Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series
Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series
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DOI：
10.1016/s0140-6736(20)31305-2
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发表时间：
2020-08-01
期刊：
影响因子：
168.9
通讯作者：
Marshall, Desiree A.
中科院分区：
文献类型：
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作者：
Bradley, Benjamin T.;Maioli, Heather;Marshall, Desiree A.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种持续流行的原因，在世界范围内死亡人数不断增加。迄今为止，由于尸检表现稀疏和器官取样不完整，由SARS-CoV-2（COVID-19）引起的疾病致死病例的组织病理学特征记录很少。我们的目的是通过记录组织病理学变化和SARS-CoV-2组织嗜性的证据来提供严重COVID-19病例的临床病理报告。方法在该病例系列中，具有阳性生前或死后SARS-CoV-2结果的患者被认为有资格入组。2020年2月至3月，金县法医办公室（美国华盛顿州西雅图）和斯诺霍米什县法医办公室（美国华盛顿州埃弗雷特）在负压隔离室对14名死于COVID-19的人进行了尸检。对临床和实验室数据进行了审查。组织检查进行了光学显微镜，免疫组化，电子显微镜，定量RT-PCR.Findings我们的队列的中位年龄为73中心点5年（范围42-84; IQR 67中心点5-77中心点25）。所有患者均患有临床上显着的合并症，最常见的是高血压、慢性肾病、阻塞性睡眠呼吸暂停以及包括糖尿病和肥胖在内的代谢性疾病。主要的肺部发现是弥漫性肺泡损伤的急性或机化阶段，与5例显示局灶性肺微血栓。在呼吸系统、肾脏和胃肠道中检测到冠状病毒样颗粒。淋巴细胞性心肌炎，观察在一个病人中检测到病毒RNA的tissue.Interpretation在我们的队列中观察到的主要病理是弥漫性肺泡损伤，与病毒位于肺细胞和气管上皮。观察到的微血栓很少，未发现内皮炎。虽然其他非肺部器官对感染表现出易感性，但它们在SARS-CoV-2感染发病机制中的作用需要进一步研究。版权所有（c）2020 Elsevier Ltd.保留所有权利。
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism.Methods In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR.Findings The median age of our cohort was 73 center dot 5 years (range 42-84; IQR 67 center dot 5-77 center dot 25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue.Interpretation The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination. Copyright (c) 2020 Elsevier Ltd. All rights reserved.