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Schädler J, Azeke AT, Ondruschka B, Steurer S, Lütgehetmann M, Fitzek A, Möbius D. Concordance between MITS and conventional autopsies for pathological and virological diagnoses. Int J Legal Med 2024; 138:431-442. [PMID: 37837537 PMCID: PMC10861633 DOI: 10.1007/s00414-023-03088-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/04/2023] [Indexed: 10/16/2023]
Abstract
In pandemics or to further study highly contagious infectious diseases, new strategies are needed for the collection of post-mortem tissue samples to identify the pathogen as well as its morphological impact. In this study, an ultrasound-guided minimally invasive tissue sampling (MITS) protocol was developed and validated for post-mortem use. The histological and microbiological qualities of post-mortem specimens were evaluated and compared between MITS and conventional autopsy (CA) in a series of COVID-19 deaths. Thirty-six ultrasound-guided MITS were performed. In five cases more, specimens for histological and virological examination were also obtained and compared during the subsequently performed CA. Summary statistics and qualitative interpretations (positive, negative) were calculated for each organ tissue sample from MITS and CA, and target genes were determined for both human cell count (beta-globin) and virus (SARS-CoV-2 specific E gene). There are no significant differences between MITS and CA with respect to the detectability of viral load in individual organs, which is why MITS can be of utmost importance and an useful alternative, especially during outbreaks of infectious diseases.
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Affiliation(s)
- Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Akhator Terence Azeke
- Department of Anatomic Pathology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Subedi N, Bhattarai S, Ranabhat S, Sharma BK, Baral MP. Determination of causes of adult deaths using minimally invasive tissue sampling in Gandaki province of Nepal: a multicenter hospital-based study. Eur J Med Res 2023; 28:407. [PMID: 37805504 PMCID: PMC10559450 DOI: 10.1186/s40001-023-01392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/23/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Minimally Invasive Tissue Sampling (MITS) has been successfully used to establish the cause of death in low- and middle-income countries, mostly in stillbirths and neonates. The objective of this study was to determine the causes of death among adults using MITS in the Gandaki province of Nepal and to find out the contribution of MITS to identify the causes of death. METHODS A multicentric hospital-based pilot study was conducted to enroll 100 cases of adult deaths. The specimens of cerebrospinal fluid, blood, brain, lungs, and liver tissue were collected utilizing MITS. These specimens underwent standard histopathological, serological, and microbiological analyses. The findings from MITS, and if available, clinical records and forensic autopsy findings were compiled and the cause of death panel identified the causes of death. The final cause of death allocated to each case was based on the WHO International Medical Certificate of Death. RESULTS Among a total of 100 cases enrolled during the study period, infectious cause attributed to the immediate cause of death in 77 (77%), cardiovascular in 10 (10%), neurological in 8 (8%), malignancy in two (2%), and gastrointestinal and hepatobiliary cause in one (1%) case. The mean age of the cases was 50.8 ± 15.9 years and 76 (76%) were males. MITS established the cause of death in the causal chain of events in 81(81%) cases and identified the cause of death significantly more with infectious than non-infectious causes (p < 0.001). CONCLUSIONS MITS was useful in establishing the cause of death in the majority of adult deaths and the most common cause was infectious disease. Our findings suggest that MITS can be a valuable and alternative tool for mortality surveillance in low-resource settings, where complete diagnostic autopsies are less accepted or less prioritized.
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Affiliation(s)
- Nuwadatta Subedi
- Department of Forensic Medicine, Gandaki Medical College Teaching Hospital and Research Center, Gandaki, Pokhara, Nepal.
- DECODE MAUN Research Project, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal.
