1
|
Zanon M, Neri M, Pizzolitto S, Radaelli D, Concato M, Peruch M, D'Errico S. Liver pathology in COVID-19 related death and leading role of autopsy in the pandemic. World J Gastroenterol 2023; 29:200-220. [PMID: 36683722 PMCID: PMC9850946 DOI: 10.3748/wjg.v29.i1.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Information on liver involvement in patients with coronavirus disease 2019 is currently fragmented.
AIM To highlight the pathological changes found during the autopsy of severe acute respiratory syndrome coronavirus 2 positive patients.
METHODS A systematic literature search on PubMed was carried out until June 21, 2022.
RESULTS A literature review reveals that pre-existing liver disease and elevation of liver enzyme in these patients are not common; liver enzyme elevations tend to be seen in those in critical conditions. Despite the poor expression of viral receptors in the liver, it seems that the virus is able to infect this organ and therefore cause liver damage. Unfortunately, to date, the search for the virus inside the liver is not frequent (16% of the cases) and only a small number show the presence of the virus. In most of the autopsy cases, macroscopic assessment is lacking, while microscopic evaluation of livers has revealed the frequent presence of congestion (42.7%) and steatosis (41.6%). Less frequent is the finding of hepatic inflammation or necrosis (19%) and portal inflammation (18%). The presence of microthrombi, frequently found in the lungs, is infrequent in the liver, with only 12% of cases presenting thrombotic formations within the vascular tree.
CONCLUSION To date, the greatest problem in interpreting these modifications remains the association of the damage with the direct action of the virus, rather than with the inflammation or alterations induced by hypoxia and hypovolemia in patients undergoing oxygen therapy and decompensated patients.
Collapse
Affiliation(s)
- Martina Zanon
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Margherita Neri
- Department of Medical Sciences, University of Ferrara, Ferrara 44121, Italy
| | - Stefano Pizzolitto
- Department of Pathology, Santa Maria della Misericordia University Hospital, Udine 33100, Italy
| | - Davide Radaelli
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Monica Concato
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Michela Peruch
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| | - Stefano D'Errico
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste 34149, Italy
| |
Collapse
|
2
|
Chainchel Singh MK, Mohd Noor MH, Ibrahim MA, Siew SF, Lai PS, Lai PS. Use of Post-Mortem Computed Tomography During the COVID-19 Pandemic: The Malaysian Experience. Malays J Med Sci 2022; 29:83-92. [PMID: 36474535 PMCID: PMC9681000 DOI: 10.21315/mjms2022.29.5.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background COVID-19 was declared a pandemic by the World Health Organization (WHO). COVID-19 is highly contagious, making it a threat to healthcare workers, including those working in mortuaries. Therefore, it is important to determine if the cause of death (COD) could be identified using limited autopsy, diagnostic tests and post-mortem imaging modalities instead of full autopsy. This study aims to examine the effectiveness of post-mortem imaging, specifically post-mortem computed tomography (PMCT) at determining the COD during a pandemic. Methods This cross-sectional study included 172 subjects with suspected or unknown COVID-19 status brought in dead to the institute's mortuary during the pandemic in Malaysia. PMCT images reported by forensic radiologists and their agreement with conventional autopsy findings by forensic pathologists regarding COD were analysed to look at the effectiveness of PMCT in determining COD during a pandemic. Results Analysis showed that 78.7% (133) of cases reported by forensic radiologists concurred with the COD certified by forensic pathologists. Of these cases, 85 (63.9%) had undergone only external examination and real-time reverse transcriptase polymerase chain reaction (rRT-PCR) COVID-19 testing, meaning that imaging was the sole method used to determine the COD besides history from available medical records and the investigating police officer. Conclusion PMCT can be used as a complement to medicolegal autopsies in pandemic contexts, as it provides significant information on the possible COD without jeopardising the safety of mortuary health care workers.
Collapse
Affiliation(s)
- Mansharan Kaur Chainchel Singh
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Selangor, Malaysia,Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selangor, Malaysia,National Institute of Forensic Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mohamad Helmee Mohd Noor
- National Institute of Forensic Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia,Radiology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Sheue Feng Siew
- National Institute of Forensic Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Poh Soon Lai
- National Institute of Forensic Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Filograna L, Manenti G, Grassi S, Zedda M, Cazzato F, Ryan CP, Arena V, Pascali VL, Colosimo C, Floris R, Oliva A. Virtual autopsy in SARS-CoV-2 breakthrough infection: a case report. FORENSIC IMAGING 2022. [PMCID: PMC9433066 DOI: 10.1016/j.fri.2022.200520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
It is well documented that COVID-19 vaccines are effective tools for limiting the pandemic. Unfortunately, as is true for all vaccines, SARS-CoV-2 infection in vaccinated individuals is still possible. We present an autopsy case of SARS-CoV-2 infection after vaccination (“breakthrough infection”) in an elderly man with several comorbidities where post-mortem CT scan was performed. The death was histologically attributed to cardio-respiratory arrest due to ischemic heart failure related to superinfected COVID-19 pneumonia and pre-existing comorbidities. For the first time in the literature, PMCT imaging related to a fatal, autopsy case of breakthrough SARS-CoV-2 infection is reported. PMCT of the lungs, in accordance with histopathological results, showed few signs of COVID-19 pneumonia, large area of consolidation in the right lower lobe, interpreted as bronco-pneumonic focus, and hypostasis. These findings were well-correlated with the previously reported literature about both PMCT and clinical CT imaging of the lungs in non-vaccinated individuals with early COVID-19 pneumonia and about pulmonary clinical CT imaging in COVID-19 pneumonia in breakthrough SARS-COV-2 infections. Further studies are needed to cover the whole spectrum of PMCT lung imaging in fatal breakthrough SARS-CoV-2 infection, however, this case represent a first step for exploring this difficult challenge during SARS-CoV-2 pandemic using virtual autopsy.
