Clinical characteristics and histopathology of COVID-19 related deaths in South African adults

Abstract

Comparisons of histopathological features and microbiological findings between decedents with respiratory symptoms due to SARS-CoV-2 infection or other causes, in settings with high prevalence of HIV and Mycobacterium tuberculosis (MTB) infections have not been reported. Deaths associated with a positive ante-mortem SARS-CoV-2 PCR test and/or respiratory disease symptoms at Chris Hani Baragwanath Academic Hospital in Soweto, South Africa from 15th April to 2nd November 2020, during the first wave of the South African COVID-19 epidemic, were investigated. Deceased adult patients had post-mortem minimally-invasive tissue sampling (MITS) performed to investigate for SARS-CoV-2 infection and molecular detection of putative pathogens on blood and lung samples, and histopathology examination of lung, liver and heart tissue. During the study period MITS were done in patients displaying symptoms of respiratory disease including 75 COVID-19-related deaths (COVID+) and 42 non-COVID-19-related deaths (COVID-). The prevalence of HIV-infection was lower in COVID+ (27%) than in the COVID- (64%), MTB detection was also less common among COVID+ (3% vs 13%). Lung histopathology findings showed differences between COVID+ and COVID- in the severity of the morphological appearance of Type-II pneumocytes, alveolar injury and repair initiated by SARS-CoV-2 infection. In the liver necrotising granulomatous inflammation was more common among COVID+. No differences were found in heart analyses. The prevalence of bacterial co-infections was higher in COVID+. Most indicators of respiratory distress syndrome were undifferentiated between COVID+ and COVID- except for Type-II pneumocytes. HIV or MTB infection does not appear in these data to have a meaningful correspondence with COVID-related deaths.

The intersecting pandemics of tuberculosis and COVID-19: population-level and patient-level impact, clinical presentation, and corrective interventions

“…In a limited (minimally invasive tissue sampling) post-mortem biopsy study undertaken in Johannesburg, South Africa (n=150), microbiologically proven tuberculosis was detected in 3% of COVID-19positive biopsies and 13% of COVID-19-negative biopsies. 61 For comparative purposes, the prevalence of tuberculosis in the same general population, including those with subclinical or undiagnosed tuberculosis in the community, is about 0•5-1%. 62 Active tuberculosis is often not considered by clinicians in the setting of acute lower respiratory tract infection (LRTI) or acute community-acquired pneumonia.…”

Differential Activation of Programmed Cell Death in Patients with Severe SARS-CoV-2 Infection

“…Table S2 shows additional correlations between patient characteristics and microscopic ndings. DISCUSSION SARS-2 mediates signi cant tissue damage and in ammation during lung infection 34,35 . In this study, we sought to identify, localize, and quantify activation of apoptosis, ferroptosis, pyroptosis, and necroptosis in FFPE lung tissues from patients that died from severe SARS-2 infection (n=28) relative to uninfected controls (n=13).…”

The Spectrum of Digestive Tract Histopathologic Findings in the Setting of Severe Acute Respiratory Syndrome Coronavirus-2 Infection: What Pathologists Need to Know

“…59 Partial or complete occlusion of intrahepatic vasculature (arterial, sinusoidal, central vein, and portal vein) by platelet-rich/fibrin microthrombi have been described in about 40% of cases. 59,61,62,65,66,[68][69][70]72,74,79,80,83,84 An interesting finding observed in 2 cases is the presence of pale eosinophilic ovoid sinusoidal (thrombotic) bodies that expressed CD61, supporting that these structures were rich in platelets. 59 Less frequent findings observed included cholestasis, necrosis, and granulomata.…”

“…Macrovesicular steatosis was the predominant type, observed in 50% to 88% of studied cases, followed by mixed micro and macrovesicular steatosis, and less frequently microvesicular steatosis was observed in nearly 3% of cases. 59,62,[66][67][68][69][70][71][72][73] Mostly minimal/ mild to rarely moderate degrees of macrovesicular steatosis, involving about 5% to 60% of hepatocytes, with a predominantly panlobular or centrilobular distribution, were observed. 15,58,59,[63][64][65]70,[74][75][76][77][78][79] It has been postulated that the presence of steatosis in the liver of COVID-19 patients is most likely associated with underlying diabetes mellitus, obesity, and/or hyperlipidemia.…”