Pathologic features of COVID-19: A concise review

Mohammadreza Tabary, Shaghayegh Khanmohammadi, Farnaz Araghi, Sahar Dadkhahfar, Seyed Mohammad Tavangar, Mohammadreza Tabary, Shaghayegh Khanmohammadi, Farnaz Araghi, Sahar Dadkhahfar, Seyed Mohammad Tavangar

Abstract

The novel coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), first appeared in December 2019, in Wuhan, China and evolved into a pandemic. As Angiotensin-Converting Enzyme 2 (ACE2) is one of the potential target receptors for SARS-CoV-2 in human body, which is expressed in different tissues, multiple organs might become affected. In the initial phase of the current pandemic, a handful of post-mortem case-series revealed COVID-19-related pathological changes in various organs. Although pathological examination is not a feasible method of diagnosis, it can elucidate pathological changes, pathogenesis of the disease, and the cause of death in COVID-19 cases. Herein, we thoroughly reviewed multiple organs including lung, gastrointestinal tract, liver, kidney, skin, heart, blood, spleen, lymph nodes, brain, blood vessels, and placenta in terms of COVID-19-related pathological alterations. Also, these findings were compared with SARS and MERS infection, wherever applicable. We found a diverse range of pathological changes, some of which resemble those found in SARS and MERS.

Keywords: COVID-19; Histopathology; Pathology; SARS-CoV-2.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 Elsevier GmbH. All rights reserved.

Figures

Fig. 1
Fig. 1
A summary of most common microscopic findings of COVID-19 in various organs. MAC: Membrane Attack Complex; ADEM: Acute Disseminated Encephalomyelitis.

