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Alfsen GC, Gulczyński J, Kholová I, Latten B, Martinez J, Metzger M, Michaud K, Pontinha CM, Rakislova N, Rotman S, Varga Z, Wassilew K, Zinserling V. Code of practice for medical autopsies: a minimum standard position paper for pathology departments performing medical (hospital) autopsies in adults. Virchows Arch 2021; 480:509-517. [PMID: 34888730 PMCID: PMC8660654 DOI: 10.1007/s00428-021-03242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/17/2022]
Abstract
The medical autopsy (also called hospital or clinical autopsy) is a highly specialised medical procedure, which requires professional expertise and suitably equipped facilities. To ensure high standards of performance, the Working Group of Autopsy Pathology of the European Society of Pathology (ESP) suggests a code of practice as a minimum standard for centres performing medical autopsies. The proposed standards exclusively address autopsies in adults, and not forensic autopsies, perinatal/or paediatric examinations. Minimum standards for organisation, standard of premises, and staffing conditions, as well as minimum requirements for level of expertise of the postmortem performing specialists, documentation, and turnaround times of the medical procedure, are presented. Medical autopsies should be performed by specialists in pathology, or by trainees under the supervision of such specialists. To maintain the required level of expertise, autopsies should be performed regularly and in a number that ensures the maintenance of good practice of all participating physicians. A minimum number of autopsies per dedicated pathologist in a centre should be at least 50, or as an average, at least one autopsy per working week. Forensic autopsies, but not paediatric/perinatal autopsies may be included in this number. Turnaround time for final reports should not exceed 3 weeks (14 working days) for autopsies without fixation of brain/spinal cord or other time-consuming additional examinations, and 6 weeks (30 working days) for those with fixation of brain/spinal cord or additional examinations.
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Affiliation(s)
- G Cecilie Alfsen
- Department of Pathology, Akershus University Hospital, Loerenskog, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jacek Gulczyński
- Department of Pathology and Neuropathology, Medical University of Gdańsk, Gdansk, Poland
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Bart Latten
- Department of Forensic Pathology, Netherlands Forensic Institute, The Hague, The Netherlands.,Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Javier Martinez
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León (CAULE), Leon, Spain
| | - Myriam Metzger
- Department of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne, Switzerland.,Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carlos M Pontinha
- Department of Anatomical Pathology, Central Lisbon University Hospital Centre, Lisbon, Portugal
| | - Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, 08036, Barcelona, Spain
| | - Samuel Rotman
- Service of Clinical Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Zsuzsanna Varga
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Vsevolod Zinserling
- Department of Pathomorphology, Institute of Experimental Medicine V.A. Almazov National Research Center, Saint Petersburg, Russian Federation
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Pearce MM, Theodoropoulos N, Mandel MJ, Brown E, Reed KD, Cianciotto NP. Legionella cardiaca sp. nov., isolated from a case of native valve endocarditis in a human heart. Int J Syst Evol Microbiol 2012; 62:2946-2954. [PMID: 22286905 PMCID: PMC4080749 DOI: 10.1099/ijs.0.039248-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A Gram-negative, rod-shaped bacterium, designated H63(T), was isolated from aortic valve tissue of a patient with native valve endocarditis. 16S rRNA gene sequencing revealed that H63(T) belongs to the genus Legionella, with its closest neighbours being the type strains of Legionella brunensis (98.8% similarity), L. londiniensis (97.0%), L. jordanis (96.8%), L. erythra (96.2%), L. dresdenensis (96.0%) and L. rubrilucens, L. feeleii, L. pneumophila and L. birminghamensis (95.7%). DNA-DNA hybridization studies yielded values of <70% relatedness between strain H63(T) and its nearest neighbours in terms of 16S rRNA gene sequence similarity, indicating that the strain represents a novel species. Phylogenetic analysis of the 16S rRNA, macrophage infectivity potentiator (mip) and RNase P (rnpB) genes confirmed that H63(T) represents a distinct species, with L. brunensis being its closest sister taxon. Fatty acid composition and biochemical traits, such as the inability to ferment glucose and reduce nitrate, supported the affiliation of H63(T) to the genus Legionella. H63(T) was distinguishable from its neighbours based on it being positive for hippurate hydrolysis. H63(T) was further differentiated by its inability to grow on BCYE agar at 17 °C, its poor growth on low-iron medium and the absence of sliding motility. Also, H63(T) did not react with antisera generated from type strains of Legionella species. H63(T) replicated within macrophages. It also grew in mouse lungs, inducing histopathological evidence of pneumonia and dissemination to the spleen. Together, these results confirm that H63(T) represents a novel, pathogenic Legionella species, for which the name Legionella cardiaca sp. nov. is proposed. The type strain is H63(T) ( = ATCC BAA-2315(T) = DSM 25049(T) = JCM 17854(T)).
