Postmortem findings in COVID-19 fatalities: A systematic review of current evidence

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19). Almost 17 months after the first COVID-19 case was reported, the exact pathogenesis of the virus is still open to interpretation. Postmortem studies have been relatively scarce due to the high infectivity rate of the virus. We systematically reviewed the literature available for studies that reported gross, histological, microscopic, and immunohistochemical findings in COVID-19 fatalities with the aim of reporting any recurrent findings among different demographics. PubMed and Scopus were searched up till the second of May 2021 and 46 studies with a total of 793 patients were shortlisted after the application of inclusion and exclusion criteria. The selected studies reported gross, histological, microscopic, and immunohistochemical autopsy findings in the lungs, heart, liver, gallbladder, bowels, kidney, spleen, bone marrow, lymph nodes, CNS, pancreas, endocrine/exocrine glands, and a few other miscellaneous locations. The SARS-CoV-2 virus was detected in multiple organs and so was the presence of widespread microthrombi. This finding suggests that the pathogenesis of this highly infectious virus might be linked to some form of coagulopathy. Further studies should focus on analyzing postmortem findings in a larger number of patients from different demographics in order to obtain more generalizable results.

Pulmonary Vascular Thrombosis in COVID-19: Clinical and Morphological Parallels

“…Гистологическими проявлениями активации эндотелия сосудов легочного русла вплоть до его повреждения являются вакуолизация эндотелия, его десквамация, фибриноидный некроз слоев стенки сосуда, а также инфильтрация лейкоцитами, что подтверждают и данные настоящего исследования [29,30]. Изменения наблюдаются как в тромбированных сосудах, так и в тех, где тромб еще не сформировался [14].…”

“…Тромбоз сосудистого русла легких при COVID-19 боза и включает тромбоциты, нейтрофильно-тромбоцитарные агрегаты, экстрацеллюлярные нейтрофильные ловушки (NETs) и фибрин [29,31].…”

“…Тромботическое поражение бассейна легочной артерии, в том числе, изолированное, охватывает крупные и мелкие ветви легочной артерии (долевые, сегментарные и субсегментарные), а также сосуды микроциркуляторного русла [35,36]. Результаты систематического обзора демонстрируют поражение главной ЛА у 13,5% пациентов, ветвей мелкого и среднего калибра -у 100% [29]. Исходя из результатов настоящей работы, можно утверждать, что в каждом случае тромбированными оказываются порядка половины сосудов легочного русла диаметром менее 3,4 мм.…”

SARS-CoV-2 Viral RNA Is Detected in the Bone Marrow in Post-Mortem Samples Using RT-LAMP

“…COVID-19 disease, caused by SARS-CoV-2 is a highly contagious infectious disease with a relatively high rate of death [ 1 ]. It is considered not only as a respiratory tract disease that affects the lungs but as a systemic disease affecting multiple organs such as the heart, brain, nervous system, liver, kidney, digestion truck, and others [ 2 ]. Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019, viral RNA has been detected in several different human tissues and organs.…”

“…Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019, viral RNA has been detected in several different human tissues and organs. Except for lungs, RNA of SARS-CoV-2 was detected in the liver, heart, kidney, spleen, pancreas, gallbladder, small and large intestine, common carotid artery, and others [ 2 ]. For some specific tissue locations, it is hard to obtain biological samples from living subjects, that is why numerous reports describe SARS-CoV-2 detection postmortem, which allows determining almost all possible organs in terms of the presents of SARS-CoV-2 and possible consequences of COVID-19 [ 2 ].…”