TITLE:
Pathological Lung Lesions of COVID-19 and Opioid Use Disorder: A Post-Mortem Lung and Toxicology Examination of 43 Decedents
AUTHORS:
Alexis Bloom, Austyn Colter, Max Jacobsen, Domnique Battles, Tamara Alberston, George Sandusky
KEYWORDS:
COVID-19, Pathology, Talc, Lung, Opioids
JOURNAL NAME:
Forensic Medicine and Anatomy Research,
Vol.10 No.4,
October
26,
2022
ABSTRACT: 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.