Table 1.
Preexisting patients’ basic characteristics.
Table 2.
Clinical course and treatment.
Fig 1.
Distribution of DAD based on 83 samples from 19 patients.
DAD = diffuse alveolar damage.
Fig 2.
Organ mapping of virus positivity by different techniques.
PCR = real—time quantitative polymerase chain reaction, RNA-ISH = RNA-in situ hybridization, IHC = immunohistochemistry, PLI = perivascular lymphocyte infiltration, ILI = interstitial lymphocyte infiltration, DAD = diffuse alveolar damage, ULL = upper left lobe, LLL = lower left lobe, LRL = lower right lobe, URL = upper right lobe, MRL = middle right lobe, CNS = central nervous system, CSF = cerebrospinal fluid); The category Histology represents lymphoplasmacellular inflammation of the respective organ system, regardless of the compartment in a four tired quantification. Thrombi are classified as being present or absent.
Fig 3.
Detection of SARS-CoV-2 in the different organs by RT-qPCR on a sample basis.
A) Positivity rata and distribution. B) Ct value categories. ULL = upper left lobe, LLL = lower left lobe, LRL = lower right lobe, URL = upper right lobe, MRL = middle right lobe, CNS = central nervous system, CSF = cerebrospinal fluid, qPCR = real-time quantitative polymerase chain reaction.
Fig 4.
A) Correlation of DAD stage and RT-qPCR Ct values (Boxplot/Bean-plot) and B) Correlation of histological lung changes and RNA-detection with RT-qPCR and RNA-ISH and IHC on a sample basis. DAD = diffuse alveolar damage, qPCR = real-time quantitative polymerase chain reaction, ct = cycling threshold, IHC = immunhistochemistry, PLI = perivascular lymphocyte infiltration, ILI = interstitial lymphocyte infiltration.
Fig 5.
Representative microscopic images.
A) H&E–Lung sample (case 8) with an early DAD with broad hyaline membranes, broadening of the alveolar septa, and mild lymphocytic inflammation. B) RNA-ISH positive-sense–same case as A); remarkable extensive SARS-CoV-2 detection in pneumocytes and interstitium. C) RNA-ISH negative-sense–the same case as A); negative -sense RNA is observed only in a few cells. F) H&E and G) RNA-ISH positive-sense; Conventional staining shows a normal mucosa with well-preserved respiratory epithelium. Detection of single infected cell with RNA-ISH. H) H&E and I) RNA-ISH positive-sense; Sclerosed gleomerulus with several infected cells. J) H&E and K) RNA-ISH positive-sense; Adipose tissue with mild hemorrhagic alteration but without relevant inflammation. High magnification of this slide reveals a single SARS-CoV-2 positive cell representation probably a histiocyte.