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Open Access 01-02-2021 | Autopsy | Original Article

Post-mortem viral dynamics and tropism in COVID-19 patients in correlation with organ damage

Authors: Kristijan Skok, Evelyn Stelzl, Michael Trauner, Harald H. Kessler, Sigurd F. Lax

Published in: Virchows Archiv | Issue 2/2021

Abstract

The persistence of SARS-CoV-2 after death of infected individuals is unclear. The aim of this study was to investigate the presence of SARS-CoV-2 RNA in different organs in correlation with tissue damage and post-mortem viral dynamics in COVID-19 deceased. Twenty-eight patients (17 males, 11 females; age 66–96 years; mean 82.9, median 82.5 years) diagnosed with COVID-19 were studied. Swabs were taken post-mortem during autopsy (N = 19) from the throat, both lungs, intestine, gallbladder, and brain or without autopsy (N = 9) only from the throat. Selective amplification of target nucleic acid from the samples was achieved by using primers for ORF1a/b non-structural region and the structural protein envelope E-gene of the virus. The results of 125 post-mortem and 47 ante-mortem swabs were presented as cycle threshold (Ct) values and categorized as strong, moderate, and weak. Viral RNA was detected more frequently in the lungs and throat than in the intestine. Blood, bile, and the brain were negative. Consecutive throat swabs were positive up to 128 h after death without significant increase of Ct values. All lungs showed diffuse alveolar damage, thrombosis, and infarction and less frequently bronchopneumonia irrespective of Ct values. In 30% the intestine revealed focal ischemic changes. Nucleocapsid protein of SARS-CoV-2 was detected by immunohistochemistry in bronchial and intestinal epithelium, bronchial glands, and pneumocytes. In conclusion, viral RNA is still present several days after death, most frequently in the respiratory tract and associated with severe and fatal organ damage. Potential infectivity cannot be ruled out post-mortem.

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Title: Post-mortem viral dynamics and tropism in COVID-19 patients in correlation with organ damage
Authors: Kristijan Skok
Evelyn Stelzl
Michael Trauner
Harald H. Kessler
Sigurd F. Lax
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Autopsy
SARS-CoV-2
COVID-19
Published in: Virchows Archiv / Issue 2/2021
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI: https://doi.org/10.1007/s00428-020-02903-8

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Post-mortem viral dynamics and tropism in COVID-19 patients in correlation with organ damage

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