Postmortem diagnosis of COVID-19: Antemortem challenges of three cases at the 37 Military Hospital, Accra, Ghana

• Main Authors: Seth A. Attoh (Author), Frederick Hobenu (Author), Lawrence Edusei (Author), Kwasi Agyeman-Bediako (Author), Clement T. Laryea (Author), Edward O. Nyarko (Author), Michael K. Amedi (Author), Richard H. Asmah (Author), Edward Asumanu (Author), Mary McAddy (Author), Anthony Maison (Author), Godwin Nyarko (Author), Raymond D. Fatchu (Author), Kafui Akakpo (Author)
• Format: Book
• Published: AOSIS, 2020-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2225-2002; 2225-2010; 10.4102/ajlm.v9i1.1290
• Keywords: covid-19; autopsy; postmortem diagnosis; false-negative; ghana; Public aspects of medicine; RA1-1270; Medicine (General); R5-920
• Source: African Journal of Laboratory Medicine, Vol 9, Iss 1, Pp e1-e8 (2020)

Background: Consistency among clinical symptoms, laboratory results and autopsy findings can be a quality measure in the diagnosis of coronavirus disease 2019 (COVID-19). There have been classic clinical cases that have met the case definition of COVID-19 but real-time reverse-transcription polymerase chain reaction (rRT-PCR) tests of nasopharyngeal swabs were negative. Objectives: This study aimed to share pathological observations of autopsies performed at the 37 Military Hospital's Department of Anatomical Pathology on three presumed COVID-19 cases in Accra, Ghana. Method: Complete autopsies with detailed gross and histopathological analysis were conducted between April 2020 and May 2020 on three suspected COVID-19 cases, of which two had initial negative (rRT-PCR) nasopharyngeal tests. Postmortem bronchopulmonary samples of two cases were collected and tested by rRT-PCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: The two postmortem bronchopulmonary samples tested for SARS-CoV-2 by rRT-PCR were positive. Though no postmortem bronchopulmonary sample was taken from the third case, a close contact tested positive for SARS-CoV-2 in later contact tracing. For all three cases, lung histopathological findings were consistent with Acute Respiratory Distress Syndrome. Conclusion: The outcome of COVID-19 testing is dependent on the sample type and accuracy of sampling amongst other factors. Histopathological findings vary and may be dependent on a patient's modifying factors, as well as the duration of infection. More autopsies are required to fully understand the pathogenesis of this disease in Ghanaians.