Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India
Objectives The 2019 novel coronavirus (2019-nCoV) has spread across the globe with more than 6 lakh deaths. Clinical autopsies are important to understand the pathobiology of the disease. Materials and Methods Autopsy techniques have been modified to be minimally invasive autopsies in all COVID-19...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-06-01
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| Series: | Journal of Laboratory Physicians |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1730750 |
| _version_ | 1819062976006586368 |
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| author | Vikarn Vishwajeet Abhishek Purohit Deepak Kumar Vijay Parag Swapnil Tripathi Tanuj Kanchan Nikhil Kothari Naveen Dutt Poonam Abhay Elhence Pradeep Kumar Bhatia Vijaya Lakshmi Nag Mahendra Kumar Garg Sanjeev Misra |
| author_facet | Vikarn Vishwajeet Abhishek Purohit Deepak Kumar Vijay Parag Swapnil Tripathi Tanuj Kanchan Nikhil Kothari Naveen Dutt Poonam Abhay Elhence Pradeep Kumar Bhatia Vijaya Lakshmi Nag Mahendra Kumar Garg Sanjeev Misra |
| author_sort | Vikarn Vishwajeet |
| collection | DOAJ |
| description | Objectives The 2019 novel coronavirus (2019-nCoV) has spread across the globe with more than 6 lakh deaths. Clinical autopsies are important to understand the pathobiology of the disease.
Materials and Methods Autopsy techniques have been modified to be minimally invasive autopsies in all COVID-19 positive cases, and tissue biopsies were sampled from lungs, liver, and bone marrow within an hour after death. Detailed histological analysis was performed in the sampled tissues, along with immunohistochemistry. Patients’ clinical records were collected.
Statistical Analysis Descriptive statistics were used to summarize data.
Results Of the 21 cases studied, 76.2% patients were ≥ 60 years of age, 80.9% were males, and 85.7% had co-morbidities. Histopathological analysis revealed diffuse alveolar damage (including exudative and organizing phase) in 88.9% cases. Microthrombi were seen in 44.4% cases. Additional findings include viral cytopathic changes, metaplastic change in the epithelium, intra-alveolar hemorrhage, and pulmonary edema. Liver showed centrizonal congestion with hepatocytic loss, lobular inflammation, steatosis, Kupffer cell hypertrophy, and sinusoidal neutrophilic infiltration, while significant portal infiltrate and cholestasis were absent to minimal. Bone marrow revealed hemophagocytosis in 60% cases.
Conclusion Incorporation of minimally invasive autopsies provides an effective method to study the pathological findings in COVID-19 deaths in resource-constrained settings. Presence of pulmonary microthrombi in a significant number of cases supports the vascular events, apart from the characteristic diffuse alveolar damage, as an important pathogenic mechanism for lung injury in COVID-19 infections. Histopathological findings in the liver and bone marrow suggest indirect insult to these organs, related to circulatory and/or hyperinflammatory response to viral infections. |
| first_indexed | 2024-12-21T15:07:20Z |
| format | Article |
| id | doaj.art-e47fd2b2384b486a854f263ac98145ec |
| institution | Directory Open Access Journal |
| issn | 0974-2727 0974-7826 |
| language | English |
| last_indexed | 2024-12-21T15:07:20Z |
| publishDate | 2021-06-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Laboratory Physicians |
| spelling | doaj.art-e47fd2b2384b486a854f263ac98145ec2022-12-21T18:59:24ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Laboratory Physicians0974-27270974-78262021-06-01130209710610.1055/s-0041-1730750Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from IndiaVikarn Vishwajeet0Abhishek Purohit1Deepak Kumar2Vijay Parag3Swapnil Tripathi4Tanuj Kanchan5Nikhil Kothari6Naveen Dutt7Poonam Abhay Elhence8Pradeep Kumar Bhatia9Vijaya Lakshmi Nag10Mahendra Kumar Garg11Sanjeev Misra12Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Forensic Medical and Toxicology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaDepartment of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, IndiaObjectives The 2019 novel coronavirus (2019-nCoV) has spread across the globe with more than 6 lakh deaths. Clinical autopsies are important to understand the pathobiology of the disease. Materials and Methods Autopsy techniques have been modified to be minimally invasive autopsies in all COVID-19 positive cases, and tissue biopsies were sampled from lungs, liver, and bone marrow within an hour after death. Detailed histological analysis was performed in the sampled tissues, along with immunohistochemistry. Patients’ clinical records were collected. Statistical Analysis Descriptive statistics were used to summarize data. Results Of the 21 cases studied, 76.2% patients were ≥ 60 years of age, 80.9% were males, and 85.7% had co-morbidities. Histopathological analysis revealed diffuse alveolar damage (including exudative and organizing phase) in 88.9% cases. Microthrombi were seen in 44.4% cases. Additional findings include viral cytopathic changes, metaplastic change in the epithelium, intra-alveolar hemorrhage, and pulmonary edema. Liver showed centrizonal congestion with hepatocytic loss, lobular inflammation, steatosis, Kupffer cell hypertrophy, and sinusoidal neutrophilic infiltration, while significant portal infiltrate and cholestasis were absent to minimal. Bone marrow revealed hemophagocytosis in 60% cases. Conclusion Incorporation of minimally invasive autopsies provides an effective method to study the pathological findings in COVID-19 deaths in resource-constrained settings. Presence of pulmonary microthrombi in a significant number of cases supports the vascular events, apart from the characteristic diffuse alveolar damage, as an important pathogenic mechanism for lung injury in COVID-19 infections. Histopathological findings in the liver and bone marrow suggest indirect insult to these organs, related to circulatory and/or hyperinflammatory response to viral infections.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1730750autopsycovid-19pathologysars-cov-2 |
| spellingShingle | Vikarn Vishwajeet Abhishek Purohit Deepak Kumar Vijay Parag Swapnil Tripathi Tanuj Kanchan Nikhil Kothari Naveen Dutt Poonam Abhay Elhence Pradeep Kumar Bhatia Vijaya Lakshmi Nag Mahendra Kumar Garg Sanjeev Misra Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India Journal of Laboratory Physicians autopsy covid-19 pathology sars-cov-2 |
| title | Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India |
| title_full | Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India |
| title_fullStr | Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India |
| title_full_unstemmed | Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India |
| title_short | Evaluation of Pathological Findings of COVID-19 by Minimally Invasive Autopsies: A Single Tertiary Care Center Experience from India |
| title_sort | evaluation of pathological findings of covid 19 by minimally invasive autopsies a single tertiary care center experience from india |
| topic | autopsy covid-19 pathology sars-cov-2 |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1730750 |
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