Collapse
|
4
|
Filograna L, Manenti G, Grassi S, Zedda M, Mecchia D, Briganti F, Ryan CP, Pascali VL, Floris R, Oliva A. Analysis of the role of PMCT during the COVID-19 pandemic: a systematic review. FORENSIC IMAGING 2022. [PMCID: PMC9134788 DOI: 10.1016/j.fri.2022.200505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives During COVID-19 pandemic PMCT has been proposed as a forensic investigation method. This systematic review is aimed to systematize evidence and peer-reviewed opinions reported during the first two years of pandemic, to evaluate the role of PMCT during the COVID-19 pandemic. Materials and methods An online literature search was performed to identify publications on PMCT during the COVID-19 pandemic between December 2019 and March 2022. For each publication included, the following data were collected: title and abstract, year of publication, type of article, number and type of individuals examined. The selected publications were also categorized based on PMCT findings, histopathological results, the comparison between PMCT and histopathological findings, cause of death and proposed role of PMCT during the pandemic. Results A total of 20 publications were included, mostly case reports (9/20). All cases examined included adults. The most frequent PMCT pattern in positive cases was diffuse mixed densities with prevalence of consolidations (pattern 1) (54%). In 97% of the cases where a comparison between PMCT and histological results was performed, a correspondence was found. In 82% of the cases the principal cause of death was COVID-19 pneumonia. PMCT has been proposed as a pre-autopsy screening tool in 62%, and as a method for augmenting post-mortem data in 50% of the papers reporting this issue. Conclusion This systematic review suggests that PMCT should be regarded as a highly valuable investigative technique for the forensic evaluation of deaths with ascertained or suspected COVID-19 pneumonia.
Collapse
|
5
|
Goncharov NV, Vasilyev KA, Kudryavtsev IV, Avdonin PP, Belinskaia DA, Stukova MA, Shamova OV, Avdonin PV. Experimental Search for New Means of Pathogenetic Therapy COVID-19: Inhibitor of H2-Receptors Famotidine Increases the Effect of Oseltamivir on Survival and Immune Status of Mice Infected by A/PR/8/34 (H1N1). J EVOL BIOCHEM PHYS+ 2022; 58:230-246. [PMID: 35283537 PMCID: PMC8897615 DOI: 10.1134/s0022093022010203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023]
Abstract
The development of drugs for the therapy of COVID-19 is one
of the main problems of modern physiology, biochemistry and pharmacology.
Taking into account the available information on the participation
of mast cells and the role of histamine in the pathogenesis of COVID-19,
as well as information on the positive role of famotidine in the
prevention and treatment of coronavirus infection, an experiment
was carried out using famotidine in a mouse model. We used a type
A/PR/8/34 (H1N1) virus adapted to mice. The antiviral drug oseltamivir
(Tamiflu), which belongs to the group of neuraminidase inhibitors,
was used as a reference drug. The use of famotidine in combination
with oseltamivir can increase survival, improve the dynamics of
animal weight, reduce the level of NKT cells and increase the level
of naive T-helpers. Further studies of famotidine in vivo should
be aimed at optimizing the regimen of drug use at a higher viral
load, as well as with a longer use of famotidine.
Collapse
Affiliation(s)
- N. V. Goncharov
- Sechenov Institute of Evolutionary
Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
- Research Institute of Hygiene,
Occupational Pathology and Human Ecology, p/o Kuzmolovsky, Vsevolozhsky District, Leningrad
Region, Russia
| | - K. A. Vasilyev
- Smorodintsev Research Institute
of Influenza of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | | | - P. P. Avdonin
- Koltsov Institute of Development
Biology, Russian Academy of Sciences, Moscow, Russia
| | - D. A. Belinskaia
- Sechenov Institute of Evolutionary
Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - M. A. Stukova
- Smorodintsev Research Institute
of Influenza of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - O. V. Shamova
- Institute of Experimental
Medicine, St. Petersburg, Russia
| | - P. V. Avdonin
- Koltsov Institute of Development
Biology, Russian Academy of Sciences, Moscow, Russia
| |
Collapse
|
6
|
Filograna L, Manenti G, Ampanozi G, Calcagni A, Ryan CP, Floris R, Thali MJ. Potentials of post-mortem CT investigations during SARS-COV-2 pandemic: a narrative review. Radiol Med 2022; 127:383-390. [PMID: 35226246 PMCID: PMC8884096 DOI: 10.1007/s11547-022-01457-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/21/2022] [Indexed: 12/22/2022]
Abstract
In December 2019, a new coronavirus, SARS-COV-2, caused a cluster of cases of pneumonia in China, and rapidly spread across the globe. It was declared a pandemic by the World Health Organization on March 11th, 2020. Virtual autopsy by post-mortem CT (PMCT) and its ancillary techniques are currently applied in post-mortem examinations as minimally or non-invasive techniques with promising results. In this narrative review, we speculate on the potentials of PMCT and its ancillary techniques, as a viable investigation technique for analysis of suspected or confirmed SARS-COV-2 deaths. An online literature search was performed by using three prefix search terms (postmortem, post-mortem, post mortem) individually combined with the suffix radiology, imaging, computed tomography, CT and with the search terms ‘SARS-CoV-2’ and ‘COVID-19’ to identify papers about PMCT and its ancillary techniques in SARS-COV-2 positive cadavers. PMCT findings suggestive for pulmonary COVID-19 in deceased positive SARS-COV-2 infection are reported in the literature. PMCT ancillary techniques were never applied in such cases. PMCT imaging of the lungs has been proposed as a pre-autopsy screening method for SARS-COV-2 infection. Further studies are needed to ascertain the value of PMCT in determining COVID-19 as the cause of death without autopsy histopathological confirmation. We advocate the application of PMCT techniques in the study of ascertained or suspected SARS-COV-2 infected deceased individuals as a screening technique and as a method of post-mortem investigation, to augment the numbers of case examined and significantly reducing infection risk for the operators.
