Histopathologic Changes and SARS-CoV-2 Immunostaining in the Lung of a Patient With COVID-19.
Citations
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Cites background from "Histopathologic Changes and SARS-Co..."
...The severe acute respiratory distress syndrome-associated coronavirus-2 (SARS-CoV-2), etiologic agent of Coronavirus disease 2019 (COVID-19), was initially identified in Wuhan, Hubei, China in December 2019.1 It was documented to be pandemic by the World Health Organization in early March 2020,2 and by early April there were over 1.5 million cases worldwide, with over 90,000 deaths.3 Organ dysfunction, particularly progressive respiratory failure and a generalized coagulopathy, are associated with the highest mortality.1,4,5 It was soon recognized that SARS-CoV-2 is but one of a large pool of prepandemic SARS-like bat coronaviruses which replicate in primary human airway epithelial cells, using human Angiotensin Converting Enzyme (ACE)2 entry receptors.6 These include the etiologic agents of the original SARS-CoV and Middle East respiratory syndrome (MERS)-CoV, for which mortality is also linked to severe respiratory failure, with pathologic evidence of acute respiratory distress syndrome (ARDS).7 Preliminary pathology studies of COVID-19 patients demonstrated diffuse alveolar damage (DAD) with edema, hyaline membranes, and inflammation, followed by type II pneumocyte hyperplasia, features characteristic of typical ARDS.8,9 But many patients with COVID-19-related severe respiratory distress have a delayed onset of respiratory distress,10 then manifest relatively well-preserved lung mechanics, despite the severity of hypoxemia, characterized by high respiratory compliance and high shunt fraction, and prolonged requirement for mechanical ventilation.10,11 Therefore, significant aspects of the pathology of COVID-19 might be expected to differ from classic ARDS....
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...An increase in the dead space fraction might be anticipated with this type of pathology, i.e., respiratory failure accompanied by greater lung compliance and less pulmonary consolidation than is characteristic of typical ARDS....
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...That is, COVID19-related severe respiratory distress can be manifest by relatively well-preserved lung mechanics, despite the severity of hypoxemia, characterized by high respiratory compliance, high shunt fraction, and prolonged requirement for mechanical ventilation.10,11 The pathology in these cases might therefore be expected to differ from the diffuse alveolar damage and hyaline membrane formation which are hallmarks of typical ARDS....
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...When activated to a great extent it may exceed the capacity of complement regulatory proteins, both soluble and normally present in abundance on the microvasculature.29 That raises the issue of why only a subset of SARS-CoV2-infected patients develops such severe disease with features atypical for ARDS....
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...Preliminary pathology studies of COVID-19 patients demonstrated diffuse alveolar damage (DAD) with edema, hyaline membranes, and inflammation, followed by type II pneumocyte hyperplasia, features characteristic of typical ARDS.(8,9) But many patients with COVID-19-related severe respiratory distress have a delayed onset of respiratory distress,(10) then manifest relatively well-preserved lung mechanics, despite the severity of hypoxemia, characterized by high respiratory compliance and high shunt fraction, and prolonged requirement for mechanical ventilation....
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Cites background or result from "Histopathologic Changes and SARS-Co..."
...The histopathologic changes in most of our cases with diffuse alveolar damage as the main finding resemble those described by Xu and colleagues (7) and Barton and colleagues (8), who reported single cases; Zhang and colleagues (26), who reported on lung biopsy in a patient with SARS–CoV-2 positivity; and Tian and colleagues (27), who described macroscopic and histologic pulmonary findings in 2 patients with lung cancer who received positive results on SARS–CoV-2 testing....
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...Lastly, indirect causes, such as immune-mediated damage by antiphospholipid antibodies, may partially contribute, as speculated by Zhang and colleagues (26)....
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References
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"Histopathologic Changes and SARS-Co..." refers methods in this paper
...Biopsy lung sections were analyzed with hematoxylin– eosin staining, and immunostaining for SARS–CoV-2 was conducted as reported elsewhere (1)....
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6,229 citations
"Histopathologic Changes and SARS-Co..." refers methods in this paper
...Throat swabs were assessed for SARS–CoV-2 by using real-time reverse transcriptase polymerase chain reaction assays (2)....
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