Abstract
Between April and June 2020, i.e., during the first wave of pandemic coronavirus disease 2019 (COVID-19), 55 patients underwent long-term treatment in the intensive care unit at the University Hospital of Regensburg. Most of them were transferred from smaller hospitals, often due to the need for an extracorporeal membrane oxygenation system. Autopsy was performed in 8/17 COVID-19-proven patients after long-term treatment (mean: 33.6 days). Autopsy revealed that the typical pathological changes occurring during the early stages of the disease (e.g., thrombosis, endothelitis, capillaritis) are less prevalent at this stage, while severe diffuse alveolar damage and especially coinfection with different fungal species were the most conspicuous finding. In addition, signs of macrophage activation syndrome was detected in 7 of 8 patients. Thus, fungal infections were a leading cause of death in our cohort of severely ill patients and may alter clinical management of patients, particularly in long-term periods of treatment.
Highlights
Clinical autopsy is an essential medical tool for quality assurance and education and to improve and advance our understanding of diseases
In unknown and emerging diseases such as pandemic coronavirus disease 2019 (COVID19), postmortem examinations are of utmost importance to gain a better understanding of the underlying pathomechanisms and disease-associated alterations in different organs
The main goal of this study was to examine the spectrum of autopsy findings in COVID-19 patients after long-term medical treatment, with a main focus on microbiological findings and particular emphasis on mycotic infections
Summary
Clinical autopsy is an essential medical tool for quality assurance and education and to improve and advance our understanding of diseases. In unknown and emerging diseases such as pandemic coronavirus disease 2019 (COVID19), postmortem examinations are of utmost importance to gain a better understanding of the underlying pathomechanisms and disease-associated alterations in different organs. During the early phase of the COVID-19 pandemic in Germany, autopsies were not recommended due to the unknown risk of infection. After the intervention of the academic German Association of Pathologists (Deutsche Gesellschaft für Pathologie) and a subsequent public discussion, this recommendation was revoked and autopsies were performed. The first autopsy studies consistently showed similar changes of the lung and other organs, consisting of neutrophilic capillaritis, microthrombosis, pulmonary thromboembolism, and signs of multi-organ failure [2] as well as diffuse alveolar damage (DAD). Squamous metaplasia as a peculiar feature and pulmonary fibrosis
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