A novel coronavirus meets the cardiovascular system: Society for Cardiovascular Pathology Symposium 2021

Buja, L. Maximilian; Stone, James R.

doi:10.1016/j.carpath.2021.107336

Cited by 13 publications

(9 citation statements)

References 46 publications

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“…Though far less frequent, examples of misidentified coronavirus can be found from the 2003 SARS‐CoV‐1 outbreak as well as from the 2012 MERS‐CoV outbreak (Alsaad et al, 2018 ; Ding et al, 2004 ). Misidentifications of SARS‐CoV‐2 particles have occurred in nearly every tissue of the body (Table 1 ), leading to possible confusion as to whether the virus itself is causing tissue damage throughout the body or if tissue damage is a result of other factors, like the cytokine storm or downstream complications due to lack of proper function of an infected organ (Buja & Stone, 2021 ; Gustine & Jones, 2021 ; Perico et al, 2021 ). To date, SARS‐CoV‐2 particles have been correctly identified by EM only in the lung, heart, olfactory mucosa, and placenta (Birkhead et al, 2021 ; Dittmayer et al, 2020 ; Martines et al, 2020 ; Meinhardt et al, 2020 ; Nardacci et al, 2021 ; Reagan‐Steiner et al, 2022 ).…”

Section: Coronavirus Misidentificationsmentioning

confidence: 99%

“…Within cardiac tissue, disrupted endothelial cells resulting in direct contact of myocardial cells with the vascular lumen were noted in severe COVID‐19 cases (Duarte‐Neto et al, 2021 ). Recent reviews of clinical and autopsy studies from 2020 indicate that endothelial dysfunction during SARS‐CoV‐2 infection, such as those seen by EM, are key to inciting the inflammatory processes that cause more severe COVID‐19 (Buja & Stone, 2021 ; Perico et al, 2021 ).…”

Section: Ultrastructural Changes Caused By Sars‐cov ...mentioning

confidence: 99%

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Detection and identification of coronaviruses in human tissues using electron microscopy

Bullock

Goldsmith

Miller

2022

Microscopy Res & Technique

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The identification of viral particles within a tissue specimen requires specific knowledge of viral ultrastructure and replication, as well as a thorough familiarity with normal subcellular organelles. The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic has underscored how challenging the task of identifying coronavirus by electron microscopy (EM) can be. Numerous articles have been published mischaracterizing common subcellular structures, including clathrin‐ or coatomer‐ coated vesicles, multivesicular bodies, and rough endoplasmic reticulum, as coronavirus particles in SARS‐CoV‐2 positive patient tissue specimens. To counter these misinterpretations, we describe the morphological features of coronaviruses that should be used to differentiate coronavirus particles from subcellular structures. Further, as many of the misidentifications of coronavirus particles have stemmed from attempts to attribute tissue damage to direct infection by SARS‐CoV‐2, we review articles describing ultrastructural changes observed in specimens from SARS‐CoV‐2‐infected individuals that do not necessarily provide EM evidence of direct viral infection. Ultrastructural changes have been observed in respiratory, cardiac, kidney, and intestinal tissues, highlighting the widespread effects that SARS‐CoV‐2 infection may have on the body, whether through direct viral infection or mediated by SARS‐CoV‐2 infection‐induced inflammatory and immune processes.

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Section: Coronavirus Misidentificationsmentioning

confidence: 99%

Section: Ultrastructural Changes Caused By Sars‐cov ...mentioning

confidence: 99%

Detection and identification of coronaviruses in human tissues using electron microscopy

Bullock

Goldsmith

Miller

2022

Microscopy Res & Technique

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“…It must be emphasized that the viral infection can not only deregulate a pre-existing heart disease, but also exacerbate mild asymptomatic pre-existing heart failure with long-term complications. The increased risk of complications in patients with heart failure, various arrhythmias, post-infarction, and similar vulnerable conditions leads to a higher risk for suspected myocardial damage ( Figure 2 ) [ 81 , 82 , 83 ].…”

Section: Discussionmentioning

confidence: 99%

“…The co-existence of myocardial inflammation and interstitial edema with cardiac fibrosis, together with an abnormal regulation of the intracellular Ca ++ and K + concentrations can facilitate arrhythmias (especially tachyarrhythmias) and subsequently heart failure, further damaging the heart. In the worst scenario, the overall systemic damage may lead to a multi-organ failure (MOF) [ 1 , 9 , 78 , 80 , 81 , 82 , 83 ] Credits: Original figure by I.A. Charitos).…”

