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1.
Srpski Arhiv za Celokupno Lekarstvo ; 150(7-8):395-399, 2022.
Article in English | Scopus | ID: covidwho-2029913

ABSTRACT

Introduction/Objective Autopsy represents the gold standard for determining cause and mechanisms of death. With this paper, the authors wanted to acquaint colleagues with our experiences while performing autopsies of COVID-positive deceased patients. Method The study included total of 12 autopsies related to COVID-19 infection, performed in our forensic pathology institution, from which one autopsy of suspected patient and 11 autopsies of confirmed COVID-positive patients. Confirmation of infection was obtained by antemortem polymerase chain reaction analysis of oropharyngeal and nasopharyngeal swabs and by postmortem swabs taken from upper airways and lungs. Results In five cases, cause of death was directly attributed to COVID-19 infection. In two cases cause of death was due to heart attack, in two cases due to gastrointestinal hemorrhage, in one case due to multiple injuries, in one case due to trauma complications and in one case due to gunshot injury. Conclusion Large number of autopsies in which cause of death has been established to be other than COVID, along with importance of these cases for litigation, strongly emphasizes the importance of forensic autopsy of COVID-positive deceased. If adequate personal protective equipment is used, there should be minimal exposure risk to virus remaining in body tissues. © 2022, Serbia Medical Society. All rights reserved.

2.
J Forensic Sci ; 2022 Jul 18.
Article in English | MEDLINE | ID: covidwho-2019042

ABSTRACT

The DNA contamination of evidentiary trace samples, included those collected in the autopsy room, has significant detrimental consequences for forensic genetics investigation. After the COVID-19 pandemic, methods to prevent environmental contamination in the autopsy room have been developed and intensified. This study aimed to evaluate the level of human DNA contamination of a postmortem examination facility before and after the introduction of COVID-19-related disinfection and cleaning procedures. Ninety-one swabs were collected from the surfaces and the dissecting instruments, analyzed by real-time quantitative PCR (q-PCR) and typed for 21 autosomal STRs. Sixty-seven out of 91 samples resulted in quantifiable human DNA, ranging from 1 pg/µl to 12.4 ng/µl, including all the samples collected before the implementation of COVID-19 cleaning procedures (n = 38) and 29 out of 53 (54.7%) samples taken afterward. All samples containing human DNA were amplified, resulting in mixed (83.6%), single (13.4%), and incomplete (3%) profiles. A statistically significant decrease in DNA contamination was found for dissecting instruments after treatment with chlorhexidine and autoclave (p < 0.05). Environmental decontamination strategies adopted during COVID-19 pandemic only partially solved the long-standing issue of DNA contamination of postmortem examination facilities. The pandemic represents an opportunity to further stress the need for standardized evidence-based protocols targeted to overcome the problem of DNA contamination in the autopsy room.

3.
Forensic Science International (Online) ; 339, 2022.
Article in English | ProQuest Central | ID: covidwho-2015271

ABSTRACT

Respiratory viruses can cause fatal systemic infections;therefore, post-mortem diagnosis is essential in forensic autopsy cases. However, little is known regarding the distribution of respiratory viruses in the body. In this study, we investigated the anatomical distribution of respiratory viruses in 48 forensic autopsy cases suspected of viral infections at our institute. Fast Track Diagnostics (FTD) Respiratory Pathogens 21 was used as a screening test for 20 respiratory viruses in nasopharyngeal swabs. In cases with positive results for virus detection by the screening test, the detected viruses were quantified in body fluid and organ specimens by virus-specific real-time reverse transcription polymerase chain reaction (RT-PCR) and digital PCR. Viruses were detected in 33 cases, with the viral distribution and load differing among the cases. Since various respiratory viruses were detected from the nasopharyngeal swab and its viral load was higher than those of other body fluid specimens, the nasopharyngeal swab was suggested as a useful specimen for the post-mortem detection of respiratory viruses. Viruses were detected in almost all specimens including the serum in six cases. Considering the viral distribution in the body, pathological findings, and ante-mortem symptoms, these cases were presumed to be systemically infected, having died in the acute infection phase. In conclusion, the anatomical distribution of respiratory viruses can help indicate ante-mortem systemic conditions and the cause of death.

