ABSTRACT
The article provided the information about the results of clinical-morphological analysis of the practical observation with pulmonary aspergillosis associated with COVID-19 and undiagnosed when the patient was alive. The pulmonary aspergillosis associated with COVID-19 is one of the widespread complications. However, in numerous cases, the pulmonary aspergillosis associated with COVID-19 is not diagnosed due to its unclear signs and lack of information about it. An infiltrate with signs of destruction was noted during X-ray examination of the lower part of the right lung of the observed patient. It was evaluated as destructive pneumonia associated with bacterial infection. However, despite the patient had type II diabetes, no additional examination methods were applied to exclude aspergillosis. Disruption of the protective properties of the bronchial epithelium and the effect of oseltamivir type drugs may also contribute to the entry of aspergillus fungi into the lung tissue. According to the authors, during the development of diagnosis, treatment and prevention strategy of COVID-19in the patients with pulmonary aspergillosis it is important to study the interaction of these diseases.Copyright © 2022 Authors. All rights reserved.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has shown the importance of postmortem investigation of deceased patients. For a correct interpretation of the pulmonary findings in this new era, it is, however, crucial to be familiar with pathologic pulmonary conditions observed in postmortem investigations in general. Adequate postmortem histopathological evaluation of the lungs may be affected by suboptimal gross work up, autolysis or poor fixation. Using a standardized preparation approach which consisted in instillation of 4% buffered formaldehyde through the large bronchi for proper fixation and preparing large frontal tissue sections of 1-2 cm thickness after at least 24 h fixation, we comprehensively analyzed postmortem pulmonary findings from consecutive adult autopsies of a two-year period before the occurrence of COVID-19 (2016-2017). In total, significant pathological findings were observed in 97/189 patients (51%), with 28 patients showing more than one pathologic condition. Acute pneumonia was diagnosed 33/128 times (26%), embolism 24 times (19%), primary pulmonary neoplasms 18 times (14%), organizing pneumonia and other fibrosing conditions 14 times (11%), pulmonary metastases 13 times (10%), diffuse alveolar damage 12 times (9%), severe emphysema 9 times (7%) and other pathologies, e.g., amyloidosis 5/128 times (4%). Pulmonary/cardiopulmonary disease was the cause of death in 60 patients (32%). Clinical and pathological diagnoses regarding lung findings correlated completely in 75 patients (40%). Autopsy led to confirmation of a clinically suspected pulmonary diagnosis in 57 patients (39%) and clarification of an unclear clinical lung finding in 16 patients (8%). Major discrepant findings regarding the lungs (N = 31; 16%) comprised cases with clinical suspicions that could not be confirmed or new findings not diagnosed intra vitam. A significant proportion of acute pneumonias (N = 8; 24% of all cases with this diagnosis; p = 0.011) was not diagnosed clinically. We confirmed the frequent occurrence of pulmonary pathologies in autopsies, including inflammatory and neoplastic lesions as the most frequent pathological findings. Acute pneumonia was an important cause for discrepancy between clinical and postmortem diagnostics.