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Mascolo P, Feola A, Zangani P, Famularo D, Liguori B, Mansueto G, Campobasso CP. Waterhouse Friderichsen Syndrome: Medico-legal issues. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bogdanović M, Skadrić I, Atanasijević T, Stojković O, Popović V, Savić S, Mihailović Z, Radnić B, Aćimović T, Damjanjuk I, Despotović S, Barać A. Case Report: Post-mortem Histopathological and Molecular Analyses of the Very First Documented COVID-19-Related Death in Europe. Front Med (Lausanne) 2021; 8:612758. [PMID: 33681247 PMCID: PMC7935505 DOI: 10.3389/fmed.2021.612758] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/19/2021] [Indexed: 01/18/2023] Open
Abstract
In Europe, the first case of coronavirus disease (COVID-19) and the first COVID-19-related death were reported in France on January 24th and February 15th, 2020, respectively. Officially, the first case of COVID-19 infection in the Republic of Serbia was registered on March 6th. Herein, we presented the first case of retrospective detection of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the post-mortem-obtained vitreous humor (VH), which took place on February 5th, 2020. This is the first death in Europe proven to be caused by COVID-19 by means of post-mortem histopathological and molecular analyses. Based on this finding, it appears that SARS-CoV-2 has been spreading faster and started spreading much earlier than it had been considered and that COVID-19 was probably the cause of the much-reported pneumonia of unknown origin in January and February 2020.
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Affiliation(s)
- Milenko Bogdanović
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Ivan Skadrić
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Tatjana Atanasijević
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Oliver Stojković
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Institute of Human Genetics, University of Belgrade, Belgrade, Serbia
| | - Vesna Popović
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Slobodan Savić
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Zoran Mihailović
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Bojana Radnić
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Tijana Aćimović
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Irina Damjanjuk
- Faculty of Medicine, Institute of Forensic Medicine "Milovan Milovanović", University of Belgrade, Belgrade, Serbia
| | - Sanja Despotović
- Faculty of Medicine, Institute of Histology and Embryology, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Gentile G, Amadasi A, Bailo P, Boracchi M, Maciocco F, Marchesi M, Zoja R. The importance of the postmortem interval for the diagnosis of Waterhouse-Friderichsen syndrome by Neisseria meningitidis in a series of forensic cases. AUTOPSY AND CASE REPORTS 2019; 9:e2019103. [PMID: 31372361 PMCID: PMC6629265 DOI: 10.4322/acr.2019.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/06/2019] [Indexed: 11/23/2022] Open
Abstract
The effective value of microbiological post-mortem examinations stands as fundamental in forensic cases involving microbiology. We ran these analyses on five victims, who suddenly died after showing persistent fever. The examinations were conducted between 48 hours and 10 days after death, and adrenal gland apoplexy was detected in all the cases. Microbiological examinations identified Neisseria meningitidis, which was accountable for Waterhouse–Friderichsen syndrome. Diplococci were isolated from three cadavers that underwent forensic dissection between 2 and 3 days after death. The remaining two cadavers showed polymicrobial contamination, and a polymerase chain reaction technique was necessary to identify the pathogen. We assumed that the microbial overlap could lead to diagnostic mistakes and conceal the identification of the lethal pathogen. Therefore, we suggest using molecular techniques for a postmortem interval (PMI) longer than 72 hours. Classical microbiological examination should be performed for PMI within 72 hours.
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Affiliation(s)
- Guendalina Gentile
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
| | - Alberto Amadasi
- Università degli Studi di Bologna, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale, Dipartimento di Scienze mediche e Chirurgiche (DIMEC). Bologna, Italy
| | - Paolo Bailo
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
| | - Michele Boracchi
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
| | - Francesca Maciocco
- Ospedale S. Carlo Borromeo, Servizio di Immunoematologia e Medicina Trasfusionale (SIMT). Milano, Italy
| | - Matteo Marchesi
- Ospedale di Bergamo, Azienda Socio Sanitaria Papa Giovanni XXIII, Responsabile USS Medicina Legale. Bergamo, Italy
| | - Riccardo Zoja
- Università degli Studi di Milano, Facoltà di Medicina e Chirurgia, Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute. Milano, Italy
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Rapid Streptococcus Pneumonia Antigen Detection on Postmortem Urine in a Death Due to Pneumococcal Meningitis. Am J Forensic Med Pathol 2019; 40:269-272. [PMID: 30663991 DOI: 10.1097/paf.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Streptococcus pneumoniae is the leading cause of adult bacterial meningitis. Differing from Neisseria meningitidis (the second most common cause of acute bacterial meningitis), contact tracing and chemoprophylaxis are not required. At postmortem, the differentiation between S. pneumoniae and N. meningitidis is traditionally done by culture and polymerase chain reaction performed on blood or cerebrospinal fluid, but may take hours, if not days, to analyze. We present a death from bacterial meningitis in a 73-year-old woman in which a rapid urinary pneumococcal antigen testing was able to identify S. pneumoniae as the causative organism within 1 hour. This was confirmed by subsequent brain swab culture. The rapid urinary pneumococcal antigen test in the case prevented the need for contact tracing and chemoprophylaxis. This case highlights the potential use of this test to rapidly identify the culprit organism at postmortem examination when acute bacterial meningitis is detected.
