Figure 3.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in plasma includes a pelletable fraction containing SARS-CoV-2 virus particles. Electron micrographs of pelleted fraction of plasma from 2 independent coronavirus disease 2019 inpatients, PID2 (A, B, and G) and PID1 (C–F). Montaged overview of a field of platelets surrounded by amorphous plasma material and large clusters of fibrils, possibly collagen (A, B). B, Tomographic reconstruction of the region indicated by the square in upper left showing a single presumptive SARS-CoV-2 virion within a membrane-bound compartment of a platelet. C, Tomogram detail of the virion with notable core puncta, clearly delineated membrane bilayer, and distinct surface spikes (B, red dots). Two-dimensional overview image of 3 platelets. D, High-magnification tomographic slice of a presumptive SARS-CoV-2 virion within an enclosed compartment of a platelet. Tomogram detail of a group of vesicles. Two spherical structures conform to presumptive SARS-CoV-2 virions (E, red arrowheads). F, Tomogram of a second platelet within the field, similarly surrounded by small vesicles. Tomogram detail of the area indicated by the rectangle in F showing 3 presumptive virions adjacent to the platelet (F, inset). Presumptive virions were identified as described (Methods section) and by comparisons with analogous electron microscopy (EM) of SARS-CoV-2–infected cultured cells. Immuno-EM image from pelleted fraction of plasma of PID2; presumptive SARS-CoV-2 virion labeled with anti-N (large 15 nm) gold particle and anti-S (smaller 10 nm) gold particles (G).