Collapse
Affiliation(s)
- Laura Filograna
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy.
| | - Guglielmo Manenti
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Garyfalia Ampanozi
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| | - Antonello Calcagni
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Colleen Patricia Ryan
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Roberto Floris
- Department of Radiological Sciences, Fondazione PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Lazio, IT, Italy
| | - Michael John Thali
- Institute of Forensic Medicine, Department of Forensic Medicine and Imaging, University of Zurich, Winterthurerstrasse 190/52, CH-8057, Zurich, Switzerland
| |
Collapse
|
7
|
Filograna L, Grassi S, Manenti G, Di Donna C, Tatulli D, Nardoni F, Masini V, Ausania F, Grassi VM, Floris R, Colosimo C, Arena V, Pascali VL, Oliva A. Postmortem CT pulmonary findings in SARS-CoV-2-positive cases: correlation with lung histopathological findings and autopsy results. Int J Legal Med 2022; 136:1407-1415. [PMID: 35157128 PMCID: PMC8853405 DOI: 10.1007/s00414-022-02793-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
Introduction/purpose Postmortem computed tomography (PMCT) is a valuable tool for analyzing the death of patients with SARS-CoV-2 infection. The purpose of this study was to investigate the correlation between PMCT lung findings in autopsy cadavers positive for SARS-CoV-2 infection and the severity of COVID-19 lung disease by histopathological analysis. Materials and methods We reviewed chest PMCT findings, paying particular attention to the lung parenchyma, in 8 autopsy cases positive for SARS-CoV-2. Correlations between chest PMCT and histopathological findings were assessed. Clinical conditions and comorbidities were also recorded and discussed. The primary cause of death was finally considered. Results In 6/8 cases, pulmonary PMCT findings were massive consolidation (4/8) and bilateral diffuse mixed densities with a crazy-paving pattern (2/8). These cases showed severe pulmonary signs of COVID-19 at histopathological analysis. In the remaining 2/8 cases, pulmonary PMCT findings were scant antideclive ground-glass opacities in prevalent gradient densities attributed to hypostasis. In 4/8 cases with massive consolidations, important comorbidities were noted. In 6/8 cases with severe pulmonary histopathological signs of lung COVID-19, autopsy found that the cause of death was cardiorespiratory failure. In the remaining 2/8 cases, histopathological analysis revealed lung alterations due to edema and some signs of SARS-CoV-2 infection; the cause of death was not attributed to SARS-CoV-2 infection (Table 1). Discussion and conclusion Chest PMCT findings correlate with the severity of COVID-19 lung disease at histopathology examination. According to our results, there may also be a relationship between cause of death and PMCT findings in COVID-19, which must be critically analyzed considering clinical antemortem data.
Collapse
Affiliation(s)
- Laura Filograna
- Department of Integrated Care Processes, Diagnostic Imaging Area, Tor Vergata University, PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, FondazioneRome, Italy.
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Guglielmo Manenti
- Department of Integrated Care Processes, Diagnostic Imaging Area, Tor Vergata University, PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, FondazioneRome, Italy
| | - Carlo Di Donna
- Department of Integrated Care Processes, Diagnostic Imaging Area, Tor Vergata University, PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, FondazioneRome, Italy
| | - Doriana Tatulli
- Department of Integrated Care Processes, Diagnostic Imaging Area, Tor Vergata University, PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, FondazioneRome, Italy
| | - Francesco Nardoni
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Valentina Masini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Diagnostic Imaging Area, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Francesco Ausania
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Vincenzo Maria Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Roberto Floris
- Department of Integrated Care Processes, Diagnostic Imaging Area, Tor Vergata University, PTV Policlinico Tor Vergata, Viale Oxford 81, 00133, FondazioneRome, Italy
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Diagnostic Imaging Area, Catholic University of Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Vincenzo Arena
- Department of Woman and Child Health and Public Health, Area of Pathology, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Vincenzo Lorenzo Pascali
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Catholic University of Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Francesco Vito, 1, 00168, Rome, Italy
| |
Collapse
|
8
|
