1
|
Molinengo L, Estrin-Serlui T, Hanley B, Osborn M, Goldin R. Infectious diseases and the role of needle biopsy post-mortem. THE LANCET. MICROBE 2024; 5:707-716. [PMID: 38604206 DOI: 10.1016/s2666-5247(24)00044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 04/13/2024]
Abstract
Post-mortem examinations continue to play a crucial role in understanding the epidemiology and pathogenesis of infectious diseases. However, the perceived infection risk can preclude traditional, invasive, complete diagnostic autopsy. Post-mortem examination is especially important in emerging infectious diseases with potentially unknown infection risks, but rapid acquisition of good quality tissue samples is needed as part of the scientific and public health response. Needle biopsy post-mortem is a minimally invasive, rapid, closed-body autopsy technique that was originally developed to minimise the infection risk to practitioners. Since its inception, needle biopsy post-mortem has also been used as a technique to support complete diagnostic autopsy provision in poorly resourced regions and to facilitate post-mortem examinations in communities that might have religious or cultural objections to an invasive autopsy. This Review analyses the evolution and applicability of needle biopsy post-mortem in investigating endemic and emerging infectious diseases.
Collapse
Affiliation(s)
- Lucia Molinengo
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | - Theodore Estrin-Serlui
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Brian Hanley
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK; Cancer Dynamics Laboratory, The Francis Crick Institute, London, UK; Department of Metabolism, Digestion and Reproduction, South Kensington Campus, Imperial College, London, UK
| | - Michael Osborn
- Cellular Pathology Department, Northwest London Pathology hosted by Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Robert Goldin
- Department of Metabolism, Digestion and Reproduction, South Kensington Campus, Imperial College, London, UK
| |
Collapse
|
2
|
Hariri LP, North CM, Shih AR, Israel RA, Maley JH, Villalba JA, Vinarsky V, Rubin J, Okin DA, Sclafani A, Alladina JW, Griffith JW, Gillette MA, Raz Y, Richards CJ, Wong AK, Ly A, Hung YP, Chivukula RR, Petri CR, Calhoun TF, Brenner LN, Hibbert KA, Medoff BD, Hardin CC, Stone JR, Mino-Kenudson M. Lung Histopathology in Coronavirus Disease 2019 as Compared With Severe Acute Respiratory Sydrome and H1N1 Influenza: A Systematic Review. Chest 2021; 159:73-84. [PMID: 33038391 PMCID: PMC7538870 DOI: 10.1016/j.chest.2020.09.259] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Patients with severe coronavirus disease 2019 (COVID-19) have respiratory failure with hypoxemia and acute bilateral pulmonary infiltrates, consistent with ARDS. Respiratory failure in COVID-19 might represent a novel pathologic entity. RESEARCH QUESTION How does the lung histopathology described in COVID-19 compare with the lung histopathology described in SARS and H1N1 influenza? STUDY DESIGN AND METHODS We conducted a systematic review to characterize the lung histopathologic features of COVID-19 and compare them against findings of other recent viral pandemics, H1N1 influenza and SARS. We systematically searched MEDLINE and PubMed for studies published up to June 24, 2020, using search terms for COVID-19, H1N1 influenza, and SARS with keywords for pathology, biopsy, and autopsy. Using PRISMA-Individual Participant Data guidelines, our systematic review analysis included 26 articles representing 171 COVID-19 patients; 20 articles representing 287 H1N1 patients; and eight articles representing 64 SARS patients. RESULTS In COVID-19, acute-phase diffuse alveolar damage (DAD) was reported in 88% of patients, which was similar to the proportion of cases with DAD in both H1N1 (90%) and SARS (98%). Pulmonary microthrombi were reported in 57% of COVID-19 and 58% of SARS patients, as compared with 24% of H1N1 influenza patients. INTERPRETATION DAD, the histologic correlate of ARDS, is the predominant histopathologic pattern identified in lung pathology from patients with COVID-19, H1N1 influenza, and SARS. Microthrombi were reported more frequently in both patients with COVID-19 and SARS as compared with H1N1 influenza. Future work is needed to validate this histopathologic finding and, if confirmed, elucidate the mechanistic underpinnings and characterize any associations with clinically important outcomes.