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Neisseria meningitidis Isolated in Vitreous Humor in a 5-Month-Old Infant Death From Meningococcal Sepsis. Am J Forensic Med Pathol 2018; 40:175-177. [PMID: 30475234 DOI: 10.1097/paf.0000000000000448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diagnosing sepsis at postmortem is challenging. With respect to meningococcal sepsis, the postmortem microbiological identification of Neisseria meningitidis is nearly always due to true infection, including in cases of decomposition. Previous case series and case reports were able to isolate N. meningitidis in vitreous humor in adult deaths from meningococcal sepsis when blood and/or cerebrospinal fluid was unavailable. It was suggested that vitreous humor polymerase chain reaction (PCR) may be useful in the diagnosis of meningococcal sepsis. We describe a fatal case of meningococcal sepsis in a 5-month-old infant where N. meningitidis was detected in vitreous humor, cerebrospinal fluid, and blood through PCR. The presented case report gives further evidence in the potential use of vitreous PCR analysis in suspected meningococcal sepsis, particularly in the pediatric population.
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Fernández-Rodríguez A, Burton JL, Andreoletti L, Alberola J, Fornes P, Merino I, Martínez MJ, Castillo P, Sampaio-Maia B, Caldas IM, Saegeman V, Cohen MC. Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings. Clin Microbiol Infect 2018; 25:570-579. [PMID: 30145399 DOI: 10.1016/j.cmi.2018.08.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/10/2018] [Accepted: 08/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autopsies, including minimally invasive autopsies, are a powerful tool for determination of the cause of death. When a patient dies from an infection, microbiology is crucial to identify the causative organism. Post-mortem microbiology (PMM) aims to detect unexpected infections causing sudden deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical errors. Additionally, the analysis of the thanatomicrobiome may help to estimate the post-mortem interval. AIMS The aim was to provide advice in the collection of PMM samples and to propose sampling guidelines for microbiologists advising autopsy pathologists facing different sudden death scenarios. SOURCES A multidisciplinary team with experts in various fields of microbiology and autopsies on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - study group of forensic and post-mortem microbiology and in collaboration with the European Society of Pathology) developed this narrative review based on a literature search using MedLine and Scopus electronic databases supplemented with their own expertise. CONTENT These guidelines address measures to prevent sample contamination in autopsy microbiology; general PMM sampling technique; protocols for PMM sampling in different scenarios and using minimally invasive autopsy; and potential use of the evolving post-mortem microbiome to estimate the post-mortem interval. IMPLICATIONS Adequate sampling is paramount to identify the causative organism. Meaningful interpretation of PMM results requires careful evaluation in the context of clinical history, macroscopic and histological findings. Networking and closer collaboration among microbiologists and autopsy pathologists is vital to maximize the yield of PMM.
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Affiliation(s)
- A Fernández-Rodríguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.
| | | | - L Andreoletti
- Molecular and Clinical Virology Department, EA-4684 CardioVir, Faculty of Medicine and University Hospital Centre, University of Reims Champagne-Ardenne, Reims, France
| | - J Alberola
- Microbiology Service, University Hospital Dr. Peset Valencia, School of Medicine, University of Valencia, Valencia, Spain
| | - P Fornes
- Pathology Department and Forensic Institute, Academic Hospital, Champagne-Ardenne, Reims, France
| | - I Merino
- Microbiology Department, Hospital Universitario Ramón y Cajal-Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M J Martínez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - P Castillo
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - B Sampaio-Maia
- Faculdade de Medicina Dentária, i3S - Instituto de Investigação e Inovação em Saúde, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - I M Caldas
- Faculdade de Medicina Dentária da Universidade do Porto, CFE - Centre os Functional Ecology, University of Coimbra, IINFACTS - Institute of Research and Advanced Training in Health Sciences, Department of Sciences, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal
| | - V Saegeman
- Clinical Laboratory, AZ Nikolaas, Sint-Niklaas, Belgium
| | - M C Cohen
- Sheffield Children's Hospital NHS FT, Histopathology Department, Sheffield UK
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Neck injury and conjunctival petechiae in a woman who underwent cardiopulmonary resuscitation and subsequently died from meningococcal sepsis. Forensic Sci Med Pathol 2017; 13:432-435. [PMID: 28776217 DOI: 10.1007/s12024-017-9901-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
Abstract
Cardiopulmonary resuscitation (CPR) can create a range of unusual lesions and injuries, which may complicate forensic evaluation. Although potentially sinister findings, neck injury and conjunctival petechiae may also be seen in patients who have undergone CPR. We report a case of an individual with subcutaneous bruising and hemorrhage in the deep structures of the neck and florid conjunctival petechiae at autopsy that can be explained by cardiopulmonary resuscitation and meningococcal sepsis.
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