Histopathologic Findings in the Explant Lungs of a Patient With COVID-19 Treated With Bilateral Orthotopic Lung Transplant

Luo, Weiren; Yu, Hong; Gou, Jizhou; Li, Xiaoxing; Sun, Yan; Li, Jinxiu; He, Jianxing; Liu, Lei

doi:10.1097/tp.0000000000003412

Cited by 62 publications

(51 citation statements)

References 4 publications

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“…Similar to our findings, other studies on COVID-19 have described the formation of pulmonary interstitial fibrosis and microthrombosis 19 . Bradley et al 12 described the presence of coronavirus-like particles inside tracheal epithelial cells and in the extracellular space, or as a mix with luminal mucus.…”

Section: Discussionsupporting

confidence: 93%

Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy

Santana

Pinto

Marcon

et al. 2021

Rev. Soc. Bras. Med. Trop.

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INTRODUCTION: Electron microscopy (EM) is a rapid and effective tool that can be used to create images of a whole spectrum of virus-host interactions and, as such, has long been used in the discovery and description of viral mechanisms. METHODS: Electron microscopy was used to evaluate the pulmonary pathologies of postmortem lung sections from three patients who died from infection with SARS-associated coronavirus 2 (SARS-CoV-2), a new member of the Coronaviridae family. RESULTS: Diffuse alveolar damage (DAD) was predominant in all three patients. The early exudative stage was characterized principally by edema and extravasation of red blood cells into the alveolar space with injury to the alveolar epithelial cells; this was followed by detachment, apoptosis, and necrosis of type I and II pneumocytes. The capillaries exhibited congestion, exposure of the basement membrane from denuded endothelial cells, platelet adhesion, fibrin thrombi, and rupture of the capillary walls. The proliferative stage was characterized by pronounced proliferation of type II alveolar pneumocytes and multinucleated giant cells. The cytopathic effect of SARS-CoV-2 was observed both in degenerated type II pneumocytes and freely circulating in the alveoli, with components from virions, macrophages, lymphocytes, and cellular debris. CONCLUSIONS: Viral particles consistent with the characteristics of SARS-CoV-2 were observed mainly in degenerated pneumocytes, in the endothelium, or freely circulating in the alveoli. In the final stage of illness, the alveolar spaces were replaced by fibrosis.

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Section: Discussionsupporting

confidence: 93%

Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy

Santana

Pinto

Marcon

et al. 2021

Rev. Soc. Bras. Med. Trop.

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“…13-15 , 17 , 19 Furthermore, autopsy specimen studies have revealed that most lung samples present thrombotic features, especially in peripheral vessels. [52][53][54][55] Another novel finding of our study is the construction of a score to predict PE during hospitalization using four easy-to-measure variables (CRP, heart rate, oxygen saturation, and D-dimer) at admission. This CHOD score was constructed after a dichotomization of the variables, choosing the cut-off points with the best prognostic value ( > 50 UI/mL, > 90 bpm, < 92% and > 956 mg/dl, respectively), and it has a range of values from 0 to 7 points.…”

Section: Article In Pressmentioning

confidence: 99%

Incidence, risk factors, and thrombotic load of pulmonary embolism in patients hospitalized for COVID-19 infection

García-Ortega

Oscullo

Calvillo

et al. 2021

Journal of Infection

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Objective: To determine the incidence, characteristics, and risk factors of pulmonary embolism (PE) among patients hospitalized for COVID-19. Patients and Methods: We performed a prospective observational study of a randomly selected cohort of consecutive patients hospitalized for COVID-19 infection between March 8, 2020 through April 25, 2020. All eligible patients underwent a computed tomography pulmonary angiography independently of their PE clinical suspicion and were pre-screened for a baseline elevated D-dimer level. Results: 119 patients were randomly selected from the 372 admitted to one tertiary hospital in Valencia (Spain) for COVID-19 infection during the period of study. Seventy-three patients fulfilled both the inclusion criteria and none of the exclusion criteria and were finally included in the study. Despite a high level of pharmacological thromboprophylaxis (89%), the incidence of PE was 35.6% (95% confidence interval [CI], 29.6 to 41.6%), mostly with a peripheral location and low thrombotic load (Qanadli score 18.5%). Multivariate analysis showed that heart rate (Hazard Ratio [HR], 1.04), room-air oxygen saturation (spO2) (HR, 0.87), D-dimer (HR, 1.02), and C-reactive protein (CRP) levels (HR, 1.01) at the time of admission were independent predictors of incident PE during hospitalization. A risk score was constructed with these four variables showing a high predictive value of incident PE (AUC-ROC: 0.86; 95% CI: 0.80 to 0.93). Conclusions: Our findings confirmed a high incidence of PE in hospitalized COVID-19 patients. Heart rate, spO2, D-dimer, and CRP levels at admission were associated with higher rates of PE during hospitalization.

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“…18,19 Additionally, congestion of alveolar septal vessels with alveolar edema, infiltration of monocytes and lymphocytes in alveolar cavity and micro-thrombosis, alveolar exudate organization, pulmonary interstitial fibrosis, desquamation of mucosal epithelium, and mucus concealed bronchi have also been reported as prominent features of COVID-19. 20,55 However, the pathogenicity mechanism of the SARS-CoV-2 to induce COVID-19 pneumonia and the pulmonary limitations in COVID-19 cases after their recovery from pneumonia remains to be determined.…”

Section: Pathologymentioning

confidence: 99%

Pathology and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Afewerky

2020

Exp Biol Med (Maywood)

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a beta coronavirus that causes infectious respiratory disease, named as coronavirus disease of 2019 (COVID-19). While extensive studies have provided basic information on clinical characteristics of COVID-19, the disease pathology is not fully known. The SARS-CoV-2 virus structural studies and biochemical experiments have also indicated that the virus receptor-binding domain (RBD) binds with a high affinity to angiotensin-converting enzyme-2 (ACE-2) receptor from humans; however, the mechanism remains unclear. Hereunder, a summary of relevant findings in the SARS-CoV-2 virus pathology and major pathogenicity mechanisms are discussed. This review of studies provides additional enlightenments on the way forward to prevent further spread or even cure for the SARS-CoV-2 virus-caused COVID-19 disease, either-or should a similar viral plague occur in the future. Impact statement The current survey of studies outlines the direct and indirect effects of SARS-CoV-2 on the specific body systems and summarizes the SARS-CoV-2 main pathogenicity mechanisms that require attention during patient hospitalization and for further research.

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Histopathologic Findings in the Explant Lungs of a Patient With COVID-19 Treated With Bilateral Orthotopic Lung Transplant

Cited by 62 publications

References 4 publications

Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy

Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy

Incidence, risk factors, and thrombotic load of pulmonary embolism in patients hospitalized for COVID-19 infection

Pathology and pathogenicity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

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