4.
J Pathol ; 2022.
Article in English | PubMed | ID: covidwho-2013710

ABSTRACT

SARS-CoV-2 virus, the cause of COVID-19 disease, establishes infection in the human body via interaction with the ACE2 (angiotensin converting enzyme 2) receptor on cell membranes. The lung is the major organ affected, and all respiratory epithelium from nose to alveolus is infectable. A recent study published in this journal looked at a wide range of other human tissues, mostly autopsy-derived, to identify susceptible cells. The virus (associated with ACE2) is found in all endothelial cells (an important finding), renal and biliary epithelium, in megakaryocytes, and occasionally in hepatocytes. It was not found in heart myofibres or brain neurones;but is present in gut myenteric plexus cells. This work confirms previous work on SARS-CoV-2-infectable cells, and so supports investigations into the pathogenesis of COVID-19 disease as it affects (or does not directly affect) the different organs. This article is protected by copyright. All rights reserved.

5.
Journal of Mahanakorn Veterinary Medicine ; 17(1):123-133, 2022.
Article in Thaï | CAB Abstracts | ID: covidwho-2012234

ABSTRACT

A male Munchkin cat was brought to a small animal teaching hospital at Mahanakorn University of Technology. The patient presentation with vomiting, chronic diarrhea, and intermittent fever. From history-taking, the owner previously had a cat that was diagnosed with feline infectious peritonitis (FIP) living in the same house but had isolated in a separate area. Fecal examination revealed bacterial enteritis. Hematology and blood chemistry results shown lymphopenia, hypoalbuminemia, and low serum albumin/globulin ratio (0.3 A: G ratio). Abdominal ultrasound revealed mesenteric lymph node (MLN) enlargement and cholecystitis. Cell cytology from the liver and MLN revealed suppurative inflammation. Reverse transcription PCR (RT-PCR) was negative for the Feline coronavirus (FCoV) in the blood sample. On the 4th day of treatment, the cat developed pleural and peritoneal effusion. Thoracentesis and abdominocentesis were performed and submitted for analysis. The fluid's results were classified as modified transudate, low A: G ratio (0.3), Rivalta's test (positive), and positive for FCoV by using RT-PCR. On the 8th day of treatment, the cat died from systemic hypotension. Viscous straw yellow-colored fluid and pyogranulomatous lesions at the liver, lung, kidney, and MLN were observed from the necropsy. Histopathology's results shown severe suppurative inflammation in all the above organs. FIP was confirmed by detected FCoV antigen in the cytoplasm of macrophages in the kidney and lung tissue by immunohistochemistry staining.

6.
Clin Ter ; 173(4): 301-303, 2022.
Article in English | MEDLINE | ID: covidwho-2010473

ABSTRACT

Abstract: Autopsy has played an extremely important role in both the forensic and clinical fields for many years. In recent years, clinical autopsy has become less important, but today, thanks to the pandemic, this importance has been rediscovered. Conversely, forensic autopsy has never lost its importance, but it would need to be updated.


Subject(s)
Forensic Medicine , Pandemics , Autopsy , Humans
7.
Annals of the Rheumatic Diseases ; 81:1697, 2022.
Article in English | EMBASE | ID: covidwho-2009121

