Full autopsy in a confirmed COVID-19 patient in Lagos, Nigeria – A case report

Abstract

Objectives To report the postmortem findings of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individual who died in Lagos (Nigeria) in June 2020 and to investigate the cause, pathogenesis as well as pathological changes noticed during the examination. Methods Complete postmortem examination was performed according to standard procedures in a regular autopsy suite using personal protective equipment including N95 masks, goggles and disposable gowns. The diagnosis of coronavirus disease 2019 (COVID-19) was confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR) testing on postmortem nasopharyngeal swabs. Results A 47-year-old man with a medical history of well controlled hypertension and dyslipidaemia died after long hours of transportation for medical care in a hospital in Lagos. He tested positive for SARS-CoV-2 on ante- and postmortem nasopharyngeal swabs. Autopsy revealed pneumonia with diffuse alveolar damage, disseminated intravascular coagulopathy and hypovolaemic shock. Conclusions Autopsy can be performed on decedents who died from or with SARS-CoV-2 infection in a low resource environment such as ours. A standard autopsy room was used while deploying recommended infection prevention control and regular decontamination. The clinical details, autopsy findings such as diffuse alveolar damage and airway inflammation were consistent with a COVID-19 related pathology. While the decedent had ‘controlled’ co-morbidity, he succumbed to multi-organ failure occasioned by shock and disseminated intravascular coagulopathy.

An autopsy case of COVID‐19 with a sudden death: Clinico‐pathological comparison

“…Autopsy findings of COVID‐19 have been reported from worldwide countries, including the United States, 13 and those from Europe, 14 , 15 , 16 Asia, 12 , 17 , 18 and Africa. 19 No national differences have been described, and most reports stated that DAD is a major cause of respiratory failure, which is different from the present case.…”

“…Autopsy findings of COVID-19 have been reported from worldwide countries, including the United States, 13 and those from Europe, [14][15][16] Asia, 12,17,18 and Africa. 19 No national differences have been described, and most reports stated that DAD is a major cause of respiratory failure, which is different from the present case. Since this pandemic occurred, efforts have been made to overcome the exaggerated host immune reactions, and a living WHO guideline on drugs for COVID-19, for example, was repeatedly updated.…”

COVID-19 Pandemic Impacts Food Security and Causes Psychosocial Stress in Nigeria

“…This is an indication that in addition to worsening health situation due to COVID-19 and inability to pay for medication, such families may also experience food insecurity, hunger and deprivation. Previous works have earlier reached similar conclusions that the COVID-19 pandemic has affected various dimensions of food security and households' incomes in developing countries, including in the low income households in high-income-economies like the US [36][37][38]. Furthermore, Olwande et al [39], have shown that the COVID pandemic caused significant decline in households' incomes and negative social and economic impacts on households living in both the urban and rural areas of Kenya.…”

“…In the USA, the median charge amount for hospitalization of a COVID-19 patient over a course of treatment until discharged range from US$34,662 for the 23-30 age group to US$45,683 for the 51-60 age group [36,37]. Although no peer-reviewed document exists yet to estimate the cost of hospitalization for a COVID patient in Nigeria, anecdotal estimation placed the average costs at between US$750 to US$13, 000 per person, depending on the duration of hospitalization [38]. These observations have some implications; there may be some distortion of the national epidemiological (morbi-mortality) data, and related health costs on COVID-19 in Nigeria, because individuals in the low and middle income groups would most likely shun hospitalization and post mortem examinations to determine the cause of death largely due to the associated huge costs [39].…”

SARS-CoV-2 Prediction Strategy Based on Classification Algorithms from a Full Blood Examination

“…A case report in [ 14 ] emphasized the importance of full autopsy in understanding the disease process and identifying potential targets for therapeutic interventions. The authors of the aforementioned study conducted a full autopsy on a confirmed COVID-19 patient in Lagos, Nigeria, providing valuable insights into the pathological features of the disease.…”