Functional changes in the respiratory system after COVID-19-associated lung injury

Since the beginning of the pandemic, COVID-19 (COronaVIrus Disease-2019) has been viewed as a respiratory disease with characteristic symptoms including cough, shortness of breath, and difficulty breathing. However, some patients still have respiratory complaints and post-inflammatory changes in the lung tissue according to high-resolution computed tomography of the chest organs (CT scan) even after discharge from the hospital. The aim. To assess the functional changes in the respiratory system in patients who had COVID-19-associated lung injury using a comprehensive testing of the respiratory function (spirometry, body plethysmography and diffusion test) in the first 6 months after discharge from the hospital. Methods. The study included 434 patients (252 men and 182 women, aged 20 to 79 years), who were divided into 3 groups depending on the time interval between discharge from the hospital and the respiratory function test: Group 1 – 15 – 45 days;Group 2 – 46 – 93 days;Group 3 – 94 – 183 days. All patients underwent a comprehensive testing of respiratory function. Results. The average pulmonary ventilation indicators remained within the normal range both in the general group and in separate groups. A decrease in DLCO was found in most patients: in 53% of people in the general group, in 54, 54 and 51% of cases in Groups 1, 2 and 3, respectively. Restrictive ventilation disorders (reduction of TLC below the lower limit of normal (LLN)) were detected in 29 % of people in the general group, 33, 27 and 26% in Groups 1, 2 and 3, respectively. Obstructive ventilation disorders (decrease in FEV1/FVC below LLN) were detected in 2 % in the general group, and in 3, 1 and 1% in groups 1, 2 and 3, respectively. Statistically significant correlations were found between the maximum volume of lung tissue damage in the acute period of COVID-19, the age of the patients, and the respiratory function indicators. Conclusion. The pulmonary ventilation indicators normalized within 6 months after COVID-19, while a decrease in lung diffusion capacity persisted in most patients and required further active follow-up. © 2022 Medical Education. All rights reserved.

Lung changes in a patient with combination of HIV infection and COVID-19

The COVID-19 pandemic is now a global medical and social problem. Little is known about COVID-19 impact on some vulnerable subgroups, such as immunocompromised patients. Therefore, scientists worldwide show interest in studying the impact of SARS-CoV-2 infection on HIV-positive individuals. We report an autopsy clinical case of a deceased 60-year-old HIV-infected patient with lung damage caused by a combination of the SARS-CoV-2 virus, human herpesvirus 6, cytomegalovirus, and pneumocystis with severe fatal respiratory failure. © 2022, MDV Group. All rights reserved.

Long term pathological changes in lungs after COVID-19

World literature is paying increasing attention to the long-term course of COVID-19 and symptoms that appear after the acute coronavirus infection. The symptoms, functional state of the lungs, and the X-ray changes are assessed. Nevertheless, post-COVID lung histology has not been described yet. The aim of this article is to study the long-term pathological changes in the lungs after acute COVID-19. Methods. We analyzed autopsy lung material from 19 deceased who had COVID-19. The average age of the deceased was 68.82 ± 14.6 years. All patients were found to have IgG to SARS-CoV-2. The median time to death following viral interstitial pneumonia was 72 days. Results. The causes of death and thrombotic complications (infarctions of various organs and venous thrombosis) were analyzed. Histological examination revealed thrombosis of small pulmonary arteries and capillaries of interalveolar septa, microinfarctions, hemorrhages, foci of organizing pneumonia, and nonspecific interstitial pneumonia. Conclusion. The first assessment of histological changes in human lungs showed that the most common post-COVID pathologic changes are microcirculation disorders combined with small areas of acute lung damage. The obtained data are essential for understanding the pathogenesis of post-COVID syndrome, necessitate diagnostic of microvasculature disorders using laboratory tests, scintigraphy, and CT imaging, as well as search for the therapeutic strategies. © 2021 Vestnik Tomskogo Gosudarstvennogo Universiteta, Matematika i Mekhanika. All rights reserved.

Pathological Features in 100 Deceased Patients With COVID-19 in Correlation With Clinical and Laboratory Data.