Thomas M, Abtin F, Roth A, Yim C, Pahwa A, Paige J, Ukpo O. Postmortem CT in decedents with SARS-CoV-2 infection. A single institution experience. Forensic Sci Res 2022; 7:255-260. [PMID: 35784405 PMCID: PMC9245975 DOI: 10.1080/20961790.2021.1977479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 produced a global pandemic with significant mortality. As autopsies are not routinely performed on all decedents with SARS-CoV-2 infection, postmortem CT (PMCT) may be valuable to provide additional information on the cause of death and risk factors known to be associated with an increased mortality in COVID-19. The purpose of this manuscript is to review the PMCT findings in a series of 42 decedents with SARS-CoV-2 infection from our institution. Retrospective analysis of 42 decedents who had a positive postmortem nasopharyngeal swab for SARS-CoV-2 and had a PMCT were included in this study. Images were reviewed for pulmonary findings seen in COVID-19 and other organ involvement. Of the 42 decedents, although the majority had imaging findings in the lungs that would be consistent with COVID-19 and acute respiratory distress syndrome, in 14% of the decedents the SARS-CoV-2 infection was likely coincidental and the PMCT findings suggested that they died from other pathology. Over half of the decedents that died from COVID-19 had PMCT findings of vascular disease. PMCT is useful to identify pulmonary and extra pulmonary findings in decedents with SARS-CoV-2 infection that can provide additional information, which may be useful for the forensic pathologist to help determine the underlying cause of death. Supplemental data for this article are available online at
Collapse
Affiliation(s)
- Mariam Thomas
- Radiology, UCLA Medical Center Olive View, Los Angeles, CA, USA
| | | | - Antoinette Roth
- Radiology, UCLA Medical Center Olive View, Los Angeles, CA, USA
| | - Catherine Yim
- Radiology, UCLA Medical Center Olive View, Los Angeles, CA, USA
| | - Anokh Pahwa
- Radiology, UCLA Medical Center Olive View, Los Angeles, CA, USA
| | - Jeremy Paige
- University of California Los Angeles, Los Angeles, CA, USA
| | - Odey Ukpo
- Los Angeles Medical Examiner-Coroner’s Office, Los Angeles, CA, USA
| |
Collapse
|
9
|
Findings and inferences from full autopsies, minimally invasive autopsies and biopsy studies in patients who died as a result of COVID19 - A systematic review. Forensic Sci Med Pathol 2022; 18:369-381. [PMID: 35817946 PMCID: PMC9273702 DOI: 10.1007/s12024-022-00494-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
Many articles on COVID19 deaths have been published since the pandemic has occurred. On reviewing the articles published until June 2021, the findings were very heterogeneous. Adding to the existing knowledge, there were also some unique observations made in the pathogenesis of COVID19. This review was done to determine the findings obtained and inferences drawn from various studies published globally among patients who died due to COVID19. PRISMA guidelines were used to conduct this systematic review. A search of databases like PubMed, ScienceDirect and Epistemonikos was done. The articles focusing on postmortem sample studies involving full autopsies, minimally invasive autopsies and tissue biopsy studies were screened and searched. The studies included were all the case reports, case series, narrative reviews and systematic reviews obtained in full text and in the English language containing study information, and samples obtained postmortem. The information obtained was tabulated using Microsoft excel sheets. The duplicates were removed at the beginning of the tabulation. Zotero referencing software was used for article sorting and citation and bibliography. Two authors independently reviewed the articles throughout the process to prevent bias. Adding to the heterogeneity of COVID19, the concept of lethality in preexisting disease conditions, the occurrence of secondary bacterial and fungal infections, and other pathogenetic mechanisms uniquely encountered are to be considered in treating the patients. Also, the presence of SARS-CoV-2 postmortem is established and should be considered a hazard.
Collapse
|
10
|
Ray A, Jain D, Goel A, Agarwal S, Swaroop S, Das P, Arava SK, Mridha AR, Nambirajan A, Singh G, Arulselvi S, Mathur P, Kumar S, Sahni S, Nehra J, Nazneen, Bm M, Rastogi N, Mahato S, Gupta C, Bharadhan S, Dhital G, Goel P, Pandey P, Kn S, Chaudhary S, Keri VC, Chauhan VS, Mahishi N, Shahi A, R R, Gupta BK, Aggarwal R, Soni KD, Nischal N, Soneja M, Lalwani S, Sarkar C, Guleria R, Wig N, Trikha A. Clinico-pathological features in fatal COVID-19 infection: a preliminary experience of a tertiary care center in North India using postmortem minimally invasive tissue sampling. Expert Rev Respir Med 2021; 15:1367-1375. [PMID: 34227439 DOI: 10.1080/17476348.2021.1951708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To study the histopathology of patients dying of COVID-19 using post-mortem minimally invasive sampling techniques. METHODS This was a single-center observational study conducted at JPNATC, AIIMS. Thirty-seven patients who died of COVID-19 were enrolled. Post-mortem percutaneous biopsies were taken from lung, heart, liver, kidney and stained with hematoxylin and eosin. Immunohistochemistry was performed using CD61 and CD163. SARS-CoV-2 virus was detected using IHC with primary antibodies. RESULTS The mean age was 48.7 years and 59.5% were males. Lung histopathology showed diffuse alveolar damage in 78% patients. Associated bronchopneumonia was seen in 37.5% and scattered microthrombi in 21% patients. Immunopositivity for SARS-CoV-2 was observed in Type II pneumocytes. Acute tubular injury with epithelial vacuolization was seen in 46% of renal biopsies. Seventy-one percent of liver biopsies showed Kupffer cell hyperplasia and 27.5% showed submassive hepatic necrosis. CONCLUSIONS Predominant finding was diffuse alveolar damage with demonstration of SARS-CoV-2 protein in the acute phase. Microvascular thrombi were rarely identified in any organ. Substantial hepatocyte necrosis, Kupffer cell hypertrophy, microvesicular, and macrovesicular steatosis unrelated to microvascular thrombi suggested that liver might be a primary target of COVID-19.