ABSTRACT

Background: Coronavirus-19 disease (COVID-19) has been responsible, to date, for more than 5 million of deaths. Immunothrombosis may be a major factor contributing to mortality in COVID-19 and pulmonary arterial tree involvement that mimics multiple pulmonary embolism could be a major contributor to disease course. Immunomodulatory drugs are of some beneft but mechanism not completely clear. We investigated pulmonary arterial tree clots to better appreciate their immunothrombotic nature, in contrast to the pathological characteristics of non-infammatory thrombi (1). Objectives: The primary objective was to study in depth the arterial thrombosis in COVID-19, by characterizing the immunohistochemical nature of thrombi, performing macroscopic and microscopic analyses, and by comparing clinical, laboratory and anatomical-pathological data of these patients with other patients died for COVID-19 but without evidence of pulmonary arterial thrombosis. Methods: Autopsies were performed in patients (cases) who died for COVID-19 with evidence of pulmonary arterial thrombosis at autopsy fnding but without pathological signs of bronchopneumonia or peripheral venous thrombosis. COVID-19 positive patients without pulmonary arterial thrombosis were selected as control group. Hematoxylin and eosin stained slides were reviewed choosing those with visible pulmonary thrombi. Further histochemical and immunohisto-chemical staining were performed in selected paraffin blocks. Each component of the thrombus was evaluated with the software application QuPath in terms of fbrin, red blood cells, platelets and immune cells percentage after scanning the slides with Aperio System. Laboratory tests were recorded at 2 points: at hospital admission and at Intensive Care Unit transfer. Results: We included 13 patients (cases) and 14 controls, matched for age, gender and time from diagnosis to death. Twenty arterial thrombi were studied. By immuno-histochemistry, arterial thrombi were composed by white blood cells (WBC) [median, IQR range: 10% (5-12.25)], mainly neutrophils [58% (35.2-64.5)], red blood cells [12%, (6-34.25)], fbrin [19% (14.5-42.25)], platelets [39%, (31.75-48)] (Figure 1). Three cases had a history of previous thrombosis. All cases had received anticoagulant treatment during hospitalization, low molecular weight heparin in 12/13 (therapeutic regimen in 4/12, prophylactic in 8/12) while 1/13 continued oral anticoagulants for comorbidity. By comparing laboratory fndings between cases and controls, cases showed signifcantly higher levels of platelet count [median, IQR range: 195000/mmc (157750-274500) vs 143500 (113000-175250), p=0.011], LDH [854 U/l (731-1315) vs 539 (391.5-660), p=0.003)] at hospital admission, and D-dimer at ICU transfer [25072 FEU (6951-50531) vs 1024 (620-5501), p=0.003)]. Conclusion: Pulmonary arterial thrombosis in COVID-19 is a type of immune-mediated infammatory thrombosis, since the amount of WBC is 6-times more than normal value seen in non-infammatory thrombi. Some markers of infammation, necrosis and coagulation are much more increased in this subset of patients. Chest CT angiography rather than simple CT scan at hospital admission could be more useful in this setting, and treatments with antiplatelet agents or anticoagulants, eventually in combination with immunotherapy, might positively affect the outcome.

8.
Pathology International ; 2022.
Article in English | EMBASE | ID: covidwho-2008755

ABSTRACT

A 61-year-old woman without significant medical history developed fever 3 days after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and went into shock the next day. She was negative for SARS-CoV-2 mRNA in real-time polymerase chain reaction (PCR). Finally, she died 10 days after vaccination. At autopsy, the heart showed moderate dilatation of both ventricles, and the myocardium showed an uneven color change and decreased elasticity. Histologically, severe myocarditis with extensive myocytolysis was observed. The myocarditis showed severe inflammatory cell infiltration with T-lymphocyte and macrophage predominance, and in addition to the inflammatory cells described above, vast nuclear dust accompanying neutrophilic infiltration was observed. In the bone marrow and lymph nodes, hemophagocytosis was observed. In postmortem examination, nucleic acids of any cardiotropic viruses including SARS-CoV-2 were not detected using multivirus real-time PCR system. We discussed the relationship between the possible immune reaction after vaccination and the myocarditis observed in this case from immunopathological viewpoints. This mRNA vaccine is the first applied nucleic acid vaccine for humans, and its mechanism of efficacy and immune acquisition remain unclear. We hope the accumulation of more detailed analyses of the similar cases to reveal the mechanism of this kind of adverse reaction.

