ORIGINAL ARTICLE

Pulmonary pathological features in coronavirus associated severe acute respiratory syndrome (SARS)

G M-K Tse¹, K-F To¹, P K-S Chan², A W I Lo¹, K-C Ng², A Wu³, N Lee³, H-C Wong¹, S-M Mak⁴, K-F Chan¹, D S C Hui³, J J-Y Sung³, H-K Ng¹

¹ Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Hong Kong SAR
² Department of Microbiology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR
³ Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR
⁴ Department of Pathology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR

Correspondence to:
Correspondence to:
Professor K-F To
Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, NT, Hong Kong SAR, China; kfto{at}cuhk.edu.hk

Background: Severe acute respiratory syndrome (SARS) became a worldwide outbreak with a mortality of 9.2%. This new human emergent infectious disease is dominated by severe lower respiratory illness and is aetiologically linked to a new coronavirus (SARS-CoV).

Methods: Pulmonary pathology and clinical correlates were investigated in seven patients who died of SARS in whom there was a strong epidemiological link. Investigations include a review of clinical features, morphological assessment, histochemical and immunohistochemical stainings, ultrastructural study, and virological investigations in postmortem tissue.

Results: Positive viral culture for coronavirus was detected in most premortem nasopharyngeal aspirate specimens (five of six) and postmortem lung tissues (two of seven). Viral particles, consistent with coronavirus, could be detected in lung pneumocytes in most of the patients. These features suggested that pneumocytes are probably the primary target of infection. The pathological features were dominated by diffuse alveolar damage, with the presence of multinucleated pneumocytes. Fibrogranulation tissue proliferation in small airways and airspaces (bronchiolitis obliterans organising pneumonia-like lesions) in subpleural locations was also seen in some patients.

Conclusions: Viable SARS-CoV could be isolated from postmortem tissues. Postmortem examination allows tissue to be sampled for virological investigations and ultrastructural examination, and when coupled with the appropriate lung morphological changes, is valuable to confirm the diagnosis of SARS-CoV, particularly in clinically unapparent or suspicious but unconfirmed cases.

Keywords: pulmonary; severe acute respiratory syndrome; coronavirus

Abbreviations: BOOP, bronchiolitis obliterans organising pneumonia; CMV, cytomegalovirus; CoV, coronavirus; CXR, chest x ray; DAD, diffuse alveolar damage; EM, electron microscopy; HSV, herpes simplex virus; SARS, severe acute respiratory syndrome

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