Histopathological Features of SARS-CoV-2 in Extrapulmonary Organ Infection: A Systematic Review of Literature

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health concern responsible for the ongoing pandemic. Histopathological pieces of evidence on COVID-19 are not fully investigated. This review aims to provide, through microscopy investigations, a histopathological overview of COVID-19 structural and ultrastructural alterations in different organs and tissues, excluding the respiratory system. The authors systematically reviewed the literature over the period February 2020–July 2022. Selected databases were PubMed, Scopus, and Google Scholar. The search strategy included the following terms: “COVID-19” or SARS-CoV-2 and “histopathology” or “pathology”; and “microscopy” and “liver”, “myocardium”,” spleen”, “testis”, and “placenta”. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. Thirty-one articles included in this systematic review demonstrated, at a histopathological level, that COVID-19 exerts detrimental effects on tissues, often promoting degenerative processes. Even if COVID-19 shows a histopathological tropism for the respiratory system, other tissues, from cardiovascular to reproductive, are affected by COVID-19. Therefore, this paper provides an up-to-date view of histopathological observations of the structural and ultrastructural alterations associated with COVID-19 and may contribute to a better knowledge of the physiopathological bases of this disease.

Clinical Predictors for Abnormal ALT in Patients Infected with COVID-19—A Retrospective Single Centre Study

“…The hypoxia of respiratory distress syndrome can result in the continuous generation of reactive oxygen species and various pro-inflammatory factors to induce liver damage [ 28 ]. Other potential mechanisms of liver injury in hypoxia include hepatic venous congestion secondary to elevated central venous pressure, hypoxia reperfusion injury, high positive end-respiratory pressure (PEEP) use in intubated patients and vascular alterations [ 3 , 30 , 31 ].…”

Case Report: COVID-19 Infection of a Transplanted Heart Simulating Cellular Rejection

“…According to the previous reports of endomyocardial biopsies taken from COVID-19-positive patients, SARS-CoV-2 viral particles will stay in the myocardial interstitial cells but not in cardiomyocytes or endothelial cells and alter the circulating lymphocytes and the immune system causing inflammation of the interstitial tissue evidenced by leukocyte infiltration and presence of CD4+ T cells indicating indirect injury to the cells by the virus [ 7 , 8 ].…”

Interaction of COVID-19 With Common Cardiovascular Disorders

“… 113 However, another up to date systematic review does show the presence of myocarditis, albeit infrequently, in available reported cases. 114 Current estimated rates of COVID-19 myocarditis are between 2.4 and 4.1 out of 1000 patients hospitalized for COIVD-19. 115 …”