NSR - Autopsy of COVID-19 victims in China - June 6, 2020

[sharon sanders]

Autopsy of COVID-19 victims in China

Xiu-Wu Bian, the COVID-19 Pathology Team
Author Notes
National Science Review, nwaa123, https://doi.org/10.1093/nsr/nwaa123
Published:

06 June 2020

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Abstract

Distribution of SARS-CoV-2 virus and pathological features of multiple organs in COVID-19 patients remains unclear, which interferes with the improvement of COVID-19 diagnosis and treatment. In this article, we summarize the pathological findings obtained from systematic autopsy (37 cases) and percutaneous multiple organ biopsy (“minimally invasive autopsy”, 54 cases). These findings should shed light on better understanding of the progression of COVID-19 infection and the means of more effective intervention.

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The postmortem discloses visible damages in the lung and immune organs in patients with COVID-19. Since some immune organs are SARS-CoV-2 positive with spleen atrophy, the immune organs may be another target organ by virus infection in addition to the lung, which emphasizes that clinical

diagnosis and treatment should consider the damages to immune system. We found that most of the deceased COVID-19 cases had mucous plug in

the alveoli and deep small airways, which might severely affect ventilation. The mechanisms of infection course and prevention measures were subject

of further investigation. In COVID-19 patients, pulmonary fibrosis occurred early and widely, suggesting that the requirement of early measures on

pulmonary fibrosis. In addition, the hyperplasia of pulmonary epithelial cells and the elevation of plasma carcinoembryonic antigen (CEA) in some patients

also require studies of the cause and follow-up.

In some deceased cases, nasopharyngeal swab test showed negative viral nucleic acid, but the acid could be detected in organs, suggesting that

current standard swab test for SARS-CoV-2 as an indicator for clinical cure and hospital discharge may not be adequate.

Detection of nuclear acids of SARS-CoV-2 in multiple organs of COVID-19 patients with severe conditions implies that the existence of SARS-

CoV-2 and related organ damage might persist throughout the disease course even in patients with a longer term of disease.

Preliminary findings of autopsy pathology revealed SARS-CoV-2 viral particles in multiple organs of several cases, suggesting a variety of viral

transmission routes such as the digestive tract, skin, and various body fluids (saliva, urine, semen, sweat and emulsion, etc.). These issues

merit further investigation.


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[sharon sanders]

The authors say that SARS-CoV-2 infection can cause damage to multiple organs and tissues, along with extensive lung lesions. Although the pathological features of lung lesions caused by SARS-CoV-2 infection are similar to SARS, there are significant differences.

In the autopsy of individual patients, the researchers found strong spatiotemporal heterogeneous lesions, and the pathological changes of the patient's respiratory system were the most obvious. The trachea and bronchial mucosa were congested, the secretions increased, and the focal epithelium fell off. Changes in lung parenchyma are manifested in differences in degree and distribution.

Under the light microscope, the parenchymal area contains diffuse alveolar injury and exudative inflammation. In cases with a long course of disease, the researchers observed pneumonia and pulmonary interstitial fibrosis.

Immunohistochemical staining showed that the entry receptor of SARS-CoV-2 virus (ie ACE2) was positive in some tracheal and bronchial mucosal epithelial cells. The trachea and lung tissue were positive for SARS-CoV-2 nucleic acid. These are considered to be the pathological basis of the patient's fatal respiratory failure.


In addition, the project researchers found that SARS-CoV-2 infection can cause acute damage to multiple organs in the human body. Obvious lesions appear in lymphatic hematopoietic organs; myocardium shows cell degeneration, sporadic necrosis; liver degeneration, spot necrosis, etc.; kidney shows glomerular hyperemia, segmental hyperplasia or necrosis, glomerular capsule cavity has Protein oozes. Esophagus, stomach and intestinal mucosa showed varying degrees of degeneration, necrosis and shedding. The patient's testes showed varying degrees of spermatogenic cell reduction and damage. Cerebral congestion, edema, and partial neuron alignment and ischemic changes were observed in the patient's brain.

The author mentioned in the article that most of the elderly patients also found basic diseases such as respiratory diseases, cardiovascular diseases, digestive system diseases, urinary system diseases, hematological abnormalities, brain damage and so on. "These diseases and the acute injury caused by SARS-CoV-2 infection jointly caused the pathological basis of multiple organ dysfunction syndrome." And autopsy cases also found that the main cause of death was multiple organ dysfunction syndrome, especially acute Respiratory distress syndrome.

Through nucleic acid detection, the researchers detected the RNA and particles of SARS-CoV-2 virus in patients' hilar lymph nodes, spleen, heart, liver, gallbladder, kidney, stomach, breast, testis, skin, nasopharynx, and oral mucosa. The author said that this prompted the possibility of multiple viral transmission routes, and these issues deserve further investigation.

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