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Affiliation(s)
- Meghan M Pearce
- Department of Microbiology-Immunology, Northwestern University, Chicago, IL, USA
| | | | - Mark J Mandel
- Department of Microbiology-Immunology, Northwestern University, Chicago, IL, USA
| | - Ellen Brown
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kurt D Reed
- Department of Pathology, Northwestern University, Chicago, IL, USA
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McClelland MR, Vaszar LT, Kagawa FT. Pneumonia and Osteomyelitis Due to Legionella longbeachae in a Woman with Systemic Lupus Erythematosus. Clin Infect Dis 2004; 38:e102-6. [PMID: 15156502 DOI: 10.1086/386322] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2003] [Accepted: 02/04/2004] [Indexed: 11/03/2022] Open
Abstract
A patient with risk factors of systemic lupus erythematosus, corticosteroid use, and malignancy received a diagnosis of concomitant pneumonia and osteomyelitis caused by Legionella longbeachae. In this report, the first description of Legionella osteomyelitis, previous cases of extrapulmonary Legionella infection are detailed.
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Affiliation(s)
- Marc R McClelland
- Department of Medicine, Stanford University, San Jose, California, USA
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Lowry PW, Tompkins LS. Nosocomial legionellosis: a review of pulmonary and extrapulmonary syndromes. Am J Infect Control 1993; 21:21-7. [PMID: 8442518 DOI: 10.1016/0196-6553(93)90203-g] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Surgical patients appear to be at highest risk for acquisition of nosocomial Legionella pneumonia; most appear to become infected during respiratory tract manipulation and mechanical ventilation. Although the lungs are the most common site of nosocomial Legionella infection, an important subset of patients have infection at extrapulmonary sites. We describe 22 cases of extrapulmonary legionellosis reported in the literature. Most of these patients were surgical patients; more than half did not have serious underlying illnesses, and only five (23%) were receiving immunosuppressive agents. A total of 13 extrapulmonary sites of infection were reported, many in the absence of clinical pneumonia; these infections included sinusitis, hip wound infection, and prosthetic valve endocarditis. Five patients (23%) had fatal infections; in four of these cases diagnosis of Legionella infection was made after death, underscoring the need for a high index of clinical suspicion. A large percentage of extrapulmonary Legionella infections may result from direct topical exposure of susceptible tissue to contaminated tap water. Use of tap water must be carefully monitored, particularly in dressing changes and bathing of surgical patients.
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Affiliation(s)
- P W Lowry
- Department of Medicine, Stanford University School of Medicine, CA
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Schmidt T, Pfeiffer A, Ehret W, Keiditsch E, Ruckdeschel G, Kaess H. Legionella infection of the colon presenting as acute attack of ulcerative colitis. Gastroenterology 1989; 97:751-5. [PMID: 2753334 DOI: 10.1016/0016-5085(89)90648-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 42-yr-old woman with long-standing ulcerative colitis of the descending colon, sigmoid, and rectum presented with bloody diarrhea, tenesmus, and high fever. Endoscopic findings were compatible with an acute attack of ulcerative colitis, which proved to be resistant to systemic corticosteroid treatment. In the presence of an acute abdomen with ascites and double-contoured colonic wall, hemicolectomy was performed. Postoperatively, high temperature, hyponatremia, and elevated liver enzyme levels persisted. Pleural effusions developed. Antibodies to Legionella pneumophila serogroup 3 were detected in the serum. Erythromycin therapy induced rapid improvement. In a massive submucosal edema of the affected colon, L. pneumophila of the same serogroup was demonstrated by direct immunofluorescence staining.
