Shortness of breath, fever, dry cough...many people are aware of the symptoms of COVID-19, but what about the pathology of the virus? Data is only beginning to emerge regarding pathology of the COVID-19 virus. In this blog post, we’ll point out some research approaches regarding the pathology of COVID-19 and briefly review some initial findings from a sampling of studies.
COVID-19 has been investigated in both living and deceased patients infected with the virus. The studies we are highlighting in this blog aimed to determine the mechanism of liver damage caused by COVID-19,1 to examine the histopathology of COVID-19 pneumonia2 and to compare the temporal evolution of pulmonary involvement between recovered and deceased patients with COVID-19.3
Researchers have taken a few approaches to investigate the pathology of COVID-19 including histology of postmortem needle core biopsies,4 postmortem PCR tests from nasopharyngeal or lung tissue swabs,5 as well as histology from lung resections on actively infected patients.2 Additionally, some medical centers have been able to investigate COVID-19 pathomorphology through complete autopsies and organ dissection.5
So what did these studies find? Pathologic examinations revealed that the lungs of patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells.2 For the liver, current understanding suggests that infection of highly pathogenic human coronavirus may result in liver injury by direct virus‐induced cytopathic effects and/or immunopathology induced by overshooting inflammatory responses.1
Clinical and pathological findings from COVID-19 cases can not only help to identify the root of the disease pathway, but also provide new insights into the pathogenesis of COVID-19-related comorbidities such as pneumonia. Robust pathology investigations might help physicians to formulate a timely therapeutic strategy for severe patients and reduce mortality.6 As this novel virus continues to spread, and more cases and deaths are reported, there will certainly be more studies into the pathology of COVID-19 which we plan to share in future blogs. For now, we’ve cited in this post and assembled a reference list for a sampling of initial studies that used a pathology approach to investigate lung and liver damage related to COVID-19.
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1 Xu L, Liu J, Lu M, Yang D, Zheng X. Liver injury during highly pathogenic human coronavirus infections. Liver Int. 2020;40(5):998-1004.
2 Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer. J Thorac Oncol. 2020;15(5):700-704.
3 Pan F, Zheng C, Ye T, et al. Different computed tomography patterns of Coronavirus Disease 2019 (COVID-19) between survivors and non-survivors. Sci Rep. 2020;10(1):11336. Published 2020 Jul 9.
4 Tian, S., Xiong, Y., Liu, H. et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol 33, 1007–1014 (2020).
5 Edler C, Schröder AS, Aepfelbacher M, et al. Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany [published correction appears in Int J Legal Med. 2020 Jun 19;:]. Int J Legal Med. 2020;134(4):1275-1284.
6 Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome [published correction appears in Lancet Respir Med. 2020 Feb 25;:]. Lancet Respir Med. 2020;8(4):420-422.