Collapse
Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Angela R Shih
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Rebecca A Israel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason H Maley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Vladimir Vinarsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonah Rubin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Daniel A Okin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Alyssa Sclafani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jehan W Alladina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jason W Griffith
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Michael A Gillette
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Yuval Raz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Christopher J Richards
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Alexandra K Wong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Raghu R Chivukula
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Whitehead Institute for Biomedical Research, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Camille R Petri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Tiara F Calhoun
- Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Laura N Brenner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kathryn A Hibbert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - C Corey Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
4
|
Allyn PR, Duffy EL, Humphries RM, Injean P, Weigt SS, Saggar R, Shino MY, Lynch JP, Ardehali A, Kubak B, Tseng CH, Belperio JA, Ross DJ, Gregson AL. Graft Loss and CLAD-Onset Is Hastened by Viral Pneumonia After Lung Transplantation. Transplantation 2016; 100:2424-2431. [PMID: 27467538 PMCID: PMC5077663 DOI: 10.1097/tp.0000000000001346] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community-acquired respiratory virus (CARV) infections occur frequently after lung transplantation and may adversely impact outcomes. We hypothesized that while asymptomatic carriage would not increase the risk of chronic lung allograft dysfunction (CLAD) and graft loss, severe infection would. METHODS All lung transplant cases between January 2000 and July 2013 performed at our center were reviewed for respiratory viral samples. Each isolation of virus was classified according to clinical level of severity: asymptomatic, symptomatic without pneumonia, and viral pneumonia. Multivariate Cox modeling was used to assess the impact of CARV isolation on progression to CLAD and graft loss. RESULTS Four thousand four hundred eight specimens were collected from 563 total patients, with 139 patients producing 324 virus-positive specimens in 245 episodes of CARV infection. Overall, the risk of CLAD was elevated by viral infection (hazard ratio [HR], 1.64; P < 0.01). This risk, however, was due to viral pneumonia alone (HR, 3.94; P < 0.01), without significant impact from symptomatic viral infection (HR, 0.97; P = 0.94) nor from asymptomatic viral infection (HR, 0.99; P = 0.98). The risk of graft loss was not increased by asymptomatic CARV infection (HR, 0.74; P = 0.37) nor symptomatic CARV infection (HR, 1.39; P = 0.41). Viral pneumonia did, however, significantly increase the risk of graft loss (HR, 2.78; P < 0.01). CONCLUSIONS With respect to CARV, only viral pneumonia increased the risk of both CLAD and graft loss after lung transplantation. In the absence of pneumonia, respiratory viruses had no impact on measured outcomes.
Collapse
Affiliation(s)
- Paul R. Allyn
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles
| | - Erin L. Duffy
- Department of Medicine Statistics Core, University of California Los Angeles
| | - Romney M. Humphries
- Department of Pathology and Laboratory Medicine, University of California Los Angeles
| | - Patil Injean
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - S. Samuel Weigt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - Rajan Saggar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - Michael Y. Shino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - Joseph P. Lynch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Los Angeles
| | - Bernard Kubak
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles
| | - Chi-Hong Tseng
- Department of Medicine Statistics Core, University of California Los Angeles
| | - John A. Belperio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - David J. Ross
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California Los Angeles
| | - Aric L. Gregson
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles
| |
Collapse
|
5
|
Voltersvik P, Aqrawi LA, Dudman S, Hungnes O, Bostad L, Brokstad KA, Cox RJ. Pulmonary changes in Norwegian fatal cases of pandemic influenza H1N1 (2009) infection: a morphologic and molecular genetic study. Influenza Other Respir Viruses 2016; 10:525-531. [PMID: 27413002 PMCID: PMC5059952 DOI: 10.1111/irv.12410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 01/22/2023] Open
Abstract
Background During the pandemic outbreak of the 2009 swine influenza (A(H1N1)pdm09), 32 fatal cases occurred in Norway and 19 of these were included in this study. Objectives We characterised pulmonary changes in these fatal Norwegian cases. Patients and Methods Upon hospitalisation, detailed clinical information and specimens from the upper and lower respiratory pathways were collected. At post‐mortem, lung tissue was collected, formalin‐fixed and paraffin‐embedded. Immunohistochemical and light microscopic examination was performed to visualise the local expression of the A(H1N1)pdm09 virus. Reverse transcription‐polymerase chain reaction (RT‐PCR) and pyrosequencing of the non‐fixed specimens allowed the identification of mutations in the influenza virus surface glycoprotein (haemagglutinin gene) particularly at position 222. Results and Conclusions The overall course of illness lasted from 2 to 40 days (median 9 days). Diffused alveolar damage (DAD) was evident in 11 cases, 4 of which had no apparent underlying illness. Obesity was prominent in 12 cases, where three individuals were classified as otherwise healthy. The HA D222G mutation was detected in six cases, 3 of which had no underlying illness. Immunohistochemistry showed the A(H1N1)pdm09 virus to be prominent at the site of inflammation both in close proximity to and inside alveolar structures in the lung tissue. In addition to a possible role for the HA D222G mutation, our findings indicate that host factors and underlying conditions in the infected individuals are fundamental for disease outcome in many cases. This study increases our understanding of determinants for the clinical outcome of pandemic influenza, which could guide future treatment.
Collapse
Affiliation(s)
- Pål Voltersvik
- The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lara A Aqrawi
- The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway.,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Bergen, Norway
| | - Susanne Dudman
- WHO National Influenza Centre, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- WHO National Influenza Centre, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Leif Bostad
- Gade Laboratory for Pathology, Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Karl A Brokstad
- The Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rebecca J Cox
- The Influenza Centre, Department of Clinical Science, University of Bergen, Bergen, Norway. .,K. G. Jebsen Centre for Influenza Vaccine Research, University of Bergen, Bergen, Norway. .,Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
| |
Collapse
|