Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction.
Thomas Menter,Jasmin D. Haslbauer,Ronny Nienhold,Spasenija Savic,Helmut Hopfer,Nikolaus Deigendesch,Stephan Frank,Daniel Turek,Niels Willi,Hans Pargger,Stefano Bassetti,Joerg D. Leuppi,Gieri Cathomas,Markus Tolnay,Kirsten D. Mertz,Alexandar Tzankov +15 more
TLDR
The general extent of organ involvement and the microscopic changes in the lungs remain insufficiently characterised, and autopsies are essential to elucidate COVID‐19‐associated organ alterations.Abstract:
Aims Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly evolved into a sweeping pandemic. Its major manifestation is in the respiratory tract, and the general extent of organ involvement and the microscopic changes in the lungs remain insufficiently characterised. Autopsies are essential to elucidate COVID-19-associated organ alterations. Methods and results This article reports the autopsy findings of 21 COVID-19 patients hospitalised at the University Hospital Basel and at the Cantonal Hospital Baselland, Switzerland. An in-corpore technique was performed to ensure optimal staff safety. The primary cause of death was respiratory failure with exudative diffuse alveolar damage and massive capillary congestion, often accompanied by microthrombi despite anticoagulation. Ten cases showed superimposed bronchopneumonia. Further findings included pulmonary embolism (n = 4), alveolar haemorrhage (n = 3), and vasculitis (n = 1). Pathologies in other organ systems were predominantly attributable to shock; three patients showed signs of generalised and five of pulmonary thrombotic microangiopathy. Six patients were diagnosed with senile cardiac amyloidosis upon autopsy. Most patients suffered from one or more comorbidities (hypertension, obesity, cardiovascular diseases, and diabetes mellitus). Additionally, there was an overall predominance of males and individuals with blood group A (81% and 65%, respectively). All relevant histological slides are linked as open-source scans in supplementary files. Conclusions This study provides an overview of postmortem findings in COVID-19 cases, implying that hypertensive, elderly, obese, male individuals with severe cardiovascular comorbidities as well as those with blood group A may have a lower threshold of tolerance for COVID-19. This provides a pathophysiological explanation for higher mortality rates among these patients.read more
Citations
More filters
Journal ArticleDOI
Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19.
Maximilian Ackermann,Stijn E. Verleden,Mark Kuehnel,Axel Haverich,Tobias Welte,Florian Laenger,Arno Vanstapel,Christopher Werlein,Helge Stark,Alexandar Tzankov,William W. Li,Vincent W. Li,Steven J. Mentzer,Danny Jonigk +13 more
TL;DR: In this small series, vascular angiogenesis distinguished the pulmonary pathobiology of Covid-19 from that of equally severe influenza virus infection.
Journal ArticleDOI
A report of two cases
TL;DR: The findings suggest that, although not the presenting feature, mild cognitive decline may be evident in the early stages of CJD associated with human cadaveric growth hormone treatment, and progression to dementia is best predicted by performance on neuropsychological tests.
Journal ArticleDOI
SARS-CoV-2 viral load is associated with increased disease severity and mortality.
Jesse Fajnzylber,James Regan,Kendyll Coxen,Heather Corry,Colline Wong,Alexandra Rosenthal,Daniel P Worrall,Francoise Giguel,Alicja Piechocka-Trocha,Caroline Atyeo,Stephanie Fischinger,Andrew T. Chan,Keith T. Flaherty,Kathryn T. Hall,Michael Dougan,Edward T. Ryan,Elizabeth Gillespie,Rida Chishti,Yijia Li,Nikolaus Jilg,Nikolaus Jilg,Dusan Hanidziar,Rebecca M. Baron,Lindsey R. Baden,Athe M. N. Tsibris,Katrina Armstrong,Daniel R. Kuritzkes,Galit Alter,Galit Alter,Bruce D. Walker,Bruce D. Walker,Bruce D. Walker,Xu G. Yu,Xu G. Yu,Jonathan Z. Li +34 more
TL;DR: It is reported that a higher prevalence of detectable SARS-CoV-2 plasma viral load is associated with worse respiratory disease severity, lower absolute lymphocyte counts, and increased markers of inflammation, including C-reactive protein and IL-6.
Journal ArticleDOI
Care for Critically Ill Patients With COVID-19.