Section: Figurementioning

confidence: 99%

Cardiac Involvement in COVID-19 Patients: A Contemporary Review

Carretta

Silva

D’Agostino

et al. 2021

Infectious Disease Reports

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Background: The widely variable clinical manifestations of SARS-CoV2 disease (COVID-19) range from asymptomatic infections to multiple organ failure and death. Among the organs affected is the heart. This does not only affect people who already have previous cardiovascular problems, but also healthy people. This is a reason not to overlook any symptoms or to perform targeted examinations, even if apparently unrelated to the heart, for quick recognition and timely therapy. Aim of the study: This review recapitulates the current state of knowledge on the potential mechanisms and manifestation of myocarditis in patients with COVID-19 infection. Methods: A web-based search of published data was performed for all relevant studies on patients diagnosed with a COVID-19-induced acute myocarditis, and a total of 50 reports were included. The analysis of the studies evaluated highlights a male predominance, with the average age of patients being 55 years. The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. Finally, we wanted to use a general evaluation without distinguishing between various countries, taking into consideration only the peer or reviewer, regardless of the declared value of the journals that have been published. Results and critical findings: The most common presenting symptoms included fever, shortness of breath, cough, and chest pain. Among ECG changes, non-specific ST-segment and T-wave amplitude alterations and ventricular tachycardia episodes were reported. In most patients, elevated levels of cardiac and inflammatory biomarkers were measured. Left ventricular dysfunction and hypokinesis were commonly exhibited symptoms. Cardiac Magnetic Resonance Imaging (CMRI) confirmed the diagnosis of myocarditis with features of cardiac edema and cardiac injury. Nine patients underwent histopathological examination. Treatment with corticosteroids and immunoglobulins was the most applied strategy following the administration of antivirals. Discussion: Despite the exponentially growing knowledge on the management of COVID-19 infection, current available data on SARS-CoV2-correlated myocarditis are still limited, and several difficulties may be encountered in the differential diagnosis of acute myocarditis in the context of COVID-19 disease. Conclusions: While diagnostic criteria and evaluation strategies for myocarditis are well described, no guidelines for the diagnosis and treatment of myocarditis in COVID-19 patients have yet been established. Therefore, further research is needed to advance the understanding of this disease process and define the most appropriate strategic approach in these patients.

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“…There are single case reports of virus-shaped particles [ 11 ] in cardiomyocytes; thus, direct infection might be possible in a subset of cases. However, the clinicopathological evidence remains scarce [ 24 ]. Another finding in COVID-19 autopsies was cardiac amyloidosis.…”

Section: Organ Specific Involvement In Covid-19mentioning

confidence: 99%

Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies?

et al. 2022

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The use of autopsies in medicine has been declining. The COVID-19 pandemic has documented and rejuvenated the importance of autopsies as a tool of modern medicine. In this review, we discuss the various autopsy techniques, the applicability of modern analytical methods to understand the pathophysiology of COVID-19, the major pathological organ findings, limitations or current studies, and open questions. This article summarizes published literature and the consented experience of the nationwide network of clinical, neuro-, and forensic pathologists from 27 German autopsy centers with more than 1200 COVID-19 autopsies. The autopsy tissues revealed that SARS-CoV-2 can be found in virtually all human organs and tissues, and the majority of cells. Autopsies have revealed the organ and tissue tropism of SARS-CoV-2, and the morphological features of COVID-19. This is characterized by diffuse alveolar damage, combined with angiocentric disease, which in turn is characterized by endothelial dysfunction, vascular inflammation, (micro-) thrombosis, vasoconstriction, and intussusceptive angiogenesis. These findings explained the increased pulmonary resistance in COVID-19 and supported the recommendations for antithrombotic treatment in COVID-19. In contrast, in extra-respiratory organs, pathological changes are often nonspecific and unclear to which extent these changes are due to direct infection vs. indirect/secondary mechanisms of organ injury, or a combination thereof. Ongoing research using autopsies aims at answering questions on disease mechanisms, e.g., focusing on variants of concern, and future challenges, such as post-COVID conditions. Autopsies are an invaluable tool in medicine and national and international interdisciplinary collaborative autopsy-based research initiatives are essential.

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A novel coronavirus meets the cardiovascular system: Society for Cardiovascular Pathology Symposium 2021

Cited by 13 publications

References 46 publications

Detection and identification of coronaviruses in human tissues using electron microscopy

Detection and identification of coronaviruses in human tissues using electron microscopy

Cardiac Involvement in COVID-19 Patients: A Contemporary Review

Organ manifestations of COVID-19: what have we learned so far (not only) from autopsies?

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