Pathological findings in organs and tissues of patients with COVID-19: A systematic review.

Sasha Peiris,Juan Manivel,Sylvain Aldighieri,Ludovic Reveiz,Ludovic Reveiz,Joao Toledo,Joao Toledo,Marcio Borges-Sa,Hector Mesa,Agnes Aysola,Agnes Aysola,Hugo Ten Cate

doi:10.1371/journal.pone.0250708

Abstract

BackgroundCoronavirus disease (COVID-19) is the pandemic caused by SARS-CoV-2 that has caused more than 2.2 million deaths worldwide. We summarize the reported pathologic findings on biopsy and autopsy in patients with severe/fatal COVID-19 and documented the presence and/or effect of SARS-CoV-2 in all organs.Methods and findingsA systematic search of the PubMed, Embase, MedRxiv, Lilacs and Epistemonikos databases from January to August 2020 for all case reports and case series that reported histopathologic findings of COVID-19 infection at autopsy or tissue biopsy was performed. 603 COVID-19 cases from 75 of 451 screened studies met inclusion criteria. The most common pathologic findings were lungs: diffuse alveolar damage (DAD) (92%) and superimposed acute bronchopneumonia (27%); liver: hepatitis (21%), heart: myocarditis (11.4%). Vasculitis was common only in skin biopsies (25%). Microthrombi were described in the placenta (57.9%), lung (38%), kidney (20%), Central Nervous System (CNS) (18%), and gastrointestinal (GI) tract (2%). Injury of endothelial cells was common in the lung (18%) and heart (4%). Hemodynamic changes such as necrosis due to hypoxia/hypoperfusion, edema and congestion were common in kidney (53%), liver (48%), CNS (31%) and GI tract (18%). SARS-CoV-2 viral particles were demonstrated within organ-specific cells in the trachea, lung, liver, large intestine, kidney, CNS either by electron microscopy, immunofluorescence, or immunohistochemistry. Additional tissues were positive by Polymerase Chain Reaction (PCR) tests only. The included studies were from numerous countries, some were not peer reviewed, and some studies were performed by subspecialists, resulting in variable and inconsistent reporting or over statement of the reported findings.ConclusionsThe main pathologic findings of severe/fatal COVID-19 infection are DAD, changes related to coagulopathy and/or hemodynamic compromise. In addition, according to the observed organ damage myocarditis may be associated with sequelae.

Highlights

On March 11, 2020, the World Health Organization classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic [1, 2]
COVID-19 pathophysiology resembles that of other coronavirus infections [5, 6]; this involves attachment of the SARS-CoV-2 virus to the angiotensin-converting enzyme 2 (ACE2) on target cells, followed by internalization and replication of the virus
ACE2 are expressed to a lesser degree in non-respiratory tissues like myocardial cells, renal epithelial cells, enterocytes, and endothelial cells in multiple organs, which may explain some of the extrapulmonary manifestations

Summary

Introduction

On March 11, 2020, the World Health Organization classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a pandemic [1, 2]. COVID-19 pathophysiology resembles that of other coronavirus infections [5, 6]; this involves attachment of the SARS-CoV-2 virus to the angiotensin-converting enzyme 2 (ACE2) on target cells, followed by internalization and replication of the virus. ACE2 are expressed to a lesser degree in non-respiratory tissues like myocardial cells, renal epithelial cells, enterocytes, and endothelial cells in multiple organs, which may explain some of the extrapulmonary manifestations. Coronavirus disease (COVID-19) is the pandemic caused by SARS-CoV-2 that has caused more than 2.2 million deaths worldwide. We summarize the reported pathologic findings on biopsy and autopsy in patients with severe/fatal COVID-19 and documented the presence and/or effect of SARS-CoV-2 in all organs

Methods

Results

Conclusion