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Histopathological Evaluation of Deceased Persons in Lusaka, Zambia With or Without Coronavirus Disease 2019 (COVID-19) Infection: Results Obtained From Minimally Invasive Tissue Sampling.
Mudenda, Victor; Mumba, Chibamba; Pieciak, Rachel C; Mwananyanda, Lawrence; Chimoga, Charles; Ngoma, Benard; Mupila, Zacharia; Kwenda, Geoffrey; Forman, Leah; Lapidot, Rotem; MacLeod, William B; Thea, Donald M; Gill, Christopher J.
  • Mudenda V; University Teaching Hospital, Department of Pathology, Lusaka, Zambia.
  • Mumba C; University Teaching Hospital, Department of Pathology, Lusaka, Zambia.
  • Pieciak RC; Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.
  • Mwananyanda L; Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.
  • Chimoga C; Right to Care Zambia, Lusaka, Zambia.
  • Ngoma B; Right to Care Zambia, Lusaka, Zambia.
  • Mupila Z; Right to Care Zambia, Lusaka, Zambia.
  • Kwenda G; Right to Care Zambia, Lusaka, Zambia.
  • Forman L; University of Zambia, School of Health Sciences, Department of Biomedical Sciences, Lusaka, Zambia.
  • Lapidot R; Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston, Massachusetts, USA.
  • MacLeod WB; Boston University School of Medicine, Boston, Massachusetts, USA.
  • Thea DM; Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.
  • Gill CJ; Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.
Clin Infect Dis ; 73(Suppl_5): S465-S471, 2021 12 15.
Article in English | MEDLINE | ID: covidwho-1575116
ABSTRACT

BACKGROUND:

Although much has been learned about the pathophysiology of coronavirus disease 2019 (COVID-19) infections, pathology data from patients who have died of COVID-19 in low- and middle-income country settings remain sparse. We integrated minimally invasive tissue sampling (MITS) into an ongoing postmortem surveillance study of COVID-19 in deceased individuals of all ages in Lusaka, Zambia.

METHODS:

We enrolled deceased subjects from the University Teaching Hospital Morgue in Lusaka, Zambia within 48 hours of death. We collected clinical and demographic information, a nasopharyngeal swab, and core tissue biopsies from the lung, liver, and kidneys for pathologic analysis. Individuals were considered eligible for MITS if they had a respiratory syndrome prior to death or a COVID-19+ polymerase chain reaction (PCR) nasopharyngeal swab specimen. Samples were retested using quantitative reverse transcriptase PCR.

RESULTS:

From June to September 2020 we performed MITS on 29 deceased individuals. PCR results were available for 28/29 (96.5%) cases. Three had a COVID-19+ diagnosis antemortem, and 5 more were identified postmortem using the recommended cycle threshold cut-point <40. When expanding the PCR threshold to 40 ≤ cycle threshold (Ct) ≤ 45, we identified 1 additional case. Most cases were male and occurred in the community The median age at death was 47 years (range 40-64). Human immunodeficiency virus (HIV)/AIDS, tuberculosis, and diabetes were more common among the COVID-19+ cases. Diffuse alveolar damage and interstitial pneumonitis were common among COVID-19+ cases; nonspecific findings of hepatic steatosis and acute kidney injury were also prevalent in the COVID-19+ group. Vascular thrombi were rarely detected.

CONCLUSIONS:

Lung abnormalities typical of viral pneumonias were common among deceased COVID-19+ individuals, as were nonspecific findings in the liver and kidneys. Pulmonary vascular thrombi were rarely detected, which could be a limitation of the MITS technique. Nonetheless, MITS offers a valuable alternative to open autopsy for understanding pathological changes due to COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Limits: Adult / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2021 Document Type: Article Affiliation country: Cid

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Limits: Adult / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: Clin Infect Dis Journal subject: Communicable Diseases Year: 2021 Document Type: Article Affiliation country: Cid