Neuropathology of patients with COVID-19 in Germany: a post-mortem case series

被引:905
作者
Matschke, Jakob [1 ]
Luetgehetmann, Marc [2 ,10 ]
Hagel, Christian [1 ]
Sperhake, Jan P. [3 ]
Schroeder, Ann Sophie [3 ]
Edler, Carolin [3 ]
Mushumba, Herbert [3 ]
Fitzek, Antonia [3 ]
Allweiss, Lena [4 ]
Dandri, Maura [4 ,10 ]
Dottermusch, Matthias [1 ]
Heinemann, Axel [3 ]
Pfefferle, Susanne [2 ]
Schwabenland, Marius [7 ]
Magruder, Daniel Sumner [5 ]
Bonn, Stefan [5 ,11 ]
Prinz, Marco [7 ,8 ,9 ]
Gerloff, Christian [6 ]
Pueschel, Klaus [3 ]
Krasemann, Susanne [1 ]
Aepfelbacher, Martin [2 ]
Glatzel, Markus [1 ]
机构
[1] Univ Med Ctr Hamburg Eppendorf, Inst Neuropathol, D-20246 Hamburg, Germany
[2] Univ Med Ctr Hamburg Eppendorf, Inst Med Microbiol Virol & Hyg, Hamburg, Germany
[3] Univ Med Ctr Hamburg Eppendorf, Inst Legal Med, Hamburg, Germany
[4] Univ Med Ctr Hamburg Eppendorf, Dept Med 1, Hamburg, Germany
[5] Univ Med Ctr Hamburg Eppendorf, Inst Med Syst Biol, Hamburg, Germany
[6] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Hamburg, Germany
[7] Univ Freiburg, Fac Med, Inst Neuropathol, Freiburg, Germany
[8] Univ Freiburg, Fac Med, Ctr Basics Neuromodulat, Freiburg, Germany
[9] Univ Freiburg, Signaling Res Ctr BIOSS & CIBSS, Freiburg, Germany
[10] Ctr Infect Res, Partner Site Hamburg Borstel Lubeck Riems, Lubeck, Germany
[11] German Ctr Neurodegenerat Dis, Tubingen, Germany
关键词
SARS-COV-2; PATHOGENESIS; INFECTION;
D O I
10.1016/S1474-4422(20)30308-2
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Prominent clinical symptoms of COVID-19 include CNS manifestations. However, it is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, gains access to the CNS and whether it causes neuropathological changes. We investigated the brain tissue of patients who died from COVID-19 for glial responses, inflammatory changes, and the presence of SARS-CoV-2 in the CNS. Methods In this post-mortem case series, we investigated the neuropathological features in the brains of patients who died between March 13 and April 24, 2020, in Hamburg, Germany. Inclusion criteria comprised a positive test for SARS-CoV-2 by quantitative RT-PCR (qRT-PCR) and availability of adequate samples. We did a neuropathological workup including histological staining and immunohistochemical staining for activated astrocytes, activated microglia, and cytotoxic T lymphocytes in the olfactory bulb, basal ganglia, brainstem, and cerebellum. Additionally, we investigated the presence and localisation of SARS-CoV-2 by qRT-PCR and by immunohistochemistry in selected patients and brain regions. Findings 43 patients were included in our study. Patients died in hospitals, nursing homes, or at home, and were aged between 51 years and 94 years (median 76 years [IQR 70-86]). We detected fresh territorial ischaemic lesions in six (14%) patients. 37 (86%) patients had astrogliosis in all assessed regions. Activation of microglia and infiltration by cytotoxic T lymphocytes was most pronounced in the brainstem and cerebellum, and meningeal cytotoxic T lymphocyte infiltration was seen in 34 (79%) patients. SARS-CoV-2 could be detected in the brains of 21 (53%) of 40 examined patients, with SARS-CoV-2 viral proteins found in cranial nerves originating from the lower brainstem and in isolated cells of the brainstem. The presence of SARS-CoV-2 in the CNS was not associated with the severity of neuropathological changes. Interpretation In general, neuropathological changes in patients with COVID-19 seem to be mild, with pronounced neuroinflammatory changes in the brainstem being the most common finding. There was no evidence for CNS damage directly caused by SARS-CoV-2. The generalisability of these findings needs to be validated in future studies as the number of cases and availability of clinical data were low and no age-matched and sex-matched controls were included.
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收藏
页码:919 / 929
页数:11
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