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Post-Mortem Diagnosis and Autopsy Findings in SARS-CoV-2 Infection: Forensic Case Series
Arthur-Atilla Keresztesi1, Filip Perde2, Andreea Ghita-Nanu1
1Ialomita County Institution of Forensic Medicine, 920013 Slobozia, Romania.
Insights
Forensic autopsies on 15 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individuals in Romania revealed significant lung pathology and small vessel thrombosis. Autopsies are crucial for understanding SARS-CoV-2
Area of Science:
- Forensic Pathology
- Infectious Diseases
- Pulmonology
Background:
- The novel coronavirus, SARS-CoV-2, caused a global pandemic starting in late 2019.
- The World Health Organization declared COVID-19 a pandemic in March 2020.
- Understanding the pathological impact of SARS-CoV-2 is critical.
Purpose of the Study:
- To present findings from 15 forensic autopsies of SARS-CoV-2 positive subjects in Romania.
- To detail a specific case of violent death in a SARS-CoV-2 infected patient.
- To analyze the role of SARS-CoV-2 in thanatogenesis.
Main Methods:
- Performed 15 forensic autopsies on SARS-CoV-2 positive individuals.
- Conducted histological examination in seven cases.
- Documented clinical history, symptoms, and associated diseases.
Main Results:
- SARS-CoV-2 infection was diagnosed post-mortem in two cases.
- Common pre-death symptoms included dry cough, dyspnea, and fever.
- Histology showed hyaline membranes, inflammatory infiltration, and small vessel thrombosis in most cases.
- A case of violent death was reported, with bronchopneumonia superimposed on SARS-CoV-2 infection.
Conclusions:
- Autopsies are vital for understanding SARS-CoV-2's role in death.
- Safe autopsy procedures are necessary for professionals.
- Findings contribute to the understanding of COVID-19 pathology.
Abstract:
Towards the end of 2019, a novel coronavirus was identified as the culprit for a cluster of pneumonia cases in Wuhan, China. Since then, it has rapidly spread worldwide, affecting more than 43 million people, and in March 2020, the World Health Organization (WHO) declared it a pandemic. The purpose of the study is to present the findings of 15 forensic autopsies performed in Romania, on SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) positive subjects, and to present the case of one SARS-CoV-2 infected patient who experienced a violent death, as established during their autopsy. A total of 11 male and 4 female patients were autopsied, and SARS-CoV-2 infection was diagnosed post-mortem in two cases. The most frequent symptoms before death were dry cough, dyspnoea, and fever. Hypertension, ischemic cardiac disease, and a history of stroke were the most frequent associated diseases. The mean duration from the symptoms' debut to a RT-PCR positive SARS-CoV-2 test was 3.7 days, while the mean survival time from the RT-PCR positive test was 4.2 days. A histological examination was performed in seven cases and revealed, in most of them, hyaline membranes, and mixed inflammatory cell infiltration of the interstitium, alveoli, and perivascular areas. In addition, all of the examined cases developed small vessel thrombosis. A case of violent death was also reported, regarding a 87-year-old male subject who suffered a femur fracture (domestic fall) and was diagnosed with SARS-CoV-2 infection the following day after surgery. After transfer to a COVID-19 (coronavirus disease-19) support hospital, during an episode of behavioral disorder, the patient jumped from the first floor window. Death occurred a few days later, and the cause was established as bronchopneumonia superimposed on SARS-CoV-2 infection. In conclusion, autopsies should be conducted while providing a safe environment for professionals to perform them, because they are crucial procedures that can help gain a better understanding of the role of SARS-CoV-2 infection in thanatogenesis.
