First Autopsy Reported of MERS-Coronavirus Patient

[Gert van der Hoek]

First autopsy of MERS patient reveals infection’s impact on lungs, other organs


Ng DL, et al. Am J Pathol. 2016;doi:10.1016/j.ajpath.2015.10.024.

February 5, 2016


Data from the first autopsy of a Middle East respiratory syndrome, or MERS, coronavirus patient revealed new information on the cells and organs targeted by the infection.

Notable findings highlighted by the researchers included the identification of diffuse alveolar damage, targeting of pneumocytes and epithelial syncytial cells, and chronic diseases throughout other organ systems despite no evidence of extrapulmonary MERS coronavirus (MERS-CoV) dissemination, the researchers wrote.

“MERS-CoV infections can result in a wide clinical spectrum from asymptomatic infection, upper respiratory tract illness, to severe pneumonia and multiorgan failure,” the researchers wrote. “Although there have been numerous cases and fatalities, the pathologic changes and viral distribution in humans associated with severe MERS-CoV illness are unknown, and knowledge of pathogenesis remains limited.”

The patient was an obese, nonsmoking man aged 45 years of Filipino ethnicity who received care at a hospital in Abu Dhabi, United Arab Emirates, during a 2014 outbreak. There was no history of patient or camel exposure and no relevant travel history. After first presenting to an ED with fever and productive cough, he was admitted to a hospital 5 days later and continued to deteriorate until death 3 days after admission. The autopsy was performed 10 days after death, with histopathologic, immunohistochemical and ultrastructural analysis conducted and described by the researchers.

Along with pleural effusion, pericardial effusion and abdominal effusion, the researchers identified exudative-phase diffuse alveolar damage. Immunohistochemistry revealed multiple foci of MERS-CoV antigens, although the cytoplasm of pneumocytes and syncytial cells were primarily affected. Various conditions were identified in the heart, kidney, liver, spleen and bone marrow; however, MERS-CoV antigen testing was negative in these and other body systems outside of the lungs. As such, the researchers suggested that many of these conditions, including acute renal failure, may not be caused by direct infection.

“Our findings provide invaluable and unprecedented insights into the histologic changes, pathogenesis and viral dissemination of MERS-CoV in humans,” the researchers wrote. “Further studies, including additional postmortem examinations, evaluation of the host immune response and identification of sites of viral replication, are necessary to strengthen knowledge on pathogenesis, transmission patterns and effective treatment strategies for optimal clinical management and infection control practices.” –
by Dave Muoio

 

[Gert van der Hoek]

First reported autopsy of patient with Middle East respiratory syndrome coronavirus infection provides critical insights

FEBR 5 2016 Three years after first reported MERS-CoV death, long-awaited findings contradict previous assumptions and highlight the continuing importance of autopsies to understand disease, according to The American Journal of Pathology.

Since 2012, at least 1,500 individuals have developed Middle East respiratory syndrome (MERS), resulting in more than 500 fatalities. Only now are results being reported of the first autopsy of a MERS patient, which was performed in 2014. Not only do these findings, published in The American Journal of Pathology, provide unprecedented, clinically-relevant insights about how MERS progresses, they challenge previously accepted ideas about MERS and the relevance of current animal models. With the number of autopsies performed on the decline, these findings underscore the critical information autopsies can provide regarding emerging infectious disease.

"The article by Dianna L. Ng et al exemplifies the value of a well-performed study of an autopsy. The long interval between the emergence of this dangerous disease three years ago and the first autopsy reminds us of the lost opportunity that the decline of the performance of autopsies, particularly research-oriented post-mortem examinations in the United States represents," commented noted expert in the field David H. Walker, MD, Director of the University of Texas Medical Branch (Galveston) Center for Biodefense and Emerging Infectious Diseases.

The 45-year-old male patient analyzed by autopsy was one of a large patient cluster treated at a hospital in the United Arab Emirates in April 2014. He worked in a storage room at a paramedic station, with no patient-care duties or exposure to camels. Between April 2 and April 10, 2014, he rapidly progressed from having fever, runny nose, and cough to death. On the last day of his life, he was treated with 100 mg of the steroid hydrocortisone every eight hours. The autopsy was performed 10 days after his death.

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