Inside the lungs of COVID-19 disease

Aguiar, Diego; Lobrinus, Johannes Alexander; Schibler, Manuel; Fracasso, Tony; Lardi, Christelle

doi:10.1007/s00414-020-02318-9

Cited by 98 publications

(113 citation statements)

References 8 publications

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“…Quite a few morphological studies have been published so far. Some are single case reports based on necropsies of lung, liver and heart 22 , partial autopsies of the thoracic cavity 23 or full autopsies 24 . Some represent small (n = 2-3) case series based on surgical lung resectates 25 or on full autopsies [26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Early postmortem mapping of SARS-CoV-2 RNA in patients with COVID-19 and correlation to tissue damage

Deinhardt‐Emmer

Wittschieber

Sanft

et al. 2020

Preprint

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AbstractClinical observations indicate that COVID-19 is a systemic disease. An investigation of the viral distribution within the human body in correlation to tissue damage can help understanding the pathophysiology of SARS-CoV-2 infection.We present a detailed mapping of viral RNA in 61 tissues and organs of 11 deceased patients with the diagnosis COVID-19. The autopsies were performed within the (very) early postmortem interval (mean: 5.6 hours) to avoid bias due to viral RNA and tissue degradation. Viral loads, blood levels of cytokines, prothrombotic factors as well as macro- and micro-morphology were correlated.Very high (> 104 copies/ml) viral loads were detected in the lungs of most patients and then correlated to severe tissue damage. Intact viral particles could be verified in the lung tissue by transmission electron microscopy. Viral loads in the lymph nodes were associated with a loss of follicular architecture. Viral RNA was detected throughout further extra-pulmonary tissues and organs without visible tissue damage. Inflammatory cytokines as well as the prothrombotic factors were elevated in all patients.In conclusion, the dissemination of SARS-CoV-2-RNA throughout the body supports the hypothesis of a maladaptive host response with viremia and multi-organ dysfunction.

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Section: Discussionmentioning

confidence: 99%

Early postmortem mapping of SARS-CoV-2 RNA in patients with COVID-19 and correlation to tissue damage

Deinhardt‐Emmer

Wittschieber

Sanft

et al. 2020

Preprint

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“…Even in the three most numerous case series, bronchopneumonia was found in 33-55% of cases [39,40,42]. Minimal submucosal inflammation was described in the bronchi/bronchioles [48,49], and in two cases, tracheitis was also reported [39,48]. Even if tracheitis may be explained as an iatrogenic lesion in some patients particularly in those who received invasive ventilation, the finding that these lesions may also frequently occur in patients without invasive ventilation (Padova experience, submitted for publication) suggests that the trachea is an important target of the disease.…”

Section: Pulmonary and Airway-associated Lesionsmentioning

confidence: 99%

“…While DAD with perivascular T cell infiltration was a common feature in SARS-CoV-2 and H1N1 infections, vascular features were instead distinctive of COVID-19 and consisted In case series, the mean value of available information was reported of severe endothelial injury, widespread thrombosis with microangiopathy, alveolar capillary microthrombi, and neoangiogenesis [46]. Studies that are more recent confirm the complexity of COVID-19, emphasizing the patchy distribution of the disease, mainly focusing on acute lung injury [47][48][49]. Similar lesions consisting in DAD and diffuse signs of thrombosis and microangiopathy in the small vessels and capillaries of the lungs have recently reported also in a small series of African American community with COVID-19 [50].…”

Section: Pathology Of Lung Lesions In Covid Deceased Patientsmentioning

confidence: 99%

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Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists

et al. 2020

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Since its initial recognition in December 2019, Coronavirus disease 19 (COVID-19) has quickly spread to a pandemic infectious disease. The causative agent has been recognized as a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), primarily affecting the respiratory tract. To date, no vaccines are available nor any specific treatment. To limit the number of infections, strict directives have been issued by governments that have been translated into equally rigorous guidelines notably for post-mortem examinations by international and national scientific societies. The recommendations for biosafety control required during specimen collection and handling have strongly limited the practice of autopsies of the COVID-19 patients to a few adequate laboratories. A full pathological examination has always been considered an important tool to better understand the pathophysiology of diseases, especially when the knowledge of an emerging disorder is limited and the impact on the healthcare system is significant. The first evidence of diffuse alveolar damage in the context of an acute respiratory distress syndrome has now been joined by the latest findings that report a more complex scenario in COVID-19, including a vascular involvement and a wide spectrum of associated pathologies. Ancillary tools such as electron microscopy and molecular biology used on autoptic tissue samples from autopsy are also significantly contributing to confirm and/or identify new aspects useful for a deeper knowledge of the pathogenetic mechanisms. This article will review and summarize the pathological findings described in COVID-19 until now, chiefly focusing on the respiratory tract, highlighting the importance of autopsy towards a better knowledge of this disease.

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“…They describe general autopsy ndings and do not quantify MKs or include a correlation with coagulation parameters. Four other reports refer to pulmonary MKs as a relevant nding [31][32][33][34][35]. Carsana et al quanti ed them revealing an increased number in 33 of their 38 patients [35].…”

Section: Discussionmentioning

confidence: 99%

Increased number of pulmonary megakaryocytes in COVID-19 patients with diffuse alveolar damage. An autopsy study with clinical correlation and review of the literature.

Valdivia-Mazeyra

Salas

Nieves-Alonso

et al. 2020

Preprint

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Megakaryocytes are normally present in the lung where they play a role in platelet homeostasis. The latter are well known to participate in the pathogenesis of lung damage, particularly in acute lung injury. Although megakaryocytes are usually not mentioned as a characteristic histopathologic finding associated to acute pulmonary injury, a few studies point out that their number is increased in the lungs of patients with diffuse alveolar damage. In this autopsy study we have observed a relevant number of pulmonary megakaryocytes in COVID-19 patients dying with acute respiratory distress syndrome. We have studied pulmonary tissue samples of 18 patients most of which died after prolonged disease and use of mechanical ventilation. Most samples showed fibroproliferative or fibrotic diffuse alveolar damage and an increased number of megakaryocytes. In six, thrombi of the pulmonary microcirculation were seen. We compare our findings with previous published autopsy reports, mainly focusing on the description of megakaryocytes. Our patients showed abnormal coagulation parameters with high levels of fibrinogen, D-dimers and variable thrombocytopenia. Since the lung is considered an active site of megakariopoiesis, a prothrombotic status leading to platelet activation, aggregation and consumption may trigger a compensatory pulmonary response. An increased number of pulmonary megakaryocytes suggests and supports a relation with the thrombotic events so often seen in COVID-19. Regardless of its etiology, future studies of patients dying with acute pulmonary injury should include pulmonary megakaryocytes as a histologic variable of interest.

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Inside the lungs of COVID-19 disease

Cited by 98 publications

References 8 publications

Early postmortem mapping of SARS-CoV-2 RNA in patients with COVID-19 and correlation to tissue damage

Early postmortem mapping of SARS-CoV-2 RNA in patients with COVID-19 and correlation to tissue damage

Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists

Increased number of pulmonary megakaryocytes in COVID-19 patients with diffuse alveolar damage. An autopsy study with clinical correlation and review of the literature.

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