Department of Pathology, Shanghai Public Health Clinical center, Fudan University, Shanghai, China.
Department of Clinical Laboratory, Shanghai Public Health Clinical center, Fudan University, Shanghai, China.
Diagn Pathol. 2021 May 5;16(1):40. doi: 10.1186/s13000-021-01082-7.
Patients with COVID-19 can also have enteric symptoms. Here we analyzed the histopathology of intestinal detachment tissue from a patient with COVID-19.
The enteric tissue was examined by hematoxylin & eosin stain, PAS (Periodic acid-Schiff) staining, Gram staining, Ziehl-Neelsen stain and Grocott's Methenamine Silver (GMS) Stain. The distribution of CD3, CD4, CK20 and CD68, cytomegalovirus (CMV) and Herpes Simplex Virus (HSV) antigen were determined by immunohistochemistry. In situ hybridization (ISH) of SARS-CoV-2 and Epstein-Barr virus-encoded small RNA (EBER) were also performed.
We observed mucosal epithelium shedding, intestinal mucosal erosion, focal inflammatory necrosis with hemorrhage, massive neutrophil infiltration, macrophage proliferation accompanied by minor lymphocyte infiltration. Fungal spores and gram positive cocci but not mycobacteria tuberculosis were identified. Immunohistochemistry staining showed abundant CD68 macrophages but few lymphocytes infiltration. HSV, CMV and EBV were negative. ISH of SARS-CoV-2 RNA showed positive signal which mostly overlapped with CD68 positivity.
The in situ detection of SARS-CoV-2 RNA in intestinal macrophages implicates a possible route for gastrointestinal infection. Further study is needed to further characterize the susceptibility of enteric cells to SARS-CoV-2 infection.
COVID-19 患者也可能出现肠道症状。在此，我们分析了一位 COVID-19 患者肠脱落组织的组织病理学。
对肠组织进行苏木精和伊红染色、过碘酸-雪夫（PAS）染色、革兰氏染色、齐尔-尼尔森染色和格罗特-美森银（GMS）染色。通过免疫组织化学检测 CD3、CD4、CK20 和 CD68、巨细胞病毒（CMV）和单纯疱疹病毒（HSV）抗原的分布。还进行了 SARS-CoV-2 和 Epstein-Barr 病毒编码的小 RNA（EBER）的原位杂交（ISH）。
我们观察到黏膜上皮脱落、肠黏膜糜烂、局灶性炎症性坏死伴出血、大量中性粒细胞浸润、巨噬细胞增殖伴少量淋巴细胞浸润。鉴定出真菌孢子和革兰氏阳性球菌，但无分枝杆菌结核。免疫组织化学染色显示大量 CD68 巨噬细胞，但淋巴细胞浸润较少。HSV、CMV 和 EBV 均为阴性。SARS-CoV-2 RNA 的原位杂交显示阳性信号，与 CD68 阳性大部分重叠。
肠道巨噬细胞中 SARS-CoV-2 RNA 的原位检测提示胃肠道感染可能存在途径。需要进一步研究以进一步表征肠细胞对 SARS-CoV-2 感染的易感性。