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Affiliation(s)
- T Schmidt
- II. Medical Department, Krankenhaus München-Bogenhausen, Federal Republic of Germany
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Martin JR, Johnson P, Miller MF. Uptake, accumulation, and egress of erythromycin by tissue culture cells of human origin. Antimicrob Agents Chemother 1985; 27:314-9. [PMID: 3994346 PMCID: PMC176268 DOI: 10.1128/aac.27.3.314] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The ability of erythromycin A base to penetrate and accumulate in tissue culture cells of human origin was investigated. The antibiotic was highly concentrated by early passage cells of normal bronchus, kidney, liver, lung, and skin and by cancer cells derived from breast, liver, and lung. Intracellular levels 4 to 12 times that of the extracellular milieu were obtained in both early-passage and transformed cells. The total quantity of erythromycin accumulated depended on the extracellular concentration of antibiotic, but the cellular/extracellular ratios were, for the most part, independent of the initial extracellular drug concentration. In all cell types tested, the accumulated antibiotic rapidly egressed when cells were incubated in antibiotic-free medium. Bioactivity assays demonstrated that the expelled drug was unmetabolized, fully active antibiotic. The concentration of erythromycin by a variety of human cell types probably accounts, in part, for the effectiveness of the antibiotic against intracellular parasites such as Legionella and Chlamydia spp.
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Winn WC. Legionella and Legionnaires' disease: a review with emphasis on environmental studies and laboratory diagnosis. Crit Rev Clin Lab Sci 1985; 21:323-81. [PMID: 3881218 DOI: 10.3109/10408368509165787] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Legionella pneumophila and related species are important causes of epidemic bacterial pneumonia and nosocomial infection. This review will discuss this new family of bacteria and the diseases they produce. The classification, general microbiologic characteristics, and ecology of the bacteria will be reviewed and the epidemiology and clinical aspects of the infection will be discussed. More emphasis will be given to issues that are more directly related to laboratory workers and with which the author has had more direct experience: pathology, laboratory diagnosis of human infection, pathogenesis of the infection, and virulence mechanisms of the bacterium. Therapy and prevention of the infection will be discussed more briefly.
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Helms CM, Viner JP, Weisenburger DD, Chiu LC, Renner ED, Johnson W. Sporadic Legionnaires' disease: clinical observations on 87 nosocomial and community-acquired cases. Am J Med Sci 1984; 288:2-12. [PMID: 6465187 DOI: 10.1097/00000441-198407000-00001] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To add information about sporadic Legionnaires' disease, 87 cases of L. pneumophila pneumonia were reviewed. Twenty cases were nosocomial infections and 67 cases were community-acquired. Most cases (64%) occurred between July and October. The mean age of patients was 51.4 years and males outnumbered females 2.5:1.0. Thirty-one percent of patients were receiving corticosteroid, immunosuppressive, or antineoplastic chemotherapy when illness began. Immunosuppression at onset of illness was more common in nosocomial infections (90%) than in community-acquired infections (14%). Seventy percent of patients had underlying diseases. Malignancies, renal failure, and transplantation were the most common conditions underlying nosocomial infections. Chronic lung disease and malignancies were the most common diseases underlying community-acquired infections. The case-fatality rate in nosocomial infection (70%) was greater than that in community-acquired disease (22%). Clinical, laboratory, and radiologic features of the cases were examined. Illness ranged from mild to severe. Extrapulmonary findings of encephalopathy and renal failure were more common in fatal than in non-fatal cases. Indirect immunofluorescent and microagglutination antibody responses plateaued by the fourth week of illness. Twenty-nine patients died. The case-fatality rate of patients receiving erythromycin (6%) was less than that of patients receiving penicillin (36%), ampicillin (28%), cephalosporin (32%), or aminoglycosides (41%). Despite erythromycin therapy, the case fatality rate for nosocomial L. pneumophilia pneumonia was unacceptably high (25%).