| | - Suraj Bhattarai
- DECODE MAUN Research Project, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
- Global Health Research & Medical Interventions for Development (GLOHMED), Kathmandu, Nepal
| | - Sunita Ranabhat
- DECODE MAUN Research Project, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
- Department of Pathology, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Binita Koirala Sharma
- DECODE MAUN Research Project, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
- Department of Microbiology, Tribhuvan University Prithvi Narayan Campus, Pokhara, Nepal
| | - Madan Prasad Baral
- DECODE MAUN Research Project, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
- Department of Forensic Medicine, Pokhara Academy of Health Sciences, Western Regional Hospital, Pokhara, Nepal
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Aborode AT, Karra-Aly A, Ogunleye SC, Olorunshola MM, Folorunso TN, Aloba CO, Ogunware AE. Overcoming hurdles: Enhancing post-mortem capabilities for neurological investigations in Africa. Aging Brain 2023; 4:100099. [PMID: 37809277 PMCID: PMC10556755 DOI: 10.1016/j.nbas.2023.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
| | - Ayah Karra-Aly
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Seto Charles Ogunleye
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, 39760 MS, USA
| | | | | | | | - Adedayo Emmanuel Ogunware
- Department of Neuroscience, Development and Regenerative Biology, The University of Texas at San Antonio, TX, USA
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Casado-Suela MA, Cuevas-Tascón G, Cabezas Quintario MA, Duffort-Falco M, Vela de la Cruz L, Burdaspall-Moratilla A, Torres-Macho J, Gimeno Aranguez M, Bernal Jorquera J, Muñoz-Rodriguez J. Could We Consider Ultrasound Guided Minimally Invasive Autopsy as a Part of POCUS? J Ultrasound Med 2023. [PMID: 36896883 DOI: 10.1002/jum.16210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
We present a 3-patient case series that support the use of ultrasound guided minimally invasive autopsy (MIA). This technique has a high diagnostic accuracy in specific clinical settings. It makes easier to diagnose pathologies once the patient has died, avoiding body deformation, with a notable reduction in sample processing time compared to the open autopsy study and, therefore, a shorter overall diagnostic response time. MIA shows some similarities with point of care ultrasound (POCUS), like examination protocols or that they can be performed at the bedside.
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Affiliation(s)
- Miguel Angel Casado-Suela
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Guillermo Cuevas-Tascón
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - María Antonia Cabezas Quintario
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Mercedes Duffort-Falco
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Laura Vela de la Cruz
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Ana Burdaspall-Moratilla
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Juan Torres-Macho
- Internal Medicine Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Margarita Gimeno Aranguez
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Javier Bernal Jorquera
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
| | - Jorge Muñoz-Rodriguez
- Department of Medicine, Complutense University, Madrid, Spain
- Pathology Department, Infanta Leonor-Virgen de la Torre University Hospital, Madrid, Spain
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Sacoor C, Vitorino P, Nhacolo A, Munguambe K, Mabunda R, Garrine M, Jamisse E, Magaço A, Xerinda E, Sitoe A, Fernandes F, Carrilho C, Maixenchs M, Chirinda P, Nhampossa T, Nhancale B, Rakislova N, Bramugy J, Nhacolo A, Ajanovic S, Valente M, Massinga A, Varo R, Menéndez C, Ordi J, Mandomando I, Bassat Q. Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.13931.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using, among other tools, the innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS). Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.
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Suwalowska H, Kingori P, Parker M. Navigating uncertainties of death: Minimally Invasive Autopsy Technology in global health. Glob Public Health 2023; 18:2180065. [PMID: 36853068 PMCID: PMC9988304 DOI: 10.1080/17441692.2023.2180065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context.
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Affiliation(s)
- Halina Suwalowska
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Halina Suwalowska Ethox Centre and Wellcome Centre for Ethics and Humanities Nuffield Department of Population Health, University of Oxford, Oxford | OX3 7LF, UK
| | - Patricia Kingori
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Parker
- Ethox Centre, Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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7