Background: Autopsies on COVID-19 deceased patients have many limitations due to necessary epidemiologic and preventative measures. The ongoing pandemic has caused a significant strain on healthcare systems and is being extensively studied around the world. Clinical data does not always corelate with post-mortem findings. The goal of our study was to find pathognomonic factors associated with COVID-19 mortality in 100 post-mortem full body autopsies. Materials and Methods: Following necessary safety protocol, we performed 100 autopsies on patients who were diagnosed with COVID-19 related death. The macroscopic and microscopic pathologies were evaluated along with clinical and laboratory findings. Results: Extensive coagulopathic changes are seen throughout the bodies of diseased patients. Diffuse alveolar damage is pathognomonic of COVID-19 viral pneumonia, and is the leading cause of lethal outcome in younger patients. Extrapulmonary pathology is predominantly seen in the liver and spleen. Intravascular thrombosis is often widespread and signs of septic shock are often present. Conclusion: The described pathological manifestations of COVID-19 in deceased patients are an insight into the main mechanisms of SARS-CoV-2 associated lethal outcome. The disease bears no obvious bias in severity, but seems to be more severe in some patients, hinting at genetic or epigenetic factors at play.

A targeted study of pulmonary pathology and chest computed tomography (ct) findings in COVID-19

Introduction. In the context of the COVID-19 pandemic, one of the most important diagnostic methods is highresolution computed tomography of the lungs (HRCT), which is highly sensitive for diagnostics of viral pneumonia. Because of a variety of radiological changes in the lungs at different periods of the disease, it became necessary to compare the changes detected by HRCT with morphological features of the disease. The aim of the research is to compare the HRCT patterns and histological changes in the lungs in the deceased with COVID-19. Material and methods. We analyzed 45 pieces from 14 deceased with COVID-19 (7 men/7 women), with an average age of 77.1 ± 12.9 (49-90 years), which underwent HRCT no more than 5 days before death. On the fixed whole lungs, tissue sites were selected, according to the target localization selected by HRCT with 3- D reconstruction. The leading HRCT patterns such as 'ground glass' opacities, “crazy paving”, consolidation, and symptoms typical for organizing pneumonia were the points of interest. We performed routine hematoxylineosin stains for histopathologic evaluation. Results. “Ground glass” opacities in the majority of cases (57.1%) corresponded to an acute phase of diffuse alveolar damage (DAD) (intraalveolar edema, hyaline membranes, cellularity, interstitial infiltration). Mosaic histological changes with alternation of filled alveoli (intraalveolar edema, clusters of red blood cells, macrophages, lymphocytes, fibrin) and aerated alveoli were detected in the areas of “crazy paving” zones. Areas of consolidation were histologically represented by extensive intraalveolar hemorrhages and/or hemorrhagic infarcts in 45.5% of cases. Perilobular consolidation, subpleural cords, symptoms of “halo” and “reverse halo”, which we considered as part of the symptom complex of organizing pneumonia in 43% of cases morphologically corresponded to organizing pneumonia (the proliferative phase of DAD) and to distelectases. Conclusion. Herein, we established the correspondence of DAD histology phases with/ or without pulmonary intravascular coagulopathy to the main HRCT-patterns of viral pneumonia. The results obtained can be used to determine therapeutic tactics at different phases of viral pneumonia in COVID- 19.

Pathology of COVID-19: Atlas

This Atlas is the result of the autopsies performed by the Moscow Pathology Service for the posthumous diagnosis of presentations and complications of COVID-19 in 2000 cases, the largest number of autopsies of COVID-19 cases in the world. This was accomplished because in Moscow an autopsy is performed in 100 % of fatal cases with suspected COVID-19 with a detailed clinical and morphological analysis. The results of the studies formed the basis of a new methodology that expands upon WHO Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death. Transferring this methodology into practice allowed not only to improve reporting of COVID-19-related deaths, but also had a significant impact on the management strategies of COVID-19 patients. A contribution to the theory of pathology is the introduction of the concept of clinical and morphological "masks" of COVID-19. Atlas presents a wide range of signs and complications of COVID-19, which outline ways for further study of their pathogenesis and morphogenesis, improvement of diagnostics and treatment of patients, and a detailed classification of the causes of death directly or indirectly associated with COVID-19. Atlas is intended for pathologists, forensic experts, as well as doctors of all clinical specialties and students in medical schools, including those in advanced training programs of continuing medical education.

