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Campos MAG, Cutrim ÉAM, Cutrim ÉMM, de Oliveira JVP, de Oliveira EJSG, Pontes DDB, de Figueiredo JA, Silva GEB. Accuracy of the Verbal Autopsy questionnaire in the diagnosis of COVID-19 deaths in a Brazilian capital. Rev Inst Med Trop Sao Paulo 2024; 66:e33. [PMID: 38747854 PMCID: PMC11095245 DOI: 10.1590/s1678-9946202466033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/27/2024] [Indexed: 05/19/2024] Open
Abstract
The Verbal Autopsy (VA) is a questionnaire about the circumstances surrounding a death. It was widely used in Brazil to assist in postmortem diagnoses and investigate excess mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to determine the accuracy of investigating acute respiratory distress syndrome (ARDS) using VA. This is a cross-sectional study with prospective data collected from January 2020 to August 2021 at the Death Verification Service of Sao Luis city, Brazil. VA was performed for suspected COVID-19 deaths, and one day of the week was randomly chosen to collect samples from patients without suspected COVID-19. Two swabs were collected after death and subjected to reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 detection. Of the 250 cases included, the VA questionnaire identified COVID-19-related ARDS in 67.2% (52.98% were positive for COVID-19). The sensitivity of the VA questionnaire was 0.53 (0.45-0.61), the specificity was 0.75 (0.64-0.84), the positive predictive value was 0.81 (0.72-0.88), and the negative predictive value was 0.44 (0.36-0.53). The VA had a lower-than-expected accuracy for detecting COVID-19 deaths; however, because it is an easily accessible and cost-effective tool, it can be combined with more accurate methods to improve its performance.
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Affiliation(s)
- Marcos Adriano Garcia Campos
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, São Paulo, Brazil
| | | | - Érico Murilo Monteiro Cutrim
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Botucatu, São Paulo, Brazil
| | | | | | | | | | - Gyl Eanes Barros Silva
- Universidade Federal do Maranhão, Faculdade de Medicina, São Luís, Maranhão, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia e Medicina Legal, Ribeirão Preto, São Paulo, Brazil
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Molinengo L, Estrin-Serlui T, Hanley B, Osborn M, Goldin R. Infectious diseases and the role of needle biopsy post-mortem. THE LANCET. MICROBE 2024:S2666-5247(24)00044-2. [PMID: 38604206 DOI: 10.1016/s2666-5247(24)00044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 04/13/2024]
Abstract
Post-mortem examinations continue to play a crucial role in understanding the epidemiology and pathogenesis of infectious diseases. However, the perceived infection risk can preclude traditional, invasive, complete diagnostic autopsy. Post-mortem examination is especially important in emerging infectious diseases with potentially unknown infection risks, but rapid acquisition of good quality tissue samples is needed as part of the scientific and public health response. Needle biopsy post-mortem is a minimally invasive, rapid, closed-body autopsy technique that was originally developed to minimise the infection risk to practitioners. Since its inception, needle biopsy post-mortem has also been used as a technique to support complete diagnostic autopsy provision in poorly resourced regions and to facilitate post-mortem examinations in communities that might have religious or cultural objections to an invasive autopsy. This Review analyses the evolution and applicability of needle biopsy post-mortem in investigating endemic and emerging infectious diseases.
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Affiliation(s)
- Lucia Molinengo
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | - Theodore Estrin-Serlui
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Brian Hanley
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK; Department of Metabolism, Digestion and Reproduction, South Kensington Campus, Imperial College, London, UK
| | - Michael Osborn
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Robert Goldin
- Department of Metabolism, Digestion and Reproduction, South Kensington Campus, Imperial College, London, UK
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3
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Das S, Roy A, Das R. New autopsy technique in COVID-19 positive dead bodies: opening the thoracic cavity with an outlook to reduce aerosol spread. J Clin Pathol 2023; 76:664-670. [PMID: 35701143 PMCID: PMC9240445 DOI: 10.1136/jclinpath-2022-208173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
AIMS After the advent of the COVID-19 pandemic, most countries have modified some of their health-related regulations. However, this has not been in the case of the postmortem of deceased because it has a legal aspect. Thus, the healthcare providers knowingly or unknowingly faced the threat of COVID-19 exposure from those dead bodies. To introduce an autopsy technique that reduces the droplet spreads, especially in those mortuaries where the biosafety mechanism is not highly equipped. METHODS The validity of the new incision was achieved through the calculation of the Scale Content Validity Index (SCVI) taking inputs from 17 forensic specialists. The subjects for the new technique were selected from the patients who were RTPCR positive for COVID-19 or clinically or radiologically showing features of COVID-19. RESULTS The dissection procedure was finalised by achieving the SCVI at 0.92. The chest cavity was approached through the abdominal cavity by opening the diaphragm and dissecting out the contents of the chest using a long blade knife. CONCLUSIONS The advantage of this approach is that the autopsy surgeon and pathologists do not have to open the chest cavity by dissecting the Sternum, and hence the chance of droplet infection becomes almost nil. This technique is complete, simple, less time-consuming and conducive for sample collection, and even reduces the possibility of body fluid seepage following a postmortem examination.
