Evidence of SARS-CoV-2 Virus in the Middle Ear of Deceased COVID-19 Patients
Ionuț Isaia Jeican,
Maria Aluaș,
Mihaela Lazăr,
Lucian Barbu-Tudoran,
Dan Gheban,
Patricia Inișca,
Camelia Albu,
Septimiu Tripon,
Silviu Albu,
Costel Siserman,
Mihaela Laura Vica,
Monica Muntean,
Iulian Opincariu,
Lia Monica Junie
Affiliations
Ionuț Isaia Jeican
Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
Maria Aluaș
Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
Mihaela Lazăr
Viral Respiratory Infections Laboratory, Cantacuzino National Military-Medical Institute for Research and Development, 050096 Bucharest, Romania
Lucian Barbu-Tudoran
Electron Microscopy Laboratory, Faculty of Biology and Geology, Babeș-Bolyai University, 400006 Cluj-Napoca, Romania
Dan Gheban
Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
Patricia Inișca
Department of Pathology, County Emergency Hospital, 330084 Deva, Romania
Camelia Albu
Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
Septimiu Tripon
Electron Microscopy Laboratory, Faculty of Biology and Geology, Babeș-Bolyai University, 400006 Cluj-Napoca, Romania
Silviu Albu
Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
Costel Siserman
Department of Legal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
Mihaela Laura Vica
Institute of Legal Medicine, Department of Legal Medicine, ‘Iuliu Haţieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Monica Muntean
Department of Infectious Disease, Clinical Hospital of Infectious Disease, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
Iulian Opincariu
Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Lia Monica Junie
Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
The presence of SARS-CoV-2 in the middle ear reveals the etiopathogenesis of otitis media in COVID-19, as well as an epidemiological risk during otologic examination and surgical procedures in COVID-19 patients. The study included 8 deceased patients with COVID-19. Tissue samples from the middle ear were subjected to virology, histopathology, scanning (SEM) and transmission (TEM) electron microscopy investigation. Ethmoidal mucosa samples were processed for virology analyses. qPCR resulted positive for 75% of nasal mucosa samples and 50% of middle ear samples. Ct values showed lower viral loads in middle ear samples. A proportion of 66.6% patients with positive results in the nasal mucosa showed positive results in the middle ear, and the subtype analysis of the complete genome sequences indicated B.1.1.7 lineage for all samples. In histopathological and SEM samples, no pathological aspects were identified. TEM revealed on the background of death critical alteration of cellular morphology, suggestive structures resembling SARS-CoV-2, goblet cells and immune cells. SARS-CoV-2 can be present in the middle ear of COVID-19 patients even if there is not clinical evidence of acute otitis media. Otolaryngologists could be particularly exposed to COVID-19 infection.
