Original Research

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

Seth A. Attoh, Frederick Hobenu, Lawrence Edusei, Kwasi Agyeman-Bediako, Clement T. Laryea, Edward O. Nyarko, Michael K. Amedi, Richard H. Asmah, Edward Asumanu, Mary McAddy, Anthony Maison, Godwin Nyarko, Raymond D. Fatchu, Kafui Akakpo
African Journal of Laboratory Medicine | Vol 9, No 1 | a1290 | DOI: https://doi.org/10.4102/ajlm.v9i1.1290 | © 2020 Seth A. Attoh, Frederick Hobenu, Lawrence Edusei, Kwasi Agyeman-Bediako, Clement T. Laryea, Edward O. Nyarko, Michael K. Amedi, Richard H. Asmah, Edward Asumanu, Mary McAddy, Anthony Maison, Godwin Nyarko, Raymond D. Fatchu, Kafui Akakpo | This work is licensed under CC Attribution 4.0
Submitted: 03 June 2020 | Published: 03 November 2020

About the author(s)

Seth A. Attoh, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Frederick Hobenu, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Lawrence Edusei, Department of Pathology, Korle-bu Teaching Hospital, Accra, Ghana
Kwasi Agyeman-Bediako, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Clement T. Laryea, Department of Medicine, 37 Military Hospital, Accra, Ghana
Edward O. Nyarko, Public Health Division, 37 Military Hospital, Accra, Ghana
Michael K. Amedi, Department of Radiology, 37 Military Hospital, Accra, Ghana
Richard H. Asmah, Department of Molecular Biology, University of Allied Health Sciences, Ho, Ghana
Edward Asumanu, Department of Surgery, 37 Military Hospital, Accra, Ghana
Mary McAddy, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Anthony Maison, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Godwin Nyarko, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Raymond D. Fatchu, J.M. Wadhwani Department of Anatomical Pathology, 37 Military Hospital, Accra, Ghana
Kafui Akakpo, Department of Pathology, University of Cape Coast, Cape Coast, Ghana

Abstract

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.


Keywords

COVID-19; autopsy; postmortem diagnosis; false-negative; Ghana

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