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Affiliation(s)
- Somnath Das
- Forensic Medicine and Toxicology, RG Kar Medical College, Kolkata, West Bengal, India
| | - Anshuman Roy
- Anatomy, Raiganj Government Medical College, Raiganj, West Bengal, India
| | - Rina Das
- Forensic Medicine and Toxicology, NRS Medical College, Kolkata, West Bengal, India
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4
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Geber Júnior JC, Monteiro RADA, Rocha JWPD, Duarte ELT, Nicodemo E, Munhoz O, Paiva EFD, Mauad T, Silva LFFD, Saldiva PHN, Dolhnikoff M, Duarte-Neto AN. What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar. Rev Inst Med Trop Sao Paulo 2023; 65:e36. [PMID: 37283411 DOI: 10.1590/s1678-9946202365036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.
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Affiliation(s)
- João Carlos Geber Júnior
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | | | - João Wilson Pedro da Rocha
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | - Edson Luiz Társia Duarte
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Elizabete Nicodemo
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Olavo Munhoz
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Edison Ferreira de Paiva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | | | | | - Marisa Dolhnikoff
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
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5
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Casado-Suela MA, Cuevas-Tascón G, Cabezas Quintario MA, Duffort-Falco M, Vela de la Cruz L, Burdaspall-Moratilla A, Torres-Macho J, Gimeno Aranguez M, Bernal Jorquera J, Muñoz-Rodriguez J. Could We Consider Ultrasound Guided Minimally Invasive Autopsy as a Part of POCUS? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023. [PMID: 36896883 DOI: 10.1002/jum.16210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
We present a 3-patient case series that support the use of ultrasound guided minimally invasive autopsy (MIA). This technique has a high diagnostic accuracy in specific clinical settings. It makes easier to diagnose pathologies once the patient has died, avoiding body deformation, with a notable reduction in sample processing time compared to the open autopsy study and, therefore, a shorter overall diagnostic response time. MIA shows some similarities with point of care ultrasound (POCUS), like examination protocols or that they can be performed at the bedside.
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Affiliation(s)
- Miguel Angel Casado-Suela
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Guillermo Cuevas-Tascón
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - María Antonia Cabezas Quintario
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Mercedes Duffort-Falco
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Laura Vela de la Cruz
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Ana Burdaspall-Moratilla
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Juan Torres-Macho
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Margarita Gimeno Aranguez
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Javier Bernal Jorquera
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Jorge Muñoz-Rodriguez
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
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6
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Melo DN, Mara Coelho T, Rolim Pinheiro Lima G, Gomes Fernandes C, Cavalcante Fales de Brito Alves B, Montenegro de Carvalho Araújo F, Aparecida de Almeida Monteiro R, Ordi J, Hilário do Nascimento Saldiva P, Pamplona de Góes Cavalcanti L. Use of minimally invasive autopsy during the COVID-19 pandemic and its possibilities in the context of developing countries. PLoS Negl Trop Dis 2021; 15:e0009629. [PMID: 34347788 PMCID: PMC8336791 DOI: 10.1371/journal.pntd.0009629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Deborah Nunes Melo
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Fortaleza, Brasil
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza, Brasil
| | - Tania Mara Coelho
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Ceará, Fortaleza, Brasil
- Hospital São Jose de Doenças Infecciosas, Fortaleza, Brasil
| | | | | | | | | | | | - Jaume Ordi
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | - Luciano Pamplona de Góes Cavalcanti
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Fortaleza, Brasil
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Ceará, Fortaleza, Brasil
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brasil
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7
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Kula BE, Clancy CJ, Hong Nguyen M, Schwartz IS. Invasive mould disease in fatal COVID-19: a systematic review of autopsies. LANCET MICROBE 2021; 2:e405-e414. [PMID: 34189490 PMCID: PMC8221729 DOI: 10.1016/s2666-5247(21)00091-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Invasive mould disease (IMD) might affect up to a third of critically ill patients with COVID-19. COVID-19-associated pulmonary aspergillosis (CAPA) is typically diagnosed on the basis of a combination of non-specific clinical, radiographical, and mycological findings, but whether most cases represent invasive disease is unresolved. We systematically reviewed autopsy series of three or more decedents with COVID-19 for evidence of IMD. We searched PubMed, Web of Science, OVID (Embase), and medRxiv for studies in English or French published from Jan 1, 2019, to Sept 26, 2020. We identified 1070 references, of which 50 studies met the criteria. These studies described autopsies from 677 decedents, with individual-level data for 443 decedents. The median age was 70·0 years (IQR 57·0–79·0). Of decedents with individual-level data, 133 (30%) had diabetes, 97 (22%) had pre-existing lung disease, and 27 (6%) had immunocompromising conditions. Of 548 decedents with such data, 320 (58%) received invasive mechanical ventilation; among 140 decedents for whom this was known, ventilation was for a median of 9·0 days (IQR 5·0–20·0). Treatment included immunomodulation in 60 decedents and antifungals in 50 decedents. Autopsy-proven IMD occurred in 11 (2%) of 677 decedents, including eight CAPA, two unspecified IMD, and one disseminated mucormycosis. Among 320 decedents who received mechanical ventilation, six (2%) had IMD. We conclude that IMD, including CAPA, is an uncommon autopsy finding in COVID-19.
