Evidence for systematic autopsies in COVID-19 positive deceased

Abstract

Forensic medicine and pathology involve specific health risks, whereby health workers are dealing with microorganisms, cells or parasites, which are referred to as biological agents. Biological agents are divided into four categories according to § 3 of the Biological Agents Ordinance. The newly identified coronavirus, severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2) that has spread rapidly around the world is placed into category 3 of the Biological Agents Ordinance, meaning pathogens that can cause serious illnesses in humans and may pose a risk to workers. The Robert Koch Institute, the German government’s central scientific institution in the field of biomedicine issued the announcement, that aerosol-producing measures (including autopsies) of SARS-CoV‑2 infected bodies should be avoided, despite the fact that autopsies are an important source of understanding the pathomorphological course of new diseases. The first German case of death due to a proven SARS-CoV‑2 infection is presented with global multifocal reticular consolidation in the post-mortem computed tomography (CT) scan, a macroscopic and microscopic viral pneumonia and viral RNA of SARS-CoV‑2 in pharyngeal mucosa and lung tissue.

Neurological Sequelae in Patients with COVID-19: A Histopathological Perspective

“…Based on the clinical studies and the limited neuropathological data, CNS histopathology encompasses hypoxic/ischemic encephalopathy, activated microglial cells with variable infiltration of perivascular T lymphocyte, cerebrovascular diseases, AHNE, encephalitis/meningitis, acute myelitis, demyelinating disorders, and PNS involvement [ 21 , 68 , 71 , 73 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 ], with histologically documented lesions in some studies [ 6 , 11 , 68 , 69 , 71 , 72 , 73 ].…”

A review of the main histopathological findings in coronavirus disease 2019

“…[ 24 ]/USA 1 X X X X X X X Fitzek et al. [ 25 ]/Germany 1 X X X X X X X Autopsias [ 26 ]/Spain 1 X X X X X X X X Luo et al. [ 27 ]/China 1 X X X X X X X X Tian et al.…”

“…Some case reports have described bilateral DAD, with evidence of hyaline membrane formation and pneumocyte denudation in the right lung, pulmonary edema with hyaline membrane formation in the left lung, interstitial lymphocytic inflammatory infiltrates in both lungs, and cytopathic viral changes, as well as hepatic steatosis and mononuclear infiltrates in the heart [ [22] , [23] , [24] ]. Other case reports have revealed congestive cardiomyopathy, with detection of the SARS-CoV-2 viral RNA in pharyngeal mucosa and lung tissue [ 25 ]. The first autopsy findings reported from Spain consisted of proliferative and fibrotic phases of DAD in the lungs with cytopathic changes and an interstitial inflammatory infiltrate composed of CD8+ lymphocytes with neutrophils.…”

Histopathological findings in COVID-19 cases: A Systematic Review

“…(18) Regarding the risk of bias assessment in the review, 4 articles scored between considered as "Good" (13, , and 20 articles scored more than 76 % which is considered as "Excellent." (48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67) A high degree of inconsistency was noticed in the review as the study populations were somehow heterogeneous in the main characteristics like age, gender, and comorbidities. Although there were no language restrictions applied in the review, publication bias may appear due to the fact that the number of the published literature was small, especially at the beginning of the pandemic.…”