[Morphological findings and medical insurance aspects in 371 exhumations]

Detection and infectivity of SARS-CoV-2 in exhumated corpses

Postmortem detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) after the exhumation of a corpse can become important, e.g. in the case of subsequent medical malpractice allegations. To date, data on possible detection periods [e.g. by reverse transcription polymerase chain reaction (RT-PCR)] or on the potential infectivity of the virus after an exhumation are rare. In the present study, these parameters were examined in two cases with a time span of approximately 4 months between day of death and exhumation. Using SARS-CoV-2 RT-PCR on swabs of both lungs and the oropharynx detection was possible with cycle threshold (C_t) values of about 30 despite signs of beginning decay. RT-PCR testing of perioral and perinasal swabs and swabs collected from the inside of the body bag, taken to estimate the risk of infection of those involved in the exhumation, was negative. Cell culture-based infectivity testing was negative for both, lung and oropharyngeal swabs. In one case, RT-PCR testing at the day of death of an oropharyngeal swab showed almost identical C_t values as postmortem testing of an oropharyngeal swab, impressively demonstrating the stability of viral RNA in the intact corpse. However, favorable climatic conditions in the grave have to be taken into account, as it was wintertime with constant low temperatures. Nevertheless, it was possible to demonstrate successful postmortem detection of SARS-CoV-2 infection following exhumation even after months in an earth grave.

Autopsy at 2 months after death: brain is satisfactorily preserved for neuropathology

Disclosure of neurological disorders by neuropathological examination may be one important aim of forensic autopsies. There are insufficient data on human brain tissue preservation after prolonged postmortem periods. Here, we describe neuropathological findings in a brain of a 77-year-old woman that was fixed at autopsy 2 months after death. The body had been stored in a cooling chamber at 3 degrees C temperature. Gross inspection of the brain was satisfactorily possible. Histomorphology was excellently preserved. Many histochemical and immunohistochemical stains allowed satisfactory neuropathological evaluation of brain tissue and the diagnosis of Alzheimer's disease. Nevertheless, some immunohistochemical stainings repeatedly yielded negative or suboptimal results. We conclude that neuropathological examination of human brain tissue extracted from the skull and fixed after prolonged body storage in a cool environment is feasible for forensic diagnosis of neurological disorders even several months after death. However, in such cases the significance of negative immunohistochemical staining results must be interpreted with caution.

Evaluation of the correlation between time corpses spent in in-ground graves and findings at exhumation

To determine how long pathological findings persist after burial and which factors play a role in decomposition of a corpse, we evaluated all bodies exhumed under the auspices of the Institute of Legal Medicine at the Hannover Medical School between 1978 and 1997. A total of 87 exhumations (54 men, 33 women) were performed in this period. The time bodies remained buried varied between 5 days and 16.8 years (mean 1.5 years, median 2.3 months). Fifty-six percent of the bodies were exhumed after at most 3 months, 10% remained buried for greater than 3 years. Pathomorphological changes of the soft tissues and the internal organs remained evident after several months, in some cases after several years of burial. Overall, it was possible to evaluate internal organs after 5 years of burial. Bodies became mostly decomposed after approximately 8 years at the earliest, although it was still possible to evaluate some soft tissue remnants after 16.8 years. In stepwise logistic regression, both the length of time the body was buried (p < 0.00005) and the time of year (p < 0.0019) clearly affected the rate of physical change. The variables of sex (p = 0.33), age (p = 0.61) and changes in the integrity of the body before burial (trauma, autopsy before burial; p = 0.15) did not influence the physical state of the body after exhumation. Our data show that much information may be gained from an exhumation even after significant time has passed since burial.

[Obligation to report occupational diseases. Importance of external post-mortem examinations before cremation]

The practical use of the legally required documentation of occupational diseases is demonstrated by a case of asbestos-related pleural mesothelioma. During the mandatory inquest before cremation, information of manifest pleural mesothelioma had been relayed to the widow of the patient, and an investigation for a possible occupational disease was performed. Reconstruction of the case showed that in the course of 3 months at least 13 physicians had been involved in in-hospital as well as ambulatory therapeutic measures. Until death, none of them informed the trade association about a suspected occupational disease in accordance with BK 4105 of the codex of occupational diseases, although the diagnosis of manifest pleural mesothelioma had been histologically confirmed already 10 weeks prior to the death of the patient. This case demonstrates obvious and evident deficiencies in applying the Code of Social Law VII, which requires physicians to report occupational diseases. In addition, it shows the importance of the post-mortem examination as a control function before cremation.