COVID-19 in an HIV-infected patient. Lessons learned from an autopsy case

Khaba, Moshawa Calvin; Ngale, Tshepo Cletus; Madala, Nomandla

doi:10.1016/j.ijid.2020.09.1435

Cited by 12 publications

(12 citation statements)

References 7 publications

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“…Moreover, neutrophil extracellular traps (NETs) can contribute to inflammation-associated lung damage, thrombosis, and fibrosis [ 52 ]. Thrombi in pre- and post-capillary vessels were frequently described [ 47 , 50 , 62 , 78 , 113 , 120 , 135 ]: thrombi usually appeared hetero-synchronous, at different stages of organization [ 48 , 66 , 79 , 83 ]. It is interesting to note that a higher presence of ACE2 in alveolar epithelial cells and capillary endothelial cells facilitate the entrance of SARS-CoV-2 [ 62 ], generating a subsequent high expression of chemokines and cytokines (IL(interleukin) -6, IL10, TNF (Tumor Necrosis Factor)-α) [ 57 ].…”

Section: Resultsmentioning

confidence: 99%

Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)

2021

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In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome—Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality.

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Section: Resultsmentioning

confidence: 99%

Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)

2021

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“…To our knowledge, this is the first large COVID-19 whole-body autopsy series of hospital inpatient deaths to be reported from sub-Saharan Africa (SSA) to date. Autopsy studies and data on the pathology of COVID-19 from SSA is scanty and has been restricted only to examination of tissue samples obtained through minimally invasive post-mortem examination of 4 cases in South Africa ( Bruce-Brand et al, 2020 ) and two autopsy reports, one of a COVID-19 and HIV co-infected person ( Khaba et al, 2020 ) and another of an infant co-infected with SARS-CoV-2 and Mycobacterium tuberculosis ( Mulale et al, 2021 ). Our study provides data from 29 autopsies of hospital COVID-19 deaths.…”

Section: Discussionmentioning

confidence: 99%

“…There remains scanty information on the actual causes of death and pathogenesis of COVID-19 from the African continent. There are only two individual case reports of whole body autopsies and lung biopsy studies of four South African ICU patients obtained after death ( Mulale et al, 2021 , Khaba et al, 2020 , Bruce-Brand et al, 2020 ). Several reports have emphasized the need for rekindling and revamping autopsy and post-mortem studies in SSA ( Mawalla, 2020 , Mucheleng’anga and Himwaze, 2020 , Maiese et al, 2020 , Mulale et al, 2021 , Khaba et al, 2020 , Bruce-Brand et al, 2020 , Mudenda et al, 2020 ), to determine the underlying pathology and causes of COVID-19 deaths occurring in hospital inpatients.…”

Section: Introductionmentioning

confidence: 99%

“…Whole-body autopsies in general, and on confirmed or suspected SARS-CoV-2 cases in Africa have not been forthcoming due to scarcity of pathologists, inadequate infrastructure, and difficulties in obtaining consent for autopsies ( Mawalla, 2020 , Mucheleng’anga and Himwaze, 2020 , Khaba et al, 2020 , Rampatige and Gilks, 2015 ). In addition, performing autopsies in environments where infectious pathogens such as SARS-CoV-2 are suspected or confirmed, requires optimal biosafety facilities ( World Health Organization, 2020 , Baj et al, 2021 , Liang et al, 2020 ), which are unavailable in most African countries.…”

Section: Introductionmentioning

confidence: 99%

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Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series

Himwaze¹,

Telendiy²,

Maate³

et al. 2021

International Journal of Infectious Diseases

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Background Since information on the pathology of COVID-19 from sub-Saharan Africa (SSA) remains scarce, the objective of our study was to define the gross pathology and histological features of COVID-19. We report data from 29 whole-body autopsies of COVID-19 deaths occurring in hospitals in Lusaka, Zambia - the first large autopsy case series from Africa. Methods We performed a descriptive post-mortem examination study of inpatient COVID-19 related deaths at two hospitals in Lusaka, Zambia. Whole-body autopsies were conducted according to Standard Operating Procedures. Gross and histopathological examinations of all organs were performed. Patient demographics, history, co-morbidities, autopsy gross and microscopic findings, and cause(s) of death were recorded and analyzed using STATA version 14. Variables were grouped and presented as frequencies and percentages. Findings Autopsies were performed on 29 decedents (mean age = 44 ± 15.8years; age range = 19-82; 17/29 [58.8%] males). 22/29 [75.9%] cases were <55 years of age. A spectrum of pathological manifestations of COVID-19 were seen in all organs. The commonest causes of death were pulmonary thromboembolism (13/29, 45%), Diffuse Alveolar Damage (9/29, 31%), and COVID-19 pneumonia (7/29, 25%). 22/29 (76%) had co-morbidities. Common co-morbidities included HIV (8/29, 28%), Hypertension (6/29, 20%) Tuberculosis (3/29, 10%), Diabetes (3/29, 10%). Conclusions A spectrum of gross anatomical and histopathological findings are seen in COVID-19 deaths in hospitalized decedents. These appear broadly similar to those reported from China, Europe and USA. Differences include a younger age group, and co-morbidities of HIV and TB co-infection which require further investigation.

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“…Regarding HIV and COVID-19 co-infection, there seems to be little impact on the effectiveness of routine ART care, and the only autopsy report, in a patient recently HIV-diagnosed, found the expected COVID-19 lung pathology from which he died. 31 …”

Section: Emerging Co-epidemics and Novel Covid-19 Clinical Pathologiementioning

confidence: 99%

Pandemics and pathology: a reflection on influenza, HIV/AIDS and SARS (COVID-19) pandemic infections

Lucas

2021

Diagnostic Histopathology

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COVID-19 in an HIV-infected patient. Lessons learned from an autopsy case

Cited by 12 publications

References 7 publications

Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)

Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2)

Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series

Pandemics and pathology: a reflection on influenza, HIV/AIDS and SARS (COVID-19) pandemic infections

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