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Affiliation(s)
- Brittany E Kula
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Cornelius J Clancy
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - M Hong Nguyen
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ilan S Schwartz
- Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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8
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Schegolev AI, Tumanova UN. Persistence of SARS-CoV-2 in deceased patients and safe handling of infected bodies. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article analyzes the literature on SARS-CoV-2 persistence in the corpses of patients infected with COVID-19, possible routes of viral transmission from the bodies and biosafety measures to prevent the spread of the infection. SARS-CoV-2 persists for quite long in the tissues and bodily fluids of decedents with COVID-19 and on various surfaces. The longest viability of the virus is on stainless steel and plastic surfaces that come in contact with the infected body. Autopsies on decedents with COVID-19 must be performed at specially conditioned facilities. Medical and forensic pathologists and other mortuary workers must adhere to stringent biosafety requirements.
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Affiliation(s)
- AI Schegolev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - UN Tumanova
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V. I. Kulakov, Moscow, Russia
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9
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Sapino A. Author's reply: Letter to the Editor in response to Guerriero "Restriction of autopsies during the COVID-19 epidemic in Italy: prudence or fear?". Pathologica 2021; 113:66-67. [PMID: 34042089 PMCID: PMC8167403 DOI: 10.32074/1591-951x-249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anna Sapino
- SC Anatomia Patologica FPO-IRCCS, Candiolo (Turin), Italy; Department of Medical Sciences, University of Turin, Italy
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10
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Teixeira TA, Bernardes FS, Oliveira YC, Hsieh MK, Esteves SC, Duarte AN, Kallas EG, Hallak J. SARS-CoV-2 and Multi-Organ damage - What men's health specialists should know about the COVID-19 pathophysiology. Int Braz J Urol 2021; 47:637-646. [PMID: 33621014 PMCID: PMC7993942 DOI: 10.1590/s1677-5538.ibju.2020.0872] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Thiago A. Teixeira
- Laboratório de Andrologia Clínica e de Pesquisa de Alta ComplexidadeCentro de Ciência e Inovação em AndrologiaSão PauloSPBrasilAndroscience - Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil
- Universidade de São PauloDivisão de Clinica UrológicaDepartamento de CirurgiaSão PauloSPBrasilDepartamento de Cirurgia, Divisão de Clinica Urológica Universidade de São Paulo - USP, São Paulo, SP, Brasil
- Universidade de São PauloInstitute for Advanced StudiesMen's Health Study GroupSão PauloSPBrasilMen's Health Study Group, Institute for Advanced Studies, Universidade de São Paulo - USP, SP, Brasil
- Universidade Federal do AmapáFaculdade de MedicinaDivisão de UrologiaAmapáAPBrasilDivisão de Urologia, Faculdade de Medicina, Universidade Federal do Amapá - UNIFAP, Amapá, AP, Brasil
| | - Felipe S. Bernardes
- Laboratório de Andrologia Clínica e de Pesquisa de Alta ComplexidadeCentro de Ciência e Inovação em AndrologiaSão PauloSPBrasilAndroscience - Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil
- Universidade de São PauloDivisão de Clinica UrológicaDepartamento de CirurgiaSão PauloSPBrasilDepartamento de Cirurgia, Divisão de Clinica Urológica Universidade de São Paulo - USP, São Paulo, SP, Brasil
- Universidade de São PauloInstitute for Advanced StudiesMen's Health Study GroupSão PauloSPBrasilMen's Health Study Group, Institute for Advanced Studies, Universidade de São Paulo - USP, SP, Brasil
| | - Yasmin C. Oliveira
- Laboratório de Andrologia Clínica e de Pesquisa de Alta ComplexidadeCentro de Ciência e Inovação em AndrologiaSão PauloSPBrasilAndroscience - Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil
- Universidade de São PauloInstitute for Advanced StudiesMen's Health Study GroupSão PauloSPBrasilMen's Health Study Group, Institute for Advanced Studies, Universidade de São Paulo - USP, SP, Brasil
- Universidade Federal do AmapáFaculdade de MedicinaDivisão de UrologiaAmapáAPBrasilDivisão de Urologia, Faculdade de Medicina, Universidade Federal do Amapá - UNIFAP, Amapá, AP, Brasil
| | - Mariana K. Hsieh
- Laboratório de Andrologia Clínica e de Pesquisa de Alta ComplexidadeCentro de Ciência e Inovação em AndrologiaSão PauloSPBrasilAndroscience - Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil
- Universidade de São PauloInstitute for Advanced StudiesMen's Health Study GroupSão PauloSPBrasilMen's Health Study Group, Institute for Advanced Studies, Universidade de São Paulo - USP, SP, Brasil
- Faculdade de MedicinaCiências da Saúde Albert EinsteinFaculdade IsraelitaSão PauloSPBrasilFaculdade Israelita de Ciências da Saúde Albert Einstein, Faculdade de Medicina, São Paulo, São Paulo, SP, Brasil
