Infectious disease pathology and the autopsy

The Importance of the Autopsy in Medicine: Perspectives of Pathology Colleagues

This article presents a perspective on the importance of the autopsy in medical practice and science based on experiences of the authors as physician-scientists involved in autopsy practice. Our perspectives are presented on the seminal contributions of the autopsy in the areas of cardiovascular disease, including congenital heart disease, atherosclerosis, coronary artery disease, and myocardial infarction, and infectious disease, including tuberculosis and viral infections. On the positive side of the future of the autopsy, we discuss the tremendous opportunities for important research to be done by application of advanced molecular biological techniques to formalin-fixed, paraffin-embedded tissue blocks obtained at autopsy. We also note with concern the countervailing forces impacting the influence of pathology in education and clinical practice at our academic medical centers, which also present impediments to increasing autopsy rates. Our challenge as academic pathologists, whose careers have been molded by involvement in the autopsy, is to counter these trends. The challenges are great but the benefits for medicine and society are enormous.

Autopsy: Infectious and Serious Communicable Diseases

The infectious autopsy is the postmortem examination of a decedent who is likely to have a serious infectious disease that can be transmitted at autopsy. Human immunodeficiency virus (HIV), viral hepatitis B and C, and tuberculosis infections are common in forensic autopsy populations. Autopsy and laboratory personnel are at risk for acquiring these postmortem infections. As the autopsy often is essential to determine the cause and manner of death and/or help the living, the use of certain standard precautions can minimize the risk of occupational infections. This chapter reviews frequently encountered occupational infections and provides preventive measures including postexposure management.

Unexplained Deaths in Connecticut, 2002–2003:Failure to Consider Category A Bioterrorism Agents in Differential Diagnoses

Background: Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.

Methods: We identified unexplained infectious deaths consistent with the clinical presentation of anthrax, tularemia, smallpox, and botulism using Connecticut death certificates and hospital chart information. Minimum work-up criteria were established to assess the completeness of diagnostic testing.

Results: Of 4558 unexplained infectious deaths, 133 were consistent with anthrax (2.9%) and 6 (0.13%) with tularemia. None were consistent with smallpox or botulism. No deaths had anthrax or tularemia listed in the differential diagnosis or had disease-specific serology performed. Minimum work-up criteria were met for only 53% of cases.

Conclusions: Except for anthrax, few unexplained deaths in Connecticut could possibly be the result of the bioterrorism agents studied. In 47% of deaths from illnesses that could be anthrax, the diagnosis would likely have been missed. As of 2004, Connecticut physicians were not well prepared to intentionally or incidentally diagnose initial cases of anthrax or tularemia. More effective clinician education and surveillance strategies are needed to minimize the potential to miss initial cases in a bioterrorism attack. (Disaster Med Public Health Preparedness. 2008;2:87–94)

Postmortem Analysis and the Role of the Clinical Microbiology Laboratory

The clinical microbiology laboratory frequently receives specimens for culture collected at autopsy. The results generated from these culture requests can either provide valuable information or produce confusion, depending largely on the selection of sites to sample, collection technique, and interpretation of results in the context of data available from patient history and histology. This mini-review is intended to provide guidance to the pathologist in the best use of microbiology testing at autopsy.