Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients
Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients
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DOI：
10.1186/s13054-020-03218-5
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发表时间：
2020-08-12
期刊：
影响因子：
15.1
通讯作者：
Salmon, Isabelle
中科院分区：
文献类型：
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作者：
Remmelink, Myriam;De Mendonca, Ricardo;Salmon, Isabelle
背景尸检可以为了解新疾病提供重要信息，小型尸检病例系列已经报道了在新冠肺炎患者中不同的结果。方法我们评估在这些患者中是否观察到一些特定的死后特征，以及这些变化是否与不同器官中病毒的存在有关。对17例新冠肺炎死亡患者的不同器官进行了完整的大体解剖和显微解剖。用免疫组织化学(IHC)和实时逆转录聚合酶链式反应(RT-PCR)检测肺组织和其他器官中SARS-CoV-2的存在。结果17例患者中15例出现早期弥漫性肺泡损伤(DAD)，11例出现肺小动脉微血栓。晚期DAD、不典型肺泡细胞和/或急性肺炎也被观察到。肺梗死4例，急性心肌梗死2例，缺血性肠炎1例。没有心肌炎、肝炎或脑炎的证据。肾脏评估显示，在大多数患者的肾小管或着色管型中存在含铁血黄素。海绵体和血管充血是最常见的脑部病变。各脏器均未见SARS-CoV-2特异性病变。免疫组化检测17例患者中有11例(65%)肺组织中存在SARS-CoV-2阳性细胞，且分布不均；RT-PCR检测到SARS-CoV-2病毒在不同组织中广泛分布，其中8例患者在所有受检器官(即肺、心、脾、肝、结肠、肾和脑)中均存在病毒。结论：总之，尸检显示新冠肺炎相关器官损伤具有很大的异质性，即使RT-PCR检测到许多器官中存在病毒，也没有任何特定的病毒损害。
Background Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients. Methods We evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in the lung and other organs. Results Pulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes, and/or acute pneumonia were also observed. Four lung infarcts, two acute myocardial infarctions, and one ischemic enteritis were observed. There was no evidence of myocarditis, hepatitis, or encephalitis. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e., lung, heart, spleen, liver, colon, kidney, and brain). Conclusions In conclusion, autopsies revealed a great heterogeneity of COVID-19-associated organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.