Nalwa Aasma, Vishwajeet Vikarn, Kumar Deepak, Purohit Abhishek, Garg Mayank, Kanchan Dr Tanuj, Dutt Naveen, Kothari Nikhil, Bhaskar Suryanarayanan, Elhence Poonam, Bhatia Pradeep, Nag Vijaya L, Garg Mahendra Kumar, Misra Sanjeev, Pandey Alok, Dhawan Alok
Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, IND.
Pathology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
Cureus. 2022 Nov 27;14(11):e31932. doi: 10.7759/cureus.31932. eCollection 2022 Nov.
The COVID-19 pandemic resulted in substantial morbidity and mortality across the world. The prognosis was found to be poor in patients with co-morbidities such as diabetes, hypertension, interstitial lung disease, etc. Although biochemical studies were done in patient samples, no study has been reported from the Indian subcontinent about ultrastructural changes in the vital organs of COVID-19 patients. The present study was, therefore, conducted to understand the ultrastructural changes in the lung, liver, and brain of the deceased patients.
The present study was conducted on samples obtained from reverse transcription-polymerase chain reaction (RT-PCR)-positive patients who were admitted to a tertiary care hospital in Western India. Core needle biopsies were done in eight fatal cases of COVID-19. The samples were taken from the lungs, liver, and brain and subjected to light microscopy, immunohistochemistry (IHC), and transmission electron microscopy (TEM). Clinical details and biochemical findings were also collected. Results: The study participants included seven males and one female. The presenting complaints included fever, breathlessness, and cough. Light microscopy revealed diffuse alveolar damage in the lungs. Further, a positive expression of SARS-CoV-2 nucleocapsid protein was observed in the pulmonary parenchyma of five patients. Also, the TEM microphotograph showed viral particles of size up to 80nm localized in alveolar epithelial cells. However, no viral particles were found in liver or brain samples. In the liver, macrovesicular steatosis and centrizonal congestion with loss of hepatocytes were observed in light microscopy.
This is the first study in the Indian population showing the presence of viral particles in core biopsies from fatal cases of COVID-19. As evident from the results, histology and ultrastructural changes in the lung correlated with the presence of viral particles. The study revealed a positive correlation between the damage in the lungs and the presence of viral particles.
新型冠状病毒肺炎（COVID-19）大流行在全球范围内导致了大量发病和死亡。研究发现，患有糖尿病、高血压、间质性肺病等合并症的患者预后较差。尽管对患者样本进行了生化研究，但印度次大陆尚未有关于COVID-19患者重要器官超微结构变化的研究报告。因此，本研究旨在了解已故患者肺、肝和脑的超微结构变化。
本研究对从印度西部一家三级护理医院收治的逆转录聚合酶链反应（RT-PCR）阳性患者获取的样本进行。对8例COVID-19死亡病例进行了粗针活检。样本取自肺、肝和脑，并进行了光学显微镜检查、免疫组织化学（IHC）和透射电子显微镜（TEM）检查。还收集了临床细节和生化检查结果。结果：研究参与者包括7名男性和1名女性。主要症状包括发热、呼吸急促和咳嗽。光学显微镜检查显示肺部弥漫性肺泡损伤。此外，在5例患者的肺实质中观察到严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核衣壳蛋白的阳性表达。而且，透射电子显微镜照片显示，大小达80纳米的病毒颗粒定位于肺泡上皮细胞中。然而，在肝或脑样本中未发现病毒颗粒。在肝脏中，光学显微镜检查观察到巨泡性脂肪变性和中心性充血伴肝细胞丧失。
这是印度人群中第一项显示COVID-19死亡病例粗针活检中存在病毒颗粒的研究。从结果可以明显看出，肺组织学和超微结构变化与病毒颗粒的存在相关。该研究揭示了肺损伤与病毒颗粒存在之间的正相关关系。
