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Volume 26, Number 9—September 2020
Synopsis

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

Roosecelis B. Martines1Comments to Author , Jana M. Ritter1, Eduard Matkovic, Joy Gary, Brigid C. Bollweg, Hannah Bullock, Cynthia S. Goldsmith, Luciana Silva-Flannery, Josilene N. Seixas, Sarah Reagan-Steiner, Timothy Uyeki, Amy Denison, Julu Bhatnagar, Wun-Ju Shieh, Sherif R. Zaki, and COVID-19 Pathology Working Group
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (R.B. Martines, J.M. Ritter, E. Matkovic, J. Gary, B.C. Bollweg, C.S. Goldsmith, L. Silva-Flannery, J.N. Seixas, S. Reagan-Steiner, T. Uyeki, A. Denison, J. Bhatnagar, W.-J. Shieh, S.R. Zaki); Synergy America Inc., Atlanta (H. Bullock).

Main Article

Table 2

Histopathologic features and severe acute respiratory syndrome coronavirus 2 detection in respiratory tissues from 8 coronavirus disease fatalities*

Patient no. 1 2 3 4 5 6 7 8
Minimum symptom duration, d 13 10 5 13 16 11 12 7
Tracheobronchitis
 ++
 +
 +
 +
 +
 +
 ++
 +
DAD, acute + + ++ ++ – – – +++
DAD, organizing
 +++
 +
 ++
 ++
 +
 +
 –
 +++
Squamous metaplasia + – – + – – – +
Atypical pneumocytes +++ – – + – – – +
Interstitial pneumonitis + – – + – ++ – +
Bronchopneumonia – – + + + – +++ –
Intravascular leukocytosis – – + + + – – –
Anthracosis
 +
 +
 +
 ++
 ++
 ++
 +
 ++
Other lung pathology
 –
 HLM
 Hemorrhage, emphysema, MA
 HLM, MA
 HLM, MA
 Hemorrhage, corpora amylacea
 Hemorrhage, HLM, microthrombi
 Hemorrhage, emphysema
SARS-CoV-2 IHC, upper airway – – – – ** ** * *
SARS-CoV-2 IHC, lung
 –
 +
 +++
 +++
 +++
 +
 ++
 ++
Electron microscopy, viral particles NA NA + + + + NA NA
Other agents detected Influenza B – – Streptococcus spp. PI-3 Streptococcus spp. PI-3 Streptococcus spp.

*DAD, diffuse alveolar damage; HLM, hemosiderin-laden macrophages; IHC, immunohistochemistry; MA, mucus aspiration; NA, not available; PI, parainfluenza; – , not present or negative; +, mild; ++, moderate; +++, extensive.

Main Article

1These authors contributed equally to this article.

2Members of the COVID-19 Pathology Working Group: Rhonda Cole, Amanda Lewis, Pamela Fair, Lindsey Estetter.

Page created: May 21, 2020
Page updated: August 18, 2020
Page reviewed: August 18, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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