Scientia et Securitas
Volume/Issue:
Volume 2: Issue 1
A COVID–19 patológiája.
Halálok SARS-CoV-2-fertőzésben: vírusfertőzésben vagy vírusfertőzéssel?
Authors:
Zsuzsa Schaff Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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Krisztina Danics Semmelweis Egyetem, Igazságügyi és Biztosítás-orvostani Intézet, Budapest, Magyarország; Semmelweis University, Department of Forensic and Insurance Medicine, Budapest, Hungary

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Adrián Pesti Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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Gábor Lotz Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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Tibor Várkonyi Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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Deján Dobi Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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István Vályi-Nagy Dél-pesti Centrumkórház – Országos Hematológiai és Infektológiai Intézet, Budapest, Magyarország; Central Hospital of Southern Pest – Institute of Hematology and Infectious Diseases, Budapest, Hungary

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Klára Törő Semmelweis Egyetem, Igazságügyi és Biztosítás-orvostani Intézet, Budapest, Magyarország; Semmelweis University, Department of Forensic and Insurance Medicine, Budapest, Hungary

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Tibor Glasz Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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András Kiss Semmelweis Egyetem, 2. Sz. Patológiai Intézet, Budapest, Magyarország; Semmelweis University 2nd Department of Pathology, Budapest, Hungary

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Pages:
94–99
Online Publication Date:
30 Jul 2021
Publication Date:
30 Jul 2021
Article Category:
Research Article
DOI:
https://doi.org/10.1556/112.2021.00002
Keywords:
SARS-CoV-2; COVID-19; pathology; autopsy; immunohistochemistry;
Keywords (Hungarian):
SARS-CoV-2; COVID–19; patológia; tüdő; immunhisztokémia;
Open access

Összefoglaló. A SARS-CoV-2-pandémia óta a Semmelweis Egyetemen és egyéb intézményekben rendszeresen végeznek boncolásokat, melyek feltárták a COVID–19 jellegzetességeit. A legsúlyosabb kép a tüdőben mutatkozik, melynek légtelensége változó kiterjedésű, oka összetett, így tüdővizenyő, fehérjében gazdag izzadmány, az erek vérrög okozta elzáródása és gyulladás. A szív, a vese, az agy és a máj változó mértékben érintett, érrögösödés, elhalás, degeneratív elváltozások mutatkoznak. A SARS-CoV-2-vírus fehérjéi (tüske, nukleokapszid) és a vírus genetikai anyaga (RNS) kimutatható az egyes szervekben, leginkább a tüdőben. Klinikopatológiai elemzéssel megállapítható, hogy a halál a SARS-CoV-2-fertőzés mint közvetlen kórok következménye, vagy egyéb krónikus megbetegedés, melyet súlyosbított a SARS-CoV-2-fertőzés, vagy a halál a vírusfertőzéstől függetlenül következett be.

Summary. Since the beginning of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic with substantial mortality, serial autopsies at the Semmelweis University Budapest Hungary and other institutions revealed the most characteristic pathological changes and cause of death of patients in Coronavirus Disease-19 (COVID-19). The virus primarily affects the respiratory system and the most severe alterations can be seen in the lungs. The most characteristic changes, however, are non-specific, as the atelectasis of various extents and severe congestion. The alveoli are filled with edema fluid, protein-rich alveolar exudates, often forming hyalin membranes. Diffuse alveolar damage (DAD) can be noted, which have exudative and fibroproliferative forms. The desquamated alveolar epithelial and inflammatory cells which fill the alveolar spaces further block the oxygen transportation, causing hypoxia and induces ventilation problems. Vascular thrombosis and emboli coming from thrombotic vessels from other organs, might involve the small and larger vessels are common findings in COVID-19 sometimes associated with vasculitis. Extended hemorrhages and giant cells are common findings too. Superimposed bacterial infection might cause purulent bronchopneumonia. Aspiration pneumonia, in which remnant of food and parts of filters etc might be present in the bronchi, causing acute bronchopneumonia, occurs specially in intubated patients. Other organs such as the heart, kidneys, the central nervous system and the liver are similarly, though less severely involved by thrombosis, necrotic and degenerative changes. Myocardial fibrosis is common, however usually associated with previous chronic diseases similarly to the findings in the kidneys. Liver steatosis is common, partly as the result of infection, however treatment and previous liver diseases could be in the background too. Smaller and larger cerebral bleedings, cerebral infarcts of various sizes are detected often. The protein components (spike and nucleocapside) of the SARS-CoV-2 could be demonstrated by immunohistochemical methods and the RNA genome of the SARS-CoV-2 by in situ hybridization in several organs, with highest amounts in the lungs. Clinicopathological analyses effectively determine whether the cause of death in SARS-CoV-2 infection had been the direct result of the infection, or any other previously known chronic disease, which had been superposed by the viral infection. However, in certain cases, the death might not be associated with the SARS-CoV-2 infection. The correct determination of the cause of death of the patients with COVID-19 is by consultation between clinicians and pathologists.

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Scientia et Securitas
Online ISSN:
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Scientia et Securitas
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