Hallazgos macroscópicos y microscópicos en el sistema respiratorio en autopsias de pacientes con covid-19.

Macroscopic and microscopic findings in the respiratory system in patients with covid-19.

Contenido principal del artículo

Laura Marcela Mendoza Carmona
Sebastian David Payares Florez

Resumen




Introducción: desde finales del 2019, el mundo se ha visto hostigado por la aparición de un nuevo coronavirus (SARS-CoV-2) en Wuhan, China, que se extendió globalmente y es el agente etiológico de la enfermedad conocida como COVID-19. Esta enfermedad tiene tres etapas consecutivas de gravedad y está asociada con el desarrollo del síndrome de dificultad respiratoria aguda (SDRA). Objetivo: describir las principales lesiones pulmonares, macroscópicas y microscópicas, asociadas con la infección por SARS-CoV-2, con base en hallazgos de autopsias realizadas a pacientes fallecidos por Covid-19. Métodos: se realizó una búsqueda en las bases de datos PubMed, Google Scholar, Scielo, Clinical Key y MedRxiv que incluyó artículos publicados entre el 1 de enero del 2020 y el 31 de diciembre de 2020. Resultados: el principal hallazgo macroscópico descrito fue la presencia de pulmones pesados además de superficies con áreas azul-rojizas. Se encontró en algunos casos traqueo-bronquitis y tráqueas levemente eritematosas. En hallazgos microscópicos el patrón de lesión pulmonar más común fue el daño alveolar difuso (DAD) presentado en el 88% de los casos. Se encontraron cambios en los capilares constituyendo 3 características histológicas: Lesión endotelial, alteración de las membranas de células endoteliales y angiogénesis intususceptiva. Conclusión: la gravedad de los hallazgos está determinada por la edad del paciente y el padecimiento de diversas comorbilidades/afecciones sobre todo relacionadas con el sistema respiratorio y cardiovascular, estos factores influyen en el desarrollo de hallazgos heterogéneos tanto macroscópicos como microscópicos.




Palabras clave:

Descargas

Los datos de descargas todavía no están disponibles.

Detalles del artículo

Biografía del autor/a (VER)

Laura Marcela Mendoza Carmona, Universidad de Cartagena

Estudiante facultad de medicina Universidad de Cartagena.

Ariel Camilo Marrugo Ortiz, Universidad de Cartagena

Estudiante de la facultad de medicina Universidad de Cartagena. 

Sebastian David Payares Florez, Universidad de Cartagena

Estudiante de la facultad de medicina Universidad de Cartagena.

Referencias (VER)

Ye ZW, Yuan S, Yuen KS, Fung SY, Chan CP, Jin DY. Zoonotic origins of human coronaviruses. Int J Biol Sci. 2020; 16(10): 1686-97. https://doi.org/10.7150/ijbs.45472

Chan JFW, Kok KH, Zhu Z, Chu H, To KKW, Yuan S, et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020; 9(1): 221-36. https://doi.org/10.1080/22221751.2020.1719902

Polak SB, Van Gool IC, Cohen D, von der Thüsen JH, van Paassen J. A systematic review of pathological findings in COVID-19: a pathophysiological timeline and possible mechanisms of disease progression. Mod Pathol [Internet]. 2020; 33(11): 2128-38. Disponible en: https://doi.org/10.1038/s41379-020-0603-3

Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020; 77(2): 198-209. https://doi.org/10.1111/his.14134

Shi Y, Wang G, Cai X peng, Deng J wen, Zheng L, Zhu H hong, et al. An overview of COVID-19. J Zhejiang Univ Sci B. 2020; 21(5): 343-60. https://doi.org/10.1631/jzus.B2000083

Calabrese F, Pezzuto F, Fortarezza F, Hofman P, Kern I, Panizo A, et al. Pulmonary pathology and COVID- 19: lessons from autopsy. The experience of European Pulmonary Pathologists. Virchows Arch. 2020; 477(3): 359-72. https://doi.org/10.1007/s00428-020-02886-6

