SARS-CoV-2 infection and persistence in the human body and brain at autopsy
Sydney R Stein, Sabrina C Ramelli, Alison Grazioli, Joon-Yong Chung, Manmeet Singh, Claude Kwe Yinda, Clayton W Winkler, Junfeng Sun, James M Dickey, Kris Ylaya, Sung Hee Ko, Andrew P Platt, Peter D Burbelo, Martha Quezado, Stefania Pittaluga, Madeleine Purcell, Vincent J Munster, Frida Belinky, Marcos J Ramos-Benitez, Eli A Boritz, Izabella A Lach, Daniel L Herr, Joseph Rabin, Kapil K Saharia, Ronson J Madathil, Ali Tabatabai, Shahabuddin Soherwardi, Michael T McCurdy, NIH COVID-19 Autopsy Consortium, Karin E Peterson, Jeffrey I Cohen, Emmie de Wit, Kevin M Vannella, Stephen M Hewitt, David E Kleiner, Daniel S Chertow, Ashley L Babyak, Luis J Perez Valencia, Shelly J Curran, Mary E Richert, Willie J Young, Sarah P Young, Billel Gasmi, Michelly Sampaio De Melo, Sabina Desar, Saber Tadros, Nadia Nasir, Xueting Jin, Sharika Rajan, Esra Dikoglu, Neval Ozkaya, Grace Smith, Elizabeth R Emanuel, Brian L Kelsall, Justin A Olivera, Megan Blawas, Robert A Star, Nicole Hays, Shreya Singireddy, Jocelyn Wu, Katherine Raja, Ryan Curto, Jean E Chung, Amy J Borth, Kimberly A Bowers, Anne M Weichold, Paula A Minor, Mir Ahmad N Moshref, Emily E Kelly, Mohammad M Sajadi, Thomas M Scalea, Douglas Tran, Siamak Dahi, Kristopher B Deatrick, Eric M Krause, Joseph A Herrold, Eric S Hochberg, Christopher R Cornachione, Andrea R Levine, Justin E Richards, John Elder, Allen P Burke, Michael A Mazzeffi, Robert H Christenson, Zackary A Chancer, Mustafa Abdulmahdi, Sabrina Sopha, Tyler Goldberg, Yashvir Sangwan, Kristen Sudano, Diane Blume, Bethany Radin, Madhat Arnouk, James W Eagan Jr, Robert Palermo, Anthony D Harris, Thomas Pohida, Marcial Garmendia-Cedillos, George Dold, Eric Saglio, Phuoc Pham, Sydney R Stein, Sabrina C Ramelli, Alison Grazioli, Joon-Yong Chung, Manmeet Singh, Claude Kwe Yinda, Clayton W Winkler, Junfeng Sun, James M Dickey, Kris Ylaya, Sung Hee Ko, Andrew P Platt, Peter D Burbelo, Martha Quezado, Stefania Pittaluga, Madeleine Purcell, Vincent J Munster, Frida Belinky, Marcos J Ramos-Benitez, Eli A Boritz, Izabella A Lach, Daniel L Herr, Joseph Rabin, Kapil K Saharia, Ronson J Madathil, Ali Tabatabai, Shahabuddin Soherwardi, Michael T McCurdy, NIH COVID-19 Autopsy Consortium, Karin E Peterson, Jeffrey I Cohen, Emmie de Wit, Kevin M Vannella, Stephen M Hewitt, David E Kleiner, Daniel S Chertow, Ashley L Babyak, Luis J Perez Valencia, Shelly J Curran, Mary E Richert, Willie J Young, Sarah P Young, Billel Gasmi, Michelly Sampaio De Melo, Sabina Desar, Saber Tadros, Nadia Nasir, Xueting Jin, Sharika Rajan, Esra Dikoglu, Neval Ozkaya, Grace Smith, Elizabeth R Emanuel, Brian L Kelsall, Justin A Olivera, Megan Blawas, Robert A Star, Nicole Hays, Shreya Singireddy, Jocelyn Wu, Katherine Raja, Ryan Curto, Jean E Chung, Amy J Borth, Kimberly A Bowers, Anne M Weichold, Paula A Minor, Mir Ahmad N Moshref, Emily E Kelly, Mohammad M Sajadi, Thomas M Scalea, Douglas Tran, Siamak Dahi, Kristopher B Deatrick, Eric M Krause, Joseph A Herrold, Eric S Hochberg, Christopher R Cornachione, Andrea R Levine, Justin E Richards, John Elder, Allen P Burke, Michael A Mazzeffi, Robert H Christenson, Zackary A Chancer, Mustafa Abdulmahdi, Sabrina Sopha, Tyler Goldberg, Yashvir Sangwan, Kristen Sudano, Diane Blume, Bethany Radin, Madhat Arnouk, James W Eagan Jr, Robert Palermo, Anthony D Harris, Thomas Pohida, Marcial Garmendia-Cedillos, George Dold, Eric Saglio, Phuoc Pham
Abstract
Coronavirus disease 2019 (COVID-19) is known to cause multi-organ dysfunction1-3 during acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with some patients experiencing prolonged symptoms, termed post-acute sequelae of SARS-CoV-2 (refs. 4,5). However, the burden of infection outside the respiratory tract and time to viral clearance are not well characterized, particularly in the brain3,6-14. Here we carried out complete autopsies on 44 patients who died with COVID-19, with extensive sampling of the central nervous system in 11 of these patients, to map and quantify the distribution, replication and cell-type specificity of SARS-CoV-2 across the human body, including the brain, from acute infection to more than seven months following symptom onset. We show that SARS-CoV-2 is widely distributed, predominantly among patients who died with severe COVID-19, and that virus replication is present in multiple respiratory and non-respiratory tissues, including the brain, early in infection. Further, we detected persistent SARS-CoV-2 RNA in multiple anatomic sites, including throughout the brain, as late as 230 days following symptom onset in one case. Despite extensive distribution of SARS-CoV-2 RNA throughout the body, we observed little evidence of inflammation or direct viral cytopathology outside the respiratory tract. Our data indicate that in some patients SARS-CoV-2 can cause systemic infection and persist in the body for months.
Conflict of interest statement
The authors declare no competing interests.
© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
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References
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Source: PubMed