Collapse
Affiliation(s)
- Animesh Ray
- Department of Medicine, AIIMS, New Delhi, India
| | - Deepali Jain
- Department of Pathology, AIIMS, New Delhi, India
| | - Ayush Goel
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | | | | | - S Arulselvi
- Department of Laboratory Medicine, Jpnatc, Aiims, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jpnatc, Aiims, New Delhi, India
| | | | | | | | - Nazneen
- Department of Medicine, AIIMS, New Delhi, India
| | - Mouna Bm
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | - S Bharadhan
- Department of Medicine, AIIMS, New Delhi, India
| | | | - Pawan Goel
- Department of Medicine, AIIMS, New Delhi, India
| | | | - Santosh Kn
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | | | - Anand Shahi
- Department of Medicine, AIIMS, New Delhi, India
| | - Ragu R
- Department of Medicine, AIIMS, New Delhi, India
| | | | | | | | | | | | - Sanjeev Lalwani
- Division of Forensic Pathology and Molecular Laboratory, JPNATC, AIIMS, New Delhi, India
| | | | - Randeep Guleria
- Department of Pulmonary Medicine, Sleep and critical care disorders, Director, AIIMS, New Delhi, India
| | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Critical Care and Pain Medicine, JPNATC, AIIMS, New Delhi, India
| |
Collapse
|
11
|
O'Donnell C, Iles L, Woodford N. Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation. Forensic Sci Med Pathol 2021; 17:611-620. [PMID: 34160740 PMCID: PMC8220885 DOI: 10.1007/s12024-021-00389-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/23/2022]
Abstract
CoVID-19 is a novel viral infection with now well-established clinical radiological findings. There is limited data on post-mortem imaging. We explore the proposition that PMCT could be used as screening test. In an 11-week period, 39 deceased persons were referred for medicolegal investigation with pre-existing or subsequent nasopharyngeal swabs showing positivity on SARS-CoV-2 RT-PCR testing. All 39 had routine whole-body CT scans on admission and 12 underwent medicolegal autopsy. These cases were contrasted with 4 others which were negative on nasopharyngeal swabs despite PMCT findings suggestive of CoVID-19 pneumonia (designated false positive). Nine of the 12 autopsies showed lung histology consistent with those reported in CoVID-19 pneumonia. Typical clinical CoVID-19 lung findings on PMCT were only detected in 5 (42%). In 3 of the 4 false positive cases, lung findings showed non-COVID-19 histology but in 1, findings were identical. PMCT CoVID-19 findings in the lungs are therefore not specific and may not be detected in all cases due to obscuration by expected agonal CT findings or other pathologies that pre-dated SARS-CoV-2 infection. PMCT findings may otherwise be subtle. Although PMCT may hint at CoVID-19, we believe that nasopharyngeal swabs are still required for definitive diagnosis. Even with positive swabs, clinical CoVID-19 lung findings on PMCT are often not detected. PMCT findings can be subtle, extreme or obscured by agonal changes. Given this range of PMCT changes, the challenge for pathologists is to determine whether death has been caused by, or merely associated with, SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Chris O'Donnell
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia. .,Department of Forensic Medicine, Monash University, Clayton, Australia.
| | - Linda Iles
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.,Department of Forensic Medicine, Monash University, Clayton, Australia
| | - Noel Woodford
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.,Department of Forensic Medicine, Monash University, Clayton, Australia
| |
Collapse
|
12
|
Claimed medical malpractice in fatal SARS-CoV-2 infections: the importance of combining ante- and post-mortem radiological data and autopsy findings for correct forensic analysis. FORENSIC IMAGING 2021. [PMCID: PMC8057686 DOI: 10.1016/j.fri.2021.200454] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We present the case of an elderly woman who died from COVID-19 during the first wave of the pandemic. The physicians in charge of the patient were later accused of medical malpractice resulting in the death of the patient. The article reviews the comprehensive medico-legal investigations into this case that included an analysis of the medical history, clinical imaging, post-mortem imaging, autopsy, histopathology, and microbiology as well as an assessment of the medical knowledge regarding transmission of the SARS-CoV-2 virus and the management of COVID-19 at the time of the patient's death. The investigation resulted in a verdict of not guilty. This case highlights the value of clinical and post-mortem imaging as well as various challenges of medico-legal investigations of COVID-19 related deaths.
Collapse
|
13
|
De-Giorgio F, Cittadini F, Cina A, Cavarretta E, Biondi-Zoccai G, Vetrugno G, Natale L, Colosimo C, Pascali VL. Use of post-mortem chest computed tomography in Covid-19 pneumonia. Forensic Sci Int 2021; 325:110851. [PMID: 34090259 PMCID: PMC8154189 DOI: 10.1016/j.forsciint.2021.110851] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 02/05/2023]
Abstract
Background and aim COVID-19 is an extremely challenging disease, both from a clinical and forensic point of view, and performing autopsies of COVID-19 deceased requires adequately equipped sectorial rooms and exposes health professionals to the risk of contagion. Among one of the categories that are most affected by SARS-Cov-2 infection are the elderly residents. Despite the need for prompt diagnoses, which are essential to implement all isolation measures necessary to contain the infection spread, deceased subjects in long-term care facilities are still are often diagnosed post-mortem. In this context, our study focuses on the use of post-mortem computed tomography for the diagnosis of COVID-19 infection, in conjunction with post-mortem swabs. The aim of this study was to assess the usefulness of post-mortem whole CT-scanning in identifying COVID-19 pneumonia as a cause of death, by comparing chest CT-findings of confirmed COVID-19 fatalities to control cases. Materials and methods The study included 24 deceased subjects: 13 subjects coming from long-term care facility and 11 subjects died at home. Whole body CT scans were performed within 48 h from death in all subjects to evaluate the presence and distribution of pulmonary abnormalities typical of COVID-19-pneumonia, including: ground-glass opacities (GGO), consolidation, and pleural effusion to confirm the post-mortem diagnosis. Results Whole-body CT scans was feasible and allowed a complete diagnosis in all subjects. In 9 (69%) of the 13 cases from long-term care facility the cause of death was severe COVID 19 pneumonia, while GGO were present in 100% of the study population. Conclusion In the context of rapidly escalating COVID-19 outbreaks, given that laboratory tests for the novel coronavirus is time-consuming and can be falsely negative, the post-mortem CT can be considered as a reliable and safe modality to confirm COVID-19 pneumonia. This is especially true for specific postmortem chest CT-findings that are rather characteristic of COVID-19 fatalities.