Woo PCY, Lau SKP, Chu C, Chan K, Tsoi H, Huang Y, et al. Characterization and Complete Genome Sequence of a Novel Coronavirus, Coronavirus HKU1 , from Patients with Pneumonia. 2005; 79(2): 884-95. https://doi.org/10.1128/JVI.79.2.884-895.2005

Martines RB, Ritter JM, Matkovic E, Gary J, Bollweg BC, Bullock H, et al. Pathology and pathogenesis of SARS-CoV-2 associated with fatal coronavirus disease, united states. Emerg Infect Dis. 2020; 26(9): 2005-15. https://doi.org/10.3201/eid2609.202095

Lax SF, Skok K, Zechner P, Kessler HH, Kaufmann N, Koelblinger C, et al. Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome : Results From a Prospective, Single-Center, Clinicopathologic Case Series. Ann Intern Med. 2020; 173(5): 350-61. https://doi.org/10.7326/M20-2566

Cipolloni L, Sessa F, Bertozzi G, Baldari B, Cantatore S, Testi R, et al. Preliminary post-mortem COVID-19 evidence of endothelial injury and factor VIII hyperexpression. Diagnostics. 2020; 10(8): 1-16. https://doi.org/10.3390/diagnostics10080575

Bryce C, Grimes Z, Pujadas E, Ahuja S, Beasley MB, Albrecht R, et al. Pathophysiology of SARS-CoV-2: targeting of endothelial cells renders a complex disease with thrombotic microangiopathy and aberrant immune response. The Mount Sinai COVID-19 autopsy experience. 2020. https://doi.org/10.1101/2020.05.18.20099960

Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ. *not peer reviewed* Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans 1) Department of Pathology, LSU Health Sciences Center, New Orleans 2) Pathology and Laboratory Medicine Service, Southeast Louisiana V eterans. medRxiv [Internet]. 2020; 2020.04.06.20050575. Disponible en: https://doi.org/10.1101/2020.04.06.20050575

Grosse C, Grosse A, Salzer HJF, Dünser MW, Motz R, Langer R. Analysis of cardiopulmonary findings in COVID-19 fatalities: High incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia. Cardiovasc Pathol. 2020; 49 (January). https://doi.org/10.1016/j.carpath.2020.107263

Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID- 19: A Prospective Cohort Study. Ann Intern Med. 2020; 173(4): 268-77. https://doi.org/10.7326/M20-2003

Nasr A, Rossi RS, Pellegrinelli A, Zerbi P, Rech R. Pulmonary post-mortem findings in a large series of COVID-19 cases from Northern Italy Since December 2019, an outbreak caused by a new coronavirus infection (severe acute respiratory syndrome coronavirus 2 , SARS-CoV-2) disease was reported, starting. 2020; 1-11.

Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, et al. Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections. medRxiv. 2020. https://doi.org/10.1101/2020.04.17.20058545

Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020; 383(2): 120-8. https://doi.org/10.1056/NEJMoa2015432

Edler C, Schröder AS, Aepfelbacher M, Fitzek A, Heinemann A, Heinrich F, et al. Erratum: Correction to: Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany (International journal of legal medicine (2020) 134 4 (1275-1284). Int J Legal Med. 2020; 134(5): 1977. https://doi.org/10.1007/s00414-020-02336-7

Nicholson AG, Osborn M, Devaraj A, Wells AU. COVID-19 related lung pathology: old patterns in new clothing? Histopathology. 2020; 77(2): 169-72. https://doi.org/10.1111/his.14162

Copin MC, Parmentier E, Duburcq T, Poissy J, Mathieu D, Caplan M, etal. Time to consider histologic pattern of lung injury to treat critically ill patients with COVID-19 infection. Intensive Care Med [Internet]. 2020; 46(6): 1124-6. Disponible en: https://doi.org/10.1007/s00134-020-06057-8

Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S. COVID-19 Autopsies, Oklahoma, USA. Am J Clin Pathol. 2020; 153(6): 725-33. https://doi.org/10.1093/ajcp/aqaa062

Borczuk AC, Salvatore SP , Seshan S V ., Patel SS, Bussel JB, Mostyka M, et al. COVID-19 pulmonary pathology: a multi-institutional autopsy cohort from Italy and New York City. Mod Pathol [Internet]. 2020; 33(11): 2156-68. Disponible en: https://doi.org/10.1038/s41379-020-00661-1

Adachi T, Chong JM, Nakajima N, Sano M, Yamazaki J, Miyamoto I, et al. Clinicopathologic and immunohistochemical findings from autopsy of patient with COVID-19, Japan. Emerg Infect Dis. 2020; 26(9): 2157-61. https://doi.org/10.3201/eid2609.201353

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect , the company' s public news and information. 2020; (January).