| | - Sandro C. Esteves
- Clínica de Andrologia e Reprodução HumanaCampinasSPBrasilANDROFERT, Clínica de Andrologia e Reprodução Humana, Campinas, SP, Brasil
- Universidade Estadual de CampinasDepartamento de CirurgiaCampinasSPBrasilDepartamento de Cirurgia, Disciplina de Urologia, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
- Aarhus UniversityFaculty of HealthAarhusDenmarkFaculty of Health, Aarhus University, Aarhus, Denmark
| | - Amaro N. Duarte
- Universidade de São PauloDepartamento de PatologiaSão PauloSPBrasilBIAS - Grupo de Estudos de Autópsia de Imagens Brasileiras, Departamento de Patologia, Universidade de São Paulo, SP, Brasil
| | - Esper G. Kallas
- Universidade de São PauloDepartamento de Doenças Infecciosas e ParasitáriasSão PauloSPBrasilDepartamento de Doenças Infecciosas e Parasitárias, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jorge Hallak
- Laboratório de Andrologia Clínica e de Pesquisa de Alta ComplexidadeCentro de Ciência e Inovação em AndrologiaSão PauloSPBrasilAndroscience - Centro de Ciência e Inovação em Andrologia e Laboratório de Andrologia Clínica e de Pesquisa de Alta Complexidade, São Paulo, SP, Brasil
- Universidade de São PauloDivisão de Clinica UrológicaDepartamento de CirurgiaSão PauloSPBrasilDepartamento de Cirurgia, Divisão de Clinica Urológica Universidade de São Paulo - USP, São Paulo, SP, Brasil
- Universidade de São PauloInstitute for Advanced StudiesMen's Health Study GroupSão PauloSPBrasilMen's Health Study Group, Institute for Advanced Studies, Universidade de São Paulo - USP, SP, Brasil
- Universidade de São PauloDepartamento de PatologiaUnidade de Toxicologia ReprodutivaSão PauloSPBrasilUnidade de Toxicologia Reprodutiva, Departamento de Patologia, Universidade de São Paulo, São Paulo, SP, Brasil
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11
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Rakislova N, Marimon L, Ismail MR, Carrilho C, Fernandes F, Ferrando M, Castillo P, Rodrigo-Calvo MT, Guerrero J, Ortiz E, Muñoz-Beatove A, Martinez MJ, Hurtado JC, Navarro M, Bassat Q, Maixenchs M, Delgado V, Wallong E, Aceituno A, Kim J, Paganelli C, Goco NJ, Aldecoa I, Martinez-Pozo A, Martinez D, Ramírez-Ruz J, Cathomas G, Haab M, Menéndez C, Ordi J. Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings. Pathogens 2021; 10:pathogens10040412. [PMID: 33915771 PMCID: PMC8065952 DOI: 10.3390/pathogens10040412] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: (a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, (b) compare the performance of MIA versus complete autopsy, and (c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.
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Affiliation(s)
- Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Lorena Marimon
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Mamudo R. Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo 1653, Mozambique; (M.R.I.); (C.C.); (F.F.)
- Department of Pathology, Maputo Central Hospital, Maputo 1653, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo 1653, Mozambique; (M.R.I.); (C.C.); (F.F.)
- Department of Pathology, Maputo Central Hospital, Maputo 1653, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo 1653, Mozambique; (M.R.I.); (C.C.); (F.F.)
- Department of Pathology, Maputo Central Hospital, Maputo 1653, Mozambique
| | - Melania Ferrando
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Maria Teresa Rodrigo-Calvo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - José Guerrero
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Estrella Ortiz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Abel Muñoz-Beatove
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Miguel J. Martinez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Mireia Navarro
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Maria Maixenchs
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Vima Delgado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
| | - Edwin Wallong
- Department of Pathology, Kenyatta National Hospital (KNH), Nairobi 20723-00202, Kenya;
| | - Anna Aceituno
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Jean Kim
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Christina Paganelli
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Norman J. Goco
- RTI International (Research Triangle Institute), Research Triangle Park, NC 12255, USA; (A.A.); (J.K.); (C.P.); (N.J.G.)
| | - Iban Aldecoa
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
- Neurological Tissue Bank of the Biobank-IDIBAPS, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Antonio Martinez-Pozo
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Daniel Martinez
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - José Ramírez-Ruz
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
| | - Gieri Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, 4410 Liestal, Switzerland;
| | - Myriam Haab
- Department of Pathology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Clara Menéndez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo 1929, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (N.R.); (L.M.); (M.F.); (M.J.M.); (J.C.H.); (Q.B.); (M.M.); (V.D.); (C.M.)
