Content note: death and autopsy of a toddler
I recently found a journal article about COVID-19 infection that everyone needs to read. Published in August, it should have been on everyone’s minds as people decided the fate of children returning to school.
Ismael Gomes, Karina Karmirian, Júlia T. Oliveira, Carolina da S.G. Pedrosa, Mayara Abud Mendes, Fernando Colonna Rosman, Leila Chimelli, Stevens Rehen. SARS-CoV-2 infection of the central nervous system in a 14-month-old child: A case report of a complete autopsy. The Lancet Regional Health – Americas, Volume 2, 2021, 100046, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2021.100046.
A 14-month old Black baby girl died due to COVID-19. Four months before her death, she fell ill. Doctors assumed she had viral meningitis. She was hospitalized multiple times between then and her death. By the time they suspected pneumonia, she was just on the cusp of becoming unstable. The child died within days.
Findings
For those of us who need the findings in plain language:
- Microthrombosis – Thrombosis is when a blood clot forms in a blood vessel. Microthrombosis simply means that these blood clots are incredibly small. These were found in the child’s left ventricle (heart), thyroid, and kidneys.
- Pulmonary Congestion – Excess fluid in the lungs, which often leads to a lack of oxygen in the blood.
- Interstitial Oedema – Swelling within the lungs in the areas surrounding the air sacs in the lungs.
- Lymphocytic Infiltrates – A non-cancerous or benign build-up of white blood cells. These were found in the child’s right ventricle (heart), the mucous bits within the throat, tongue, stomach, intestines, liver, and more.
- Bronchiolar Injury – A complication connected to blunt trauma and injuries during intubation. Without proper treatment, this can lead to pneumonia and other life-threatening conditions.
- Collapsed Aalveolar Spaces – A complete or partial collapsed lung. Some of these spaces were filled with collections of protein and inflammatory cells.
- Cortical Atrophy – The loss of brain cells called neurons. Other conditions that can lead to this include stroke, dementia, seizures, a traumatic brain injury, Huntington’s disease, AIDS. “The brain weight (635 grams) was about 33% less than normal for age.”
- Severe Neuronal Loss – The death of brain cells. This often occurs in those with conditions that are linked to brain and cardiovascular health.
- Hemorrhagic Foci – A type of bleeding within the brain.
- Spongiosis – Parts of the brain turn into sponge-like tissues. Her brain became sponge-like.
- Gliosis – A process where your body creates new or very large glial cells (which support nerve cells). These cells can cause scars and lesions on the brain.
- Macrophages – We know that one, right?
- Diffuse white matter edema – Swelling in the white matter.
- Neuronal Mineralization – Tissue within the brain turns into minerals.
- Encephalopathy – Brain swelling.
- Overproduction of cytokines, leading to systemic inflammation.
- Other Issues Found
- Laryngitis.
- Infection in the salivary glands.
- Fewer lymph-related cells in the tonsils, thymus, appendix, and lymph nodes.
- Swelling and blood clots within the esophagus.
- Stomach congestion, blood in the mucous, gastritis.
- Steatosis, or fatty liver disease.
- Necrosis or dying tissue in and around the pancreas.
- Blood clots within the pelvic region.
- The taste and smell center of the brain was not around due to softening.
- A breakdown in the blood-Cerebral Spinal Fluid barrier.
I want to highlight that MIS-C – or Multisystem Inflammatory Syndrome in Children – is similar to both Kawasaki Syndrome and Macrophage Activation Syndrome. Many of these are symptoms that those of us familiar with those conditions are very aware of. And, again, this child’s brain began to turn into a literal sponge.
Please continue to wear your mask, especially if you’re at higher risk.