Suess C, Hausmann R. Gross and histopathological pulmonary findings in a COVID-19 associated death during self-isolation. Int J Legal Med. 2020; 134(4): 1285-90. https://doi.org/10.1007/s00414-020-02319-8

Falasca L, Nardacci R, Colombo D, Lalle E, Di Caro A, Nicastri E, et al. Postmortem Findings in Italian Patients With COVID-19: A Descriptive Full Autopsy Study of Cases With and Without Comorbidities. J Infect Dis. 2020; 222(11): 1807-15. https://doi.org/10.1093/infdis/jiaa578

Del Nonno F, Colombo D, Nardacci R, Falasca L. Fatal pulmonary arterial thrombosis in a COVID-19 patient, with asymptomatic history, occurred after swab negativization. Thromb J. 2021; 19(1): 1. https://doi.org/10.1186/s12959-020-00255-6

Stoyanov GS, Petkova L, Dzhenkov DL, Sapundzhiev NR, Todorov I. Gross and Histopathology of COVID-19 With First Histology Report of Olfactory Bulb Changes. Cureus. 2020; 12(12). https://doi.org/10.7759/cureus.11912

Bösmüller H, Traxler S, Bitzer M, Häberle H, Raiser W, Nann D, etal. The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation. Virchows Arch. 2020; 477(3): 349-57. https://doi.org/10.1007/s00428-020-02881-x

Scendoni. Histopath 2 oncology COVIDs. Diagn Pathol. 2020; 1-4.

Bian X. Autopsy of COVID-19 patients in China. 2020.

Aguiar D, Lobrinus JA, Schibler M, Fracasso T, Lardi C. Inside the lungs of COVID-19 disease. Int J Legal Med. 2020; 134(4): 1271-4. https://doi.org/10.1007/s00414-020-02318-9

Konopka KE, Wilson A, Myers JL. Postmortem Lung Findings in a Patient With Asthma and Coronavirus Disease 2019. Chest. 2020; 158(3): e99-101. https://doi.org/10.1016/j.chest.2020.04.032

Chmielik E, Jazowiecka-Rakus J, Dyduch G, Nasierowska-Guttmejer A, Michalowski L, Sochanik A, et al. COVID-19 Autopsies: A Case Series from Poland. Pathobiology. 2020. https://doi.org/10.1159/000512768

Ducloyer M, Gaborit B, Toquet C, Castain L, Bal A, Arrigoni PP, et al. Complete post-mortem data in a fatal case of COVID-19: clinical, radiological and pathological correlations. Int J Legal Med. 2020; 134(6): 2209-14. https://doi.org/10.1007/s00414-020-02390-1

Remmelink M, De Mendonça R, D'Haene N, De Clercq S, Verocq C, Lebrun L, et al. Unspecific post- mortem findings despite multiorgan viral spread in COVID-19 patients. Crit Care. 2020; 24(1): 1-10. https://doi.org/10.1186/s13054-020-03218-5

Buja LM, Wolf D, Zhao B, Akkanti B, McDonald M, Lelenwa L, etal. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovasc Pathol [Internet]. 2020; 48: 107233. Disponible en: https://doi.org/10.1016/j.carpath.2020.107233

Sauter JL, Baine MK, Butnor KJ, Buonocore DJ, Chang JC, Jungbluth AA, etal. Insights into pathogenesis of fatal COVID-19 pneumonia from histopathology with immunohistochemical and viral RNA studies. Histopathology. 2020; 77(6): 915-25. https://doi.org/10.1111/his.14201

Calvin M, Cletus T, Madala N. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information. 2020; (January).

