Temporal Patterns of COVID-19-Associated Pulmonary Pathology : An Autopsy Study
Copyright © 2021, Stoyanov et al..
Introduction The novel coronavirus variant - severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes clinically (novel coronavirus disease 2019 or COVID-19) have placed medical science into a frenzy due to the significant morbidity and mortality, as well as the myriad of clinical complications developing as a direct result of infection. The most notable and one of the most severe changes in COVID-19 develops in the lungs. Materials and methods All cases of real-time polymerase chain reaction (rtPCR)-proved COVID-19 subjected to autopsy were withdrawn from the central histopathology archive of a single tertiary medical institution - St. Marina University Hospital - Varna, Varna, Bulgaria. Pulmonary gross and histopathology changes observed on light microscopy with hematoxylin and eosin as well with other histochemical and immunohistochemical stains were compared with the time from patient-reported symptom onset to expiration, to compare the extent and type of changes based on disease duration. Results A total of 27 autopsy cases fit the established criteria. All cases clinically manifested with severe COVID-19. From the selected 27 cases, n=14 were male and n=13 were female. The mean age in the cohort was 67.44 years (range 18-91 years), with the mean age for males being 68.29 (range 38-80 years) and the mean age for females being 66.54 (range 18-91 years). Gross changes in patients who expired in the first 10 days after disease onset showed a significantly increased mean weight - 1050g, compared to a relatively lower weight in patients expiring more than 10 days after symptom onset - 940g. Histopathology changes were identified as intermittent (developing independent from symptom onset and persisting) - diffuse alveolar damage with hyaline membranes - acute respiratory distress syndrome, endothelitis with vascular degeneration and fibrin thrombi; early (developing within the first week, but persisting) - type II pneumocyte hyperplasia, alveolar cell multinucleation and scant interstitial mononuclear inflammation; intermediate (developing within the late first and second weeks) - Clara cell hyperplasia and late (developing after the second week of symptom onset) - respiratory tract and alveolar squamous cell metaplasia and fibrosis. Conclusion COVID-19-associated pulmonary pathology, both gross and histopathology, show a time-related dynamic with persistent early and a myriad of later developing dynamic changes in patients with severe disease. These changes underline both the severity of the condition, as well as the mechanisms and the probability of long-lasting severe complications in patients with post-COVID syndrome.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2021 |
---|---|
Erschienen: |
2021 |
Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
---|---|
Enthalten in: |
Cureus - 13(2021), 12 vom: 27. Dez., Seite e20522 |
Sprache: |
Englisch |
---|
Beteiligte Personen: |
Stoyanov, George S [VerfasserIn] |
---|
Links: |
---|
Themen: |
Autopsy |
---|
Anmerkungen: |
Date Revised 02.02.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
---|
doi: |
10.7759/cureus.20522 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM336368135 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM336368135 | ||
003 | DE-627 | ||
005 | 20231225232003.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231225s2021 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.7759/cureus.20522 |2 doi | |
028 | 5 | 2 | |a pubmed24n1121.xml |
035 | |a (DE-627)NLM336368135 | ||
035 | |a (NLM)35103119 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Stoyanov, George S |e verfasserin |4 aut | |
245 | 1 | 0 | |a Temporal Patterns of COVID-19-Associated Pulmonary Pathology |b An Autopsy Study |
264 | 1 | |c 2021 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Revised 02.02.2022 | ||
500 | |a published: Electronic-eCollection | ||
500 | |a Citation Status PubMed-not-MEDLINE | ||
520 | |a Copyright © 2021, Stoyanov et al. | ||
520 | |a Introduction The novel coronavirus variant - severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes clinically (novel coronavirus disease 2019 or COVID-19) have placed medical science into a frenzy due to the significant morbidity and mortality, as well as the myriad of clinical complications developing as a direct result of infection. The most notable and one of the most severe changes in COVID-19 develops in the lungs. Materials and methods All cases of real-time polymerase chain reaction (rtPCR)-proved COVID-19 subjected to autopsy were withdrawn from the central histopathology archive of a single tertiary medical institution - St. Marina University Hospital - Varna, Varna, Bulgaria. Pulmonary gross and histopathology changes observed on light microscopy with hematoxylin and eosin as well with other histochemical and immunohistochemical stains were compared with the time from patient-reported symptom onset to expiration, to compare the extent and type of changes based on disease duration. Results A total of 27 autopsy cases fit the established criteria. All cases clinically manifested with severe COVID-19. From the selected 27 cases, n=14 were male and n=13 were female. The mean age in the cohort was 67.44 years (range 18-91 years), with the mean age for males being 68.29 (range 38-80 years) and the mean age for females being 66.54 (range 18-91 years). Gross changes in patients who expired in the first 10 days after disease onset showed a significantly increased mean weight - 1050g, compared to a relatively lower weight in patients expiring more than 10 days after symptom onset - 940g. Histopathology changes were identified as intermittent (developing independent from symptom onset and persisting) - diffuse alveolar damage with hyaline membranes - acute respiratory distress syndrome, endothelitis with vascular degeneration and fibrin thrombi; early (developing within the first week, but persisting) - type II pneumocyte hyperplasia, alveolar cell multinucleation and scant interstitial mononuclear inflammation; intermediate (developing within the late first and second weeks) - Clara cell hyperplasia and late (developing after the second week of symptom onset) - respiratory tract and alveolar squamous cell metaplasia and fibrosis. Conclusion COVID-19-associated pulmonary pathology, both gross and histopathology, show a time-related dynamic with persistent early and a myriad of later developing dynamic changes in patients with severe disease. These changes underline both the severity of the condition, as well as the mechanisms and the probability of long-lasting severe complications in patients with post-COVID syndrome | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a autopsy | |
650 | 4 | |a covid-19 | |
650 | 4 | |a endotheliitis | |
650 | 4 | |a fibrosis | |
650 | 4 | |a histopathology | |
650 | 4 | |a lung changes | |
650 | 4 | |a pathology | |
650 | 4 | |a pulmonary morphology | |
650 | 4 | |a sars-cov-2 | |
650 | 4 | |a squamous cell metaplasia | |
700 | 1 | |a Yanulova, Nevena |e verfasserin |4 aut | |
700 | 1 | |a Stoev, Lyuben |e verfasserin |4 aut | |
700 | 1 | |a Zgurova, Nedyalka |e verfasserin |4 aut | |
700 | 1 | |a Mihaylova, Viktoriya |e verfasserin |4 aut | |
700 | 1 | |a Dzhenkov, Deyan L |e verfasserin |4 aut | |
700 | 1 | |a Stoeva, Martina |e verfasserin |4 aut | |
700 | 1 | |a Stefanova, Nadezhda |e verfasserin |4 aut | |
700 | 1 | |a Kalchev, Kalin |e verfasserin |4 aut | |
700 | 1 | |a Petkova, Lilyana |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t Cureus |d 2013 |g 13(2021), 12 vom: 27. Dez., Seite e20522 |w (DE-627)NLM24118083X |x 2168-8184 |7 nnns |
773 | 1 | 8 | |g volume:13 |g year:2021 |g number:12 |g day:27 |g month:12 |g pages:e20522 |
856 | 4 | 0 | |u http://dx.doi.org/10.7759/cureus.20522 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 13 |j 2021 |e 12 |b 27 |c 12 |h e20522 |