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[Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019].
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Jun 12; 43(6):496-502.ZJ

Abstract

Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) shared similar pathogenetic, clinical and pathological features. Fever and cough were the most common symptoms of both diseases, while myalgia and diarrhea were less common in patients with COVID-19. Acute respiratory distress syndrome (ARDS) was the most severe pulmonary complication that caused high mortality rate. Histologically, diffuse alveolar damage (DAD) was the most characteristic finding in non-survivors with either SARS or COVID-19. Cases of patients died less than 10-14 days of disease duration demonstrated acute-phase DAD, while cases beyond 10-14 days of disease duration exhibited organizing-phase DAD in SARS. Meanwhile, organization and fibrosis were usually accompanied by exudation. Coronavirus was mostly detected in pneumocytes, but less in macrophages and bronchiolar epithelial cells. Hemorrhagic necrosis and lymphocyte depletion were found in lymph nodes and spleen in both SARS and COVID-19, indicating a pathological basis of lymphocytopenia. Thrombosis was commonly observed in small vessels and microvasculaturr in lungs accompanying DAD. Microthrombosis was also found in extrapulmonary organs in COVID-19, that was less reported in SARS. Damages in multiple extrapulmonary organs were observed, but coronavirus was not detected in some of those organs, indicating an alternative mechanism beyond viral infection, such as hypoxemia, ischemia and cytokine storm induced immunological injury. DAD due to viral infection and immunological injury, as well as multi-organ dysfunction and extensive microthrombus formation, brought huge challenge to the management of patients with severe SARS or COVID-19.

Authors+Show Affiliations

Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.Division of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

Pub Type(s)

Comparative Study
Journal Article

Language

chi

PubMed ID

32241072

Citation

Zhang, T, et al. "[Comparison of Clinical and Pathological Features Between Severe Acute Respiratory Syndrome and Coronavirus Disease 2019]." Zhonghua Jie He He Hu Xi Za Zhi = Zhonghua Jiehe He Huxi Zazhi = Chinese Journal of Tuberculosis and Respiratory Diseases, vol. 43, no. 6, 2020, pp. 496-502.
Zhang T, Sun LX, Feng RE. [Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(6):496-502.
Zhang, T., Sun, L. X., & Feng, R. E. (2020). [Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019]. Zhonghua Jie He He Hu Xi Za Zhi = Zhonghua Jiehe He Huxi Zazhi = Chinese Journal of Tuberculosis and Respiratory Diseases, 43(6), 496-502. https://doi.org/10.3760/cma.j.cn112147-20200311-00312
Zhang T, Sun LX, Feng RE. [Comparison of Clinical and Pathological Features Between Severe Acute Respiratory Syndrome and Coronavirus Disease 2019]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Jun 12;43(6):496-502. PubMed PMID: 32241072.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019]. AU - Zhang,T, AU - Sun,L X, AU - Feng,R E, PY - 2020/4/4/pubmed PY - 2020/6/9/medline PY - 2020/4/3/entrez KW - Coronavirus disease 2019 KW - Diffuse alveolar damage KW - Pathology KW - Severe acute respiratory syndrome SP - 496 EP - 502 JF - Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases JO - Zhonghua Jie He He Hu Xi Za Zhi VL - 43 IS - 6 N2 - Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) shared similar pathogenetic, clinical and pathological features. Fever and cough were the most common symptoms of both diseases, while myalgia and diarrhea were less common in patients with COVID-19. Acute respiratory distress syndrome (ARDS) was the most severe pulmonary complication that caused high mortality rate. Histologically, diffuse alveolar damage (DAD) was the most characteristic finding in non-survivors with either SARS or COVID-19. Cases of patients died less than 10-14 days of disease duration demonstrated acute-phase DAD, while cases beyond 10-14 days of disease duration exhibited organizing-phase DAD in SARS. Meanwhile, organization and fibrosis were usually accompanied by exudation. Coronavirus was mostly detected in pneumocytes, but less in macrophages and bronchiolar epithelial cells. Hemorrhagic necrosis and lymphocyte depletion were found in lymph nodes and spleen in both SARS and COVID-19, indicating a pathological basis of lymphocytopenia. Thrombosis was commonly observed in small vessels and microvasculaturr in lungs accompanying DAD. Microthrombosis was also found in extrapulmonary organs in COVID-19, that was less reported in SARS. Damages in multiple extrapulmonary organs were observed, but coronavirus was not detected in some of those organs, indicating an alternative mechanism beyond viral infection, such as hypoxemia, ischemia and cytokine storm induced immunological injury. DAD due to viral infection and immunological injury, as well as multi-organ dysfunction and extensive microthrombus formation, brought huge challenge to the management of patients with severe SARS or COVID-19. SN - 1001-0939 UR - https://www.unboundmedicine.com/medline/citation/32241072/[Comparison_of_clinical_and_pathological_features_between_severe_acute_respiratory_syndrome_and_coronavirus_disease_2019]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&DOI=10.3760/cma.j.cn112147-20200311-00312 DB - PRIME DP - Unbound Medicine ER -