ABSTRACT
Objective:
Studies show that in patients diagnosed with Coronavirus disease-2019 (COVID-19), polymerase chain reaction (PCR) tests can give false negative results depending on sampling techniques/regions. In this study; the positivity of virus RNA was studied consecutive lung tru-cut needle biopsy taken at 6-hour intervals in cases who died during treatment due to COVID-19 infection, it was aimed to determine the postmortem safe working range.
Methods:
In May 2020-April 2021, 21 patients who died during treatment due to COVID-19 infection diagnosed with clinical and/or RNA detection in Muğla Training Research Hospital, Anesthesia Intensive Care Unit were included. Antemortem, postmortem swabs results, and virus RNA detection by PCR made from postmortem lung tissue samples were compared with their clinics. Statistical analysis was performed.
Results:
Fifteen (71.4%) of 21 cases were male and 6 (28.6%) were female. The mean age is 71.9 (standard deviation=12.079). All of the toracic CT findings at hospitalization had a ground-glass opacity. The mean hospitalization time was 11.7 days. Antemortem nasopharyngeal virus positivity was shown in 13 cases (61.9%), postmortem nasopharyngeal virus positivity in 5 cases (23.8%), and virus positivity in lung tissue samples in 7 cases (33.3%). No significant correlation was found virus positivity in nasopharyngeal swab and lung tissue sample, the incompatibility rate was 19.1%, which was statistically significant.
Conclusion:
Although the targeted sample size could not be reached due to study limitations, the inconsistency in virus positivity in nasopharyngeal swabs and lung tissue samples is significant. It is certain that studies with a large comparative sample are needed in terms of postmortem survival time, clinical and organ damage caused by the virus.
Keywords: COVID-19, SARS-CoV-2, swab sample, tissue sample, PCR, postmortem
References
1
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-534. http://doi.org/10.1016/S1473-3099(20)30120-1
2
He F, Deng Y, Li W. Coronavirus Disease 2019: What we know?. J Med Virol. 2020;92:719-725. http://doi.org/10.1002/jmv.25766
3
Helmrich E, Decker L, Adolphi N, Makino Y. Postmortem CT lung findings in decedents with Covid-19: A review of 14 decedents and potential triage implications. Forensic Imaging. 2020;23:200419. http://doi.org/10.1016/j.fri.2020.200419
4
WHO press conference on global health issues - 2 June 2023”. https://www.who.int/publications/m/item/virtual-press-conference-on-global-health-issues-transcript---2-june-2023.). Erişim tarihi: 20.06.2023
5
WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/. Erişim tarihi: 20.06.2023.
6
WHO Coronavirus (COVID-19) Global- Türkiye. https://covid19.who.int/region/euro/country/tr. Erişim tarihi: 20.06.2023.
7
Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-1242. http://doi.org/10.1001/jama.2020.2648.
8
COVID-19 Pandemisi’nde Meslek Hastalığı Tanı Kılavuzu. İş ve Meslek Hastalıkları Uzmanları Derneği ve Halk Sağlığı Uzmanları Derneği. 22.03.2020. https://korona.hasuder.org.tr/wp-content/uploads/Mesleksel-COVID_19_Tan%C4%B1_Rehberi_2020.pdf. Erişim tarihi: 20.06.2023.
9
Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol. 2020;73(5):239-242. http://doi.org/10.1136/jclinpath-2020-206522
10
Rakislova N, Marimon L, Ismail MR, Carrilho C, Fernandes F, Ferrando M, et al. Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings. Pathogens. 2021;10(4):412. http://doi.org/10.3390/pathogens10040412
11
Center for Disease Control and Prevention. Clinical Questions about COVID-19: Questions and Answers. 25 June-2020. file:///C:/Users/asus6315/Downloads/cdc_89817_DS1.pdf. Erişim tarihi: 20.06.2023.
12
Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL, et al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PloS One. 2020;15(6):e0234765. http://doi.org/10.1371/journal.pone.0234765.
13
Fineschi V, Aprile A, Aquila I, Arcangeli M, Asmundo A, Bacci M, et al. Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection - Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice. Pathologica. 2020;112(2):64-77. http://doi.org/10.32074/1591-951X-13-20.
14
Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol. 2020;5(4):335-337. http://doi.org/10.1016/S2468-1253(20)30048-0.
15
HSE. The Approved List of biological agents Advisory Committee on Dangerous Pathogens. http://www.hse.gov.uk/pubns/misc208.pdf.
16
Finegan O, Fonseca S, Guyomarc’h P, Morcillo Mendez MD, Rodriguez Gonzalez J, Tidball-Binz M, et al. International Committee of the Red Cross (ICRC): General Guidance for the Management of the Dead Related to COVID-19. Forensic Sci Int Synergy. 2020;2:129-137. http://doi.org/10.1016/j.fsisyn.2020.03.007.
