Association of myocarditis with SARS CoV-2 in confirmed four COVID-19 autopsy cases.
ESCMID eAcademy. Ziyade N. 03/02/23; 376024
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While coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract, pathophysiological changes of the cardiovascular system remain to be elucidated. Although the lung is seen as the main target organ affected by SARS-CoV-2, other organs are also damaged. Coronavirus disease-2019 (COVID-19) affects many organs in the body, including the heart. One complication of particular concern is inflammation of the heart muscle, called myocarditis. We present four cases of Covid-19 myocarditis due to SARS-Cov-2 in postmortem. Two cases were 41-year-old man, third case was 53-year-old woman and fourth case was 55 year-old man.The first 3 cases were sudden death cases. The fourth case had 8 months of hospitalization. We performed macroscopic, histopathological and microbiological analysis of 4 cases; and detected Sars-Cov-2 RNA by RT-PCR in the cardiac tissue samples. In the microscopic examination of the hearts of all cases, mixed type inflammatory cell infiltration accompanied by myocyte damage was observed between the muscle fibers, although various differences were detected. In three cases, SARS CoV-2 PCR was positive in the tracheal swab sample taken before the autopsy, while it was negative in one case. All cases were reported as the person's death as a result of Covid-19 myocarditis. In conclusion, this case reports thus gives new insight in the pathogenesis of SARS-CoV-2-induced myocarditis and emphasizes on the importance and reliability of post-mortem analyses in order to better understand the physiopathology of this worldwide spreading new viral disease.
While coronavirus disease 2019 (COVID-19) primarily affects the respiratory tract, pathophysiological changes of the cardiovascular system remain to be elucidated. Although the lung is seen as the main target organ affected by SARS-CoV-2, other organs are also damaged. Coronavirus disease-2019 (COVID-19) affects many organs in the body, including the heart. One complication of particular concern is inflammation of the heart muscle, called myocarditis. We present four cases of Covid-19 myocarditis due to SARS-Cov-2 in postmortem. Two cases were 41-year-old man, third case was 53-year-old woman and fourth case was 55 year-old man.The first 3 cases were sudden death cases. The fourth case had 8 months of hospitalization. We performed macroscopic, histopathological and microbiological analysis of 4 cases; and detected Sars-Cov-2 RNA by RT-PCR in the cardiac tissue samples. In the microscopic examination of the hearts of all cases, mixed type inflammatory cell infiltration accompanied by myocyte damage was observed between the muscle fibers, although various differences were detected. In three cases, SARS CoV-2 PCR was positive in the tracheal swab sample taken before the autopsy, while it was negative in one case. All cases were reported as the person's death as a result of Covid-19 myocarditis. In conclusion, this case reports thus gives new insight in the pathogenesis of SARS-CoV-2-induced myocarditis and emphasizes on the importance and reliability of post-mortem analyses in order to better understand the physiopathology of this worldwide spreading new viral disease.
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7. Aytul Bugra et al. Postmortem pathological changes in extrapulmonary organs in SARS‑CoV‑2 rt‑PCR–positive cases: a single‑center experience. Ir J Med Sci 2022 Feb;191(1):81-91.
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2. Ana Ferrer-Gómez, et al. Late Cardiac Pathology in Severe Covid-19. A Postmortem Series of 30 Patients. Front Cardiovasc Med 2021 Oct 15;8:748396.
3. Lindner D, et al. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases .JAMA Cardiol. 2020. Nov 1;5(11):1281-1285.
4. Marc K Halushka et al. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc Pathol Jan-Feb 2021;50:107300.
5. E S Romanova et al. Cause of death based on systematic post-mortem studies in patients with positive SARS-CoV-2 tissue PCR during the COVID-19 pandemic. J Intern Med 2021 Sep;290(3):655-665.
6. Jasmin D Haslbauer et al. Characterisation of cardiac pathology in 23 autopsies of lethal COVID-19. J Pathol Clin Res. 2021 Jul;7(4):326-337.
7. Aytul Bugra et al. Postmortem pathological changes in extrapulmonary organs in SARS‑CoV‑2 rt‑PCR–positive cases: a single‑center experience. Ir J Med Sci 2022 Feb;191(1):81-91.
8. Arslan MN et al. COVID‑19 autopsies of Istanbul. Ir J Med Sci. 2022 Apr;191(2):529-541.
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