A series of COVID-19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza.
A series of COVID-19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza.
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DOI：
10.1002/cjp2.220
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Mueller J
中科院分区：
文献类型：
--
作者：
McMullen P;Pytel P;Snyder A;Smith H;Vickery J;Brainer J;Guzy R;Wu D;Schoettler N;Adegunsoye A;Sperling A;Hart J;Alpert L;Chang A;Gurbuxani S;Krausz T;Husain AN;Mueller J
对死于COVID-19的患者进行尸检对于描述与SARS-CoV-2感染相关的损伤模式至关重要。尽管其实用性，但相对于全球疾病负担，全面的尸检研究有些缺乏，并且很少有全面的研究将这些发现与其他致命病毒感染联系起来。我们开发了一种新的尸检方案，以便对COVID-19受害者进行尸检，并在此描述了前16例完整COVID-19尸检中观察到的详细临床信息、大体发现和组织学特征。我们还严格评估了用于在尸检时确定COVID-19诊断的辅助研究的作用，包括免疫组织化学（IHC），原位杂交（ISH）和电子显微镜（EM）。针对SARS-CoV-2的IHC和ISH在肺组织中感染细胞的位置和数量方面相当;然而，IHC偶尔观察到细菌的非特异性染色。EM在盲法取样组织中未显示。然后，我们比较了临床和组织学特征，目前在这个系列的6个档案病例的致命性季节性流感和6个档案病例的大流行性流感从第四波的“西班牙流感”在1920年冬天。除了常规组织学检查外，还使用定量IHC比较了COVID-19和季节性流感患者肺部的炎症浸润。我们的研究结果表明，COVID-19的临床和组织学特征与致命的流感病例相似，这两种疾病在组织学上往往重叠。尸检时，急性肺损伤部位的COVID-19和流感的炎性浸润物组成无显著差异。我们的研究强调了COVID-19和流感重症病例之间相对非特异性的临床特征和病理变化，同时也为病毒检测的辅助方法提供了重要的警告。
Autopsies of patients who have died from COVID‐19 have been crucial in delineating patterns of injury associated with SARS‐CoV‐2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies contextualize the findings to other fatal viral infections. We developed a novel autopsy protocol in order to perform postmortem examinations on victims of COVID‐19 and herein describe detailed clinical information, gross findings, and histologic features observed in the first 16 complete COVID‐19 autopsies. We also critically evaluated the role of ancillary studies used to establish a diagnosis of COVID‐19 at autopsy, including immunohistochemistry (IHC), in situ hybridization (ISH), and electron microscopy (EM). IHC and ISH targeting SARS‐CoV‐2 were comparable in terms of the location and number of infected cells in lung tissue; however, nonspecific staining of bacteria was seen occasionally with IHC. EM was unrevealing in blindly sampled tissues. We then compared the clinical and histologic features present in this series to six archival cases of fatal seasonal influenza and six archival cases of pandemic influenza from the fourth wave of the ‘Spanish Flu’ in the winter of 1920. In addition to routine histology, the inflammatory infiltrates in the lungs of COVID‐19 and seasonal influenza victims were compared using quantitative IHC. Our results demonstrate that the clinical and histologic features of COVID‐19 are similar to those seen in fatal cases of influenza, and the two diseases tend to overlap histologically. There was no significant difference in the composition of the inflammatory infiltrate in COVID‐19 and influenza at sites of acute lung injury at the time of autopsy. Our study underscores the relatively nonspecific clinical features and pathologic changes shared between severe cases of COVID‐19 and influenza, while also providing important caveats to ancillary methods of viral detection.
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