17
Skok K, Vander K, Setaffy L, Kessler HH, Aberle S, Bargfrieder U, et al. COVID-19 autopsies: procedure, technical aspects and cause of fatal course. Experiences from a single-center. Pathol Res Pract. 2021;217:153305. http://doi.org/10.1016/j.prp.2020.153305.
18
Nichols L. Pulmonary arterial thrombosis in COVID-19 with fatal outcome. Ann Intern Med. 2021;174(1):139. http://doi.org/10.7326/L20-1275
19
Skok K, Stelzl E, Trauner M, Kessler HH, Lax SF. Post-mortem viral dynamics and tropism in COVID-19 patients in correlation with organ damage. Virchows Arch. 2021;478(2):343-353. http://doi.org/10.1007/s00428-020-02903-8 /
20
Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis. 2020;20(6):656-657. http://doi.org/10. 1016/S1473-3099(20)30232-2
21
Xiao AT, Tong YX, Zhang S. Profile of RT-PCR for SARS-CoV-2: A Preliminary Study From 56 COVID-19 Patients. Clin Infect Dis. 2020;71(16):2249-2251. http://doi.org/10.1093/cid/ciaa460.
22
Wu Y, Guo C, Tang L, Hong Z, Zhou J, Dong X, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020;5(5):434-435. http:// doi.org/10.1016/S2468-1253(20)30083-2
23
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology. 2020;158(6):1831-1833. http://doi.org/10.1053/j.gastro.2020. 02.055
24
Osborn M, Lucas S, Stewart R, Swift B, Youd E. Briefing on COVID-19. Autopsy practice relating to possible cases of COVID-19 (2019-nCov, novel coronavirus from China 2019/2020). The Royal College of Pathologists. 2019. https://www.rcpath.org/uploads/assets/d5e28baf-5789-4b0f-acecfe370eee6223/fe8fa85a-f004-4a0c-81ee4b2b9cd12cbf/Briefing-on-COVID-19-autopsy-Feb-2020.pdf. Erişim tarihi: 20.06.2023
25
Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. 2020;9(1):29. http://doi.org/10.1186/s40249-020-00646-x
26
Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323:1843-1844. doi:10.1001/jama.2020.3786.
27
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296:32-40. https://doi.org/10.1148/radiol.2020200642.
28
WHO. Coronavirus disease (COVID-19) pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Erişim tarihi: 20.06.2023
29
WHO. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases. Interim guidance 16 March 2020 publications. https://www.who.int/publications/i/item/10665-331501. Erişim tarihi: 20.06.2023
30
Keresztesi AA, Perde F, Ghita-Nanu A, Radu CC, Negrea M, Keresztesi G. Post-Mortem Diagnosis and Autopsy Findings in SARS-CoV-2 Infection: Forensic Case Series. Diagnostics (Basel). 2020;10(12):1070. http://doi.org/10.3390/diagnostics10121070
31
Sperhake JP. Autopsies of COVID-19 deceased? Absolutely! Legal Med (Tokyo). 2020;47:101769. http://doi.org/10.1016/j.legalmed.2020.101769
32
Youd E, Moore L. COVID-19 autopsy in people who died in community settings: the first series. J Clin Pathol. 2020;73(12):840-844. http://dx.doi.org/10.1136/jclinpath-2020-206710
33
Maiese A, Manetti AC, La Russa R, Di Paolo M, Turillazzi E, Frati P, et al. Autopsy findings in COVID-19-related deaths: a literature review. Forensic Scie Med Pathol. 2020;17(2):279-296. http://doi.org/10.1007/s12024-020-00310-8
34
Thailand Reports First Case of COVID-19 Spreading to Forensic Examiner from Deceased. http://www.forensicmag.com/563175-Thailand-Reports-First-Case-of-COVID-19-Spreading-to-Forensic-Examiner-From-Deceased/. Erişim tarihi: 20.06.2023.
35
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. http://doi.org/10.1016/j.jtho.2020.02.010
36
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422. http://doi.org/10.1016/S2213-2600(20)30076-X
37
Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S. COVID-19 Autopsies, Oklahoma, USA. Am J Clin Pathol. 2020;153(6):725-733. http://doi.org/10.1093/ajcp/aqaa062
38
Fox SE, Akmatbekov A, Harbert Jl, Li G, Brown JQ, Heide RSV. Pulmonary and cardiac pathology in Covid-19: the first autopsy series from New Orleans. MedRxiv. 2020. doi: http://doi.org/10.1101/2020.04.06.20050575
39
Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med. 2020;173(4):268-277. http://doi.org/10.7326/M20-2003.
40
Tian S, Xiong Y, Liu H, Niu L, Guo J, Liao M, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol. 2020;33(6):1007-1014. http://doi.org/10.1038/s41379-020-0536-x
41
Fernández-Rodríguez A, Casas I, Culebras E, Morilla E, Cohen MC, Alberola J. COVID-19 and post-mortem microbiological studies. Spanish J Legal Med. 2020;46(3):127-138. http://doi.org/10.1016/j.remle.2020.05.007
