Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19—experiences of a longitudinal series of 92 patients
Minimally invasive autopsies (MIAs) allow the collection of tissue samples for diagnostic and research purposes in special situations, e.g., when there is a high risk of infection which is the case in the context of COVID-19 or restrictions due to legal or personal reasons. We performed MIA to analy...
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| Veröffentlicht in: | Virchows Archiv : an international journal of pathology 2023-11, Vol.483 (5), p.611-619 |
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| creator | Noack, Petar Grosse, Claudia Bodingbauer, Jacob Almeder, Marion Lohfink-Schumm, Sylvia Salzer, Helmut J.F. Meier, Jens Lamprecht, Bernd Schmitt, Clemens A. Langer, Rupert |
| description | Minimally invasive autopsies (MIAs) allow the collection of tissue samples for diagnostic and research purposes in special situations, e.g., when there is a high risk of infection which is the case in the context of COVID-19 or restrictions due to legal or personal reasons. We performed MIA to analyze lung tissue from 92 COVID-19 patients (mean age 78 years; range 48–98; 35 women, 57 men), representing 44% of all patients who died from the disease between October 2020 and April 2021. An intercostal approach was used with removal of a 5-cm rib section followed by manual collection of four lung tissue samples (5–8 cm in size). Diffuse alveolar damage (DAD) was found in 89 (97%) patients at various stages. Exudative DAD (eDAD) predominated in 18 (20%) patients, proliferative DAD (pDAD) in 43 (47%) patients, and mixed DAD (mDAD) in 31 (34%) patients. There were no significant differences in the predominant DAD pattern between tissue samples from the same patient. Additional purulent components were present in 46 (50%) cases. Fungi were detected in 11 (12%) patients. The pDAD pattern was associated with longer hospital stay including intensive care unit (
p
=0.026 and
p |
| doi_str_mv | 10.1007/s00428-023-03622-6 |
| format | Article |
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p
=0.026 and
p
<0.001) and younger age (
p
=0.019). Positive bronchoalveolar lavage and blood cultures were observed more frequently in pDAD patterns (
p
<0.001;
p
=0.018). In contrast, there was no significant association between intravital positive microbiological results and superimposed bronchopneumonia or fungal infection at autopsy. Having demonstrated the characteristic lung changes in a large longitudinal autopsy series, we conclude that the presented MIA approach can be considered a reliable and safe method for performing post mortem lung diagnostics in COVID-19 and other high-risk situations. The lack of correlation between histological changes indicative of bacterial or fungal superinfection and microbiology could have clinical implications for disease and treatment surveillance.</description><identifier>ISSN: 0945-6317</identifier><identifier>EISSN: 1432-2307</identifier><identifier>DOI: 10.1007/s00428-023-03622-6</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alveoli ; Autopsies ; Autopsy ; Bronchopneumonia ; Bronchus ; COVID-19 ; Exudation ; Fatalities ; Fungi ; Health risks ; Lavage ; Lungs ; Medicine ; Medicine & Public Health ; Microbiology ; Original Article ; Pathology ; Patients ; Superinfection ; Viral diseases</subject><ispartof>Virchows Archiv : an international journal of pathology, 2023-11, Vol.483 (5), p.611-619</ispartof><rights>The Author(s) 2023</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c347t-62707b576cd2a96d4312e3d2a87fabe587ecfc0904ebcd5d821f80e2fa5613c73</cites><orcidid>0000-0001-9491-3609</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00428-023-03622-6$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00428-023-03622-6$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids></links><search><creatorcontrib>Noack, Petar</creatorcontrib><creatorcontrib>Grosse, Claudia</creatorcontrib><creatorcontrib>Bodingbauer, Jacob</creatorcontrib><creatorcontrib>Almeder, Marion</creatorcontrib><creatorcontrib>Lohfink-Schumm, Sylvia</creatorcontrib><creatorcontrib>Salzer, Helmut J.F.</creatorcontrib><creatorcontrib>Meier, Jens</creatorcontrib><creatorcontrib>Lamprecht, Bernd</creatorcontrib><creatorcontrib>Schmitt, Clemens A.