Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa.
S Afr Med J. 2020 Oct 19;110(12):1195-1200. doi: 10.7196/SAMJ.2020.v110i12.15290.
An outbreak of a novel coronavirus in China in late 2019 has resulted in a global pandemic. The virus (SARS-CoV-2) causes a severe acute respiratory syndrome and had been responsible for >14 000 deaths in South Africa (SA) at the time of writing, 30 August 2020. Autopsies in our setting have not been prioritised owing to the infective risks for staff, resulting in a lack of information on the histopathology of the disease in the SA setting. Postmortem biopsies are relatively quick and easy to perform and reduce the infective risk posed by full autopsies.
To determine whether postmortem biopsies of lung tissue could be used to determine cause of death in lieu of full autopsies in patients dying from COVID-19.
We performed postmortem biopsies of lung tissue on 4 patients with SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction who died in the Tygerberg Hospital (Cape Town, SA) intensive care unit (ICU) in June - July 2020, in order to determine their cause of death. The biopsies were performed in the ICU with the necessary personal protective equipment within 2 hours after death. Clinical information was obtained from the hospital records and the histopathology was reviewed by two consultant histopathologists. Microbiology and electron microscopy were also performed on this tissue.
All 4 patients were aged >50 years and had multiple comorbidities. Pulmonary pathology was present in only 3 cases, and the findings were surprisingly heterogeneous. One case demonstrated several findings including diffuse alveolar damage, extensive fibrin thrombi in pulmonary arteries with pulmonary infarction, organising pneumonia and bronchopneumonia. Other findings included type 2 pneumocyte hyperplasia, intra-alveolar macrophages and squamous metaplasia. An organising pneumonia was present in 2 other cases, although these findings were not deemed to be severe enough to be the cause of death. Fibrin thrombi were present in pulmonary arteries of 3 cases. One case showed no significant acute pulmonary pathology. The cause of death could only be determined in 1 case.
The pulmonary findings we observed are in keeping with those described in the international literature. However, the pathology was surprisingly heterogeneous between cases, and was only deemed severe enough to be the cause of death in 1 of 4 cases. While lung-targeted, standardised postmortem biopsies may be safe, easy to perform and provide useful insights into the disease, they are not suitable to replace full autopsies in determining cause of death.
2019 年末中国爆发了一种新型冠状病毒，导致了全球大流行。该病毒（SARS-CoV-2）引起严重急性呼吸系统综合征，截至 2020 年 8 月 30 日撰写本文时，已导致南非（SA）超过 14000 人死亡。由于对工作人员的感染风险，我们的尸检未被优先考虑，因此，SA 环境中疾病的组织病理学信息缺乏。死后活检相对快速且易于进行，并降低了全尸检带来的感染风险。
确定在死于 COVID-19 的患者中，死后肺组织活检是否可以代替全尸检来确定死因。
我们对 2020 年 6 月至 7 月在开普敦泰格伯格医院（SA）重症监护病房（ICU）死于 SARS-CoV-2 经逆转录聚合酶链反应（RT-PCR）确诊的 4 例患者进行了肺组织死后活检，以确定其死因。在 ICU 内使用必要的个人防护设备，在死亡后 2 小时内进行活检。临床信息来自医院记录，两名顾问病理学家对组织病理学进行了审查。还对该组织进行了微生物学和电子显微镜检查。
所有 4 名患者均年龄大于 50 岁，且患有多种合并症。仅在 3 例中发现肺部病变，且发现结果出乎意料地存在异质性。1 例表现出多种发现，包括弥漫性肺泡损伤、肺动脉内广泛纤维蛋白血栓伴肺梗死、机化性肺炎和支气管肺炎。其他发现包括 II 型肺泡细胞增生、肺泡内巨噬细胞和鳞状化生。另外 2 例存在机化性肺炎，但这些发现被认为不足以成为死亡原因。3 例肺动脉中存在纤维蛋白血栓。1 例无明显急性肺病理学表现。仅在 1 例中确定了死因。
我们观察到的肺部发现与国际文献中描述的发现一致。然而，病例之间的病理学表现出乎意料地存在异质性，在 4 例中只有 1 例被认为严重到足以成为死亡原因。虽然针对肺部的标准化靶向死后活检可能是安全、易于进行的，并能为疾病提供有用的见解，但它们不适合替代全尸检来确定死因。
