A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza
Abstract Autopsies of patients who have died from COVID‐19 have been crucial in delineating patterns of injury associated with SARS‐CoV‐2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-09-01
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| Series: | The Journal of Pathology: Clinical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cjp2.220 |
| _version_ | 1828919984734076928 |
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| author | Phillip McMullen Peter Pytel Alexis Snyder Heather Smith Jasmine Vickery James Brainer Robert Guzy David Wu Nathan Schoettler Ayodeji Adegunsoye Anne Sperling John Hart Lindsay Alpert Anthony Chang Sandeep Gurbuxani Thomas Krausz Aliya N Husain Jeffrey Mueller |
| author_facet | Phillip McMullen Peter Pytel Alexis Snyder Heather Smith Jasmine Vickery James Brainer Robert Guzy David Wu Nathan Schoettler Ayodeji Adegunsoye Anne Sperling John Hart Lindsay Alpert Anthony Chang Sandeep Gurbuxani Thomas Krausz Aliya N Husain Jeffrey Mueller |
| author_sort | Phillip McMullen |
| collection | DOAJ |
| description | Abstract Autopsies of patients who have died from COVID‐19 have been crucial in delineating patterns of injury associated with SARS‐CoV‐2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies contextualize the findings to other fatal viral infections. We developed a novel autopsy protocol in order to perform postmortem examinations on victims of COVID‐19 and herein describe detailed clinical information, gross findings, and histologic features observed in the first 16 complete COVID‐19 autopsies. We also critically evaluated the role of ancillary studies used to establish a diagnosis of COVID‐19 at autopsy, including immunohistochemistry (IHC), in situ hybridization (ISH), and electron microscopy (EM). IHC and ISH targeting SARS‐CoV‐2 were comparable in terms of the location and number of infected cells in lung tissue; however, nonspecific staining of bacteria was seen occasionally with IHC. EM was unrevealing in blindly sampled tissues. We then compared the clinical and histologic features present in this series to six archival cases of fatal seasonal influenza and six archival cases of pandemic influenza from the fourth wave of the ‘Spanish Flu’ in the winter of 1920. In addition to routine histology, the inflammatory infiltrates in the lungs of COVID‐19 and seasonal influenza victims were compared using quantitative IHC. Our results demonstrate that the clinical and histologic features of COVID‐19 are similar to those seen in fatal cases of influenza, and the two diseases tend to overlap histologically. There was no significant difference in the composition of the inflammatory infiltrate in COVID‐19 and influenza at sites of acute lung injury at the time of autopsy. Our study underscores the relatively nonspecific clinical features and pathologic changes shared between severe cases of COVID‐19 and influenza, while also providing important caveats to ancillary methods of viral detection. |
| first_indexed | 2024-12-13T21:37:27Z |
| format | Article |
| id | doaj.art-57fc9257ef47416bbb35391229da3920 |
| institution | Directory Open Access Journal |
| issn | 2056-4538 |
| language | English |
| last_indexed | 2024-12-13T21:37:27Z |
| publishDate | 2021-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Journal of Pathology: Clinical Research |
| spelling | doaj.art-57fc9257ef47416bbb35391229da39202022-12-21T23:30:38ZengWileyThe Journal of Pathology: Clinical Research2056-45382021-09-017545947010.1002/cjp2.220A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenzaPhillip McMullen0Peter Pytel1Alexis Snyder2Heather Smith3Jasmine Vickery4James Brainer5Robert Guzy6David Wu7Nathan Schoettler8Ayodeji Adegunsoye9Anne Sperling10John Hart11Lindsay Alpert12Anthony Chang13Sandeep Gurbuxani14Thomas Krausz15Aliya N Husain16Jeffrey Mueller17Department of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medical Center Chicago IL USADepartment of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medical Center Chicago IL USADepartment of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medical Center Chicago IL USADepartment of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medical Center Chicago IL USADepartment of Medicine, Section of Pulmonary and Critical Care Medicine University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USADepartment of Pathology University of Chicago Medical Center Chicago IL USAAbstract Autopsies of patients who have died from COVID‐19 have been crucial in delineating patterns of injury associated with SARS‐CoV‐2 infection. Despite their utility, comprehensive autopsy studies are somewhat lacking relative to the global burden of disease, and very few comprehensive studies contextualize the findings to other fatal viral infections. We developed a novel autopsy protocol in order to perform postmortem examinations on victims of COVID‐19 and herein describe detailed clinical information, gross findings, and histologic features observed in the first 16 complete COVID‐19 autopsies. We also critically evaluated the role of ancillary studies used to establish a diagnosis of COVID‐19 at autopsy, including immunohistochemistry (IHC), in situ hybridization (ISH), and electron microscopy (EM). IHC and ISH targeting SARS‐CoV‐2 were comparable in terms of the location and number of infected cells in lung tissue; however, nonspecific staining of bacteria was seen occasionally with IHC. EM was unrevealing in blindly sampled tissues. We then compared the clinical and histologic features present in this series to six archival cases of fatal seasonal influenza and six archival cases of pandemic influenza from the fourth wave of the ‘Spanish Flu’ in the winter of 1920. In addition to routine histology, the inflammatory infiltrates in the lungs of COVID‐19 and seasonal influenza victims were compared using quantitative IHC. Our results demonstrate that the clinical and histologic features of COVID‐19 are similar to those seen in fatal cases of influenza, and the two diseases tend to overlap histologically. There was no significant difference in the composition of the inflammatory infiltrate in COVID‐19 and influenza at sites of acute lung injury at the time of autopsy. Our study underscores the relatively nonspecific clinical features and pathologic changes shared between severe cases of COVID‐19 and influenza, while also providing important caveats to ancillary methods of viral detection.https://doi.org/10.1002/cjp2.220COVID‐19autopsyviral pneumoniadiffuse alveolar damageviral sepsisinfluenza |
| spellingShingle | Phillip McMullen Peter Pytel Alexis Snyder Heather Smith Jasmine Vickery James Brainer Robert Guzy David Wu Nathan Schoettler Ayodeji Adegunsoye Anne Sperling John Hart Lindsay Alpert Anthony Chang Sandeep Gurbuxani Thomas Krausz Aliya N Husain Jeffrey Mueller A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza The Journal of Pathology: Clinical Research COVID‐19 autopsy viral pneumonia diffuse alveolar damage viral sepsis influenza |
| title | A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza |
| title_full | A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza |
| title_fullStr | A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza |
| title_full_unstemmed | A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza |
| title_short | A series of COVID‐19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza |
| title_sort | series of covid 19 autopsies with clinical and pathologic comparisons to both seasonal and pandemic influenza |
| topic | COVID‐19 autopsy viral pneumonia diffuse alveolar damage viral sepsis influenza |
| url | https://doi.org/10.1002/cjp2.220 |
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