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Pathological post-mortem findings in lungs infected with SARS-CoV-2.
Damiani, Stefania; Fiorentino, Michelangelo; De Palma, Alessandra; Foschini, Maria Pia; Lazzarotto, Tiziana; Gabrielli, Liliana; Viale, Pier Luigi; Attard, Luciano; Riefolo, Mattia; D'Errico, Antonia.
  • Damiani S; Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Fiorentino M; Azienda Ospedaliero-Universitaria di Bologna and the Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • De Palma A; Department of Forensic Medicine, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Foschini MP; Department of Forensic Medicine, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Lazzarotto T; Department of Microbiology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Gabrielli L; Department of Microbiology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Viale PL; Department of Infectious Diseases, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Attard L; Department of Infectious Diseases, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • Riefolo M; Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
  • D'Errico A; Department of Pathology, Bellaria-Maggiore Hospital, University of Bologna School of Medicine, Bologna, Italy.
J Pathol ; 253(1): 31-40, 2021 01.
Article in English | MEDLINE | ID: covidwho-757847
ABSTRACT
Italy was the first European nation to be massively infected by SARS-CoV-2. Up to the end of May 2020, more than 33,000 deaths had been recorded in Italy, with a large prevalence among males, those over 75 years of age, and in association with co-morbidities. We describe the lung pathological and immunohistochemical post-mortem findings at the autopsy of nine patients who died of SARS-CoV-2-associated disease. We found in the lung tissues of all patients histological changes consistent with diffuse alveolar damage in various evolution phases ranging from acute exudative to acute proliferative to fibrotic phase. Alveolar damage was associated with prominent involvement of the vascular component in both the interstitial capillaries and the mid-size vessels, with capillary fibrin micro-thrombi, as well as organized thrombi even in medium-sized arteries, in most cases not related to sources of embolism. Eosinophilic infiltrate was also seen, probably reactive to pharmacological treatment. Viral RNA of SARS-CoV-2 was detected from the lung tissues of all the nine patients. Immunohistochemistry for the receptor of the SARS-CoV-2, ACE2, and its priming activator TMPRSS2 revealed that both proteins co-localize in airway cells. In particular, the ACE2 protein was expressed in both endothelial cells and alveolar type I and II pneumocytes in the areas of histological diffuse alveolar damage (DAD). Pneumocytes, but not endothelial cells, also expressed TMPRSS2. There are no distinctive histological features of SARS-CoV-2 infection with respect to SARS-CoV-1 and other DAD with different aetiology. The identification of the cause of death in the course of SARS-CoV-2 infection is more likely multi-factorial. © 2020 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Endothelial Cells / SARS-CoV-2 / COVID-19 / Lung Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Pathol Year: 2021 Document Type: Article Affiliation country: Path.5549

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Endothelial Cells / SARS-CoV-2 / COVID-19 / Lung Type of study: Etiology study / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Pathol Year: 2021 Document Type: Article Affiliation country: Path.5549