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Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy
Cordilia Maria Himwaze1, Viktor Telendiy2, Fred Maate3
1Ministry of Home Affairs, Office of the State Forensic Pathologist, Nationalist Road, Lusaka, Zambia; Department of Pathology and Microbiology, Adult and Emergency Hospital-University Teaching Hospitals, Nationalist Road, Lusaka, Zambia.
Insights
This study analyzed 29 COVID-19 autopsies in Zambia, revealing widespread organ pathology. Findings in this sub-Saharan African population showed younger patients and common co-morbidities like HIV and TB.
Area of Science:
- Pathology
- Infectious Diseases
- Public Health
Background:
- Limited data exists on COVID-19 pathology in sub-Saharan Africa (SSA).
- This study presents the first large autopsy case series from Africa, focusing on COVID-19 deaths in Lusaka, Zambia.
Purpose of the Study:
- To define the gross pathology and histological features of COVID-19.
- To analyze autopsy findings in a sub-Saharan African population.
Main Methods:
- Descriptive post-mortem examination of 29 inpatient COVID-19 deaths.
- Whole-body autopsies with gross and histopathological examination of all organs.
- Analysis of patient demographics, co-morbidities, and causes of death.
Main Results:
- Autopsies revealed a spectrum of COVID-19 pathological manifestations across all organs.
- Common causes of death included pulmonary thromboembolism (45%), Diffuse Alveolar Damage (31%), and COVID-19 pneumonia (25%).
- The majority of decedents (76%) had co-morbidities, notably HIV (28%), hypertension (20%), tuberculosis (10%), and diabetes (10%).
Conclusions:
- COVID-19 deaths exhibit diverse gross and histopathological findings, similar to those reported globally.
- Key differences observed in this Zambian cohort include a younger age group and a higher prevalence of HIV and TB co-infections.
- Further investigation into these demographic and co-morbidity differences is warranted.
Background:
Since information on the pathology of COVID-19 from sub-Saharan Africa (SSA) remains scarce, the objective of our study was to define the gross pathology and histological features of COVID-19. We report data from 29 whole-body autopsies of COVID-19 deaths occurring in hospitals in Lusaka, Zambia - the first large autopsy case series from Africa.
Methods:
We performed a descriptive post-mortem examination study of inpatient COVID-19 related deaths at two hospitals in Lusaka, Zambia. Whole-body autopsies were conducted according to Standard Operating Procedures. Gross and histopathological examinations of all organs were performed. Patient demographics, history, co-morbidities, autopsy gross and microscopic findings, and cause(s) of death were recorded and analyzed using STATA version 14. Variables were grouped and presented as frequencies and percentages.
Findings:
Autopsies were performed on 29 decedents (mean age = 44 ± 15.8years; age range = 19-82; 17/29 [58.8%] males). 22/29 [75.9%] cases were <55 years of age. A spectrum of pathological manifestations of COVID-19 were seen in all organs. The commonest causes of death were pulmonary thromboembolism (13/29, 45%), Diffuse Alveolar Damage (9/29, 31%), and COVID-19 pneumonia (7/29, 25%). 22/29 (76%) had co-morbidities. Common co-morbidities included HIV (8/29, 28%), Hypertension (6/29, 20%) Tuberculosis (3/29, 10%), Diabetes (3/29, 10%).
Conclusions:
A spectrum of gross anatomical and histopathological findings are seen in COVID-19 deaths in hospitalized decedents. These appear broadly similar to those reported from China, Europe and USA. Differences include a younger age group, and co-morbidities of HIV and TB co-infection which require further investigation.