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (P.C.); (M.T.R.-C.); (J.G.); (E.O.); (A.M.-B.); (I.A.); (A.M.-P.); (D.M.); (J.R.-R.)
- Correspondence:
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Mondello C, Roccuzzo S, Malfa O, Sapienza D, Gualniera P, Ventura Spagnolo E, Di Nunno N, Salerno M, Pomara C, Asmundo A. Pathological Findings in COVID-19 as a Tool to Define SARS-CoV-2 Pathogenesis. A Systematic Review. Front Pharmacol 2021; 12:614586. [PMID: 33867981 PMCID: PMC8047201 DOI: 10.3389/fphar.2021.614586] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: The World Health Organization declared the COVID-19 pandemic in March 2020. COVID-19 still represents a worldwide health emergency, which causesa severe disease that has led to the death of many patients. The pathophysiological mechanism of SARS-CoV-2 determining the tissue damage is not clear and autopsycan be auseful tool to improve the knowledge of this infection and, thus, it can help achieve a timely diagnosis and develop an appropriate therapy. This is an overview of the main post-mortem findings reporting data on the infection effects on several organs. Methods: A systematic literature search was conducted in the PubMed database searching for articles from 1 January to August 31, 2020. Thearticles were selected identifying words/concepts in the titles and/or abstracts that indicated the analysis of the morphological/pathological tissue injuries related to SARS-CoV-2 disease by several investigations. Results: A total of 63 articles were selected. The main investigated tissue was the lung showing a diffuse alveolar damage (DAD) frequently associated with pulmonary thrombotic microangiopathy. Inflammatory findings and vascular damage were observed in other organs such as heart, liver, kidney, brain, spleen, skin and adrenal gland. The immunohistochemical analysis showed tissue inflammatory cells infiltrates. The virus presence was detected by several investigations such as RT-PCR, immunohistochemistry and electron microscope, showing the effect ofSARS-CoV-2not exclusively in the lung. Discussion: The evidence emerging from this review highlighted the importance of autopsy to provide a fundamental base in the process of understanding the consequences ofSARS-CoV-2 infection. COVID-19 is strictly related to a hyper inflammatory state that seems to start with DAD and immuno-thrombotic microangiopathy. Massive activation of the immune system and microvascular damage might also be responsible for indirect damage to other organs, even if the direct effect of the virus on these tissues cannot be excluded.
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Affiliation(s)
- Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Salvatore Roccuzzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Orazio Malfa
- Institute of Legal Medicine and Department of Surgical and Medical Sciences, University “Magna Graecia”, Catanzaro, Italy
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Elvira Ventura Spagnolo
- Section of Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, Lecce, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
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Nucci RAB, Dolhnikoff M, Saldiva PHDN, Jacob-Filho W. Ultrasound-Guided Minimally Invasive Autopsy of Respiratory Muscles as a Safe and Cost-Effective Technique in COVID-19 Pandemic Era. Acta Cytol 2021; 65:276-278. [PMID: 33690234 PMCID: PMC8018195 DOI: 10.1159/000514222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Ricardo Aparecido Baptista Nucci
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil,
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil,
| | - Marisa Dolhnikoff
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Brazilian Image Autopsy Study Group (BIAS), Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Paulo Hilário do Nascimento Saldiva
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Brazilian Image Autopsy Study Group (BIAS), Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
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Sekhawat V, Green A, Mahadeva U. COVID-19 autopsies: conclusions from international studies. DIAGNOSTIC HISTOPATHOLOGY (OXFORD, ENGLAND) 2021; 27:103-107. [PMID: 33312230 PMCID: PMC7719010 DOI: 10.1016/j.mpdhp.2020.11.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The rapid pace at which COVID-19 studies are being published is surpassed only by the spread of the virus and the destruction wreaked by the pandemic globally. Therefore, it is likely that, even in the few months prior to this article reaching print, the COVID-19 literature would have moved on. The authors of this article work at a centre for COVID autopsies in London, and the aim of the article is, using their first-hand experience of COVID-19 autopsies, to distil what in their judgement are the most valid and important findings of internationally published COVID-19 autopsy studies. The intention is to provide an illustrated summary of the pathology of the organ systems most often affected by COVID-19, which will be particularly useful to trainee histopathologists and to busy consultant surgical histopathologists who may not have encountered COVID-19 first hand. For the reader who wishes to probe further the question of pathogenesis, a few pertinent references are provided.