Collapse
Affiliation(s)
- Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Francesca Cittadini
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Cina
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Diagnostic Imaging Area, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giuseppe Vetrugno
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Natale
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Diagnostic Imaging Area, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Colosimo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Diagnostic Imaging Area, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo L Pascali
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
14
|
Sessa F, Salerno M, Pomara C. Autopsy Tool in Unknown Diseases: The Experience with Coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2). MEDICINA (KAUNAS, LITHUANIA) 2021; 57:309. [PMID: 33806100 PMCID: PMC8064502 DOI: 10.3390/medicina57040309] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023]
Abstract
In the last two decades, three unknown pathogens have caused outbreaks, generating severe global health concerns. In 2003, after nucleic acid genotyping, a new virus was named severe acute respiratory syndrome coronavirus (SARS-CoV). After nine years, another coronavirus emerged in the middle east and was named MERS-CoV (Middle East Respiratory Syndrome-Coronavirus). Finally, in December 2019, a new unknown coronavirus was isolated from a cluster of patients and was named SARS-CoV-2 (COVID-19, coronavirus disease 2019). This review aims to propose a complete overview of autopsy in the three coronaviruses over the past two decades, showing its pivotal role in the management of unknown diseases. A total of 116 studies fulfilled the inclusion criteria: 14 studies were collected concerning SARS-CoV (87 autopsy reports, from Asian and American countries), 2 studies for MERS-CoV (2 autopsy reports, from Middle-East Asian countries), and 100 studies on SARS-CoV-2 (930 autopsy reports). Analyzing the data obtained on COVID-19, based on the country criterion, a large number of post-mortem investigation were performed in European countries (580 reports), followed by American countries (251 reports). It is interesting to note that no data were found from the Oceanic countries, maybe because of the minor involvement of the outbreak. In all cases, autopsy provided much information about each unknown coronavirus. Despite advanced technologies in the diagnostic fields, to date, autopsy remains the gold standard method to understand the biological features and the pathogenesis of unknown infections, especially when awareness of a pathogen is restricted and the impact on the healthcare system is substantial. The knowledge gained through this technique may positively influence therapeutic strategies, ultimately reducing mortality.
Collapse
Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, Institute of Legal Medicine, University of Foggia, 71122 Foggia, Italy
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, Institute of Legal Medicine, University of Catania, 95121 Catania, Italy;
| |
Collapse
|
15
|
Malone RW, Tisdall P, Fremont-Smith P, Liu Y, Huang XP, White KM, Miorin L, Moreno E, Alon A, Delaforge E, Hennecker CD, Wang G, Pottel J, Blair RV, Roy CJ, Smith N, Hall JM, Tomera KM, Shapiro G, Mittermaier A, Kruse AC, García-Sastre A, Roth BL, Glasspool-Malone J, Ricke DO. COVID-19: Famotidine, Histamine, Mast Cells, and Mechanisms. Front Pharmacol 2021; 12:633680. [PMID: 33833683 PMCID: PMC8021898 DOI: 10.3389/fphar.2021.633680] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 infection is required for COVID-19, but many signs and symptoms of COVID-19 differ from common acute viral diseases. SARS-CoV-2 infection is necessary but not sufficient for development of clinical COVID-19 disease. Currently, there are no approved pre- or post-exposure prophylactic COVID-19 medical countermeasures. Clinical data suggest that famotidine may mitigate COVID-19 disease, but both mechanism of action and rationale for dose selection remain obscure. We have investigated several plausible hypotheses for famotidine activity including antiviral and host-mediated mechanisms of action. We propose that the principal mechanism of action of famotidine for relieving COVID-19 symptoms involves on-target histamine receptor H2 activity, and that development of clinical COVID-19 involves dysfunctional mast cell activation and histamine release. Based on these findings and associated hypothesis, new COVID-19 multi-drug treatment strategies based on repurposing well-characterized drugs are being developed and clinically tested, and many of these drugs are available worldwide in inexpensive generic oral forms suitable for both outpatient and inpatient treatment of COVID-19 disease.
Collapse
Affiliation(s)
- Robert W Malone
- RW Malone MD LLC, Madison, VA, United States.,Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, United States
| | - Philip Tisdall
- Medical School Companion LLC, Marco Island, FL, United States
| | | | - Yongfeng Liu
- Department of Pharmacology, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Xi-Ping Huang
- Department of Pharmacology, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Kris M White
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Lisa Miorin
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elena Moreno
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Assaf Alon
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, United States
| | - Elise Delaforge
- Department of Chemistry, McGill University, Montreal, QC, Canada
| | | | - Guanyu Wang
- Department of Chemistry, McGill University, Montreal, QC, Canada
| | | | - Robert V Blair
- Tulane National Primate Research Center, Covington, LA, United Sates.,Department of Pathology and Laboratory Animal Medicine, Tulane University School of Medicine, New Orleans, LA, United States
| | - Chad J Roy
- Tulane National Primate Research Center, Covington, LA, United Sates.,Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
| | - Nora Smith
- MIT Lincoln Laboratory, Lexington, MA, United States
| | - Julie M Hall
- Frank H. Netter MD School of Medicine - Quinnipiac University, Hamden, CT, United States
| | - Kevin M Tomera
- Department of Urology, Beloit Memorial Hospital, Beloit, WI, United States
| | | | | | - Andrew C Kruse
- Department of Biological Chemistry and Molecular Pharmacology, Blavatnik Institute, Harvard Medical School, Boston, MA, United States
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, United States
| | - Bryan L Roth
- Department of Pharmacology, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | | | | |
Collapse
|
16
|
Roshdy A, Zaher S, Fayed H, Coghlan JG. COVID-19 and the Heart: A Systematic Review of Cardiac Autopsies. Front Cardiovasc Med 2021; 7:626975. [PMID: 33585586 PMCID: PMC7876291 DOI: 10.3389/fcvm.2020.626975] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/17/2020] [Indexed: 01/06/2023] Open
Abstract
Importance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated cardiac injury has been postulated secondary to several mechanisms. While tissue diagnosis is limited during the acute illness, postmortem studies can help boost our understanding and guide management. Objective: To report the cardiac tissue autopsy findings in coronavirus disease 2019 (COVID-19) decedents. Evidence Review: Articles published in PubMed and Embase reporting postmortem cardiac pathology of COVID-19 decedents till September 2020. We included adult studies excluding preprints. The Joanna Briggs Institute Critical Appraisal Checklist for Case Reports was used to assess quality. We extracted gross and histology data as well as the incidence of myocarditis, cardiac ischemia, thrombosis, and dilatation. We also looked at the reported cause of death (PROSPERO registration CRD42020190898). Findings: Forty-one relevant studies identified including 316 cases. The deceased were mostly male (62%) and elderly (median age, 75; range, 22-97 years). The most common comorbidities were hypertension (48%) and coronary artery disease (33%). Cardiac pathologies contributed to the death of 15 cases. Besides chronic cardiac pathologies, postmortem examination demonstrated cardiac dilatation (20%), acute ischemia (8%), intracardiac thrombi (2.5%), pericardial effusion (2.5%), and myocarditis (1.5%). SARS-CoV-2 was detected within the myocardium of 47% of studied hearts. Conclusions and Relevance: SARS-CoV-2 can invade the heart, but a minority of cases were found to have myocarditis. Cardiac dilatation, ischemia, mural, and microthrombi were the most frequent findings. The systematic review was limited by the small number of cases and the quality of the studies, and there is a need to standardize the cardiac postmortem protocols.
