lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

The Lung Tissue Microbiota Feature of Fatal COVID-19

31 Pages Posted: 16 Jun 2020

See all articles by Jun Fan

Jun Fan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Xiang Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

Sihua Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Thoracic Surgery

Junjie Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Bo Huang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Junhua Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Qin Cao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Yajun Chen

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Zhenkao Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Danju Luo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Ting Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine

Ruiting Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine

You Shang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine

Xiu Nie

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

More...

Abstract

Background: Coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. About 5·0% of infected patients had severe lung injury or developed multiorgan dysfunction. Secondary infection and sepsis were common complications in critically ill patients, but the underlying pathogen was not clear. We used culture-independent methods to explore the microbiota characteristic of lung tissue from 20 deceased patients infected with COVID-19.

Methods: Lung specimens were obtained by minimally invasive autopsy (MIA) from 20 deceased patients with COVID-19. The demographic data, clinical information, laboratory values, comorbidities, and treatments were all collected. The samples underwent pathological evaluation and were analyzed by sequencing the 16S rRNA gene hypervariable region 3-4 (V3-4) and internal transcribed spacer (ITS) DNA regions using barcoded primers for microbial community varieties.

Findings: The mean age of the 20 subjects was 67·35 (SD 12·86) year-old. Among them 14 (70%) were men, and 15 (75%) had a comorbidity and the median duration from presentation to death was 33·5 (IQR 27·75–38·25) days. Sepsis was developed in 18 (90%) of 20 patients. The main morphological finding was diffuse alveolar damage (DAD). In 8 of 20 cases, bacteria or fungi were present under the microscope. Using culture-independent techniques, we found that the predominate taxon of the bacterial was Acinetobacter spp.. Meanwhile, gut-specific bacteria (Enterobacteriaceae spp.) were detected commonly in the lung tissues. The fungal population was typically dominated by Cutaneotrichosporon (Cryptococcus) and Issatchenkia at genus level. Furthermore, most fatal COVID-19 patients have a both bacterial and fungal co-infections in lung tissues.

Interpretation: Our findings highlight that fatal COVID-19 is associated with complex mixed infections in lung tissue. It is important to serially monitor the microbiota in the lower respiratory tract and peripheral blood, so as to provide the accurate etiological evidence for timely personalized treatment.

Funding Statement: The Key Special Project of Ministry of Science and Technology, China (No.2020YFC 0845700); the National Natural Science Foundation of China (No. 81773022); the Fundamental Research Funds for the Central Universities (No. 2020 kfyXG YJ101).

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The study was approved by health commission of Hubei province and the ethics committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (protocol code:2020-0043-1).

Keywords: Fatal COVID-19, minimally invasive autopsy, lung tissue, microbiota feature

Suggested Citation

Fan, Jun and Li, Xiang and Wang, Sihua and Zhou, Junjie and Huang, Bo and Wu, Junhua and Cao, Qin and Chen, Yajun and Wang, Zhenkao and Luo, Danju and Zhou, Ting and Li, Ruiting and Shang, You and Nie, Xiu, The Lung Tissue Microbiota Feature of Fatal COVID-19 (5/6/2020). Available at SSRN: https://ssrn.com/abstract=3594615 or http://dx.doi.org/10.2139/ssrn.3594615

Jun Fan

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Xiang Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Radiology

Wuhan
China

Sihua Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Thoracic Surgery

Wuhan, 430022
China

Junjie Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Bo Huang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Junhua Wu

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Qin Cao

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Yajun Chen

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Zhenkao Wang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Danju Luo

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology

Wuhan 430022
China

Ting Zhou

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine

Wuhan
China

Ruiting Li

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine

Wuhan
China

You Shang

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Critical Care Medicine ( email )

Wuhan
China

Xiu Nie (Contact Author)

Huazhong University of Science and Technology (Formerly Tongi Medical University) - Department of Pathology ( email )

1277 Jiefang Avenue
Wuhan 430022
China

Click here to go to TheLancet.com

Paper statistics

Abstract Views
505
Downloads
43
PlumX Metrics