Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States

• Published in: Emerging infectious diseases Vol. 26; no. 9; pp. 2005 - 2015
• Main Authors: Martines, Roosecelis B, Ritter, Jana M, Matkovic, Eduard, Gary, Joy, Bollweg, Brigid C, Bullock, Hannah, Goldsmith, Cynthia S, Silva-Flannery, Luciana, Seixas, Josilene N, Reagan-Steiner, Sarah, Uyeki, Timothy, Denison, Amy, Bhatnagar, Julu, Shieh, Wun-Ju, Zaki, Sherif R
• Format: Journal Article
• Language: English
• Published: United States U.S. National Center for Infectious Diseases 01-09-2020; Centers for Disease Control and Prevention
• Subjects: Aged; B cells; Betacoronavirus - pathogenicity; coronavirus; Coronavirus Infections - pathology; Coronavirus Infections - virology; Coronaviruses; COVID-19; Epidemics; Female; Health aspects; histopathology; Humans; Immunohistochemistry; Long term care; Long term care facilities; Lung - pathology; Lung - virology; Male; Microscopy, Electron; Middle Aged; Middle East respiratory syndrome; Pandemics; pathology; Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States; Pneumonia, Viral - pathology; Pneumonia, Viral - virology; Prevention; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; United States - epidemiology; Viruses; United States; United States > US; viruses; pathology; diffuse alveolar damage; histopathology; coronavirus; zoonoses; respiratory infections; COVID-19; SARS-CoV-2; severe acute respiratory syndrome coronavirus 2; electron microscopy; 2019 novel coronavirus disease; coronavirus disease; immunohistochemistry
• ISSN: 1080-6040; 1080-6059
• DOI: 10.3201/eid2609.202095

An ongoing pandemic of coronavirus disease (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Characterization of the histopathology and cellular localization of SARS-CoV-2 in the tissues of patients with fatal COVID-19 is critical to further understand its pathogenesis and transmission and for public health prevention measures. We report clinicopathologic, immunohistochemical, and electron microscopic findings in tissues from 8 fatal laboratory-confirmed cases of SARS-CoV-2 infection in the United States. All cases except 1 were in residents of long-term care facilities. In these patients, SARS-CoV-2 infected epithelium of the upper and lower airways with diffuse alveolar damage as the predominant pulmonary pathology. SARS-CoV-2 was detectable by immunohistochemistry and electron microscopy in conducting airways, pneumocytes, alveolar macrophages, and a hilar lymph node but was not identified in other extrapulmonary tissues. Respiratory viral co-infections were identified in 3 cases; 3 cases had evidence of bacterial co-infection.