PATHOGENETIC ROLE OF ENDOTOXICOSIS IN DEVELOPMENT OF COVID-19 SEVERE CASES: CLINICAL AND PATHOMORPHOLOGICAL RESEARCH
DOI:
https://doi.org/10.11603/1681-2727.2022.1.13016Abstract
The aim of the work. Based on a clinical and morphological study of lung and gastrointestinal tract lesions at different stages of the inflammatory process characteristics, the hypothesis of endotoxicosis as a key pathogenetic factor of systemic endothelial dysfunction and secondary lung damage in COVID-19 cases were set up.
Materials and methods. The research is based on a clinical and pathomorphological study of 52 deaths from COVID-19 from which the autopsy material from 18 deaths was selected for histological research. In some cases, the method of immersion microscopy was used, and an immunohistochemical study was performed.
Results. The main evidence of diffuse alveolar damage (DAD) alternative’s factor action was the microthrombosis against the leukocyte traps background, which was formed by the netosis of hyperactivated polymorphonuclear leukocytes. The absence of a preexisting inflammatory process and signs of PMNs migration through the walls of the capillaries into the lumen of the alveoli were noted. At the same time, the histological image of changes in the small intestine corresponded to the acute desquamative-erosive inflammatory process of viral-bacterial etiology with signs of active endotoxin translocation. Hyperergic focal lymphoid infiltrates were formed in the inflammatory infiltrate of the small intestinal mucosa, both in the stage of early exudation (p<0.005) and in the stage of proliferation of DAP (p<0.001).The significantly low immunoregulatory index (IRI) CD4 /CD8 was demonstrated in histological samples of inflammatory pulmonary infiltrate compared with IRI in inflammatory bowel infiltrate (p<0.001). A model of the pathogenesis of COVID-19 has been proposed, according to which lung damage can occur secondarily, by the mechanism of hepatopulmonary syndrome.
Conclusions. There is a reason to believe that the entrance gate of infection in the severe cases of COVID-19, along with the respiratory system is the mucous membrane of the distal small intestine. The revealed morphological demonstration of severe endothelial dysfunction with endothelial damage in COVID-19 indicates endotoxin damage by the similarity of para-allergic reaction rather than direct viral damage.
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