9.
Forensic Sci Med Pathol ; : 1-14, 2022.
Article in English | PMC | ID: covidwho-2007252

ABSTRACT

Clinical features of COVID-19 range from mild respiratory symptoms to fatal outcomes. Autopsy findings are important for understanding COVID-19-related pathophysiology and clinical manifestations. This systematic study aims to evaluate autopsy findings in paediatric cases. We searched PubMed, EMBASE, and Cochrane Database Reviews. We included studies that reported autopsy findings in children with COVID-19. A total of 11 studies (24 subjects) were included. The mean age of patients was 5.9 +/- 5.7 years. Grossly, there was pericardial and pleural effusion, hepatosplenomegaly, cardiomegaly, heavy soft lung, enlarged kidney, and enlarged brain. The autopsy findings of the lungs were diffuse alveolar damage (78.3%), fibrin thrombi (43.5%), haemorrhage (30.4%), pneumonia (26%), congestion and oedema (26%), angiomatoid pattern (17.4%), and alveolar megakaryocytes (17.4%). The heart showed interstitial oedema (80%), myocardial foci of band necrosis (60%), fibrin microthrombi (60%), interstitial and perivascular inflammation (40%), and pancarditis (30%). The liver showed centrilobular congestion (60%), micro/macrovesicular steatosis (30%), and arterial/venous thrombi (20%). The kidney showed acute tubular necrosis (75%), congestion (62.5%), fibrin thrombi in glomerular capillaries (37.5%), and nephrocalcinosis, mesangial cell hyperplasia, tubular hyaline/granular casts (25% each). The spleen showed splenitis (71.4%), haemorrhage (71.4%), lymphoid hypoplasia (57.1%), and haemophagocytosis (28.6%). The brain revealed oedema (87.5%), congestion (75%), reactive microglia (62.5%), neuronal ischaemic necrosis (62.5%), meningoencephalitis (37.5%), and fibrin thrombi (25%). SARS-CoV-2 and CD68 were positive by immunohistochemistry in 85.7% and 33.3% cases, respectively. Autopsy findings of COVID-19 in children are variable in all important organs. It may help in better understanding the pathogenesis of SARS-CoV-2.

10.
Journal of Public Health in Africa ; 13:9-10, 2022.
Article in English | EMBASE | ID: covidwho-2006897

ABSTRACT

Introduction/ Background: COVID-19 impact on all-cause mortality in tropical Africa remains unknown. In Kenya, there were 3,000 COVID-19-attributabledeaths by May 2021. We used the Kilifi Health and Demographic Surveillance System (KHDSS) to monitor mortality among 300,000 residents in rural Kenya during the pandemic and investigated excess mortality. Methods: Using a negative binomial model, accounting for seasonality and trend, we fitted mortality data from 2010-2019 and predicted mortality in April 2020-May 2021. Excess mortality was calculated as [(observedexpected mortality)/expected mortality]-1. We examined the impact of the pandemic on 8 leading causes of death using Verbal Autopsy (VA). Finally, we calculated the anticipated number of COVID-19 deaths in KHDSS, in 10 age strata, as the product of the number of KHDSS residents, KHDSS seroprevalence of SARS-CoV-2 (see impact) and infection fatality ratios (IFR) from a meta-analysis of 28 populations, largely in Europe and America. Results: We observed 1424 deaths between April 2020-May 2021. Based on 2010-19 mortality, we predicted 1510 deaths (excess mortality -5.7%, 95% CI -9.8%, 1.9%). Mortality was significantly lower among children <5 years old (-26.2% 95% CI -33.5, -14.9%). By VA, there were fewer deaths attributable to acute respiratory infections in 2020, compared to 2010-19, in all age groups. External IFRs predicted 327 (95% CI 265-403) COVID-19-attributable deaths, which would represent an excess mortality of 22%. Impact: The impact of COVID-19 on all-cause mortality cannot be assessed without simultaneous evidence of COVID-19 transmission in the same population. A random sample survey of 850 KHDSS residents during December 2020-May 2021 has already reported seroprevalence of anti-SARS-CoV-2 IgG as 12% in children and 26% in adults, suggesting widespread transmission. Conclusion: The lack of mortality impact in Kilifi could be explained either by a compensatory reduction in all non-COVID-19 causes of death or by a substantially lower age-specific risk of death among individuals infected with SARS-CoV-2 in Kenya compared to Europe or America.

11.
Journal of Forensic Medicine and Toxicology ; 39(1):1-4, 2022.
Article in English | EMBASE | ID: covidwho-2006462
12.
Thrombosis Research ; 218:171-176, 2022.
Article in English | ScienceDirect | ID: covidwho-2004546

ABSTRACT

Background Infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) results in respiratory syndromes but also in vascular complications such as thromboembolism (TE). In this regard, immunothrombosis, resulting from inflammation in SARS-CoV-2 infected tissues, has been described. Data on TE in COVID-19 are mainly based on clinical observational and/or incomplete autopsy studies. The true burden of TE and the relevance of genetic predisposition, however, have not been resolved. Objectives Here, we report on a consecutive cohort of 100 fully autopsied patients deceased by SARS-CoV-2 infections during the first wave of the pandemic (March to April 2020). We investigated the localization of TE, potential clinical risk factors, and the prothrombotic gene mutations, factor V Leiden and prothrombin G20210A, in postmortem blood or tissue samples. Results

