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J Pathol
. 2021 Apr 8.
doi: 10.1002/path.5679. Online ahead of print.
Salivary glands are a target for SARS-CoV-2: A source for saliva contamination
Bruno Fernandes Matuck 1 , Marisa Dolhnikoff 1 , Amaro Nunes Duarte-Neto 1 2 , Gilvan Maia 3 , Sara Costa Gomes 3 , Daniel Isaac Sendyk 4 , Amanda Zarpellon 4 , Nathalia Paiva de Andrade 5 , Renata Aparecida Monteiro 1 , Jo?o Renato Rebello Pinho 6 , Michele Soares Gomes-Gouv?a 6 , Suzana C O M Souza 4 , Cristina Kanamura 2 , Thais Mauad 1 , Paulo Hil?rio do Nascimento Saldiva 1 , Paulo H Braz-Silva 4 7 , Elia Garcia Caldini 1 , Luiz Fernando Ferraz da Silva 1 8
Affiliations
- PMID: 33834497
- DOI: 10.1002/path.5679
Abstract
The ability of the new coronavirus SARS-CoV-2 to spread and contaminate is one of the determinants of the COVID-19 pandemic status. SARS-CoV-2 has been detected in saliva consistently, with similar sensitivity as observed in nasopharyngeal swabs. We conducted ultrasound-guided postmortem biopsies in COVID-19 fatal cases. Samples of salivary glands (SG; Parotid, Submandibular and Minor) were obtained. We analyzed samples using RT-qPCR, immunohistochemistry, electron microscopy and histopathological analysis, to identify the SARS-CoV-2 and elucidate qualitative and quantitative viral profiles in salivary glands. The study included 13 female and 11 male patients, with a mean age of 53.12 years (range 8-83). RT-qPCR for SARS-CoV-2 was positive in 30 SG samples from 18 patients (60% of total SG samples and 75% of all cases). Ultrastructural analyses showed spherical 70-100 nm viral particles, consistent in size and shape with the Coronaviridae family, in the ductal lining cell cytoplasm, acinar cells, and ductal lumen of SG. There was also degeneration of organelles in infected cells and the presence of a cluster of nucleocapsids, which suggests viral replication in SG cells. Qualitative histopathological analysis showed morphologic alterations in the duct lining epithelium characterized by cytoplasmic and nuclear vacuolization, as well as nuclear pleomorphism. Acinar cells showed degenerative changes of the zymogen granules and enlarged nuclei. Ductal epithelium and serous acinar cells showed intense expression of ACE2 and TMPRSS receptors. An anti-SARS-CoV-2 antibody was positive in 8 (53%) of the 15 tested cases in duct lining epithelial cells and acinar cells of major SG. Only 2 minor salivary glands were positive for SARS-CoV-2 by immunohistochemistry. Salivary glands are a reservoir for SARS-CoV-2 and provide a pathophysiological background for studies that indicate the use of saliva as a diagnostic method for COVID19 and highlight this biological fluid's role in spreading the disease. This article is protected by copyright. All rights reserved.
Keywords: Autopsy; COVID-19; Infection Control; RT-PCR, SARS-CoV-2; Saliva; Salivary Gland.