Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Embolia Pulmonar/etiología , Células Epiteliales Alveolares/ultraestructura , Células Epiteliales Alveolares/virología , Autopsia , COVID-19 , Infecciones por Coronavirus/epidemiología , Resultado Fatal , Humanos , Masculino , Microscopía Electrónica de Transmisión , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/epidemiología , Arteria Pulmonar/patología , Embolia Pulmonar/patología , SARS-CoV-2RESUMEN
BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism. METHODS: In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR. FINDINGS: The median age of our cohort was 73·5 years (range 42-84; IQR 67·5-77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue. INTERPRETATION: The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. FUNDING: None.
Asunto(s)
Infecciones por Coronavirus/patología , Neumonía Viral/patología , Adulto , Anciano , Anciano de 80 o más Años , Células Epiteliales Alveolares/patología , Células Epiteliales Alveolares/ultraestructura , Células Epiteliales Alveolares/virología , Autopsia , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Femenino , Tracto Gastrointestinal/patología , Tracto Gastrointestinal/ultraestructura , Tracto Gastrointestinal/virología , Corazón/virología , Humanos , Riñón/patología , Riñón/ultraestructura , Riñón/virología , Hígado/patología , Hígado/ultraestructura , Hígado/virología , Masculino , Persona de Mediana Edad , Miocardio/patología , Miocardio/ultraestructura , Pandemias , Neumonía Viral/epidemiología , Alveolos Pulmonares/patología , Alveolos Pulmonares/ultraestructura , Mucosa Respiratoria/patología , Mucosa Respiratoria/ultraestructura , Mucosa Respiratoria/virología , SARS-CoV-2 , Bazo/patología , Bazo/ultraestructura , Bazo/virología , Trombosis/patología , Tráquea/patología , Tráquea/ultraestructura , Tráquea/virología , Washingtón/epidemiologíaRESUMEN
We describe the implementation of a COVID-19 Autopsy Programme in our Hospital, report the main findings from the first autopsy of the programme and briefly review the reports of lung pathology of these patients.
Asunto(s)
Autopsia , Betacoronavirus , Infecciones por Coronavirus/patología , Control de Infecciones/métodos , Pulmón/patología , Enfermedades Profesionales/prevención & control , Pandemias , Neumonía Viral/patología , Embolia Pulmonar/etiología , Células Epiteliales Alveolares/ultraestructura , Autopsia/métodos , Betacoronavirus/aislamiento & purificación , Plaquetas/química , Plaquetas/ultraestructura , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Hialina , Control de Infecciones/organización & administración , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Integrina beta3/análisis , Pulmón/virología , Masculino , Persona de Mediana Edad , Salud Laboral/normas , Pandemias/prevención & control , Equipo de Protección Personal , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Embolia Pulmonar/patología , SARS-CoV-2 , España/epidemiología , Manejo de Especímenes , Flujo de TrabajoRESUMEN
The new coronavirus SARS-CoV-2, first identified in Wuhan, China in December, 2019, can cause Severe Acute Respiratory Syndrome (SARS) with massive alveolar damage and progressive respiratory failure. We present the relevant autopsy findings of the first patient known to have died from COVID19 pneumonia in Spain, carried out on the 14th of February, 2020, in our hospital (Hospital Arnau de Vilanova-Lliria, Valencia). Histological examination revealed typical changes of diffuse alveolar damage (DAD) in both the exudative and proliferative phase of acute lung injury. Intra-alveolar multinucleated giant cells, smudge cells and vascular thrombosis were present. The diagnosis was confirmed by reverse real-time PCR assay on a throat swab sample taken during the patient's admission. The positive result was reported fifteen days subsequent to autopsy.