Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India.
Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute and Prolife Diagnostics, Bhubaneswar, India.
Diagn Pathol. 2020 Aug 14;15(1):103. doi: 10.1186/s13000-020-01017-8.
The world is currently witnessing a major devastating pandemic of Coronavirus disease-2019 (COVID-19). This disease is caused by a novel coronavirus named Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). It primarily affects the respiratory tract and particularly the lungs. The virus enters the cell by attaching its spike-like surface projections to the angiotensin-converting enzyme-2 (ACE-2) expressed in various tissues. Though the majority of symptomatic patients have mild flu-like symptoms, a significant minority develop severe lung injury with acute respiratory distress syndrome (ARDS), leading to considerable morbidity and mortality. Elderly patients with previous cardiovascular comorbidities are particularly susceptible to severe clinical manifestations. BODY: Currently, our limited knowledge of the pathologic findings is based on post-mortem biopsies, a few limited autopsies, and very few complete autopsies. From these reports, we know that the virus can be found in various organs but the most striking tissue damage involves the lungs resulting almost always in diffuse alveolar damage with interstitial edema, capillary congestion, and occasional interstitial lymphocytosis, causing hypoxia, multiorgan failure, and death. A few pathology studies have also reported intravascular microthrombi and pulmonary thrombembolism. Although the clinical presentation of this disease is fairly well characterized, knowledge of the pathologic aspects remains comparatively limited.
In this review, we discuss clinical, pathologic, and genomic features of COVID-19, review current hypotheses regarding the pathogenesis, and briefly discuss the clinical characteristics. We also compare the salient features of COVID-19 with other coronavirus-related illnesses that have posed significant public health issues in the past, including SARS and the Middle East Respiratory Syndrome (MERS).
目前，全球正面临着由新型冠状病毒（SARS-CoV-2）引发的 2019 年冠状病毒病（COVID-19）大流行。该病毒主要侵袭呼吸道，尤其是肺部。病毒通过其表面的刺突状突起与各种组织中表达的血管紧张素转换酶-2（ACE-2）结合而进入细胞。虽然多数有症状的患者表现为轻度流感样症状，但少数患者会发生严重的肺损伤，伴急性呼吸窘迫综合征（ARDS），从而导致较高的发病率和死亡率。有既往心血管合并症的老年患者尤其容易出现严重的临床表现。
目前，我们对病理发现的认识仅限于尸检活检、少数有限的解剖和极少数完整的解剖。根据这些报告，我们知道病毒可以在各种器官中找到，但最明显的组织损伤涉及肺部，几乎总是导致弥漫性肺泡损伤，伴有间质水肿、毛细血管充血和偶尔间质淋巴细胞增多，导致缺氧、多器官衰竭和死亡。少数病理学研究还报告了血管内微血栓和肺血栓栓塞。尽管该疾病的临床表现已经相当明确，但对病理方面的了解仍然相对有限。
在这篇综述中，我们讨论了 COVID-19 的临床、病理和基因组特征，回顾了目前关于发病机制的假说，并简要讨论了临床特征。我们还将 COVID-19 的显著特征与过去造成重大公共卫生问题的其他冠状病毒相关疾病进行了比较，包括 SARS 和中东呼吸综合征（MERS）。