References

    1. Alsaad K.O., Hajeer A.H., Al Balwi M., Al Moaiqel M., Al Oudah N., Al Ajlan A., AlJohani S., Alsolamy S., Gmati G.E., Balkhy H. Histopathology of Middle East respiratory syndrome coronovirus (MERS‐CoV) infection–clinicopathological and ultrastructural study. Histopathology. 2018;72:516–524.
    1. Baergen R.N., Heller D.S. Placental pathology in Covid-19 positive mothers: preliminary findings. Pediatric Dev. Pathol. 2020;23:177–180.
    1. Carsana L., Sonzogni A., Nasr A., Rossi R., Pellegrinelli A., Zerbi P., Rech R., Colombo R., Antinori S., Corbellino M. medRxiv; 2020. Pulmonary Post-Mortem Findings in a Large Series of COVID-19 Cases from Northern Italy.
    1. Cha R.-h., Yang S.H., Moon K.C., Joh J.-S., Lee J.Y., Shin H.-S., Kim D.K., Kim Y.S. A case report of a Middle East respiratory syndrome survivor with kidney biopsy results. J. Korean Med. Sci. 2016;31:635–640.
    1. Copin M.-C., Parmentier E., Duburcq T., Poissy J., Mathieu D. Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection. Intensive Care Med. 2020:1–3.
    1. Diao B., Feng Z., Wang C., Wang H., Liu L., Wang C., Wang R., Liu Y., Liu Y., Wang G. medRxiv; 2020. Human Kidney Is a Target for Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.
    1. Ding Y., Wang H., Shen H., Li Z., Geng J., Han H., Cai J., Li X., Kang W., Weng D. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J. Pathol. 2003;200:282–289.
    1. El Hachem M., Diociaiuti A., Concato C., Carsetti R., Carnevale C., Ciofi Degli Atti M., Giovannelli L., Latella E., Porzio O., Rossi S. A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain‐like lesions: lights and shadows on the relationship with COVID‐19 infection. J. Eur. Acad. Dermatol. Venereol. 2020
    1. Feng Z., Diao B., Wang R., Wang G., Wang C., Tan Y., Liu L., Wang C., Liu Y., Liu Y. medRxiv; 2020. The Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Directly Decimates Human Spleens and Lymph Nodes.
    1. Fox S.E., Akmatbekov A., Harbert J.L., Li G., Brown J.Q., Vander Heide R.S. MedRxiv; 2020. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans.
    1. Galván Casas C., Català A., Carretero Hernández G., Rodríguez‐Jiménez P., Fernández Nieto D., Rodríguez‐Villa Lario A., Navarro Fernández I., Ruiz‐Villaverde R., Falkenhain D., Llamas Velasco M. Classification of the cutaneous manifestations of COVID‐19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br. J. Dermatol. 2020
    1. Gianotti R., Veraldi S., Recalcati S., Cusini M., Ghislanzoni M., Boggio F., Fox L. Cutaneous clinico-pathological findings in three COVID-19-positive patients observed in the metropolitan area of Milan, Italy. Acta Derm. Venereol. 2020
    1. Hamming I., Timens W., Bulthuis M.L., Lely A.T., Navis G., van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J. Pathol. 2004;203:631–637.
    1. Hanley B., Lucas S.B., Youd E., Swift B., Osborn M. Autopsy in suspected COVID-19 cases. J. Clin. Pathol. 2020;73:239–242.
    1. Joob B., Wiwanitkit V. Pulmonary pathology of early phase 2019 novel coronavirus pneumonia. J. Thoracic Oncol. 2020;15:e67.
    1. Kupferschmidt K. American Association for the Advancement of Science; 2013. Researchers Scramble to Understand Camel Connection to MERS.
    1. Lavi E., Cong L. Type I astrocytes and microglia induce a cytokine response in an encephalitic murine coronavirus infection. Exp. Mol. Pathol. 2020
    1. Li G., Fox S.E., Summa B., Hu B., Wenk C., Akmatbekov A., Harbert J.L., Vander Heide R.S., Brown J.Q. bioRxiv; 2020. Multiscale Three-Dimensional Pathology Findings of COVID-19 Diseased Lung Using High-Resolution Cleared Tissue Microscopy.
    1. Li J., Fan J.-G. Characteristics and mechanism of liver injury in 2019 coronavirus disease. J. Clin. Transl. Hepatol. 2020;8:13.
    1. Li W., Shi Z., Yu M., Ren W., Smith C., Epstein J.H., Wang H., Crameri G., Hu Z., Zhang H. Bats are natural reservoirs of SARS-like coronaviruses. Science. 2005;310:676–679.
    1. Liu J., Zheng X., Tong Q., Li W., Wang B., Sutter K., Trilling M., Lu M., Dittmer U., Yang D. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS‐CoV, MERS‐CoV, and 2019‐nCoV. J. Med. Virol. 2020;92:491–494.
    1. Luo W., Yu H., Gou J., Li X., Sun Y., Li J., Liu L. 2020. Clinical Pathology of Critical Patient With Novel Coronavirus Pneumonia (COVID-19) Preprints 2020.
