tetano
Editor, Senior Moderator
Clin Infect Dis
. 2021 Dec 15;73(Supplement_5):S465-S471.
doi: 10.1093/cid/ciab858.
Histopathological Evaluation of Deceased Persons in Lusaka, Zambia With or Without Coronavirus Disease 2019 (COVID-19) Infection: Results Obtained From Minimally Invasive Tissue Sampling
Victor Mudenda[SUP] 1 [/SUP], Chibamba Mumba[SUP] 1 [/SUP], Rachel C Pieciak[SUP] 2 [/SUP], Lawrence Mwananyanda[SUP] 2 3 [/SUP], Charles Chimoga[SUP] 3 [/SUP], Benard Ngoma[SUP] 3 [/SUP], Zacharia Mupila[SUP] 3 [/SUP], Geoffrey Kwenda[SUP] 4 [/SUP], Leah Forman[SUP] 5 [/SUP], Rotem Lapidot[SUP] 6 [/SUP], William B MacLeod[SUP] 2 [/SUP], Donald M Thea[SUP] 2 [/SUP], Christopher J Gill[SUP] 2 [/SUP]
Affiliations
Abstract
Background: Although much has been learned about the pathophysiology of coronavirus disease 2019 (COVID-19) infections, pathology data from patients who have died of COVID-19 in low- and middle-income country settings remain sparse. We integrated minimally invasive tissue sampling (MITS) into an ongoing postmortem surveillance study of COVID-19 in deceased individuals of all ages in Lusaka, Zambia.
Methods: We enrolled deceased subjects from the University Teaching Hospital Morgue in Lusaka, Zambia within 48 hours of death. We collected clinical and demographic information, a nasopharyngeal swab, and core tissue biopsies from the lung, liver, and kidneys for pathologic analysis. Individuals were considered eligible for MITS if they had a respiratory syndrome prior to death or a COVID-19+ polymerase chain reaction (PCR) nasopharyngeal swab specimen. Samples were retested using quantitative reverse transcriptase PCR.
Results: From June to September 2020 we performed MITS on 29 deceased individuals. PCR results were available for 28/29 (96.5%) cases. Three had a COVID-19+ diagnosis antemortem, and 5 more were identified postmortem using the recommended cycle threshold cut-point <40. When expanding the PCR threshold to 40 ≤ cycle threshold (Ct) ≤ 45, we identified 1 additional case. Most cases were male and occurred in the community The median age at death was 47 years (range 40-64). Human immunodeficiency virus (HIV)/AIDS, tuberculosis, and diabetes were more common among the COVID-19+ cases. Diffuse alveolar damage and interstitial pneumonitis were common among COVID-19+ cases; nonspecific findings of hepatic steatosis and acute kidney injury were also prevalent in the COVID-19+ group. Vascular thrombi were rarely detected.
Conclusions: Lung abnormalities typical of viral pneumonias were common among deceased COVID-19+ individuals, as were nonspecific findings in the liver and kidneys. Pulmonary vascular thrombi were rarely detected, which could be a limitation of the MITS technique. Nonetheless, MITS offers a valuable alternative to open autopsy for understanding pathological changes due to COVID-19.
Keywords: COVID-19; autopsy; minimally invasive tissue sampling; pathology; postmortem.
. 2021 Dec 15;73(Supplement_5):S465-S471.
doi: 10.1093/cid/ciab858.
Histopathological Evaluation of Deceased Persons in Lusaka, Zambia With or Without Coronavirus Disease 2019 (COVID-19) Infection: Results Obtained From Minimally Invasive Tissue Sampling
Victor Mudenda[SUP] 1 [/SUP], Chibamba Mumba[SUP] 1 [/SUP], Rachel C Pieciak[SUP] 2 [/SUP], Lawrence Mwananyanda[SUP] 2 3 [/SUP], Charles Chimoga[SUP] 3 [/SUP], Benard Ngoma[SUP] 3 [/SUP], Zacharia Mupila[SUP] 3 [/SUP], Geoffrey Kwenda[SUP] 4 [/SUP], Leah Forman[SUP] 5 [/SUP], Rotem Lapidot[SUP] 6 [/SUP], William B MacLeod[SUP] 2 [/SUP], Donald M Thea[SUP] 2 [/SUP], Christopher J Gill[SUP] 2 [/SUP]
Affiliations
- PMID: 34910177
- DOI: 10.1093/cid/ciab858
Abstract
Background: Although much has been learned about the pathophysiology of coronavirus disease 2019 (COVID-19) infections, pathology data from patients who have died of COVID-19 in low- and middle-income country settings remain sparse. We integrated minimally invasive tissue sampling (MITS) into an ongoing postmortem surveillance study of COVID-19 in deceased individuals of all ages in Lusaka, Zambia.
Methods: We enrolled deceased subjects from the University Teaching Hospital Morgue in Lusaka, Zambia within 48 hours of death. We collected clinical and demographic information, a nasopharyngeal swab, and core tissue biopsies from the lung, liver, and kidneys for pathologic analysis. Individuals were considered eligible for MITS if they had a respiratory syndrome prior to death or a COVID-19+ polymerase chain reaction (PCR) nasopharyngeal swab specimen. Samples were retested using quantitative reverse transcriptase PCR.
Results: From June to September 2020 we performed MITS on 29 deceased individuals. PCR results were available for 28/29 (96.5%) cases. Three had a COVID-19+ diagnosis antemortem, and 5 more were identified postmortem using the recommended cycle threshold cut-point <40. When expanding the PCR threshold to 40 ≤ cycle threshold (Ct) ≤ 45, we identified 1 additional case. Most cases were male and occurred in the community The median age at death was 47 years (range 40-64). Human immunodeficiency virus (HIV)/AIDS, tuberculosis, and diabetes were more common among the COVID-19+ cases. Diffuse alveolar damage and interstitial pneumonitis were common among COVID-19+ cases; nonspecific findings of hepatic steatosis and acute kidney injury were also prevalent in the COVID-19+ group. Vascular thrombi were rarely detected.
Conclusions: Lung abnormalities typical of viral pneumonias were common among deceased COVID-19+ individuals, as were nonspecific findings in the liver and kidneys. Pulmonary vascular thrombi were rarely detected, which could be a limitation of the MITS technique. Nonetheless, MITS offers a valuable alternative to open autopsy for understanding pathological changes due to COVID-19.
Keywords: COVID-19; autopsy; minimally invasive tissue sampling; pathology; postmortem.