Submitted Successfully!
To reward your contribution, here is a gift for you: A free trial for our video production service.
Thank you for your contribution! You can also upload a video entry or images related to this topic.
Version Summary Created by Modification Content Size Created at Operation
1 -- 693 2022-10-31 07:44:38

Video Upload Options

Do you have a full video?

Confirm

Are you sure to Delete?
Cite
If you have any further questions, please contact Encyclopedia Editorial Office.
Zhang, B. Gross Pathology in COVID-19. Encyclopedia. Available online: https://encyclopedia.pub/entry/31989 (accessed on 29 March 2024).
Zhang B. Gross Pathology in COVID-19. Encyclopedia. Available at: https://encyclopedia.pub/entry/31989. Accessed March 29, 2024.
Zhang, Bei. "Gross Pathology in COVID-19" Encyclopedia, https://encyclopedia.pub/entry/31989 (accessed March 29, 2024).
Zhang, B. (2022, October 31). Gross Pathology in COVID-19. In Encyclopedia. https://encyclopedia.pub/entry/31989
Zhang, Bei. "Gross Pathology in COVID-19." Encyclopedia. Web. 31 October, 2022.
Peer Reviewed
Gross Pathology in COVID-19

The global infectious disease COVID-19 is caused by SARS-CoV-2, a new member of the Coronaviridae family. Though presented as a novel disease that primarily affects the respiratory system, multi-organ involvement has been well-noticed and documented since the beginning of the pandemic. When performed properly with adequate safety measures, autopsy provides the most valuable information to decipher the pathogenesis of this novel disease, therefore providing a basis for clinical management. In addition to reviewing the macroscopic changes in organs and tissues involved in COVID-19, the relevant microscopic alterations and possible pathogenesis are also discussed.

COVID-19 SARS-CoV-2 gross pathology autopsy post-mortem
Coronavirus disease (COVID-19), a novel seventh coronavirus disease, initially broke out in Wuhan, China, in December 2019 [1]. It quickly spread worldwide and became a pandemic, as declared by the World Health Organization in March 2020 [2]. As of Friday, 22 July 2022, more than 567 million have been affected, with more than 6.38 million deaths all over the world [3]. The unprecedented public health threat and the gravity of the situation have inevitably overwhelmed the healthcare system of many countries and created much turmoil and emerging challenges in many aspects of human life [4]. Social distancing has been used worldwide to limit the spread of the virus [5]. COVID-19 and its causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have been studied extensively.
The Coronaviridae family viruses are enveloped, positive-sense, single-stranded RNA viruses [6]. Previously, six coronaviruses have been identified to cause human diseases. Two of them, severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), can cause severe respiratory illness with fatality rates of 10% and 40%, respectively. In contrast, the other four usually cause mild upper respiratory diseases similar to the common flu [7][8].
SARS-CoV-2 is transmitted via inhalation or direct contact of the virus with the mucous membrane [9]. Like SARS-CoV, SARS-CoV-2 also binds to the angiotensin-converting enzyme 2 (ACE2) receptor primarily present on the surface of the alveolar epithelial cells in the lung, resulting in respiratory symptoms [7]. ACE2 is also found in the small intestinal epithelium, endothelial cells of blood vessels, alveolar macrophage and monocyte, and epithelial cells of trachea and bronchi, which may explain the multiple organ involvement in COVID-19 [7]. The virus contains four structural proteins: spike (S), envelope (E), membrane glycoprotein (M), and nucleocapsid phosphoprotein (N). The virus enters the cell via the interaction between the viral spike (S) protein and the host cell proteases, TMPRSS2 [10].
Like other coronaviruses, SARS-CoV-2 continuously develops mutations. Since the global outbreak, five major variants of concern (VOC) with increased transmissibility, varied virulence, evasion from therapeutic drugs, or decreased effectiveness of vaccines have been reported after the ancestral one. Those VOCs are alpha (B.1.1.7), beta (B.1.351), gamma (P.1), delta (B.1.617.2), and omicron (B.1.1.529) [11]. Selective pressures such as the use of monoclonal antibodies further drive the evolution of SARS-CoV-2, especially in immunocompromised patients [12].
Though often present as a mild disease with typical flu-like symptoms such as fever, cough, myalgia, or fatigue [13], about 19%, however, develop severe to critical disease that may result in progressive respiratory failure, presumably due to massive alveolar damage [5]. Deceased patients present with severe pneumonitis and advance to acute respiratory distress syndrome, often accompanied by multi-organ failure [14], which may be contributed by severe endothelial damage, disseminated intravascular coagulation, and a cytokine storm [15][16]. The severity and prognosis of the disease seem to be associated with age; gender; blood group A; cigarette smoking; obesity; and a variety of comorbidities, including coronary artery disease, diabetes mellitus, chronic kidney disease, hypertension, congestive heart failure, and chronic obstructive pulmonary disease [14][17]. Most fatal cases have significant underlying diseases, with systemic hypertension and diabetes mellitus being the most common [18]. Besides the comorbidities listed above, HIV infection and tuberculosis are common among COVID-19 decedents in Africa [19].
The complexity of COVID-19 has been made well aware of since its outbreak. It is a multiorgan disease that presents with a broad spectrum of clinical manifestations and a wide range of degrees of severity [13][14][20]. For example, autopsies have revealed the systemic multiorgan involvement of vessels in the lungs, heart, kidney, liver, GI tract, kidney, brain, and skin [21]. Gross examination of involved organs obtained from autopsy provides valuable information, which is imperative for elucidating the pathogenesis of COVID-19 and laying out the basis for clinical management.

