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Am J Pathol. 2016 Mar;186(3):652-8. doi: 10.1016/j.ajpath.2015.10.024. Epub 2016 Feb 5.

Clinicopathologic, Immunohistochemical, and Ultrastructural Findings of a Fatal Case of Middle East Respiratory Syndrome Coronavirus Infection in the United Arab Emirates, April 2014.

Author information

1
Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Communicable Diseases Department, Abu Dhabi, United Arab Emirates.
3
Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
4
Gastroenteritis and Respiratory Virus Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
5
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; International Research and Programs Branch, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
6
Office of the Director, Centers for Disease Control and Prevention, Atlanta, Georgia.
7
Emergency and Disaster Department, Abu Dhabi, United Arab Emirates.
8
Pathology and Laboratory Medicine Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
9
Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
10
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
11
Health Authority-Abu Dhabi, Abu Dhabi, United Arab Emirates.
12
Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: szaki@cdc.gov.

Abstract

Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes an acute respiratory illness and is associated with a high case fatality rate; however, the pathogenesis of severe and fatal MERS-CoV infection is unknown. We describe the histopathologic, immunohistochemical, and ultrastructural findings from the first autopsy performed on a fatal case of MERS-CoV in the world, which was related to a hospital outbreak in the United Arab Emirates in April 2014. The main histopathologic finding in the lungs was diffuse alveolar damage. Evidence of chronic disease, including severe peripheral vascular disease, patchy cardiac fibrosis, and hepatic steatosis, was noted in the other organs. Double staining immunoassays that used anti-MERS-CoV antibodies paired with immunohistochemistry for cytokeratin and surfactant identified pneumocytes and epithelial syncytial cells as important targets of MERS-CoV antigen; double immunostaining with dipeptidyl peptidase 4 showed colocalization in scattered pneumocytes and syncytial cells. No evidence of extrapulmonary MERS-CoV antigens were detected, including the kidney. These results provide critical insights into the pathogenesis of MERS-CoV in humans.

PMID:
26857507
DOI:
10.1016/j.ajpath.2015.10.024
[Indexed for MEDLINE]

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