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Affiliation(s)
- Vivek Sekhawat
- ST4 Histopathology, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Conflicts of interest: none declared
- Consultant Histopathologist, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Conflicts of interest: none declared
- Consultant Histopathologist, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; Honorary Senior Clinical Lecturer, Faculty of Life Sciences and Medicine, King's College London. Conflicts of interest: none declared
| | - Anna Green
- ST4 Histopathology, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Conflicts of interest: none declared
- Consultant Histopathologist, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Conflicts of interest: none declared
- Consultant Histopathologist, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; Honorary Senior Clinical Lecturer, Faculty of Life Sciences and Medicine, King's College London. Conflicts of interest: none declared
| | - Ula Mahadeva
- ST4 Histopathology, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Conflicts of interest: none declared
- Consultant Histopathologist, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK. Conflicts of interest: none declared
- Consultant Histopathologist, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; Honorary Senior Clinical Lecturer, Faculty of Life Sciences and Medicine, King's College London. Conflicts of interest: none declared
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de Almeida Monteiro RA, Duarte-Neto AN, Ferraz da Silva LF, de Oliveira EP, do Nascimento ECT, Mauad T, Saldiva PHDN, Dolhnikoff M. Ultrasound assessment of pulmonary fibroproliferative changes in severe COVID-19: a quantitative correlation study with histopathological findings. Intensive Care Med 2021; 47:199-207. [PMID: 33392642 PMCID: PMC7779089 DOI: 10.1007/s00134-020-06328-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study was designed to evaluate the usefulness of lung ultrasound (LUS) imaging to characterize the progression and severity of lung damage in cases of COVID-19. METHODS We employed a set of combined ultrasound parameters and histopathological images obtained simultaneously in 28 patients (15 women, 0.6-83 years) with fatal COVID-19 submitted to minimally invasive autopsies, with different times of disease evolution from initial symptoms to death (3-37 days, median 18 days). For each patient, we analysed eight post-mortem LUS parameters and the proportion of three histological patterns (normal lung, exudative diffuse alveolar damage [DAD] and fibroproliferative DAD) in eight different lung regions. The relationship between histopathological and post-mortem ultrasonographic findings was assessed using various statistical approaches. RESULTS Statistically significant positive correlations were observed between fibroproliferative DAD and peripheral consolidation (coefficient 0.43, p = 0.02) and pulmonary consolidation (coefficient 0.51, p = 0.005). A model combining age, time of evolution, sex and ultrasound score predicted reasonably well (r = 0.66) the proportion of pulmonary parenchyma with fibroproliferative DAD. CONCLUSION The present study adds information to previous studies related to the use of LUS as a tool to assess the severity of acute pulmonary damage. We provide a histological background that supports the concept that LUS can be used to characterize the progression and severity of lung damage in severe COVID-19.
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Affiliation(s)
- Renata Aparecida de Almeida Monteiro
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Amaro Nunes Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Luiz Fernando Ferraz da Silva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
- Serviço de Verificação de Óbitos da Capital, Universidade de São Paulo, Sao Paulo, Brazil
| | - Ellen Pierre de Oliveira
- Departamento de Cardiopneumologia, Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ellen Caroline Toledo do Nascimento
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Paulo Hilário do Nascimento Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, sala 1155, Sao Paulo, SP, 01246-903, Brazil.
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Giorgetti A, Orazietti V, Busardò FP, Pirani F, Giorgetti R. Died with or Died of? Development and Testing of a SARS CoV-2 Significance Score to Assess the Role of COVID-19 in the Deaths of Affected Patients. Diagnostics (Basel) 2021; 11:190. [PMID: 33525705 PMCID: PMC7912253 DOI: 10.3390/diagnostics11020190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
Since December 2019, a new form of coronavirus, SARS-CoV-2, has spread from China to the whole word, raising concerns regarding Coronavirus Disease 2019 (COVID-19) endangering public health and life. Over 1.5 million deaths related with COVID-19 have been recorded worldwide, with wide variations among countries affected by the pandemic and continuously growing numbers. The aim of this paper was to provide an overview of the literature cases of deaths involving COVID-19 and to evaluate the application of the COVID-19 Significance Score (CSS) in the classification of SARS CoV-2-related fatalities, comparing it with the Hamburg rating scale. The results obtained allowed us to highlight that CSS used after a complete accurate post-mortem examination, coupled to the retrieval of in vivo data, post-mortem radiology, histology and toxicology, as well as to additional required analyses (e.g., electronic microscopy) is a useful and concise tool in the assessment of the cause of death and the role played by this virus. A shared use of this scale might hopefully lower the inhomogeneities in forensic evaluation of SARS CoV-2-related fatalities.
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Affiliation(s)
- Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy;
| | - Vasco Orazietti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Filippo Pirani
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
| | - Raffaele Giorgetti
- Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, Via Conca 71, 60126 Ancona, Italy; (V.O.); (F.P.B.); (R.G.)
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17
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Theodoro-Filho J, Monteiro RADA, Duarte-Neto AN, Mauad T, da Silva LFF, Saldiva PHN, Dolhnikoff M. Extended minimally invasive autopsy: Technical improvements for the investigation of cardiopulmonary events in COVID-19. Clinics (Sao Paulo) 2021; 76:e3543. [PMID: 34852147 PMCID: PMC8595572 DOI: 10.6061/clinics/2021/e3543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19. METHOD US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart). RESULTS EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US. CONCLUSIONS Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.