Collapse
Affiliation(s)
- Ashraf Roshdy
- Critical Care Unit, Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom.,Critical Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Shroque Zaher
- Department of Pathology, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Hossam Fayed
- National Pulmonary Hypertension Unit-Cardiology Department, Royal Free Hospital, London, United Kingdom.,Institute of Cardiovascular Science, UCL, London, United Kingdom
| | - John Gerry Coghlan
- National Pulmonary Hypertension Unit-Cardiology Department, Royal Free Hospital, London, United Kingdom
| |
Collapse
|
17
|
Shafer LA, Nesca M, Balshaw R. Relaxation of social distancing restrictions: Model estimated impact on COVID-19 epidemic in Manitoba, Canada. PLoS One 2021; 16:e0244537. [PMID: 33406102 PMCID: PMC7787456 DOI: 10.1371/journal.pone.0244537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The unprecedented worldwide social distancing response to COVID-19 resulted in a quick reversal of escalating case numbers. Recently, local governments globally have begun to relax social distancing regulations. Using the situation in Manitoba, Canada as an example, we estimated the impact that social distancing relaxation may have on the pandemic. METHODS We fit a mathematical model to empirically estimated numbers of people infected, recovered, and died from COVID-19 in Manitoba. We then explored the impact of social distancing relaxation on: (a) time until near elimination of COVID-19 (< one case per million), (b) time until peak prevalence, (c) proportion of the population infected within one year, (d) peak prevalence, and (e) deaths within one year. RESULTS Assuming a closed population, near elimination of COVID-19 in Manitoba could have been achieved in 4-6 months (by July or August) if there were no relaxation of social distancing. Relaxing to 15% of pre-COVID effective contacts may extend the local epidemic for more than two years (median 2.1). Relaxation to 50% of pre-COVID effective contacts may result in a peak prevalence of 31-38% of the population, within 3-4 months of initial relaxation. CONCLUSION Slight relaxation of social distancing may immensely impact the pandemic duration and expected peak prevalence. Only holding the course with respect to social distancing may have resulted in near elimination before Fall of 2020; relaxing social distancing to 15% of pre-COVID-19 contacts will flatten the epidemic curve but greatly extend the duration of the pandemic.
Collapse
Affiliation(s)
- Leigh Anne Shafer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marcello Nesca
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
18
|
Abstract
This systematic review summarizes the evidence on the earliest patients with COVID-19-HIV co-infection. We searched PubMed, Scopus, Web of Science, Embase, preprint databases, and Google Scholar from December 01, 2019, to June 1, 2020. From an initial 547 publications and 75 reports, 25 studies provided specific information on COVID-19 patients living with HIV. Studies described 252 patients, 80.9% were male, the mean age was 52.7 years, and 98% were on antiretroviral treatment (ART). Co-morbidities in addition to HIV and COVID-19 (multimorbidity) included hypertension (39.3%), obesity or hyperlipidemia (19.3%), chronic obstructive pulmonary disease (18.0%), and diabetes (17.2%). Two-thirds (66.5%) had mild to moderate symptoms, the most common being fever (74.0%) and cough (58.3%). Among patients who died, the majority (90.5%) were over 50 years old, male (85.7%), and had multimorbidity (64.3%). Our findings highlight the importance of identifying co-infections, addressing co-morbidities, and ensuring a secure supply of ART for PLHIV during the COVID-19 pandemic.