</creatorcontrib><creatorcontrib>Langer, Rupert</creatorcontrib><title>Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19—experiences of a longitudinal series of 92 patients</title><title>Virchows Archiv : an international journal of pathology</title><addtitle>Virchows Arch</addtitle><description>Minimally invasive autopsies (MIAs) allow the collection of tissue samples for diagnostic and research purposes in special situations, e.g., when there is a high risk of infection which is the case in the context of COVID-19 or restrictions due to legal or personal reasons. We performed MIA to analyze lung tissue from 92 COVID-19 patients (mean age 78 years; range 48–98; 35 women, 57 men), representing 44% of all patients who died from the disease between October 2020 and April 2021. An intercostal approach was used with removal of a 5-cm rib section followed by manual collection of four lung tissue samples (5–8 cm in size). Diffuse alveolar damage (DAD) was found in 89 (97%) patients at various stages. Exudative DAD (eDAD) predominated in 18 (20%) patients, proliferative DAD (pDAD) in 43 (47%) patients, and mixed DAD (mDAD) in 31 (34%) patients. There were no significant differences in the predominant DAD pattern between tissue samples from the same patient. Additional purulent components were present in 46 (50%) cases. Fungi were detected in 11 (12%) patients. The pDAD pattern was associated with longer hospital stay including intensive care unit (
p
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p
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p
=0.019). Positive bronchoalveolar lavage and blood cultures were observed more frequently in pDAD patterns (
p
<0.001;
p
=0.018). In contrast, there was no significant association between intravital positive microbiological results and superimposed bronchopneumonia or fungal infection at autopsy. Having demonstrated the characteristic lung changes in a large longitudinal autopsy series, we conclude that the presented MIA approach can be considered a reliable and safe method for performing post mortem lung diagnostics in COVID-19 and other high-risk situations. The lack of correlation between histological changes indicative of bacterial or fungal superinfection and microbiology could have clinical implications for disease and treatment surveillance.</description><subject>Alveoli</subject><subject>Autopsies</subject><subject>Autopsy</subject><subject>Bronchopneumonia</subject><subject>Bronchus</subject><subject>COVID-19</subject><subject>Exudation</subject><subject>Fatalities</subject><subject>Fungi</subject><subject>Health risks</subject><subject>Lavage</subject><subject>Lungs</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microbiology</subject><subject>Original Article</subject><subject>Pathology</subject><subject>Patients</subject><subject>Superinfection</subject><subject>Viral 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Rupert</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19—experiences of a longitudinal series of 92 patients</atitle><jtitle>Virchows Archiv : an international journal of pathology</jtitle><stitle>Virchows Arch</stitle><date>2023-11-01</date><risdate>2023</risdate><volume>483</volume><issue>5</issue><spage>611</spage><epage>619</epage><pages>611-619</pages><issn>0945-6317</issn><eissn>1432-2307</eissn><abstract>Minimally invasive autopsies (MIAs) allow the collection of tissue samples for diagnostic and research purposes in special situations, e.g., when there is a high risk of infection which is the case in the context of COVID-19 or restrictions due to legal or personal reasons. 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p
=0.026 and
p
<0.001) and younger age (
p
=0.019). Positive bronchoalveolar lavage and blood cultures were observed more frequently in pDAD patterns (
p
<0.001;
p
=0.018). In contrast, there was no significant association between intravital positive microbiological results and superimposed bronchopneumonia or fungal infection at autopsy. Having demonstrated the characteristic lung changes in a large longitudinal autopsy series, we conclude that the presented MIA approach can be considered a reliable and safe method for performing post mortem lung diagnostics in COVID-19 and other high-risk situations. The lack of correlation between histological changes indicative of bacterial or fungal superinfection and microbiology could have clinical implications for disease and treatment surveillance.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><doi>10.1007/s00428-023-03622-6</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9491-3609</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Alveoli Autopsies Autopsy Bronchopneumonia Bronchus COVID-19 Exudation Fatalities Fungi Health risks Lavage Lungs Medicine Medicine & Public Health Microbiology Original Article Pathology Patients Superinfection Viral diseases |
| title | Minimally invasive autopsies for the investigation of pulmonary pathology of COVID-19—experiences of a longitudinal series of 92 patients |
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