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Affiliation(s)
- Jair Theodoro-Filho
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Renata Aparecida de Almeida Monteiro
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Amaro Nunes Duarte-Neto
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Thais Mauad
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Fernando Ferraz da Silva
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Hilário Nascimento Saldiva
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marisa Dolhnikoff
- Laboratorio de Investigacao Medica (LIM-05), Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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de Souza PMM, Gerson G, Dias JS, de Melo DN, de Souza SG, Ruiz EM, Fernandes Tavora FR, Cavalcanti LPDG. Validation of verbal autopsy and nasopharyngeal swab collection for the investigation of deaths at home during the COVID-19 pandemics in Brazil. PLoS Negl Trop Dis 2020; 14:e0008830. [PMID: 33147211 PMCID: PMC7641351 DOI: 10.1371/journal.pntd.0008830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Pedro Mansueto Melo de Souza
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
- Universidade Estadual do Ceará, Fortaleza, Ceará, Brasil
- * E-mail:
| | - Gunter Gerson
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
- Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | - Josebson Silva Dias
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
| | - Deborah Nunes de Melo
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
- Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | | | | | - Fabio Rocha Fernandes Tavora
- Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
- Brown University, Providence, Rhode Island, United States of America
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Vasquez-Bonilla WO, Orozco R, Argueta V, Sierra M, Zambrano LI, Muñoz-Lara F, López-Molina DS, Arteaga-Livias K, Grimes Z, Bryce C, Paniz-Mondolfi A, Rodríguez-Morales AJ. A review of the main histopathological findings in coronavirus disease 2019. Hum Pathol 2020; 105:74-83. [PMID: 32750378 PMCID: PMC7395947 DOI: 10.1016/j.humpath.2020.07.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has been declared by the World Health Organization as an emerging public health problem of global importance and classified as a pandemic. SARS-CoV-2 infection can result in diverse, multiorgan pathology, the most significant being in the lungs (diffuse alveolar damage in its different phases, microthrombi, bronchopneumonia, necrotizing bronchiolitis, viral pneumonia), heart (lymphocytic myocarditis), kidney (acute tubular injury), central nervous system (microthrombi, ischemic necrosis, acute hemorrhagic infarction, congestion, and vascular edema), lymph nodes (hemophagocytosis and histiocytosis), bone marrow (hemophagocytosis), and vasculature (deep vein thrombosis). An understanding of the spectrum and frequency of histologic findings in COVID-19 is essential for gaining a better understanding of disease pathophysiology and its ongoing impact on public health. To this end, we conducted a systematic meta-analysis of histopathologic observations to date and review the reported findings.
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Affiliation(s)
- Walter O Vasquez-Bonilla
- Department of Pathology, Hospital General San Juan de Dios, Guatemala City (Ciudad de Guatemala), 01001, Guatemala; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia
| | - Roberto Orozco
- Department of Pathology, Hospital General San Juan de Dios, Guatemala City (Ciudad de Guatemala), 01001, Guatemala
| | - Víctor Argueta
- Department of Pathology, Hospital General San Juan de Dios, Guatemala City (Ciudad de Guatemala), 01001, Guatemala
| | - Manuel Sierra
- Central American Technological University, Francisco Morazán, Distrito Central, Tegucigalpa, 11101 Honduras
| | - Lysien I Zambrano
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Department of Morphological Sciences, School of Medical, Sciences, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, 11101, Honduras
| | - Fausto Muñoz-Lara
- Department of Internal Medicine, Hospital Escuela, Tegucigalpa, 11101, Honduras; Department of Internal Medicine, School of Medical, Sciences, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, 11101, Honduras
| | - Dennis Salomón López-Molina
- Institute Pasteur, Paris, 75008, France; Health Biology: Microbiology and Immunology, Faculté de Sciences, Université de Montpellier, 34000, France
| | - Kovy Arteaga-Livias
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Facultad de Medicina, Universidad Nacional Hermilio Valdizán, Huánuco, 10160, Peru; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 15046, Peru
| | - Zachary Grimes
- Icahn School of Medicine at Mount Sinai, New York, NY, 15046, USA
| | - Clare Bryce
- Icahn School of Medicine at Mount Sinai, New York, NY, 15046, USA
| | - Alberto Paniz-Mondolfi
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Icahn School of Medicine at Mount Sinai, New York, NY, 15046, USA; Laboratorio de Señalización Celular y Bioquímica de Parásitos, Instituto de Estudios Avanzados (IDEA), Caracas, Caracas, 1020, Venezuela; Academia Nacional de Medicina, Caracas, 1010, Venezuela; Instituto de Investigaciones Biomedicas IDB / Incubadora Venezolana de la Ciencia, Cabudare, Edo. Lara, 3023, Venezuela
| | - Alfonso J Rodríguez-Morales
- Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19), Pereira, Risaralda, 660003, Colombia; Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, 15046, Peru; Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Risaralda, 660001, Colombia; Grupo de Investigación Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Americas, Pereira, Risaralda, 660003, Colombia.
