Multi-organ pathological findings associated with COVID-19 in postmortem needle core biopsies in four patients and a review of the current literature

Pessolani, Tais González; Legaria, Marta Muñoz Fernández de; Apellániz, Margarita Elices; Moreno, Silvia Salinas; García, Cortés, María del Mar Lorido, Sánchez, Sagrario; Sánchez, Sagrario García

doi:10.1016/j.patol.2020.09.003

Cited by 7 publications

(5 citation statements)

References 16 publications

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“…Binuclear and multinuclear hepatocytes were identified, similar to the findings of Wang et al [33], who report that this morphological phenomenon may be attributed to reactive changes. Few hepatocytes showed glycogenic intranuclear vacuolisation, a finding that contrasts with that found by Pessolani et al [34], who described many hepatocytes with this finding. In a series of 40 cases, Lagana et al [35] found macrovesicular steatosis in all patients, whereas microvesicular steatosis was found in our patient.…”

Section: Discussioncontrasting

confidence: 90%

Amoebic liver abscess in a COVID-19 patient: a case report

et al. 2021

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Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

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Section: Discussioncontrasting

confidence: 90%

Amoebic liver abscess in a COVID-19 patient: a case report

et al. 2021

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“…Clinical trials of surfactant use in ARDS in SARS-CoV-2 infections are currently underway. Despite important differences in the underlying populations and the methods utilized, this MITS-based study of decedents presenting with symptoms of respiratory disease shows substantial conformity with prior results from other parts of the world concerning lung pathology among persons testing positive for SARS-CoV-2 infection [23,34].…”

Section: Plos Onesupporting

confidence: 67%

“…Recently, studies of larger numbers of decedents and meta-analyses of smaller studies have been published [ 18 , 19 ]. Because ARDS is common in severely ill patients with SARS-CoV-2 infections, the large majority of the literature has focused on the analysis of lung tissue samples [ 20 , 21 ], with only a few study reporting on multiple tissue findings [ 19 , 22 , 23 ]. This study documents post-mortem lung, liver and heart histopathology, and blood and lung culture and molecular assay findings among adult decedents in Soweto, South Africa diagnosed with respiratory symptoms, and compares these findings based on SARS-CoV-2 infection status diagnosed either ante-mortem or post-mortem.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…The spleen typically shows lymphocytic depletion of the white pulp, leading to a decrease or absence of lymphoid follicles. Kidney involvement manifests as acute tubular necrosis (ATN), characterized by glomerular capillary thrombi, vacuolization, and dilatation of tubules 6 .…”

Section: Intruductionmentioning

confidence: 99%

M Multi-Organ Histopathological Changes in SARS COV2 Infection: A Systematic Review and Meta-analysis

Al-Haboobi,

Rihab Hameed Al-Mudhafar

2024

KMJ

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Background: The World Health Organization has officially acknowledged the emergence of Coronavirus Disease 2019 (COVID-19), attributed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, as a rapidly escalating global public health issue and declared it a pandemic. SARS-CoV-2 infection can lead to varied and multiorgan pathologies, with the most notable impacts occurring in the lungs (characterized by phases of diffuse alveolar damage, microthrombi, and bronchopneumonia), heart (involving lymphocytic myocarditis), kidney (resulting in acute tubular injury), and vasculature (involving microthrombi and deep vein thrombi). Objectives: To summarize, resolve contradiction and provide solid evidence on multiorgan histopathological changes caused by SARS-CoV2 infection. Material and method: Histological data obtained from autopsy and biopsy studies were gathered following the guidelines of the Preferred Reporting Items for Systematic Review (PRISMA). An extensive electronic search was conducted on databases such as PubMed, Science Direct, Scopus, and Google Scholar, covering the period from database inception to March 2022. The collected studies underwent a systematic literature search, and a thorough critical review was performed. Result: After excluding studies that did not meet the eligibility criteria, a total of 58 articles were included in the review. We estimate the histopathological findings of 13 organ. For the pool proportion of exudative, proliferative and fibrotic phase of diffuse alveolar damage of lung is (70.666%, 56.126% and 33.031%) respectively. For liver steotosis is 35.808%. For acute tubular injury of kidney is 74.872%. For adrenal cortical necrosis is 13.113%. For brain gliosis is 13.865%. For heart necrosis is 5.477%. For gastrointestinal tract the pool proportion of inflammatory cells infiltration is 6.171%. For placental infarction is 25.684%. For orchitis is 29.019%. For perivascular inflammation of skin is 35.176%. For lymphocytic depletion of white pulp of spleen is 69.204%. For hemophagiocytosis of lymph node is 7.022%. For bone marrow fibrosis is 8.473%. Conclusion: COVID-19 is characterized as a multiorgan infection closely associated with a hyperinflammatory state, believed to initiate with diffuse alveolar damage and immuno-thrombotic microangiopathy. The extensive activation of the immune system and microvascular damage may contribute to indirect harm to other organs, although the direct impact of the virus on these tissues cannot be ruled out.

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Multi-organ pathological findings associated with COVID-19 in postmortem needle core biopsies in four patients and a review of the current literature

Cited by 7 publications

References 16 publications

Amoebic liver abscess in a COVID-19 patient: a case report

Amoebic liver abscess in a COVID-19 patient: a case report

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

M Multi-Organ Histopathological Changes in SARS COV2 Infection: A Systematic Review and Meta-analysis

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