Clinical autopsy in COVID-19

The Coronavirus Pandemic and the Future: Virology, Epidemiology, Translational Toxicology and Therapeutics

Autopsy findings provide an opportunity to gain a better understanding of COVID-19

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The SARS-CoV-2 outbreak started in December 2019 and was declared pandemic on 11 March 2020. In severely affected individuals, the infections result in a massive release of pro-inflmmmatory cytokines and lead to the development of acute respiratory distress syndrome. The clinical course evolves into a hypercoagulable state and multi-organ dysfunction. Autopsy findings provide an opportunity to gain a better knowledge of the disease and increase our understandings of the disease. Autopsy in COVID-19 (coronavirus disease 2019) deaths need to be conducted by taking standard safety precautions by keeping the exposure to the prosectors and other health care personnel to a minimum. The lungs face the major brunt of the disease and show features of diffuse alveolar damage on histopathological analysis. The presence of microthrombi in small pulmonary vessels has also been documented, which points towards the hypercoagulable state associated with the disease. A spectrum of histopathological findings are noted in extra-pulmonary organs. Most of these changes are attributed to the systemic effects of elevated cytokine levels, ischemia, and shock. However, different orthogonal approaches (using immunohistochemistry, in-situ hybridization, electron microscopy, and molecular testing) have been used to detect the presence of viral particles in pulmonary as well as extra-pulmonary organs.

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