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Autopsy findings of pediatric COVID-19: a systematic review
Gilbert Sterling Octavius1, Jeremiah Hilkiah Wijaya1, Alexa Ovilia Tan1
1Department of Pediatrics, Faculty of Medicine, Universitas Pelita Harapan, MH Thmarin Boulevard 1100, Karawaci, Tangerang, Banten 15811 Indonesia.
Insights
Autopsies reveal that COVID-19 significantly impacts the heart and lungs in children. Key findings include inflammation, necrosis, and diffuse alveolar damage, highlighting the need for further pediatric SARS-CoV-2 research.
Area of Science:
- Pediatric Pathology
- Infectious Diseases
- Cardiovascular and Pulmonary Medicine
Background:
- Limited understanding of COVID-19's impact on pediatric populations.
- Autopsies are crucial for understanding disease pathophysiology.
- Few pediatric post-mortem studies exist compared to adult COVID-19 research.
Purpose of the Study:
- To systematically review autopsy findings in pediatric COVID-19 patients.
- To investigate the specific pathological changes associated with SARS-CoV-2 infection in children.
Main Methods:
- Systematic review of published literature.
- Analysis of autopsy reports from pediatric COVID-19 cases.
- Compilation of histopathological findings from multiple studies.
Main Results:
- Review included 15 pediatric patients from eight studies.
- Primary findings in heart: diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, interstitial edema.
- Primary findings in lungs: diffuse alveolar damage, cytopathic changes, thrombi, congestion, hemorrhage, edema.
Conclusions:
- Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are significant findings.
- Further research is needed to fully understand SARS-CoV-2 pathophysiology in pediatric autopsies.
- Determining the exact cause of death requires consideration of COVID-19 and comorbidities.
Background:
Little is known how COVID-19 is affecting children. Autopsies help gain an understanding of the pathophysiology of new and developing diseases. Numerous post-mortem studies had been conducted in adults with COVID-19, but few in children. Thereby, this systematic review aims to investigate the autopsy findings from pediatric COVID-19 patients.
Results:
There were a total of 15 patients from eight studies. COVID-19 mainly affects the heart and lungs. Pathology findings from the heart of COVID-19 pediatric patients include diffuse inflammatory infiltrate, myocarditis, cardiomyocyte necrosis, pericarditis, and interstitial edema. Histopathology abnormalities observed in the lungs are diffuse alveolar damage, cytopathic changes, thrombi in arterioles and septal capillaries, lung congestion, focal acute hemorrhage and edema, focal exudative changes, and mild pneumocyte hyperplasia. In addition, pathological findings from other organs, such as the liver, kidney, brain, bone marrow, lymph node, skin, spleen, muscle, colon, parotid gland, and adrenal of COVID-19 pediatric patients are also included in this review.
Conclusion:
Cardiomyocyte necrosis, interstitial edema, lung congestion, and diffuse alveolar damage are the most significant pathologic findings of the heart and lung in pediatric COVID-19 patients. More studies are needed to elucidate the pathophysiology of SARS-CoV-2 in autopsy findings and to determine the exact cause of death since it could be related to COVID-19 or other comorbidities.
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