Collapse
|
19
|
Singh DD, Han I, Choi EH, Yadav DK. Immunopathology, host-virus genome interactions, and effective vaccine development in SARS-CoV-2. Comput Struct Biotechnol J 2020; 18:3774-3787. [PMID: 33235690 PMCID: PMC7677077 DOI: 10.1016/j.csbj.2020.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 02/06/2023] Open
Abstract
Coronaviruses are a group of enveloped RNA viruses that are diversely found in humans and now declared a global pandemic by the World Health Organization in March 2020. The population's susceptibility to these highly pathogenic coronaviruses has contributed to large outbreaks, evolved into public health events, and rapidly transmitted globally. Thus, there is an urgent need to develop effective therapies and vaccines against this disease. In the primary stage of severe acute respiratory syndrome coronavirus (SARS-COV-2) infection, the signs and symptoms are nonspecific, and many more cases have been observed than initially expected. Genome sequencing is performed regularly to identify genetic changes to SARS-COV-2, and vaccine development is focused on manufacture, production, and based on specific problems, and very few are available on recent developments in the prevention of outbreaks. The aim of this review article to explore recent updates on SARS-COV-2 in the context of pathogenesis during disease progression, and innate acquired mechanisms of defense, This includes advances in diagnostics, susceptibility, and severity of host-virus genome interactions, modes of transmission, active compounds being used in pre-clinical and clinical trials for the treatment of patients, vaccine developments, and the effectiveness of SARS-COV-2 prevention and control measures. We have summarized the importance of pathophysiology immune response, Diagnostics, vaccine development currently approaches explored for SARS-COV-2.
Collapse
Affiliation(s)
- Desh Deepak Singh
- Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, India
| | - Ihn Han
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical & Biological Physics, Kwangwoon University, Seoul, Republic of Korea
| | - Eun-Ha Choi
- Plasma Bioscience Research Center, Applied Plasma Medicine Center, Department of Electrical & Biological Physics, Kwangwoon University, Seoul, Republic of Korea
| | - Dharmendra Kumar Yadav
- Gachon Institute of Pharmaceutical Science and Department of Pharmacy, College of Pharmacy, Hambakmoeiro 191, Yeonsu-gu, Gachon University, Incheon, Republic of Korea
| |
Collapse
|
20
|
Polak SB, Van Gool IC, Cohen D, von der Thüsen JH, van Paassen J. A systematic review of pathological findings in COVID-19: a pathophysiological timeline and possible mechanisms of disease progression. Mod Pathol 2020; 33:2128-2138. [PMID: 32572155 PMCID: PMC7306927 DOI: 10.1038/s41379-020-0603-3] [Citation(s) in RCA: 297] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/06/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023]
Abstract
Since the outbreak of the COVID-19 pandemic, much has been learned regarding its clinical course, prognostic inflammatory markers, disease complications, and mechanical ventilation strategy. Clinically, three stages have been identified based on viral infection, pulmonary involvement with inflammation, and fibrosis. Moreover, low and high elastance phenotypes can be distinguished in mechanically ventilated patients, based on lung mechanics, ventilation-to-perfusion ratio, and CT scans; these two phenotypes have presumed differences in their underlying pathophysiology. Although essential for therapeutic guidance, the pathophysiology of COVID-19 is poorly understood. Here, we systematically reviewed published case reports and case series in order to increase our understanding of COVID-19 pathophysiology by constructing a timeline and correlating histopathological findings with clinical stages of COVID-19. Using PRISMA-IPD guidelines, 42 articles reporting 198 individual cases were included in our analysis. In lung samples (n = 131 cases), we identified three main histological patterns: epithelial (n = 110, 85%), with reactive epithelial changes and DAD; vascular (n = 76, 59%) with microvascular damage, (micro)thrombi, and acute fibrinous and organizing pneumonia; and fibrotic (n = 28, 22%) with interstitial fibrosis. The epithelial and vascular patterns can present in all stages of symptomatic COVID-19, whereas the fibrotic pattern presents starting at ~3 weeks. Moreover, patients can present with more than one pattern, either simultaneously or consecutively. These findings are consistent with knowledge regarding clinical patterns of viral infection, development of hyperinflammation and hypercoagulability, and fibrosis. Close collaboration among medical staff is necessary in order to translate this knowledge and classification of pathophysiological mechanisms into clinical stages of disease in individual patients. Moreover, further research, including histopathological studies, is warranted in order to develop reliable, clinically relevant biomarkers by correlating these pathological findings with laboratory results and radiological findings, thus, increasing our understanding of COVID-19 and facilitating the move to precision medicine for treating patients.
Collapse
Affiliation(s)
- Samuel B. Polak
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge C. Van Gool
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan H. von der Thüsen
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith van Paassen
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.
| |
Collapse
|
21
|
Costenaro P, Minotti C, Barbieri E, Giaquinto C, Donà D. SARS-CoV-2 infection in people living with HIV: a systematic review. Rev Med Virol 2020; 31:1-12. [PMID: 32875716 DOI: 10.1002/rmv.2155] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND SETTING Little is known about SARS-CoV-2 impact on some vulnerable subgroups, such as people living with HIV/AIDS (PLWHA). In our study we reviewed the current knowledge on SARS-CoV-2 cases in PLWHA. METHODS A systematic review was conducted by searching the MEDLINE, EMBASE and Google Scholar databases. Studies reporting data on PLWHA affected by SARS-CoV-2 were considered for inclusion. The aim of this study was the systematic characterization of cases of SARS-CoV-2 infection among PLWHA, particularly focusing on age, clinical findings at diagnosis, radiological features, therapeutic management and clinical outcomes. RESULTS Twenty three relevant articles were identified, which reported 164 adults with both HIV and SARS-CoV-2 infection. Of those, the large majority were males (120/142, 84.5%), often with one or more comorbidities. Fifteen cases needed intensive care treatment and 16 died. For each group, respectively three patients had underlying comorbidities. There were no studies on children. The included studies were mostly retrospective or case series/reports (19 studies). The overall risk of bias was moderate, due to the study types and characteristics. CONCLUSION It is still unclear if HIV infection may influence SARS-CoV-2 infection and disease course, however some PLWHA and particularly males affected by ARV-related complications may be at greater risk of severe Covid-19 course.
Collapse
Affiliation(s)
- Paola Costenaro
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy.,Infectious Diseases Department, Alto Vicentino Hospital, Santorso (Vicenza), Italy
| | - Chiara Minotti
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| |
Collapse
|