COVID-19 Analysis in Tissue Samples Acquired by Minimally Invasive Autopsy in Out-of-Hospital Deaths with Postmortem Degeneration

• Published in: Japanese Journal of Infectious Diseases Vol. 76; no. 5; pp. 302 - 309
• Main Authors: Hirata, Yuichiro, Makino, Yohsuke, Iida, Shun, Katano, Harutaka, Nagasawa, Sayaka, Rokutan, Hirofumi, Hinata, Munetoshi, Iwasaki, Akiko, Yasunaga, Yoichi, Abe, Hiroyuki, Ikemura, Masako, Motomura, Ayumi, Kira, Kei, Kobayashi, Susumu, Tsuneya, Shigeki, Torimitsu, Suguru, Yamamoto, Isao, Nakagawa, Kimiko, Hasegawa, Iwao, Akitomi, Shinji, Yajima, Daisuke, Ushiku, Tetsuo, Saitoh, Hisako, Suzuki, Tadaki, Iwase, Hirotaro
• Format: Journal Article
• Language: English
• Published: Tokyo National Institute of Infectious Diseases 30.09.2023; Japan Science and Technology Agency
• Subjects: Autopsies; Autopsy; Biopsy; Coronaviruses; COVID-19; Degeneration; Fatalities; Genomes; Hospitals; Immunohistochemistry; Localization; Lungs; minimally invasive autopsy; out-of-hospital death; Pathogenesis; Polymerase chain reaction; postmortem change; Respiratory diseases; RNA-directed DNA polymerase; Severe acute respiratory syndrome coronavirus 2; Tissues; Viral diseases
• DOI: 10.7883/yoken.JJID.2023.140
• ISSN: 1344-6304; 1884-2836

Minimally invasive autopsy (MIA) is an alternative to a full autopsy for the collection of tissue samples from patients’ bodies using instruments such as a biopsy needle. MIA has been conducted in many cases of coronavirus disease 2019 (COVID-19) and has contributed to the elucidation of the disease pathogenesis. However, most cases analyzed are hospital deaths, and there are few reports on the application of MIA in out-of-hospital deaths with varying extents of post-mortem changes. In this study, MIA and autopsies were performed in 15 patients with COVID-19 2–30 days after death, including 11 out-of-hospital deaths. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome detection by reverse transcriptase quantitative polymerase chain reaction using MIA samples was mostly consistent with autopsy samples, particularly lung tissue, even in out-of-hospital cases. MIA had high sensitivity and specificity (> 0.80). Histological examination of lung tissue obtained by MIA showed characteristics of COVID-19 pneumonia, with 91% agreement with autopsy samples, whereas localization of SARS-CoV-2 protein in lung tissue was indicated by immunohistochemistry, with 75% agreement. In conclusion, these results suggest that MIA is applicable to out-of-hospital deaths due to COVID-19 with various postmortem changes, especially when autopsies are not available.