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Published on: December 19, 2020
Postmortem lung and heart examination of COVID-19 patients in a case series from Jordan
Maram Abdaljaleel1,2, Isra Tawalbeh3, Malik Sallam1,2,4
1Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan.
Insights
Autopsy findings in COVID-19 cases revealed significant lung damage, including diffuse alveolar damage and pulmonary microthrombi. While cardiac involvement was minimal, autopsies are crucial for determining the cause of death in complex cases.
Area of Science:
- Pathology
- Infectious Diseases
- Forensic Medicine
Background:
- Coronavirus disease 2019 (COVID-19) has been a global pandemic for over two years.
- Autopsy examination is vital for understanding the pathogenesis and mortality of emerging infectious diseases.
Purpose of the Study:
- To document the lung and heart pathological findings in COVID-19 positive autopsies conducted in Jordan.
Main Methods:
- Inclusion of medicolegal cases with legally mandated autopsies.
- Analysis of clinical and pathological findings from gross and microscopic examinations.
- Confirmation of SARS-CoV-2 using real-time PCR, serologic testing, and electron microscopy.
Main Results:
- Seventeen autopsies were analyzed, predominantly affecting males (76.5%) with a mean age of 50.
- Diffuse alveolar damage (76.5%) and pulmonary microthrombi (47.1%) were common lung findings.
- Cardiac microscopic findings were rare, though two cases showed direct cardiac death with limited pulmonary pathology.
Conclusions:
- Postmortem detection of SARS-CoV-2 can be incidental or contributory.
- Autopsy examination is essential for clarifying the cause of death in medicolegal cases involving COVID-19.
Background:
Coronavirus disease 2019 (COVID-19) has emerged as a pandemic for more than 2 years. Autopsy examination is an invaluable tool to understand the pathogenesis of emerging infections and their consequent mortalities. The aim of the current study was to present the lung and heart pathological findings of COVID-19-positive autopsies performed in Jordan.
Methods:
The study involved medicolegal cases, where the cause of death was unclear and autopsy examination was mandated by law. We included the clinical and pathologic findings of routine gross and microscopic examination of cases that were positive for COVID-19 at time of death. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed through molecular detection by real-time polymerase chain reaction, serologic testing for IgM and electron microscope examination of lung samples.
Results:
Seventeen autopsies were included, with male predominance (76.5%), Jordanians (70.6%), and 50 years as the mean age at time of death. Nine out of 16 cases (56.3%) had co-morbidities, with one case lacking such data. Histologic examination of lung tissue revealed diffuse alveolar damage in 13/17 cases (76.5%), and pulmonary microthrombi in 8/17 cases (47.1%). Microscopic cardiac findings were scarcely detected. Two patients died as a direct result of acute cardiac disease with limited pulmonary findings.
Conclusions:
The detection of SARS-CoV-2 in postmortem examination can be an incidental or contributory finding which highlights the value of autopsy examination to determine the exact cause of death in controversial cases.
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