13.
Forensic Imaging ; : 200520, 2022.
Article in English | ScienceDirect | ID: covidwho-2004075

ABSTRACT

It is well documented that COVID-19 vaccines are effective tools for limiting the pandemic. Unfortunately, as is true for all vaccines, SARS-CoV-2 infection in vaccinated individuals is still possible. We present an autopsy case of SARS-CoV-2 infection after vaccination (“breakthrough infection”) in an elderly man with several comorbidities where post-mortem CT scan was performed. The death was histologically attributed to cardio-respiratory arrest due to ischemic heart failure related to superinfected COVID-19 pneumonia and pre-existing comorbidities. For the first time in the literature, PMCT imaging related to a fatal, autopsy case of breakthrough SARS-CoV-2 infection is reported. PMCT of the lungs, in accordance with histopathological results, showed few signs of COVID-19 pneumonia, large area of consolidation in the right lower lobe, interpreted as bronco-pneumonic focus, and hypostasis. These findings were well-correlated with the previously reported literature about both PMCT and clinical CT imaging of the lungs in non-vaccinated individuals with early COVID-19 pneumonia and about pulmonary clinical CT imaging in COVID-19 pneumonia in breakthrough SARS-COV-2 infections. Further studies are needed to cover the whole spectrum of PMCT lung imaging in fatal breakthrough SARS-CoV-2 infection, however, this case represent a first step for exploring this difficult challenge during SARS-CoV-2 pandemic using virtual autopsy.

14.
New Zealand Journal of Medical Laboratory Science ; 76(2):104-105, 2022.
Article in English | EMBASE | ID: covidwho-2003249
15.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003006

ABSTRACT

Introduction: Gestational alloimmune liver disease (GALD) is a leading cause of neonatal acute liver failure (NALF), a rare but important diagnosis. Congenital portosystemic shunts (CPSs) are rare vascular anomalies that leave patients at risk for developing a wide spectrum of complications and have not been previously associated with GALD. In this case, we present a newborn male with NALF secondary to GALD complicated by intrahepatic shunts. Case Description: The patient is a 30 weeks gestational age male born to a 28-year-old gravida 2 para 0 mother via urgent cesarean section for severe placental malperfusion. The pregnancy was complicated by severe intrauterine growth restriction, oligohydramnios, and maternal COVID-19 infection. The patient's initial NICU course was remarkable for respiratory distress requiring ventilatory support, hypotension requiring inotropes and stress dose steroids, and coagulopathy with bleeding requiring transfusion of multiple blood products. An abdominal ultrasound showed large congenital intrahepatic portosystemic shunts. Over the course of the hospitalization, the infant progressed to fulminant hepatic failure with associated coagulopathy, hypoalbuminemia, direct hyperbilirubinemia, and hyperammonemia. There was persistent anasarca in addition to elevated ferritin (1,922 ng/dL) and alpha-fetoprotein (97,855 ng/mL). Serial SARS-CoV-2 NAAT were negative. In consultation with the hepatologist there was high clinical suspicion for GALD, and treatment with intravenous immunoglobulin was initiated, however, no clinical or laboratory improvement was noted. Abdominal MRI showed progression of the large CPSs and enlargement of the hepatic arteries. The infant continued to deteriorate, was transitioned to comfort care, and died on day of life 82. A limited autopsy revealed a markedly edematous and jaundiced male with grossly enlarged liver with hepatocellular cholestasis, portal fibrosis, diffuse hepatobiliary iron depositions, and C5b9 positivity within hepatocytes confirming a diagnosis of GALD. Discussion: Neonatal hemochromatosis is the phenotypic result of severe liver injury leading to iron overload and extrahepatic siderosis, the mechanism of hepatic injury now recognized in GALD. Liver failure in newborns with GALD often presents with marked coagulopathy, hypoalbuminemia, and edema with and without ascites. The establishment of the diagnosis is crucial given without treatment, the prognosis is very poor. There have been no case reports of neonates with acute liver failure from CPSs or CPSs occurring with GALD. We hypothesize that the presence of CPSs worsens the clinical course of GALD through an unknown mechanism that further expedites hepatocellular damage. Furthermore, the role of SARS-CoV-2 infection and transmission in the neonatal population is still unknown. Conclusion: Neonatal acute liver failure caused by GALD is a rare but potentially fatal diagnosis. CPSs associated with GALD have not been previously documented. This case demonstrates the interplay of these disease entities likely contributing towards a more severe course of NALF and highlights the importance of early identification for guiding management. (Figure Presented).

