Journal Article

In situ detection of SARS-CoV-2 in lungs and airways of patients with COVID-19

Sholl, Lynette M., Solomon, Isaac H., Hornick, Jason L., Schaefer, Inga-Marie, Padera, Robert F., Hammer, Mark M., Kanjilal, Sanjat

2020

Overview

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has led to a global public health crisis. In elderly individuals and those with comorbidities, COVID-19 is associated with high mortality, frequently caused by acute respiratory distress syndrome. We examine in situ expression of SARS-CoV-2 in airways and lung obtained at autopsy of individuals with confirmed COVID-19 infection. Seven autopsy cases (male, N = 5; female, N = 2) with reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection and a median age of 66 years (range, 50–77 years) were evaluated using a rabbit polyclonal antibody against SARS Nucleocapsid protein in correlation with clinical parameters. The median time from symptom onset to death was 9 days (range, 6–31 days), from hospitalization 7 days (range, 1–21 days), from positive RT-PCR 7 days (range, 0–18 days), and from intensive care unit admission defining onset of respiratory failure 3 days (range, 1–18 days). Chest imaging identified diffuse airspace disease in all patients corresponding to acute and (N = 5) or organizing (N = 2) diffuse alveolar damage (DAD) on histologic examination. Among five patients with acute-phase DAD (≤7 days from onset of respiratory failure), SARS-CoV-2 was detected in pulmonary pneumocytes and ciliated airway cells (N = 5), and in upper airway epithelium (N = 2). In two patients with organizing DAD (>14 days from onset of respiratory failure), no virus was detected in lungs or airways. No endothelial cell infection was observed. The findings suggest that SARS-CoV-2 infection of epithelial cells in lungs and airways of patients with COVID-19 who developed respiratory failure can be detected during the acute phase of lung injury and is absent in the organizing phase.

• Publisher: Elsevier Inc,Nature Publishing Group US,Elsevier Limited
• Subject: 14 / 14/63 / 692/420/254 / 692/699/255/2514 / 82 / 82/51 / Aged / Alveoli / Autopsy / Betacoronavirus - isolation & purification / Coronavirus Infections - pathology / Coronavirus Infections - virology / Coronaviruses / COVID-19 / Endothelial cells / Epithelial cells / Epithelium / Female / Humans / Infections / Laboratory Medicine / Lungs / Male / Medicine / Medicine & Public Health / Middle Aged / Nucleocapsids / Pandemics / Pathology / Pneumocytes / Pneumonia, Viral - pathology / Pneumonia, Viral - virology / Polyclonal antibodies / Polymerase chain reaction / Public health / Respiratory distress syndrome / Respiratory failure / Respiratory System - pathology / Respiratory System - virology / Respiratory tract / Reverse Transcriptase Polymerase Chain Reaction / RNA-directed DNA polymerase / SARS-CoV-2 / Severe Acute Respiratory Syndrome - pathology / Severe Acute Respiratory Syndrome - virology / Severe acute respiratory syndrome coronavirus 2