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Ghosh AK, Chaudhari VA, Joseph NM, Shaha KK. The prevalence of pulmonary and extrapulmonary tuberculosis in forensic autopsies in a teaching hospital in South India. J Family Med Prim Care 2024; 13:1434-1439. [PMID: 38827695 PMCID: PMC11141973 DOI: 10.4103/jfmpc.jfmpc_1412_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 06/04/2024] Open
Abstract
Introduction An autopsy is a valuable tool for finding the cause of death, exploring the clinical diagnosis, documenting unexpected findings, and resolving diagnostic questions. However, this may subject the forensic pathologist and other workers to a wide variety of blood-borne and aerosolized pathogens. Tuberculosis (TB) is the most common cause of illness and death, resulting in infection transmission in the autopsy room. Our objective in this study was to estimate the prevalence of pulmonary and extrapulmonary tuberculosis among forensic autopsies in a tertiary care hospital in South India. Material and Methods We identified positive TB cases from acid-fast bacteria staining and culture (Mycobacterium Growth Indicator Tube and Lowenstein-Jensen medium) out of 380 autopsy cases. Results The prevalence of tuberculosis was 2.4% (n = 9), among which 2.1% of cases were positive for only pulmonary tuberculosis (n = 8), and 0.3% of cases had both pulmonary and extrapulmonary involvement (n = 1). In the bivariate analysis of TB cases, sex, occupation, family history of TB, habit of smoking, BCG vaccine scar, period of hospital stay, and cause of death were potentially significant. Conclusion The prevalence of TB in forensic autopsy cases were similar to forensic autopsy-based studies, and it was less as compared to the prevalence of TB in the general population.
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Affiliation(s)
- Ajoy Kumar Ghosh
- Department of Forensic Medicine and Toxicology, Government Stanley Medical College and Hospital, Chennai, India
| | - Vinod Ashok Chaudhari
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Noyal Mariya Joseph
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Kusa Kumar Shaha
- Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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2
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Zarembaitė G, Žiūkaitė G, Chmieliauskas S, Vasiljevaitė D, Laima S, Stasiūnienė J. Tuberculosis and Sudden Death in Lithuania. Acta Med Litu 2023; 30:152-162. [PMID: 38516517 PMCID: PMC10952429 DOI: 10.15388/amed.2023.30.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 03/23/2024] Open
Abstract
Background Tuberculosis is one of the most common infectious diseases in the world. 10.6 million people fell ill in 2021 and 1.6 million died from the disease. Lithuania has the third-highest tuberculosis incidence rate per 100,000 and the second-highest mortality rate per 100,000 in EU/EEA countries. During 2015-2021 years, there were 799 deaths of pulmonary tuberculosis in Lithuania. However, the presence of pulmonary tuberculosis is often unknown before death and is only revealed during autopsy. The aim of the study is to review current literature on this topic and present statistical analysis on evaluated socioeconomical, epidemiological indicators, as well as autopsy findings that may suggest pulmonary tuberculosis infection. Materials and methods This research was designed as a retrospective study focusing on full forensic pathology autopsies between 2015 and 2021. Of these, 100 cases were randomly selected where the cause of death was tuberculosis diagnosed during post-mortem examination and compared to a control group consisting of 415 cases of sudden death. Results The study revealed that out of 100 pulmonary tuberculosis cases, 90% were male with the mean age of 53.48 ± 11.12 years old. In the case of sudden death where tuberculosis was found, a significant portion of the sample (91%) was not followed up at any medical institution. Regarding socioeconomic factors, a moderate negative correlation between Lithuania's gross domestic product and tuberculosis distribution was observed, as well as a weak negative correlation between alcohol consumption (l per capita) in the general population and tuberculosis distribution. The lung weight of the pulmonary tuberculosis group was statistically significantly higher than that of the control group. Conclusions Tuberculosis remains a major problem in Lithuania and the combination of socioeconomic indicators determines the prevalence of tuberculosis in the country. In cases of sudden death, autopsy helps to identify tuberculosis cases that have not been clinically detected and ensures tuberculosis monitoring. Therefore, the person who performs autopsy remains at high risk of contracting tuberculosis. Furthermore, extreme caution is advised if higher lung weight or hardenings are seen during autopsy because of the possibility of tuberculosis.
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Affiliation(s)
| | | | - Sigitas Chmieliauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Diana Vasiljevaitė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Sigitas Laima
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Jurgita Stasiūnienė
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
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3
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Inokuchi G, Chiba F, Makino Y, Tsuneya S, Iwase H. Sudden death due to tension pneumothorax associated with pulmonary tuberculosis. Forensic Sci Med Pathol 2020; 17:152-156. [PMID: 32974890 DOI: 10.1007/s12024-020-00317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
A man in his seventies who lived alone was found dead in his home. Postmortem computed tomography (CT) performed prior to autopsy showed right-sided tension pneumothorax. Autopsy revealed an active pulmonary tuberculosis (TB) lesion. Macroscopic and histopathological findings showed pleural infiltration by TB lesions, suggesting that tension pneumothorax developed in association with TB infection. Routine postmortem CT performed prior to autopsy is useful in screening for TB because the presence of TB lesions can be confirmed from characteristic pulmonary findings. However, it may be difficult to identify tuberculous pulmonary lesions on CT if pneumothorax occurs and the lung collapses completely as in this case. Thus, forensic pathologists and radiologists should be cognizant of this rare complication of TB.