TL;DR: The COVID-19 Treatment Guidelines Panel recommends using an N95 respirator (or equivalent or higher-level respirator) rather than surgical masks, in addition to other personal protective equipment (PPE) (i.e., gloves, gown, and eye protection such as a face shield or safety goggles).
Features, Evaluation, and Treatment of Coronavirus
TL;DR: The SARS-CoV-2 virus, a novel virus belonging to the coronavirus (CoV) family, has become the major pathogens of emerging respiratory disease outbreaks and has quickly spread globally.
References
More filters
Journal ArticleDOI
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Chaolin Huang,Yeming Wang,Xingwang Li,Lili Ren,Jianping Zhao,Yi Hu,Li Zhang,Guohui Fan,Jiuyang Xu,Xiaoying Gu,Zhenshun Cheng,Ting Yu,Jia'an Xia,Yuan Wei,Wenjuan Wu,Xuelei Xie,Wen Yin,Li Hui,Min Liu,Yan Xiao,Hong Gao,Li Guo,Jungang Xie,Guang-Fa Wang,Rongmeng Jiang,Zhancheng Gao,Qi Jin,Jianwei Wang,Bin Cao +28 more
TL;DR: The epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of patients with laboratory-confirmed 2019-nCoV infection in Wuhan, China, were reported.
Journal ArticleDOI
SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor
Markus Hoffmann,Hannah Kleine-Weber,Simon Schroeder,Nadine Krüger,Tanja Herrler,Sandra Erichsen,Tobias S. Schiergens,Georg Herrler,Nai Huei Wu,Andreas Nitsche,Marcel A. Müller,Christian Drosten,Christian Drosten,Stefan Pöhlmann +13 more
TL;DR: It is demonstrated that SARS-CoV-2 uses the SARS -CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming, and it is shown that the sera from convalescent SARS patients cross-neutralized Sars-2-S-driven entry.
Journal ArticleDOI
Pathological findings of COVID-19 associated with acute respiratory distress syndrome.
Zhe Xu,Lei Shi,Yijin Wang,Ji-Yuan Zhang,Lei Huang,Chao Zhang,Shuhong Liu,Peng Zhao,Hongxia Liu,Li Zhu,Yanhong Tai,Changqing Bai,Tingting Gao,Jin-Wen Song,Peng Xia,Jing-Hui Dong,Jingmin Zhao,Fu-Sheng Wang +17 more
TL;DR: O surto do novo coronavÃrus (COVID-19) em Wuhan, China, iniciado em dezembro de 2019, evoluiu para se tornar uma pandemia global A.
Journal ArticleDOI
Virological assessment of hospitalized patients with COVID-2019.
Roman Wölfel,Victor M. Corman,Wolfgang Guggemos,M Seilmaier,Sabine Zange,Marcel A. Müller,Daniela Niemeyer,Terry Jones,Terry Jones,Patrick Vollmar,Camilla Rothe,Michael Hoelscher,Tobias Bleicker,Sebastian Brünink,Julia Schneider,Rosina Ehmann,Katrin Zwirglmaier,Christian Drosten,Clemens M. Wendtner +18 more
TL;DR: Detailed virological analysis of nine cases of coronavirus disease 2019 (COVID-19) provides proof of active replication of the SARS-CoV-2 virus in tissues of the upper respiratory tract.
Journal ArticleDOI
Endothelial cell infection and endotheliitis in COVID-19.
Zsuzsanna Varga,Andreas J. Flammer,Peter Steiger,Martina Haberecker,Rea Andermatt,Annelies S. Zinkernagel,Mandeep R. Mehra,Reto A. Schuepbach,Frank Ruschitzka,Holger Moch +9 more
TL;DR: The vascular endothelium is an active paracrine, endocrine, and Endothelial cell infection and endotheliitis in COVID-19 and recruitment of immune cells can result in widespread endothelial dysfunction associated with apoptosis.
Related Papers (5)
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Chaolin Huang,Yeming Wang,Xingwang Li,Lili Ren,Jianping Zhao,Yi Hu,Li Zhang,Guohui Fan,Jiuyang Xu,Xiaoying Gu,Zhenshun Cheng,Ting Yu,Jia'an Xia,Yuan Wei,Wenjuan Wu,Xuelei Xie,Wen Yin,Li Hui,Min Liu,Yan Xiao,Hong Gao,Li Guo,Jungang Xie,Guang-Fa Wang,Rongmeng Jiang,Zhancheng Gao,Qi Jin,Jianwei Wang,Bin Cao +28 more