16.
BMC Public Health ; 22(1):1607, 2022.
Article in English | PubMed | ID: covidwho-2002155

ABSTRACT

INTRODUCTION: Indonesia has not optimally provided complete and reliable civil registration and vital statistics (CRVS). Death certification is one of the elements of the CRVS system. Reliable data on death rates and causes serve as the basis for building a strong evidence base for public health policy, planning, monitoring, and evaluation. This study aims to implement an approach to identifying the cause of death through verbal autopsy by empowering community health workers during the pandemic. METHOD: This study is implementation research with the empowerment of the community, in this case, health cadres and health facilitators/workers, to identify the cause of death through a mobile-based verbal autopsy. This implementation research consisted of four main activities: community-based verbal autopsy, mobile-based verbal autopsy development, data collection, and analysis of the suspected causes of death using InterVA-5. RESULT: From October to November 2020, a total of 143 respondents were willing to do a verbal autopsy interview (response rate of 58%). Of 143 respondents, most of them were women (112 or 78.3%), was the child of the deceased (61 or 42.7%) and lived with the deceased until before he/she died (120 or 83.9%). Based on the characteristics of the deceased, of 143 deceased, 78 (54.5%) were male, 134 (93.7%) were adults, 100 (69.9%) died at home, and 119 (83.2%) did not have a death certificate stating the cause of death. The cause of death of 143 deceased mainly was infectious disease (92 or 64.3%), followed by non-communicable disease (39 or 27.3%), external factors (5 or 3.5%), and unknown factors (4 or 2.8%). In sequence, the top five suspected causes of death are acute respiratory infection, including pneumonia (72 or 50.3%), other and unspecified infectious disease (18 or 12.6%), other and unspecified cardiac disease (17 or 11.9%), acute cardiac disease (4 or 2.8%), and Digestive neoplasms (4 or 2.8%). CONCLUSION: The findings showed that the mobile-based verbal autopsy using a community-based mechanism was feasible during the COVID-19 pandemic.

17.
Indian Journal of Forensic Medicine and Toxicology ; 16(1):76-82, 2022.
Article in English | EMBASE | ID: covidwho-1998193

ABSTRACT

Sudden death due to cardiac cause is considered as a major health problem worldwide accounting for 15–20% of all deaths and cardiomyopathies account for 10–15% of the cases.According to the 2016 WHO classification, angiomatous meningioma is a rare subtype of meningioma classified as Grade I. It is an aggressive variety with a fair prognosis, with typical symptoms including headache and seizures. We present a case of a 60-year-old man brought to the morgue for autopsy with a history of progressive left-sided weakness and headache for several months with no prior diagnosis or treatment for the same because of current pandemic of COVID-19.On conducting medicolegal autopsy significant pathologies in heart and brain were found which could have contributed to the cause of death.

