The COVID-19 pandemic has continued from 2019 to current times, exacerbating
existing epidemics since its beginning. Pathologic lung lesions in acute cases
have consisted of hyaline membrane disease and microthrombi. More severe cases
have pathologic lesions of alveolar and bronchiolar epithelial necrosis,
lymphocytic interstitial infiltrate, and peribronchiolar and perivascular
lymphocytic infiltrate. The opioid epidemic is one epidemic exacerbated by
COVID-19. Those with opioid use disorder (OUD) are more likely to have
compromised lung function, of which infection with the SARS-CoV-2 virus can
worsen. The combined symptoms lead to an increased risk of overdose. In
addition to anatomical risks, those with OUD require person-to-person contact
to obtain opioids. This enhances the spread of COVID-19 and increases the risk
of acquiring the disease. Pathological findings in those with chronic OUD can
contain fluorescing talc powder with multinucleated giant cells and granulomas
in the lung tissue. Twenty-one positive cases and twenty-two negative cases
were collected from COVID-19 suspicious decedents in Marion County Coroner’s Office. Toxicology screens and COVID-19 RT-PCR tests were run on each of the 43 decedents. Microscopic evaluation was done by
hematoxylin and eosin (H & E) and Masson’s Trichrome stains. The age range
of those collected was 3 to 81 years. The ethnicities were 1 Asian, 8 African
American, 1 Cuban, 3 Hispanic, 29 Caucasian, and 1 unknown. The male to female
ratio was 3.8:1. The histological features found in this study were alveolar
and bronchiolar epithelial necrosis, lymphocytic interstitial infiltrates, perivascular
and peribronchiolar lymphocytic infiltrate, fibrosis, microthrombi, and hyaline
membrane. Fluorescing talc was seen in 5 cases with granulomas and
multinucleated giant cells. Toxicology reports showed 11 drug-related deaths, with cocaine,
methamphetamine, alcohol, fentanyl, morphine, acetyl fentanyl, and
sertraline as the causative agents.
References
[1]
Tian, S., Xiong, Y., Liu, H., et al. (2020) Pathological Study of the 2019 Novel Coronavirus Disease (COVID-19) through Post-Mortem Core Biopsies. Modern Pathology. https://doi.org/10.20944/preprints202003.0311.v1
[2]
Fox, S., Akmatbekov, A., et al. (2020) Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. MedRxiv. https://doi.org/10.1101/2020.04.06.20050575
[3]
Edler, C., Schroder, A.S., Aepfelbacher, M., et al. (2020) Dying with SARS-CoV-2 Infection—An Autopsy Study of the First Consecutive 80 Cases in Hamburg, Germany. International Journal of Legal Medicine, 134, 1275-1284. https://doi.org/10.1007/s00414-020-02317-w
[4]
Fox, S.E., Akmatbekov, A., Harbert, J.L., Li, G., Brown, J.Q. and Vander Heide, R.S. (2020) Pulmonary and Cardiac Pathology in African American Patients with COVID-19: An Autopsy Series from New Orleans. The Lancet Respiratory Medicine, 8, 681-686.
[5]
Wu, J.H., Li, X., Huang, B., et al. (2020) Pathological Changes of Fatal Coronavirus Disease 2019 (COVID-19) in the Lungs: Report of 10 Cases by Postmortem Needle Autopsy. Chinese Journal of Pathology, 49, 568-575.
[6]
Varga, Z., Flammer, A., et al. (2020) Endothelial Cell Infection and Endotheliitis in COIVD-19. The Lancet, 395, 1417-1418. https://doi.org/10.1016/S0140-6736(20)30937-5
[7]
Alanagreh, L., Alzoughool, F. and Atoum, M. (2020) The Human Coronavirus Disease COVID-19: Its Origin, Characteristics, and Insights into Potential Drugs and Its Mechanisms. Pathogens, 9, Article No. 331. https://doi.org/10.3390/pathogens9050331
[8]
Bourgonje, A., Abdulle, A.E., Timens, W., et al. (2019) Angiotensin-Converting Enzyme-2 (ACE2), SARS-CoV-2 and Pathophysiology of Coronavirus Disease 2019 (COVID-19). The Journal of Pathology, 251, 228-248.
[9]
Volkow, N.D. (2020) Collision of the COVID-19 and Addiction Epidemics. Annals of Internal Medicine, 173, 61-62. https://doi.org/10.7326/M20-1212
[10]
Mitchell, M., Shee, K., Champlin, K., Essary, A.C. and Evans, M. (2021) Opioid Use Disorder and COVID-19: Implications for Policy and Practice. JAAPA, 34, 1-4. https://doi.org/10.1097/01.JAA.0000742976.14811.36
[11]
Jenkins, W.D., Bolinski, R., Bresett, J., Van Ham, B., Fletcher, S., Walters, S., Friedman, S.R., Ezell, J.M., Pho, M., Schneider, J. and Ouellet, L. (2021) COVID-19 during the Opioid Epidemic—Exacerbation of Stigma and Vulnerabilities. The Journal of Rural Health, 37, 172-174. https://doi.org/10.1111/jrh.12442
[12]
Holland, K.M., Jones, C., Vivolo-Kantor, A.M., Idaikkadar, N., Zwald, M., Hoots, B., Yard, E., D’Inverno, A., Swedo, E., Chen, M.S., Petrosky, E., Board, A., Martinez, P., Stone, D.M., Law, R., Coletta, M.A., Adjemian, J., Thomas, C., Puddy, R.W., Peacock, G., Dowling, N.F. and Houry, D. (2021) Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes before and during the COVID-19 Pandemic. JAMA Psychiatry, 78, 372-379. https://doi.org/10.1001/jamapsychiatry.2020.4402
[13]
Khatri, U.G. and Perrone, J. (2020) Opioid Use Disorder and COVID-19: Crashing of the Crises. Journal of Addiction Medicine, 14, e6-e7. https://doi.org/10.1097/ADM.0000000000000684
[14]
Becker, W.C. and Fiellin, D.A. (2020) When Epidemics Collide: Coronavirus Disease 2019 (COVID-19) and the Opioid Crisis. Annals of Internal Medicine, 173, 59-60. https://doi.org/10.7326/M20-1210
[15]
Marion County Coroner’s Office (2019) Marion County Coroner’s Office 2019 Annual Report. https://citybase-cms-prod.s3.amazonaws.com/ae291d010aa246119733a742dbfe6b48.pdf
[16]
Marion County Coroner’s Office (2020) Marion County Coroner’s Office 2020 Annual Report. https://media.graphassets.com/2u1y4IhNQBmQ8p1ssw2I
[17]
Aguiar, D., Lobrinus, J.A., Schibler, M., Fracasso, T. and Lardi, C. (2020) Inside the Lungs of COVID-19 Disease. International Journal of Legal Medicine, 134, 1271-1274. https://doi.org/10.21203/rs.3.rs-24321/v1
[18]
Tian, S., Weidong, H., et al. (2020) Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients with Lung Cancer. Journal of Thoracic Oncology, 15, 700-704. https://doi.org/10.1016/j.jtho.2020.02.010
[19]
Dolhnikoff, M., Duarte-Neto, A.N., et al. (2020) Pathological Evidence of Pulmonary Thrombotic Phenomena in Severe COVID-19. Journal of Thrombosis and Haemostasis, 18, 1517-1519. https://doi.org/10.1111/jth.14844