Histopathological observations in COVID-19: a systematic review

Deshmukh, Vishwajit Ravindra; Motwani, Rohini; Kumar, Ashutosh; Kumari, Chiman; Raza, Khursheed

doi:10.1136/jclinpath-2020-206995

Cited by 150 publications

(210 citation statements)

References 40 publications

(66 reference statements)

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“…As evident from the published research reports COVID-19 autopsies provide deeper mechanistic and clinical insights into this challenging disease, particularly, with severe and fatal course [ 5 , 14 , 20 , 23 ]. Pathological changes of the various organs and the cause of death have become more clear as well as the impression of COVID-19 being a complex multisystemic disease [ 11 ]. Thus, the importance of a standardized autopsy procedure and a systematic examination of tissue samples became apparent [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

Skok

Vander

Setaffy

et al. 2021

Pathology - Research and Practice

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Autopsies on COVID-19 have provided deep insights into a novel disease with unpredictable and potentially fatal outcome. A standardized autopsy procedure preferably with an in-situ technique and systematic tissue processing is important. Strict safety measures include personal protective equipment with a standardized protocol for dressing and undressing, usage of FFP-3 masks and minimization of aerosol production. The use of an airborne infection isolation (AIIR) room is preferred. Viral RNA analysis using swabs from throat, both lungs and other organs provides information on cross-organ viral dynamics. To correctly determine the full extent of pathological organ changes an adequate processing procedure is of the utmost importance. Systematic dissection and processing of the lungs revealed pulmonary infarction caused by thrombosis and thromboembolism and subsequent bacterial bronchopneumonia as the most frequent cause of death. Fungal pneumonia (aspergillus) was found in one case. The quality of the tissue was sufficient for histopathological and immunohistochemistry analyses in all cases. Viral RNA from throat or lung swabs was detectable post mortem in 89% of the cases and could also be detected from paraffin-embedded tissue by real-time PCR. Complete COVID-19 autopsies including extensive histopathological studies and viral RNA analysis require approximately three times more human and technical resources and time compared to standard non-COVID autopsies. Autopsies on COVID-19 are feasible, present a manageable risk, while following a strict protocol, and provide novel insights into disease pathogenesis and the clinician with important feedback.

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Section: Discussionmentioning

confidence: 99%

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

Skok

Vander

Setaffy

et al. 2021

Pathology - Research and Practice

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“…There may be the presence of congested vessels, fibrinoid necrosis of the small vasculature, hyaline thrombi in microvessels. Edema in the respiratory mucosa along with infiltration by lymphocytes highlights the presence of severe inflammation [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Acute SARS-CoV-2 pneumonitis with cytotoxic CD8 positive T-lymphocytes: Case report and review of the literature

Puzyrenko

Felix

Sun

et al. 2021

Pathology - Research and Practice

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As of October 2020, there are over 40 million confirmed cases, and more than 1 million confirmed deaths of Covid-19 worldwide. The main cause of death in hospitalized patients is a respiratory failure due to acute respiratory distress syndrome. It has been suggested that the very intense immune response induces diffuse alveolar damage that far exceeds the harm that would have been caused by virus replication per se, resulting in lethal tissue destruction. We present a detailed report of the histopathological findings on cryo transbronchial biopsy in the patient with persistent (3 months) interstitial pneumonitis and severe CD8 positive cell infiltration in the lungs due to SARS-CoV-2 infection. CD8 positive T-lymphocytes have a great potential to damage tissue either through direct cytotoxicity or through cytokines release.

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“…Also, it has been observed that the COVID-19 is associated with the pathological features in the cardiovascular system, such as presence of inflammatory cells and apoptotic bodies in the cardiac tissue and acute myocyte necrosis. In the ultrastructural assessments, the viral inclusion bodies in vascular endothelial cells and CD61 + megakaryocytes were observed (Deshmukh et al 2020). The histopathological findings of patients with a positive SARS-CoV2 result showed that the most common cardiac alterations were fibrosis in 14/14 (100%) and myocyte hypertrophy in 13/14 (93%) patients (Bradley et al 2020).…”

Section: Mechanisms Of Sars-cov2-induced Heart Diseasesmentioning

confidence: 99%

COVID-19 and multiorgan failure: A narrative review on potential mechanisms

et al. 2020

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The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in December 2019 form Wuhan, China leads to coronavirus disease 2019 (COVID-19) pandemic. While the common cold symptoms are observed in mild cases, COVID-19 is accompanied by multiorgan failure in severe patients. The involvement of different organs in severe patients results in lengthening the hospitalization duration and increasing the mortality rate. In this review, we aimed to investigate the involvement of different organs in COVID-19 patients, particularly in severe cases. Also, we tried to define the potential underlying mechanisms of SARS-CoV2 induced multiorgan failure. The multi-organ dysfunction is characterized by acute lung failure, acute liver failure, acute kidney injury, cardiovascular disease, and as well as a wide spectrum of hematological abnormalities and neurological disorders. The most important mechanisms are related to the direct and indirect pathogenic features of SARS-CoV2. Although the presence of angiotensin-converting enzyme 2, a receptor of SARS-CoV2 in the lung, heart, kidney, testis, liver, lymphocytes, and nervous system was confirmed, there are controversial findings to about the observation of SARS-CoV2 RNA in these organs. Moreover, the organ failure may be induced by the cytokine storm, a result of increased levels of inflammatory mediators, endothelial dysfunction, coagulation abnormalities, and infiltration of inflammatory cells into the organs. Therefore, further investigations are needed to detect the exact mechanisms of pathogenesis. Since the involvement of several organs in COVID-19 patients is important for clinicians, increasing their knowledge may help to improve the outcomes and decrease the rate of mortality and morbidity.

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Histopathological observations in COVID-19: a systematic review

Cited by 150 publications

References 40 publications

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

Acute SARS-CoV-2 pneumonitis with cytotoxic CD8 positive T-lymphocytes: Case report and review of the literature

COVID-19 and multiorgan failure: A narrative review on potential mechanisms

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