    1. Mauad T., Hajjar L.A., Callegari G.D., da Silva L.F., Schout D., Galas F.R., Alves V.A., Malheiros D.M., Auler J.O., Jr, Ferreira A.F. Lung pathology in fatal novel human influenza A (H1N1) infection. Am. J. Respir. Crit. Care Med. 2010;181:72–79.
    1. Menter T., Haslbauer J., Nienhold R., Savic S., Hopfer H., Deigendesch N., Frank S., Turek D., Willi N., Pargger H. Post‐mortem examination of COVID19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings of lungs and other organs suggesting vascular dysfunction. Histopathology. 2020
    1. Ng D.L., Al Hosani F., Keating M.K., Gerber S.I., Jones T.L., Metcalfe M.G., Tong S., Tao Y., Alami N.N., Haynes L.M. Clinicopathologic, immunohistochemical, and ultrastructural findings of a fatal case of Middle East respiratory syndrome coronavirus infection in the United Arab Emirates, April 2014. Am. J. Pathol. 2016;186:652–658.
    1. Nicholls J.M., Poon L.L., Lee K.C., Ng W.F., Lai S.T., Leung C.Y., Chu C.M., Hui P.K., Mak K.L., Lim W. Lung pathology of fatal severe acute respiratory syndrome. Lancet. 2003;361:1773–1778.
    1. Paniz‐Mondolfi A., Bryce C., Grimes Z., Gordon R.E., Reidy J., Lednicky J., Sordillo E.M., Fowkes M. Central nervous system involvement by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) J. Med. Virol. 2020
    1. Peleg Y., Kudose S., D’Agati V., Siddall E., Ahmad S., Kisselev S., Gharavi A., Canetta P. Acute kidney injury due to collapsing glomerulopathy following COVID-19 infection. Kidney Int. Rep. 2020
    1. Reichard R.R., Kashani K.B., Boire N.A., Constantopoulos E., Guo Y., Lucchinetti C.F. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol. 2020:1–6.
    1. Shieh W.-J., Hsiao C.-H., Paddock C.D., Guarner J., Goldsmith C.S., Tatti K., Packard M., Mueller L., Wu M.-Z., Rollin P. Immunohistochemical, in situ hybridization, and ultrastructural localization of SARS-associated coronavirus in lung of a fatal case of severe acute respiratory syndrome in Taiwan. Hum. Pathol. 2005;36:303–309.
    1. Sonzogni A., Previtali G., Seghezzi M., Alessio M.G., Gianatti A., Licini L., Zerbi P., Carsana L., Rossi R., Lauri E. 2020. Liver and COVID 19 Infection: A Very Preliminary Lesson Learnt from Histological Post-Mortem Findings in 48 Patients.
    1. Su H., Yang M., Wan C., Yi L.-X., Tang F., Zhu H.-Y., Yi F., Yang H.-C., Fogo A.B., Nie X. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020
    1. Suchonwanit P., Leerunyakul K., Kositkuljorn C. Cutaneous manifestations in COVID-19: lessons learned from current evidence. J. Am. Acad. Dermatol. 2020
    1. Varga Z., Flammer A.J., Steiger P., Haberecker M., Andermatt R., Zinkernagel A.S., Mehra M.R., Schuepbach R.A., Ruschitzka F., Moch H. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395:1417–1418.
    1. Wang C., Wu H., Ding X., Ji H., Jiao P., Song H., Li S., Du H. Does infection of 2019 novel coronavirus cause acute and/or chronic sialadenitis? Med. Hypotheses. 2020
    1. Xiao F., Tang M., Zheng X., Liu Y., Li X., Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 2020;158:1831–1833. e1833.
    1. Xu X., Barth R.F., Buja L.M. A call to action: the need for autopsies to determine the full extent of organ involvement associated with COVID-19 infections. Chest. 2020
    1. Xu X., Chang X., Pan H., Su H., Huang B., Yang M., Luo D., Weng M., Ma L., Nie X. Pathological changes of the spleen in ten patients with new coronavirus infection by minimally invasive autopsies. Zhonghua Bing li xue za zhi. 2020;49 E014–E014.
    1. Xu Z., Shi L., Wang Y., Zhang J., Huang L., Zhang C., Liu S., Zhao P., Liu H., Zhu L. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 2020;8:420–422.
    1. Yao X.-H., He Z.-C., Li T.-Y., Zhang H.-R., Wang Y., Mou H., Guo Q., Yu S.-C., Ding Y., Liu X. Pathological evidence for residual SARS-CoV-2 in pulmonary tissues of a ready-for-discharge patient. Cell Res. 2020;30:541–543.
    1. Zhang D., Guo R., Lei L., Liu H., Wang Y., Wang Y., Dai T., Zhang T., Lai Y., Wang J. medRxiv; 2020. COVID-19 Infection Induces Readily Detectable Morphological and Inflammation-Related Phenotypic Changes in Peripheral Blood Monocytes, the Severity of Which Correlate With Patient Outcome.

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