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Dhaded SM, Saleem S, Goudar SS, Tikmani SS, Hwang K, Guruprasad G, Aradhya GH, Kusagur VB, Patil LGC, Yogeshkumar S, Somannavar MS, Reza S, Roujani S, Raza J, Yasmin H, Aceituno A, Parlberg L, Kim J, Moore J, Bann CM, Silver RM, Goldenberg RL, McClure EM. The causes of preterm neonatal deaths in India and Pakistan (PURPOSe): a prospective cohort study. Lancet Glob Health 2022; 10:e1575-e1581. [PMID: 36240824 PMCID: PMC9579353 DOI: 10.1016/s2214-109x(22)00384-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/17/2022] [Accepted: 08/22/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Preterm birth remains the major cause of neonatal death worldwide. South Asia contributes disproportionately to deaths among preterm births worldwide, yet few population-based studies have assessed the underlying causes of deaths. Novel evaluations, including histological and bacteriological assessments of placental and fetal tissues, facilitate more precise determination of the underlying causes of preterm deaths. We sought to assess underlying and contributing causes of preterm neonatal deaths in India and Pakistan. METHODS The project to understand and research preterm pregnancy outcomes and stillbirths in South Asia (PURPOSe) was a prospective cohort study done in three hospitals in Davangere, India, and two hospitals in Karachi, Pakistan. All pregnant females older than 14 years were screened at the time of presentation for delivery, and those with an expected or known preterm birth, defined as less than 37 weeks of gestation, were enrolled. Liveborn neonates with a weight of 1000 g or more who died by 28 days after birth were included in analyses. Placentas were collected and histologically evaluated. In addition, among all neonatal deaths, with consent, minimally invasive tissue sampling was performed for histological analyses. PCR testing was performed to assess microbial pathogens in the placental, blood, and fetal tissues collected. An independent panel reviewed available data, including clinical description of the case and all clinical maternal, fetal, and placental findings, and results of PCR bacteriological investigation and minimally invasive tissue sampling histology, from all eligible preterm neonates to determine the primary and contributing maternal, placental, and neonatal causes of death. FINDINGS Between July 1, 2018, and March 26, 2020, of the 3470 preterm neonates enrolled, 804 (23%) died by 28 days after birth, and, of those, 615 were eligible and had their cases reviewed by the panel. Primary maternal causes of neonatal death were hypertensive disease (204 [33%] of 615 cases), followed by maternal complication of pregnancy (76 [12%]) and preterm labour (76 [11%]), whereas the primary placental causes were maternal and fetal vascular malperfusion (172 [28%] of 615) and chorioamnionitis, funisitis, or both (149 [26%]). The primary neonatal cause of death was intrauterine hypoxia (212 [34%] of 615) followed by congenital infections (126 [20%]), neonatal infections (122 [20%]), and respiratory distress syndrome (126 [20%]). INTERPRETATION In south Asia, intrauterine hypoxia and congenital infections were the major causes of neonatal death among preterm babies. Maternal hypertensive disorders and placental disorders, especially maternal and fetal vascular malperfusion and placental abruption, substantially contributed to these deaths. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sangappa M Dhaded
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | | | - Kay Hwang
- Research Triangle Institute International, Durham, NC, USA
| | - Gowdar Guruprasad
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Gayathri H Aradhya
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | - Varun B Kusagur
- Bapuji Educational Association's JJM Medical College, Davangere, Karnataka, India
| | | | - S Yogeshkumar
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, JN Medical College, Belagavi, Karnataka, India
| | - Sayyeda Reza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sana Roujani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - Anna Aceituno
- Research Triangle Institute International, Durham, NC, USA
| | | | - Jean Kim
- Research Triangle Institute International, Durham, NC, USA
| | - Janet Moore
- Research Triangle Institute International, Durham, NC, USA
| | - Carla M Bann
- Research Triangle Institute International, Durham, NC, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Elizabeth M McClure
- Research Triangle Institute International, Durham, NC, USA,Correspondence to: Dr Elizabeth M McClure, Research Triangle Institute International, Durham, NC 27709, USA
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McClure EM, Saleem S, Goudar SS, Tikmani SS, Dhaded SM, Hwang K, Guruprasad G, Shobha D, Sarvamangala B, Yogeshkumar S, Somannavar MS, Roujani S, Reza S, Raza J, Yasmin H, Aceituno A, Parlberg L, Kim J, Bann CM, Silver RM, Goldenberg RL. The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe). Lancet Glob Health 2022; 10:e970-e977. [PMID: 35714647 PMCID: PMC9210259 DOI: 10.1016/s2214-109x(22)00180-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Kay Hwang
- Research Triangle Institute International, Durham, NC, USA
| | - Gowdar Guruprasad
- Department of Neonatology, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - Dhananjaya Shobha