Okudela K, Hayashi H, Yoshimura Y, Sasaki H, Horiuchi H, Miyata N, et al. A Japanese case of COVID-19: An autopsy report. Pathol Int. 2020; 70(10): 820-4. https://doi.org/10.1111/pin.13002

ZengZ, XuL, XieXY, YanHL, XieBJ, XuWZ, et al. Pulmonary pathology of early-phase COVID-19 pneumonia in a patient with a benign lung lesion. Histopathology. 2020; 77(5): 823-31. https://doi.org/10.1111/his.14138

Flikweert AW, Grootenboers MJJH, Yick DCY, du Mée AWF, van der Meer NJM, Rettig TCD, et al. Late histopathologic characteristics of critically ill COVID- 19 patients: Different phenotypes without evidence of invasive aspergillosis, a case series. J Crit Care [Internet]. 2020; 59: 149-55. Disponible en: https://doi.org/10.1016/j.jcrc.2020.07.002

Rubin JE, Crowe SE. Annals of internal medicine®. Ann Intern Med. 2020; 172(1): ITC1-14. https://doi.org/10.7326/AITC202001070

Beigmohammadi MT, Jahanbin B, Safaei M, Amoozadeh L, Khoshavi M, Mehrtash V , et al. Pathological Findings of Postmortem Biopsies From Lung, Heart, and Liver of 7 Deceased COVID-19 Patients. Int J Surg Pathol. 2020; 1-11. https://doi.org/10.1177/1066896920935195

YaoX, LiT, HeZ, PingY, LiuH, YuS, et al. Histopathological Study of New Coronavirus Pneumonia (COVID-19) in Three Patients. Chinese J Pathol. 2020; 49 DOI: https://doi.org/10.3760/cma.j.cn112151-20200312-00193

Recalde-Zamacona B, García-Tobar L, Argueta A, Álvarez L, De Andrea CE, Fernández Alonso M, et al. Histopathological findings in fatal COVID-19 severe acute respiratory syndrome: Preliminary experience from a series of 10 Spanish patients. Thorax. 2020; 75(12): 1116-8. https://doi.org/10.1136/thoraxjnl-2020-215577

Xu Z, Shi L, Wang Y et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome [published correction appears in Lancet Respir Med. 2020 Feb 25;:]. Lancet Respir Med. 2020.

(4): 420-422. doi: 10.1016/S2213-2600(20)30076-X Lancet Respir Med [Internet]. 2020;8(feb 25):420-2. Disponible en: https://doi.org/10.1016/S2213-2600(20)30076-X

Ding M, Zhang Q, Li Q, Wu T, Huang Y. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information. 2020; (January).

Beasley MB, Franks TJ, Galvin JR, Gochuico B, Travis WD. Acute fibrinous and organizing pneumonia: A histologic pattern of lung injury and possible variant of diffuse alveolar damage. Arch Pathol Lab Med. 2002; 126(9): 1064-70. https://doi.org/10.5858/2002-126-1064-AFAOP

Valdivia-Mazeyra MF, Salas C, Nieves-Alonso JM, Martín-Fragueiro L, Bárcena C, Muñoz-Hernández P , et al. Increased number of pulmonary megakaryocytes in COVID-19 patients with diffuse alveolar damage: an autopsy study with clinical correlation and review of the literature. Virchows Arch. 2020. https://doi.org/10.21203/rs.3.rs-49093/v1

Schaefer IM, Padera RF, Solomon IH, Kanjilal S, Hammer MM, Hornick JL, et al. In situ detection of SARS-CoV-2 in lungs and airways of patients with COVID-19. Mod Pathol [Internet]. 2020; 33(11): 2104-14. Disponible en: https://doi.org/10.1038/s41379-020-0595-z

Barisione E, Grillo F, Ball L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch. 2020. https://doi.org/10.1007/s00428-020-02934-1

Pernazza A, Mancini M, Rullo E, Bassi M, De Giacomo T, Rocca C Della, et al. Early histologic findings of pulmonary SARS-CoV-2 infection detected in a surgical specimen. Virchows Arch. 2020; 477(5): 743-8. https://doi.org/10.1007/s00428-020-02829-1