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Becq-Giraudon B, Maréchaud R, Abadie JC, Sudre Y. [Legionnaires' disease: an autochthonous, sporadic disease. Apropos of 5 cases]. Rev Med Interne 1982; 3:227-35. [PMID: 7178709 DOI: 10.1016/s0248-8663(82)80021-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Fogliani J, Domenget J, Fleurette J, Bornstein N. Legionnaires' disease with intestinal localisation. J Infect 1982. [DOI: 10.1016/s0163-4453(82)92062-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lehot JJ, Bui Xuan B, Sagnard P, Perrot D, Bornstein N, Motin J. [Postoperative legionnaires' disease. 1 case following esophagectomy for cancer]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1982; 1:325-8. [PMID: 7165148 DOI: 10.1016/s0750-7658(82)80050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kasper W, Treese N, Bechtold H, Pop T, Meinertz T. Diagnosis of acute pulmonary embolism and thrombosis by echocardiography. Lancet 1981; 2:202. [PMID: 6114266 DOI: 10.1016/s0140-6736(81)90382-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Serota AI, Meyer RD, Wilson SE, Edelstein PH, Finegold SM. Legionnaires' disease in the postoperative patient. J Surg Res 1981; 30:417-27. [PMID: 7242059 DOI: 10.1016/0022-4804(81)90085-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Following the discovery of Legionella pneumophila as the cause of an epidemic of pneumonia at an American Legion convention in Philadelphia, a group of related bacteria were recognized as additional human pathogens. This newly established bacterial genus, Legionella, includes the agents of Legionnaires' disease, Pittsburgh pneumonia, and several related infections. There are many similarities in the pathology of human infection caused by all the Legionella species. All produce a severe confluent lobular or lobar pneumonia, and abscess formation is not uncommon. A leukocytoclastic inflammatory infiltrate of neutrophils and macrophages, "septic" vasculitis of small blood vessels, coagulation necrosis, and focal septal disruption are characteristic but not diagnostic features. The inflammatory response is clearly that of a bacterial pneumonia with a necrotizing component, and does not resemble most mycoplasmal, chlamydial, or viral pneumonias. The bacteria can be demonstrated well by special stains. Acid fastness of Legionella micdadei, the cause of Pittsburgh pneumonia, is a helpful presumptive clue to diagnosis. The bacteria can be presumptively speciated in tissue by direct immunofluorescence. In addition, reliable recovery of the organisms on agar media now allows a specific diagnosis to be made. As a group, these infections are properly referred to as the Legionella pneumonias.
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Helms CM, Viner JP, Renner ED, Chiu LC, Weisenburger DD. Legionnaires' disease among pneumonias in Iowa (FY 1972-1978) II. Epidemiologic and clinical features of 30 sporadic cases of L. pneumophila infection. Am J Med Sci 1981; 281:2-13. [PMID: 7468637 DOI: 10.1097/00000441-198101000-00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We reviewed retrospectively the clinical records of 30 cases of sporadic Legionella pneumophila infection that occurred in Iowa between FY 1972 and 1978. Cases occurred throughout the year, most between May and December. Twenty-one male patients and 9 female patients ranging in age from 5-80 years were infected. Half the patients smoked or had an underlying illness; five were receiving corticosteroids or immunosuppressive therapy. Occupations and exposures related to hospitals, construction and travel were common; four patients had been exposed to birds. In addition to L. pneumophila infection, six patients had evidence of infection with a viral, mycoplasmal, bacterial, mycobacterial or fungal pathogen; three had had preceding dental infections. Twenty-seven cases were pneumonias visible on radiographs. Fever, cough, chills, myalgia and rales occurred inover half the cases. Headache, gastrointestinal symptoms and encephalopathy also were seen. Upper respiratory symptoms were uncommon. Urinalysis and blood studies often suggested renal and hepatic involvement, but other routine laboratory diagnostic tests were not helpful. All but two patients were hospitalized; seven required intensive care. The median duration of hospitalization was 12 days. Two patients who did not receive erythromycin or tetracycline therapy died.
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