathological findings were reported by subspecialist pathologists. Viral quantitative RT-PCR analysis was done on tissue samples from a subset of patients. Findings: The median age at death of our cohort of ten patients was 73 years (IQR 52–79). Thrombotic features were observed in at least one major organ in all full autopsies, predominantly in the lung (eight [89%] of nine patients), heart (five [56%]), and kidney (four [44%]). Diffuse alveolar damage was the most consistent lung finding (all ten patients); however, organisation was noted in patients with a longer clinical course. We documented lymphocyte depletion (particularly CD8-positive T cells) in haematological organs and haemophagocytosis. Evidence of acute tubular injury was noted in all nine patients examined. Major unexpected findings were acute pancreatitis (two [22%] of nine patients), adrenal micro-infarction (three [33%]), pericarditis (two [22%]), disseminated mucormycosis (one [10%] of ten patients), aortic dissection (one [11%] of nine patients), and marantic endocarditis (one [11%]). Viral genomes were detected outside of the respiratory tract in four of five patients. The presence of subgenomic viral RNA transcripts provided evidence of active viral replication outside the respiratory tract in three of five patients. Interpretation: Our series supports clinical data showing that the four dominant interrelated pathological processes in severe COVID-19 are diffuse alveolar damage, thrombosis, haemophagocytosis, and immune cell depletion. Additionally, we report here several novel autopsy findings including pancreatitis, pericarditis, adrenal micro-infarction, secondary disseminated mucormycosis, and brain microglial activation, which require additional investigation to understand their role in COVID-19. Funding: Imperial Biomedical Research Centre, Wellcome Trust, Biotechnology and Biological Sciences Research Council. |
| تدمد: | 2666-5247 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cbda26adce5deac1afb2b77719e1cf14 https://doi.org/10.1016/s2666-5247(20)30115-4 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....cbda26adce5deac1afb2b77719e1cf14 |
| قاعدة البيانات: | OpenAIRE |
Full Text via ClinicalKey | تدمد: | 26665247 |
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