Elsoukkary SS, Mostyka M, Dillard A, Berman DR, Ma LX, Chadburn A, et al. Autopsy Findings in 32 Patients with COVID-19: A Single-Institution Experience. Pathobiology. 2020. https://doi.org/10.1159/000511325

Sociedade Chinesa de Medicina de Reabilitação, Comitê de Reabilitação Respiratória da Associação Chinesa de Medicina de Reabilitação G de RC do R de MFeRdaAMC,QianxueM,HaoD,YinZ,HongZ, Hospital T. Nova Orientação para Reabilitação Respiratória de Coronavírus Pneumonia (Segunda Edição). 2020; 44: 1-8.

Mac Dowall MP, Barrionuevo-Poquet A, Carnero- Fuentes O, Pareja-Begazo G, Coayla-Cano C, Gallo- Lopez A, et al. Clinical-pathological characterization, viral genotipification and genetic heterogeneity as risk determinants in COVID-19: Study design and initial findings. Rev la Fac Med Humana. 2020; 20(3): 433- 43. https://doi.org/10.25176/RFMH.v20i3.3040

Wang XX, Shao C, Huang XJ, Sun L, Meng LJ, Liu H, et al. Histopathological features of multiorgan percutaneous tissue core biopsy in patients with COVID-19. J Clin Pathol. 2020; 1-6. https://doi.org/10.1136/jclinpath-2020-206623

Eckermann M, Frohn J, Reichardt M, Osterhoff M, Sprung M, Westermeier F, etal. 3D Virtual Pathohistology of Lung Tissue From Covid-19 Patients Based on Phase Contrast X-Ray Tomography. Elife. 2020; 9: 1-25. https://doi.org/10.7554/eLife.60408

Kommoss FKF, Schwab C, Tavernar L, Schreck J, Wagner WL, Merle U, et al. Pathologie der schweren COVID-19-bedingten Lungenschädigung. Dtsch Arztebl Int. 2020; 117 (29-30): 500-6.

Ochoa Salmorán H, Martínez Martínez I, Díaz Greene EJ. Ventilación mecánica en pacientes con COVID-19 de acuerdo a los fenotipos de Gattinoni. Acta Médica Grup Ángeles. 2020; 18(3): 336-40. https://doi.org/10.35366/95421

LengL,CaoR,MaJ,MouD,ZhuY,LiW,etal. Pathological features of COVID-19-associated lung injury: a preliminary proteomics report based on clinical samples. Signal Transduct Target Ther [Internet]. 2020; 5(1): 1-9. Disponible en: https://doi.org/10.1038/s41392-020-00355-9

COAGULOPATÍA EN PACIENTES CON COVID- 19 [Internet]. [citado 27 de enero de 2021]. Disponible en: https://www.siicsalud.com/dato/resiiccompleto.php/163612

Comino-Trinidad O, Calvo A, Ojeda A, Mercadal J, Cornellas L, Ferrando C. Disseminated intravascular coagulation as a form of presentation of coronavirus- 19 disease. Clinical case. Rev Esp Anestesiol Reanim. 1 de enero de 202; 68(1): 41-5. https://doi.org/10.1016/j.redare.2020.05.014

Iba T, Levy JH. Inflammation and thrombosis: roles of neutrophils, platelets and endothelial cells and their interactions in thrombus formation during sepsis. J Thromb Haemost. 2018; 16(2): 231-41. https://doi.org/10.1111/jth.13911

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost [Internet]. 1 de abril de 2020 [citado 27 de enero de 2021]; 18(4): 844-7. Disponible en: /pmc/articles/PMC7166509/?report=abstract ; https://doi.org/10.1111/jth.14768

Iba T, Levy JH, Levi M, Thachil J. Coagulopathy in COVID‐19. J Thromb Haemost [Internet]. 21 de septiembre de 2020 [citado 27 de enero de 2021]; 18(9):2 103-9. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14975 ; https://doi.org/10.1111/jth.14975

Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 1 de junio de 2020; 127: 104362. https://doi.org/10.1016/j.jcv.2020.104362