References

  1. Zavascki, A.P.; Falci, D.R. Clinical Characteristics of COVID-19 in China. N. Engl. J. Med. 2020, 382, 1859.
  2. Mahase, E. COVID-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ 2020, 368, m1036.
  3. JHU. COVID-19 Dashboard. Available online: https://coronavirus.jhu.edu/map.html (accessed on 31 May 2021).
  4. Beneke, R.; Leithäuser, R.M. COVID-19: Impact of a “Global Player”-A Reflection 1 Year On. Int. J. Sports Physiol. Perform 2021, 16, 323–324.
  5. Hassan, S.A.; Sheikh, F.N.; Jamal, S.; Ezeh, J.K.; Akhtar, A. Coronavirus (COVID-19): A Review of Clinical Features, Diagnosis, and Treatment. Cureus 2020, 12, e7355.
  6. Lu, G.; Liu, D. SARS-like virus in the Middle East: A truly bat-related coronavirus causing human diseases. Protein Cell 2012, 3, 803–805.
  7. Lin, P.; Wang, M.; Wei, Y.; Kim, T.; Wei, X. Coronavirus in human diseases: Mechanisms and advances in clinical treatment. MedComm 2020, 1, 270–301.
  8. Calabrese, F.; Pezzuto, F.; Fortarezza, F.; Hofman, P.; Kern, I.; Panizo, A.; von der Thüsen, J.; Timofeev, S.; Gorkiewicz, G.; Lunardi, F. Pulmonary pathology and COVID-19: Lessons from autopsy. The experience of European Pulmonary Pathologists. Virchows Arch. 2020, 477, 359–372.
  9. (CDC). Centers for Disease Control and Prevent. Scientific Brief: SARS-CoV-2 Transmission. Available online: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fscience%2Fscience-briefs%2Fscientific-brief-sars-cov-2.html#anchor_1619805167515 (accessed on 22 May 2021).
  10. Marsh, M.; Helenius, A. Virus entry: Open sesame. Cell 2006, 124, 729–740.
  11. WHO. Tracking SARS-CoV-2 variants. Available online: https://www.who.int/en/activities/tracking-SARS-CoV-2-variants (accessed on 26 July 2022).
  12. Scherer, E.M.; Babiker, A.; Adelman, M.W.; Allman, B.; Key, A.; Kleinhenz, J.M.; Langsjoen, R.M.; Nguyen, P.V.; Onyechi, I.; Sherman, J.D.; et al. SARS-CoV-2 Evolution and Immune Escape in Immunocompromised Patients. N. Engl. J. Med. 2022, 386, 2436–2438.
  13. Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020, 395, 497–506.
  14. Zhou, F.; Yu, T.; Du, R.; Fan, G.; Liu, Y.; Liu, Z.; Xiang, J.; Wang, Y.; Song, B.; Gu, X.; et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020, 395, 1054–1062.
  15. Li, H.; Liu, L.; Zhang, D.; Xu, J.; Dai, H.; Tang, N.; Su, X.; Cao, B. SARS-CoV-2 and viral sepsis: Observations and hypotheses. Lancet 2020, 395, 1517–1520.
  16. Stasi, A.; Castellano, G.; Ranieri, E.; Infante, B.; Stallone, G.; Gesualdo, L.; Netti, G.S. SARS-CoV-2 and Viral Sepsis: Immune Dysfunction and Implications in Kidney Failure. J. Clin. Med. 2020, 9, 4057.
  17. Al-Ansari, R.Y.; Alshaer, A.; Al-Anazi, A.; Al-Otaibi, N.; Abdalla, L.; Al-Tarrah, S.; Shilash, A.; Al-Zahrani, N. ABO in Correlation to the Requirement of Mechanical Ventilation and Mortality in Critically Ill Patients With COVID-19. J. Hematol. 2021, 10, 64–70.
  18. Hooper, J.E.; Padera, R.F.; Dolhnikoff, M.; da Silva, L.F.F.; Duarte-Neto, A.N.; Kapp, M.E.; Lacy, J.M.; Mauad, T.; Saldiva, P.H.N.; Rapkiewicz, A.V.; et al. A Postmortem Portrait of the Coronavirus Disease 2019 (COVID-19) Pandemic: A Large Multi-institutional Autopsy Survey Study. Arch. Pathol. Lab. Med. 2021, 145, 529–535.
  19. Himwaze, C.M.; Telendiy, V.; Maate, F.; Songwe, M.; Chanda, C.; Chanda, D.; Julius, P.; Mumba, C.; Marimo, C.; Hamukale, A.; et al. Post Mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia—A Descriptive Whole Body Autopsy Series. Int. J. Infect. Dis. 2021, 108, 363–369.
  20. Weiss, P.; Murdoch, D.R. Clinical course and mortality risk of severe COVID-19. Lancet 2020, 395, 1014–1015.
  21. Xu, Z.; Shi, L.; Wang, Y.; Zhang, J.; Huang, L.; Zhang, C.; Liu, S.; Zhao, P.; Liu, H.; Zhu, L.; et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 2020, 8, 420–422.
More
Information
Subjects: Pathology
Contributor MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
View Times: 962
Online Date: 31 Oct 2022
1000/1000