18.
Russian Journal of Cardiology ; 27(7):147-157, 2022.
Article in Russian | EMBASE | ID: covidwho-1998086

ABSTRACT

The presence of coronavirus-associated myocarditis remains controversial despite elevations in cardiac troponin and natriuretic peptide in many patients. Aim. To assess the morphological changes in the myocardium of patients who died due to coronavirus disease 2019 (COVID-19) and compare them with the intravital level of cardiac biomarkers. Material and methods. A total of 420 hospital charts and 77 autopsies of those who died from COVID-19 were analyzed. In 15 of 77 cases (19%) with histologically suspected myocarditis, an immunohistochemical examination of the myocardium with antibodies to CD3, CD45, CD8, CD68, CD34, Ang1, VWF, VEGF, HLA-DR, MHC1, C1q, VP1 of enteroviruses was performed, and in 8 patients with immunohistochemically confirmed myocarditis (10%) — polymerase chain reaction for SARS-CoV-2. Results. Hemorrhage, intramural thrombosis, necrosis of non-coronary origin, myocardial infarction and lymphocytic myocarditis were detected in 43%, 10%, 17%, 19% and 10% of cases, respectively, without coronavirus N and E gene sequences in the myocardium. Dysplasia, hyperplasia and hypertrophy of the vascular endothelium, expression of Ang1, VWF, VEGF, MHC1, C1q, VP1 of enteroviruses were determined in 100, 100, 87, 100, 75 and 62% of cases of myocarditis, respectively. There were no significant correlations between inflammatory biomarkers and myo-carditis. Conclusion. The main morphological manifestation of COVID-19 in the myo-cardium is the so-called endotheliitis with dysplasia and endothelial activation, leading to hemorrhages, intramural thrombosis and necrosis. There is no con-vincing evidence of a direct involvement of coronavirus in myocarditis induction.

19.
Legal Medicine ; : 102134, 2022.
Article in English | ScienceDirect | ID: covidwho-1996409

ABSTRACT

Background COVID-19 vaccines have been used across Japan since 17 February 2021, and as of 17 April 2022, 1690 deaths potentially caused by vaccine-related adverse effects have been reported to the Ministry of Health, Labour and Welfare. However, the causal relationship between vaccination and death could not be fully evaluated because of a lack of sufficient information. Methods Autopsy cases in which deaths occurred within seven days after COVID-19 vaccination in Tokyo Metropolis and were handled by medical examiners were selected (n = 54). Age, sex, vaccine-related information, cause of death, and possible causal relationship between vaccination and death were examined. Results The mean age of the deceased individuals was 68.1 years, and the study sample consisted of 34 males (63.9%) and 20 females (37.0%). Thirty-seven and six individuals received Comirnaty and Spikevax, respectively (68.5% and 11.1% respectively). The manner of death included natural (n = 43), non-natural (n = 8), and undetermined (n = 3). The most frequent cause of death was ischemic heart disease (n = 16). Regarding causal relationships, 46 cases (85.2%) did not show a causal relationship to vaccination, except for myocarditis (n = 3), thrombosis-related death (n = 4), and others (n =1). Conclusion Although many cases of deaths after COVID-19 vaccination in this study showed no definite causal relationship between the vaccination and deaths, some cases showed possible adverse events such as myocarditis. Autopsies are essential for detecting vaccine-related deaths, and the Japanese death investigation system needs to be reinforced from this viewpoint.

20.
eBioMedicine ; 83:104229, 2022.
Article in English | ScienceDirect | ID: covidwho-1996119

ABSTRACT

Summary Background Severe COVID-19 lung disease exhibits a high degree of spatial and temporal heterogeneity, with different histological features coexisting within a single individual. It is important to capture the disease complexity to support patient management and treatment strategies. We provide spatially decoded analyses on the immunopathology of diffuse alveolar damage (DAD) patterns and factors that modulate immune and structural changes in fatal COVID-19. Methods We spatially quantified the immune and structural cells in exudative, intermediate, and advanced DAD through multiplex immunohistochemistry in autopsy lung tissue of 18 COVID-19 patients. Cytokine profiling, viral, bacteria, and fungi detection, and transcriptome analyses were performed. Findings Spatial DAD progression was associated with expansion of immune cells, macrophages, CD8+ T cells, fibroblasts, and (lymph)angiogenesis. Viral load correlated positively with exudative DAD and negatively with disease/hospital length. In all cases, enteric bacteria were isolated, and Candida parapsilosis in eight cases. Cytokines correlated mainly with macrophages and CD8+T cells. Pro-coagulation and acute repair were enriched pathways in exudative DAD whereas intermediate/advanced DAD had a molecular profile of elevated humoral and innate immune responses and extracellular matrix production. Interpretation Unraveling the spatial and molecular immunopathology of COVID-19 cases exposes the responses to SARS-CoV-2-induced exudative DAD and subsequent immune-modulatory and remodeling changes in proliferative/advanced DAD that occur side-by-side together with secondary infections in the lungs. These complex features have important implications for disease management and the development of novel treatments. Funding CNPq, Bill and Melinda Gates Foundation, HC-Convida, FAPESP, Regeneron Pharmaceuticals, and the Swedish Heart & Lung Foundation.

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