Macromorphology findings of 11 Covid-19 patients reveals involvement of multiple organs. (a) Pneumonectomy of patient one showed strong congestion with liquids and hemorrhages. The tissue consistency was fragile. (b) Cut surface of lung tissue in higher magnification as shown in (a). The pleura shows further hemorrhages. (c) Pneumonectomy of patient seven showed a more solid lung tissue without congestion. The tissue consistency was very firm. (d) Cut surface of lung tissue in higher magnification as shown in (c). Lung tissue was retracted adjacent to the bronchus. (e) Pale pleura visceralis of the lung of patient 6 with disseminated hemorrhages and signs of disturbed ventilation. (f) Nodular transformation of lung tissue as phenomenon of fungal superinfection in patient 3. (g) Hemorrhagic lung infarct in patient 4 due to a thrombembolus in a pulmonary artery branch. (h) Anemic spleen infarct due to a clotted small artery in patient 4. (i) Fulminant stasis and thromboses in the periprostatic plexus in patient 4. (j) Cerebellar infarction (hemorrhagic) in patient 9.

Image source: Deinhardt-Emmer et al., eLife 2021 (CC BY 4.0)

---

“Clinical observations suggest that Covid-19 is a systemic disease, meaning that it affects the entire body rather than just a single organ such as the lungs,” explains co-first author Stefanie Deinhardt-Emmer, Resident in Medical Microbiology, Jena University Hospital, Jena, Germany. “But we don’t currently have a clear understanding of disease development in humans and other organisms, due to the lack of appropriate experimental models. Investigating the viral distribution of SARS-CoV-2 within the human body and how this relates to tissue damage would help us address this gap.” To do this, Deinhardt-Emmer and colleagues studied 11 autopsy cases of patients with Covid-19. They performed the autopsies at the early postmortem stage to minimise bias due to the degradation of tissues and viral ribonucleic acid (RNA – a molecule similar to DNA).

Their analysis revealed high viral loads in most of the patients’ lungs, which had caused significant damage to those organs. Using an imaging technique called transmission electron microscopy, the team also visualised intact viral particles in the lung tissue. “Interestingly, we also detected SARS-CoV-2 RNA throughout various other tissues and organs unrelated to the lungs that did not cause visible tissue damage,” says co-first author Daniel Wittschieber, Senior Forensic Pathologist at Jena University Hospital. The researchers say that this distribution of viral RNA throughout the body supports the idea that our immune system is unable to respond adequately to the virus’ presence in the blood. 

“We show that Covid-19 is a systemic disease as determined by the presence of virus RNA, and yet unrelated to tissue damage outside the lungs,” says co-senior author Bettina Löffler, Director of the Institute for Medical Microbiology, Jena University Hospital. “To our knowledge, this study is the only one to date that has measured viral loads in a wide variety of organs and tissues, with more than 60 samples studied per patient.”

“The insights gathered from our work may add to our understanding of how Covid-19 develops in the body following infection,” concludes co-senior author Gita Mall, Head of the Institute of Forensic Medicine, Jena University Hospital.

Source: Jena University Hospital