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20
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Abstract
Autopsies are an essential tool for understanding new diseases. Against this background, it is incomprehensible why there is great reluctance worldwide to perform autopsies on COVID-19 deceased patients. The article provides an overview of the status of the autopsy series published worldwide and shows the path taken by the city of Hamburg in Germany, where autopsies are ordered by the health authorities in the interests of disease control. The risk of infection posed by SARS-CoV-2-positive deceased persons may be overestimated. The scientific benefit that can be drawn from experience with autopsies and further examination of tissue samples is immeasurable.
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21
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Hariri LP, North CM, Shih AR, Israel RA, Maley JH, Villalba JA, Vinarsky V, Rubin J, Okin DA, Sclafani A, Alladina JW, Griffith JW, Gillette MA, Raz Y, Richards CJ, Wong AK, Ly A, Hung YP, Chivukula RR, Petri CR, Calhoun TF, Brenner LN, Hibbert KA, Medoff BD, Hardin CC, Stone JR, Mino-Kenudson M. Lung Histopathology in Coronavirus Disease 2019 as Compared With Severe Acute Respiratory Sydrome and H1N1 Influenza: A Systematic Review. Chest 2020; 159:73-84. [PMID: 33038391 PMCID: PMC7538870 DOI: 10.1016/j.chest.2020.09.259] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Patients with severe coronavirus disease 2019 (COVID-19) have respiratory failure with hypoxemia and acute bilateral pulmonary infiltrates, consistent with ARDS. Respiratory failure in COVID-19 might represent a novel pathologic entity. Research Question How does the lung histopathology described in COVID-19 compare with the lung histopathology described in SARS and H1N1 influenza? Study Design and Methods We conducted a systematic review to characterize the lung histopathologic features of COVID-19 and compare them against findings of other recent viral pandemics, H1N1 influenza and SARS. We systematically searched MEDLINE and PubMed for studies published up to June 24, 2020, using search terms for COVID-19, H1N1 influenza, and SARS with keywords for pathology, biopsy, and autopsy. Using PRISMA-Individual Participant Data guidelines, our systematic review analysis included 26 articles representing 171 COVID-19 patients; 20 articles representing 287 H1N1 patients; and eight articles representing 64 SARS patients. Results In COVID-19, acute-phase diffuse alveolar damage (DAD) was reported in 88% of patients, which was similar to the proportion of cases with DAD in both H1N1 (90%) and SARS (98%). Pulmonary microthrombi were reported in 57% of COVID-19 and 58% of SARS patients, as compared with 24% of H1N1 influenza patients. Interpretation DAD, the histologic correlate of ARDS, is the predominant histopathologic pattern identified in lung pathology from patients with COVID-19, H1N1 influenza, and SARS. Microthrombi were reported more frequently in both patients with COVID-19 and SARS as compared with H1N1 influenza. Future work is needed to validate this histopathologic finding and, if confirmed, elucidate the mechanistic underpinnings and characterize any associations with clinically important outcomes.
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Angela R Shih
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Rebecca A Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason H Maley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Vladimir Vinarsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonah Rubin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Daniel A Okin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Alyssa Sclafani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jehan W Alladina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason W Griffith
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Michael A Gillette
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Yuval Raz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher J Richards
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Alexandra K Wong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Raghu R Chivukula
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Whitehead Institute for Biomedical Research, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Camille R Petri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Tiara F Calhoun
- Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Laura N Brenner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - C Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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22
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Pandey P, Agarwal S, Rajkumar. Lung Pathology in COVID-19: A Systematic Review. Int J Appl Basic Med Res 2020; 10:226-233. [PMID: 33376694 PMCID: PMC7758785 DOI: 10.4103/ijabmr.ijabmr_381_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/30/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023] Open
Abstract
Sparse literature is available regarding autopsy findings of coronavirus disease 2019 (COVID-19) despite high mortality due to its highly contagious nature and lack of robust infrastructure for appropriate handling of the infected cases. Based on clinical findings and various diagnostic tests, it is evident that it holds the potential to affect multiple organ systems of the body preferably lungs and immune and coagulation systems. Cytokine storm-induced thrombotic complication such as disseminated intravascular coagulation is a significant feature in severe cases of COVID-19. This review captures the current information on lung histopathology in COVID-19 infection and severe respiratory failure. In COVID-19, lungs are affected bilaterally, become edematous and red/tan mottled to maroon in color with firm consistency. Distinct parenchymal changes, firm thrombi in the peripheral pulmonary vessels along with diffuse alveolar damage, have been the most consistent feature of COVID-19-related lung pathology. Electron microscopy has also been used to demonstrate viral particles.
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Affiliation(s)
- Pinki Pandey
- Department of Pathology, UP University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Savita Agarwal
- Department of Pathology, UP University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Rajkumar
- Department of Neurosurgery, UP University of Medical Sciences, Etawah, Uttar Pradesh, India
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