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An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C
Duarte-Neto, Amaro Nunes; Caldini, Elia Garcia; Gouvêa-Gomes, Michele Soares; Kanamura, Cristina Takami; Monteiro, Renata Aparecida de Almeida; Ferranti, Juliana Ferreira; Ventura, Andrea Maria Cordeiro; Regalio, Fabiane Aliotti; Fiorenzano, Daniela Matos; Gibelli, Maria Augusta Bento Cicaroni; Carvalho, Werther Brunow; Leal, Gabiela Nunes; Pinho, João Renato Rebello; Delgado, Arthur Figueiredo; Carneiro-Sampaio, Magda; Mauad, Thais; Silva, Luiz Fernando Ferraz da; Saldiva, Paulo Hilario Nascimento; Dolhnikoff, Marisa.
  • Duarte-Neto, Amaro Nunes; Instituto Adolfo Lutz. BR
  • Caldini, Elia Garcia; Universidade de São Paulo. BR
  • Gouvêa-Gomes, Michele Soares; Universidade de São Paulo. BR
  • Kanamura, Cristina Takami; Instituto Adolfo Lutz. BR
  • Monteiro, Renata Aparecida de Almeida; Universidade de São Paulo. BR
  • Ferranti, Juliana Ferreira; Universidade de São Paulo. BR
  • Ventura, Andrea Maria Cordeiro; Universidade de São Paulo. BR
  • Regalio, Fabiane Aliotti; Universidade de São Paulo. BR
  • Fiorenzano, Daniela Matos; Universidade de São Paulo. BR
  • Gibelli, Maria Augusta Bento Cicaroni; Universidade de São Paulo. BR
  • Carvalho, Werther Brunow; Universidade de São Paulo. BR
  • Leal, Gabiela Nunes; Universidade de São Paulo. BR
  • Pinho, João Renato Rebello; Universidade de São Paulo. BR
  • Delgado, Arthur Figueiredo; Universidade de São Paulo. BR
  • Carneiro-Sampaio, Magda; Universidade de São Paulo. BR
  • Mauad, Thais; Universidade de SãoPaulo. BR
  • Silva, Luiz Fernando Ferraz da; Universidade de SãoPaulo. BR
  • Saldiva, Paulo Hilario Nascimento; Universidade de São Paulo. BR
  • Dolhnikoff, Marisa; Universidade de São Paulo. BR
EClinicalMedicine ; 35: 1-13, 2021. ilus
Article in Portuguese | LILACS, ColecionaSUS, SES-SP, CONASS, SESSP-IALPROD, SES-SP | ID: biblio-1222994
ABSTRACT

Background:

COVID-19 in children is usually mild or asymptomatic, but severe and fatal paediatric cases have been described. The pathology of COVID-19 in children is not known; the proposed pathogenesis for severe cases includes immune-mediated mechanisms or the direct effect of SARS-CoV-2 on tissues. We describe the autopsy findings in five cases of paediatric COVID-19 and provide mechanistic insight into the mechanisms involved in the pathogenesis of the disease.

Methods:

Children and adolescents who died with COVID-19 between March 18 and August 15, 2020 were autopsied with a minimally invasive method. Tissue samples from all vital organs were analysed by histology, electron microscopy (EM), reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry (IHC).

Findings:

Five patients were included, one male and four female, aged 7 months to 15 years. Two patients had severe diseases before SARS-CoV-2 infection adrenal carcinoma and Edwards syndrome. Three patients were previously healthy and had multisystem inflammatory syndrome in children (MIS-C) with distinct clinical presentations myocarditis, colitis, and acute encephalopathy with status epilepticus. Autopsy findings varied amongst patients and included mild to severe COVID-19 pneumonia, pulmonary microthrombosis, cerebral oedema with reactive gliosis, myocarditis, intestinal inflammation, and haemophagocytosis. SARSCoV- 2 was detected in all patients in lungs, heart and kidneys by at least one method (RT-PCR, IHC or EM), and in endothelial cells from heart and brain in two patients with MIS-C (IHC). In addition, we show for the first time the presence of SARS-CoV-2 in the brain tissue of a child with MIS-C with acute encephalopathy, and in the intestinal tissue of a child with acute colitis.

Interpretation:

SARS-CoV-2 can infect several cell and tissue types in paediatric patients, and the target organ for the...(AU)
Subject(s)
Full text: Available Index: LILACS (Americas) Main subject: Phenotype / Autopsy Language: Portuguese Journal: EClinicalMedicine Year: 2021 Type: Article Institution/Affiliation country: Instituto Adolfo Lutz/BR / Universidade de São Paulo/BR / Universidade de SãoPaulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: Phenotype / Autopsy Language: Portuguese Journal: EClinicalMedicine Year: 2021 Type: Article Institution/Affiliation country: Instituto Adolfo Lutz/BR / Universidade de São Paulo/BR / Universidade de SãoPaulo/BR