An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C
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)
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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