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Affiliation(s)
- Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. .,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shigeki Tsuneya
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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4
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Aquila I, Sacco MA, Abenavoli L, Malara N, Arena V, Grassi S, Ausania F, Boccuto L, Ricci C, Gratteri S, Oliva A, Ricci P. Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic. Arch Pathol Lab Med 2020; 144:1048-1056. [PMID: 32383963 DOI: 10.5858/arpa.2020-0165-sa] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The novel coronavirus disease 2019 (COVID-19) pandemic is significantly changing methodologic approaches in all branches of the health system. From a forensic point of view, this event is partly changing the manner in which forensic pathologists and all those who work in autopsy services operate, but above all, it is changing the patterns established for years by which cadavers are analyzed postmortem. OBJECTIVE.— To present a review of the literature and a proposal for COVID-19 autopsy protocols. To contain the infection risk, a revision of all the protocols that until now have been applied to the examination of bodies that require autopsy services is required. DATA SOURCES.— Currently, the diagnosis and postmortem analysis of positive or suspected COVID-19 cases plays a crucial role in scientific research. A review of the main recommendations proposed by international scientific societies regarding the risk of infection during autopsy was carried out. Scientific papers currently available via the PubMed NCBI search engine on COVID-19 postmortem diagnosis were also examined. CONCLUSIONS.— Throughout the history of medicine, autopsy has been fundamental to the understanding of multiple pathogenic processes that are investigated postmortem. The purpose of the study is to propose an operating protocol that can be useful for all clinical and forensic autopsies, with particular reference to the correct methods to be applied to the examination of positive or suspected COVID-19 cases, regarding both the autopsy procedure and the collection and analysis of biological samples.
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Affiliation(s)
- Isabella Aquila
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Matteo Antonio Sacco
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Ludovico Abenavoli
- Department of Health Sciences (Abenavoli), University "Magna Graecia," Catanzaro, Italy
| | - Natalia Malara
- Department of Clinical and Experimental Medicine (Malara), University "Magna Graecia," Catanzaro, Italy
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica (Arena)
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS (Grassi, Ausania, Oliva), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ausania
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS (Grassi, Ausania, Oliva), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Boccuto
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, South Carolina (Boccuto).,School of Health Research, Clemson University, Clemson, South Carolina (Boccuto)
| | - Cristoforo Ricci
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Santo Gratteri
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS (Grassi, Ausania, Oliva), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietrantonio Ricci
- From the Institute of Legal Medicine and Department of Surgical and Medical Sciences (Aquila, Sacco, C. Ricci, Gratteri, P. Ricci)
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Unuma K, Watanabe R, Hirayama N, Uemura K. Autopsy Identification of Viable Mycobacterium Tuberculosis in the Lungs of a Markedly Decomposed Body. J Forensic Sci 2020; 65:2194-2197. [PMID: 32866302 DOI: 10.1111/1556-4029.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
Various infectious diseases, including COVID-19, MERS, and tuberculosis, are global public health issues. Tuberculosis, which is caused by Mycobacterium tuberculosis (MTB), is highly contagious and can be transmitted through inhalation of the bacteria. However, it has been assumed that the infectiousness of bacteria and viruses in dead bodies weakens as the time from death increases. In particular, there is little awareness of infection control measures concerning decomposed bodies or even the need for such measures. The deceased, in whom we discovered MTB 3 months following her death, was a woman in her 80s who died at home. We performed judicial autopsy, because police suspected homicide when her husband hanged himself. Obtained organs were used for microscopic examination by hematoxylin-eosin staining and Ziehl-Neelsen staining. In addition, real-time PCR and mycobacterial culture testing using Ogawa's medium were performed for the detection of MTB. We found that the MTB in the decomposed body remained viable and potentially infectious. To identify the bacterial strain further, we performed DNA-DNA hybridization and identified the strain as MTB complex. Potentially infectious live MTB survived in the dead body far longer than had been previously reported. Pathologists should consider microbial culture tests for all autopsied cases in which the decedent's medical history or macro-examination suggests possible infection, even when a long duration of time has passed since death. Pathologists and specialists who perform autopsies should recognize that all dead bodies are potentially infectious, including those in which long periods have elapsed since death.
