Pathological diagnosis of Coronavirus-related nephropathy: insight from postmortem studies

Abstract Background Limited clinical data suggest ~16% prevalence of bacterial superinfections among critically ill patients with coronavirus disease 2019 (COVID-19). Methods We reviewed postmortem studies of patients with COVID-19 published in English through 26 September 2020 for histopathologic findings consistent with bacterial lung infections. Results Worldwide, 621 patients from 75 studies were included. The quality of data was uneven, likely because identifying superinfections was not a major objective in 96% (72/75) of studies. Histopathology consistent with potential lung superinfection was reported in 32% (200/621) of patients (22-96 years old; 66% men). Types of infections were pneumonia (95%), abscesses or empyema (3.5%), and septic emboli (1.5%). Seventy-three percent of pneumonias were focal rather than diffuse. Predominant histopathologic findings were intra-alveolar neutrophilic infiltrations that were distinct from those typical of COVID-19-associated diffuse alveolar damage. In studies with available data, 79% of patients received antimicrobial treatment; most common agents were beta-lactam/beta-lactamase inhibitors (48%), macrolides (16%), cephalosoprins (12%), and carbapenems (6%). Superinfections were proven by direct visualization or recovery of bacteria in 25.5% (51/200) of potential cases, and 8% of all patients in postmortem studies. In rank order, pathogens included Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae. Lung superinfections were causes of death in 16% of potential cases, and 3% of all patients with COVID-19. Conclusions Potential bacterial lung superinfections were evident at postmortem examination in 32% of persons who died with COVID-19 (proven, 8%; possible, 24%), but they were uncommonly the cause of death.

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367 Effect of waiting time from pathological diagnosis to definitive concurrent chemoradiation (CCRT) for cervical cancer on overall survival

10.1136/ijgc-2020-igcs.317 ◽

2020 ◽

Author(s):

H Yeo ◽

K Noh ◽

Y Lee ◽

CH Choi ◽

T Kim ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Waiting Time ◽

Pathological Diagnosis ◽

Concurrent Chemoradiation

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Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

BMC Infectious Diseases ◽

10.1186/s12879-021-06245-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Arsénia J. Massinga ◽

Marcelino Garrine ◽

Augusto Messa ◽

Nélio A. Nobela ◽

Nadia Boisen ◽

...

Keyword(s):

Antimicrobial Susceptibility ◽

Case Fatality ◽

Multidrug Resistant ◽

Childhood Mortality ◽

Fatal Disease ◽

Appropriate Treatment ◽

Antimicrobial Resistance Profile ◽

Postmortem Blood ◽

Postmortem Studies ◽

Klebsiella Spp

Abstract Background Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children. Methods Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR. Results Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75). Conclusion Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control.

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Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

Pathogens ◽

10.3390/pathogens10040412 ◽

2021 ◽

Vol 10 (4) ◽

pp. 412

Author(s):

Natalia Rakislova ◽

Lorena Marimon ◽

Mamudo R. Ismail ◽

Carla Carrilho ◽

Fabiola Fernandes ◽

...

Keyword(s):

Minimally Invasive ◽

Cause Of Death ◽

Diffuse Alveolar Damage ◽

The Body ◽

Protective Equipment ◽

Safe Alternative ◽

Minimally Invasive Autopsy ◽

Postmortem Studies ◽

Death Investigation ◽

Insight Into

Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, b) compare the performance of MIA versus complete autopsy, and c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.

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Is There Pathological Uniformity between the Periphery and Center of a Gastrointestinal Stromal Tumor?

Journal of Clinical Medicine ◽

10.3390/jcm10040687 ◽

2021 ◽

Vol 10 (4) ◽

pp. 687

Author(s):

Seong Ji Choi ◽

Kwan Hong Lee ◽

Chan Kyoo Yoo ◽

Jai Hoon Yoon ◽

Ki Seok Jang ◽

...

Keyword(s):

Risk Stratification ◽

Mitotic Index ◽

High Power ◽

Malignant Potential ◽

Mitotic Count ◽

Pathological Diagnosis ◽

High Power Field ◽

Gastric Gists ◽

Significant Difference ◽

The Mean

Background: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. In general, endoscopic ultrasound-guided fine-needle aspiration and deep biopsy are used for pathological diagnosis of GIST before making decisions about surgery. This study sought to evaluate the pathological uniformity of gastric GISTs for mitotic index of the center and periphery of the GIST. Methods: We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University Hospital. We used Armed Forces Institute of Pathology criteria to classify gastric GISTs. To determine the pathological uniformity of gastric GISTs, we compared GIST risk stratification between the center and periphery of GISTs. Results: The mean size of GISTs was 3.56 ± 2.10 cm. Three lesions were located in the antrum, 11 in the fundus, 9 in the cardia, and 14 in the body. The mean age of patients was 58.65 ± 9.44 years; 18 patients were male and 19 were female. Thirty-five patients (94.6%) showed the same level of risk stratification between the center and periphery of gastric GISTs, while two patients (5.4%) presented different levels of risk between the two sites. No significant difference in mitotic count was observed between the two sites (kappa value = 0.863; p = 0.001). Conclusions: Mitotic index category (either more than five mitoses per high-power field or five or fewer mitoses per high-power field) of GISTs showed good concurrence between the center and periphery.

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GDNF Therapy: Can We Make It Work?

Journal of Parkinson s Disease ◽

10.3233/jpd-212706 ◽

2021 ◽

pp. 1-4

Author(s):

Anders Björklund

Keyword(s):

Gene Therapy ◽

Transcription Factor ◽

Signaling Pathway ◽

Therapeutic Potential ◽

Threshold Level ◽

New Findings ◽

The Status ◽

Interesting Discussion ◽

Postmortem Studies ◽

Made In

In two recent postmortem studies, Jeffrey Kordower and colleagues report new findings that open up for an interesting discussion on the status of GDNF/NRTN signaling in patients with Parkinson’s disease (PD), adding an interesting perspective on the, admittedly very limited, signs of restorative effects previously seen in GDNF/NRTN-treated patients. Their new findings show that the level of the GDNF signaling receptor Ret is overall reduced by about 65% relative to non-PD controls, and most severely, up to 80%, in nigral neurons containing α-synuclein inclusions, accompanied by impaired signaling downstream of the Ret receptor. Notably, however, the vast majority of the remaining nigral neurons retained a low level of Ret expression, and hence a threshold level of signaling. Further observations made in two patients who had received AAV-NRTN gene therapy 8–10 years earlier suggest the intriguing possibility that NRTN is able to restore Ret expression and upregulate its own signaling pathway. This “wind-up” mechanism, which is likely to depend on an interaction with dopaminergic transcription factor Nurr1, has therapeutic potential and should encourage renewed efforts to turn GDNF/NRTN therapy into success, once the recurring problem of under-dosing is resolved.

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