SARS-CoV-2 Matter Found in Autopsied Brain Tissue- Lancet Ne
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SARS-CoV-2 -- viral RNA, viral protein, or both -- was detected in brain tissue of more than 50% of patients who died with COVID-19, a post-mortem case series in Germany showed.

However, the presence of SARS-CoV-2 was not associated with the severity of pathological changes in the brain, reported researchers in Lancet Neurology.

"In this case series, we show that the virus gains access to the brainstem, and we were able to pinpoint the presence of viral proteins to structures such as cranial nerves in some patients," they said.

The case series looked at brain tissue from 43 people in Hamburg who died in hospitals, nursing homes, or at home with COVID-19 from March 13 to April 24. Patients were 51 to 94 years old, with a median age of 76. All had positive SARS-CoV-2 tests: 40 patients had samples to detect SARS-CoV-2 by immunohistochemistry, and 27 patients had samples to detect SARS-CoV-2 by quantitative RT-PCR.

Nearly two-thirds (63%) of patients were men. Almost all patients (93%) had relevant pre-existing chronic medical conditions, mainly cardiorespiratory problems; 30% had pre-existing neurological diseases, including neurodegenerative disease or epilepsy. Cause of death was attributed mainly to the respiratory system, with viral pneumonia as the underlying condition in most cases. Most patients (74%) died in the hospital.

Overall, SARS-CoV-2 RNA or proteins were detected in brain tissues of 21 (53%) of 40 investigated patients; both were detected in eight patients. SARS-CoV-2 viral proteins were found in cranial nerves originating from the lower brainstem and in isolated cells of the brainstem.

A variable degree of astrogliosis was seen in all patients, and 86% had astrogliosis in all regions assessed. "Because astrogliosis occurs in a variety of pre-existing medical conditions, and because critical illness also contributes to astrogliosis, a causal connection to SARS-CoV-2 cannot be drawn at present," the researchers said.

Activation of microglia and infiltration by cytotoxic T lymphocytes was most pronounced in the brainstem and cerebellum. Meningeal cytotoxic T lymphocyte infiltration was seen in 79% of patients. The olfactory bulb showed a high degree of astrogliosis and microgliosis, but only minor infiltration by cytotoxic T lymphocytes. In addition, the researchers detected fresh territorial ischemic lesions in six patients.

In this case series, researchers detected SARS-CoV-2 protein expression in brain tissue of a substantial portion of patients, he pointed out. "While the replicative and infective potential of the viral RNA remains unclear, the in-situ detection of SARS-CoV-2 proteins is an important finding, as it confirms the presence of the virus in the brain," they wrote.

Source: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30308-2/fulltext
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