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Affiliation(s)
- Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ryo Watanabe
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Naho Hirayama
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Tarka P, Borowska-Solonynko A, Brzozowska M, Nitsch-Osuch A, Kanecki K, Kuthan R, Garczewska B. No-Touch Automated Room Disinfection after Autopsies of Exhumed Corpses. Pathogens 2020; 9:pathogens9080648. [PMID: 32806609 PMCID: PMC7460184 DOI: 10.3390/pathogens9080648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022] Open
Abstract
Autopsies of exhumed bodies pose a risk of infections with environmental bacteria or fungi, which may be life-threatening. Thus, it is important to use effective methods of disinfection in forensic pathology facilities. In this study, we investigated the effectiveness of no-touch automated disinfection (NTD) system after autopsies of exhumed bodies. Directly after 11 autopsies of exhumed bodies, we used an NTD system based on a peroxone vapor to disinfect the air and surfaces. We measured microbial burden in the air and on surfaces before and after NTD. The NTD system reduced the mean bacterial burden in the air from 171 colony forming units (CFU)/m3 to 3CFU/m3. The mean fungal burden in the air decreased from 221 CFU/m3 to 9CFU/m3. The mean all-surface microbial burden was 79 CFU/100 cm2 after all autopsies, and it decreased to 2 CFU/100 cm2 after NTD. In conclusion, the peroxone-based NTD system was effective for decontamination of the air and surfaces in a dissecting room after autopsies of exhumed bodies.
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Affiliation(s)
- Patryk Tarka
- Department of Social Medicine and Public Health; Medical University of Warsaw, 3 Oczki St., 02-007 Warsaw, Poland; (A.N.-O.); (K.K.)
- Correspondence:
| | - Aleksandra Borowska-Solonynko
- Department of Forensic Medicine, Medical University of Warsaw, 1 Oczki st., 02-007 Warsaw, Poland; (A.B.-S.); (M.B.)
| | - Małgorzata Brzozowska
- Department of Forensic Medicine, Medical University of Warsaw, 1 Oczki st., 02-007 Warsaw, Poland; (A.B.-S.); (M.B.)
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health; Medical University of Warsaw, 3 Oczki St., 02-007 Warsaw, Poland; (A.N.-O.); (K.K.)
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health; Medical University of Warsaw, 3 Oczki St., 02-007 Warsaw, Poland; (A.N.-O.); (K.K.)
| | - Robert Kuthan
- Chair and Department of Medical Microbiology, Medical University of Warsaw, 5 Chalubinski st., 02-004 Warsaw, Poland;
| | - Barbara Garczewska
- Laboratory of Mycology, Institute of Tuberculosis and Lung Diseases, 26 Płocka st., 01-138 Warsaw, Poland;
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7
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Solarino B, Ferorelli D, Dell'Erba A. Post-mortem routine practice in the era of the COVID-19 pandemic. J Forensic Leg Med 2020; 74:102010. [PMID: 32658768 PMCID: PMC7836613 DOI: 10.1016/j.jflm.2020.102010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/06/2020] [Accepted: 06/28/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Biagio Solarino
- Interdisciplinary Department of Medicine, University of Bari - Section of Legal Medicine, Bari General Hospital, Bari, Italy
| | - Davide Ferorelli
- Interdisciplinary Department of Medicine, University of Bari - Section of Legal Medicine, Bari General Hospital, Bari, Italy.
| | - Alessandro Dell'Erba
- Interdisciplinary Department of Medicine, University of Bari - Section of Legal Medicine, Bari General Hospital, Bari, Italy
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8
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Byard RW. A forensic evaluation of plague - a re-emerging infectious disease with biowarfare potential. MEDICINE, SCIENCE, AND THE LAW 2020; 60:200-205. [PMID: 32192402 DOI: 10.1177/0025802420908483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Plague is an acute infectious disease caused by the gram-negative cocco-bacillus Yersinia pestis. It has been responsible for 200 million deaths throughout history with three major pandemics. There are three forms: bubonic, septicaemic and pneumonic, each carrying a significant mortality rate. The usual transmission is from fleas carried by rodents. Recently, it has been listed as one of the reemerging infectious diseases globally, with a potential use in bioterrorism. At autopsy there may be lymphadenopathy, fulminant pneumonia or diffuse interstitial pneumonitis. However any organ may be affected with myocarditis, meningitis, pharyngitis and hepatic and splenic necrosis. The lethality of plague with the resurgence in numbers of cases, development of antibiotic resistance, recent occurrence in urban areas and the lack of a vaccine make it a disease not to be missed in the mortuary.
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Affiliation(s)
- Roger W Byard
- School of Medicine, The University of Adelaide, Australia
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9
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Liu X, Cong B. Influence and challenge of COVID-19 in forensic identification. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2020. [DOI: 10.4103/jfsm.jfsm_32_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Stephenson L, Byard RW. An atlas overview of characteristic features of tuberculosis that may be encountered at autopsy. Forensic Sci Med Pathol 2019; 16:143-151. [PMID: 31471869 DOI: 10.1007/s12024-019-00161-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in any organ or tissue. Global population movements and the emergence of resistant strains are contributing to increasing numbers of cases in certain populations. Subtlety of symptoms and signs, chronicity of disease and failure to seek medical assistance may result in the diagnosis only being made at the time of autopsy. For this reason forensic pathologists need to understand the protean manifestations of the disease and the variable mechanisms by which TB may cause death. This atlas overview provides descriptions of the pathological manifestations of TB in a variety of organs with accompanying illustrations. It serves as a summary of conditions that should be checked for at autopsy in suspected or confirmed cases.
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Affiliation(s)
- Lilli Stephenson
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia.
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