Analysis of the first fatal outcome cases of a new coronavirus infection covid-19 in medical organizations of the state healthcare system of Moscow

COVID-19 posed a new challenge to the global medical science, and not all traditional approaches used earlier, for example, in the treatment of SARS and other viral infections, were acceptable. On March 20, 2020, the first fatal outcome from a new coro-navirus infection was registered in Moscow. By the time the article was published (6 weeks later) more than 1000 deaths were reg-istered. Taking into account the fact that there is still a growth in the number of patients and, consequently, deaths, the analysis of lethal outcomes of the first (in chronological order of patients) seems to be extremely relevant. As information about a new coro-navirus infection accumulates, our actions and recommendations on its treatment will change. Most drugs to treat the new coro-navirus infection are still under clinical trials. A vaccine has not been developed, and data on the use of plasma, convalescents, hydroxychloroquine and a number of other drugs are insufficient to provide recommendations that meet the principles of evidence-based medicine. We believe that the analysis of the first 157 fatal cases of a new coronavirus infection is only the first step in the for-mation of carefully verified treatment recommendations. © 2020, Media Sphera Publishing Group. All rights reserved.

Features of pathological anatomy of lungs at COVID-19

The research aim is to study the morphological features of COVID-19 in the lungs of patients who died in Moscow from March 20 to June 6, 2020. Methods. Autopsy material of the lungs from 123 deceased (54 women, 69 men) with COVID-19 coronavirus infection (confirmed by PCR) was analyzed, the median age was 71 (30 - 94) years, and the duration of the disease was 14 (3 - 65) days. In all cases, the patient's medical records and autopsy reports were analyzed. Macro- and microscopic changes in the lungs were evaluated in all the observations. Results. The pathology of the lungs in COVID-19 corresponds to various phases of diffuse alveolar damage (DAD). The exudative phase of DAD was detected in 54 (43.9%), the proliferative phase - in 21 (14.63%), and their combination - in 51 (41.46%) of the deceased. Histological features of different phases of DAD are described. Conclusion. An analysis of autopsy material revealed a mismatch between the duration of the course of the disease and the phase of diffuse alveolar damage. A significant portion of the dead found a combination of exudative and proliferative phases of the disease. Histological signs that indirectly indicate a violation of the coagulation system during COVID-19 are described. © 2020 Medical Education. All rights reserved.

Lung pathology of covid-19 in Moscow

We analyzed lung material from 22 dead obtained on autopsy for the period from March, 6 to April,30, 2020, in various clin-ics in Moscow. For this period died 532 patients (219 female, 324 male),with mean age 67.47±14.67 years. In all 22 deceased patients, the diagnosis of COVID-19 was confirmed in vivo (PCR study on material from the nasopharynx, in some patients by a positive PCR analysis in material obtained from trachea and lung tissue during autopsy). The average age of these deceased was 72.27±10.74 years, the duration of the disease ranged from 5 to 32 days. In severe COVID-19, patients develop viral interstitial pneumonia with the development of diffuse alveolar damage, which causes a severe course of the disease, hypoxia, and respiratory failure. An incomplete correspondence was found between morphological changes in the lungs (phases of diffuse alveolar damage) and the duration of the disease, which is most likely due to the unspecified duration of the asymptomatic course in many patients. The course of a new coronavirus infection is characterized by primary damage to the lungs, an increase in hemoglobin concentration in the blood, a decrease in SpO2, lymphopenia with a simultaneous increase in leukocytosis, and signs of hyperco-agulation in extremely severe patients. Virus-bacterial pneumonia may occur mainly in individuals with tracheal intubation, with tracheostomy and prolonged mechanical ventilation on any stage of the disease. © 2020, Media Sphera Publishing Group. All rights reserved.