- Department of Obstetrics, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - B Sarvamangala
- Department of Obstetrics, Bapuji Educational Association's JJM Medical College, Davangere, India
| | - S Yogeshkumar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy of Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Sana Roujani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sayyeda Reza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Anna Aceituno
- Research Triangle Institute International, Durham, NC, USA
| | | | - Jean Kim
- Research Triangle Institute International, Durham, NC, USA
| | - Carla M Bann
- Research Triangle Institute International, Durham, NC, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Melo DN, Lima GRP, Fernandes CG, Teixeira AC, Filho JB, Araújo FMC, Araújo LC, Siqueira AM, Farias LABG, Monteiro RAA, Ordi J, Martinez MJ, Saldiva PHN, Cavalcanti LPG. Post-Mortem Diagnosis of Pediatric Dengue Using Minimally Invasive Autopsy during the COVID-19 Pandemic in Brazil. Trop Med Infect Dis 2022; 7:tropicalmed7070123. [PMID: 35878135 PMCID: PMC9316822 DOI: 10.3390/tropicalmed7070123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
We report the first pediatric disease in which the use of minimally invasive autopsy (MIA) confirmed severe dengue as the cause of death. During the COVID-19 pandemic, a previously healthy 10-year-old girl living in north-eastern Brazil presented fever, headache, diffuse abdominal pain, diarrhoea, and vomiting. On the fourth day, the clinical symptoms worsened and the patient died. An MIA was performed, and cores of brain, lungs, heart, liver, kidneys, and spleen were collected with 14G biopsy needles. Microscopic examination showed diffuse oedema and congestion, pulmonary intra-alveolar haemorrhage, small foci of midzonal necrosis in the liver, and tubular cell necrosis in the kidneys. Dengue virus RNA and NS1 antigen were detected in blood and cerebrospinal fluid samples. Clinical, pathological, and laboratory findings, in combination with the absence of other lesions and microorganisms, allowed concluding that the patient had died from complications of severe dengue.
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Affiliation(s)
- Deborah N. Melo
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza 60842-395, Brazil; (D.N.M.); (A.C.T.); (J.B.F.)
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Fortaleza 60020-181, Brazil
| | - Giovanna R. P. Lima
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
| | - Carolina G. Fernandes
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
| | - André C. Teixeira
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza 60842-395, Brazil; (D.N.M.); (A.C.T.); (J.B.F.)
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
- Argos Laboratory, Fortaleza 60175-047, Brazil
| | - Joel B. Filho
- Serviço de Verificação de Óbitos Dr Rocha Furtado, Fortaleza 60842-395, Brazil; (D.N.M.); (A.C.T.); (J.B.F.)
| | | | - Lia C. Araújo
- Programa de Residencia Medica em Patologia pela Universidade Federal do Ceará, 60, Fortaleza 60020-181, Brazil;
| | | | | | - Renata A. A. Monteiro
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (R.A.A.M.); (P.H.N.S.)
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
- ISGlobal, Hospital Clínic, University of Barcelona, 08007 Barcelona, Spain;
| | - Miguel J. Martinez
- ISGlobal, Hospital Clínic, University of Barcelona, 08007 Barcelona, Spain;
| | - Paulo H. N. Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (R.A.A.M.); (P.H.N.S.)
| | - Luciano P. G. Cavalcanti
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Fortaleza 60020-181, Brazil
- Faculdade de Medicina, Centro Universitário Christus, Fortaleza 60190-180, Brazil; (G.R.P.L.); (C.G.F.)
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Ceará, Fortaleza 60020-181, Brazil
- Correspondence: ; Tel.: +55-85-999878969
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Ritter JM, Seixas JN, Walong E, Dawa J, Onyango C, Pimenta FC, da Gloria Carvalho M, Silva-Flannery L, Jenkinson T, Howard K, Bhatnagar J, Diaz M, Winchell JM, Zaki SR, Chaves SS, Martines RB. Histopathology Is Key to Interpreting Multiplex Molecular Test Results From Postmortem Minimally Invasive Tissue Samples. Clin Infect Dis 2021; 73:S351-S359. [PMID: 34910182 PMCID: PMC8672755 DOI: 10.1093/cid/ciab772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Minimally invasive tissue sampling (MITS) is an alternative to complete autopsy for determining causes of death. Multiplex molecular testing performed on MITS specimens poses challenges of interpretation, due to high sensitivity and indiscriminate detection of pathogenic, commensal, or contaminating microorganisms. Methods MITS was performed on 20 deceased children with respiratory illness, at 10 timepoints up to 88 hours postmortem. Samples were evaluated by multiplex molecular testing on fresh tissues by TaqMan® Array Card (TAC) and by histopathology, special stains, immunohistochemistry (IHC), and molecular testing (PCR) on formalin-fixed, paraffin-embedded (FFPE) tissues. Results were correlated to determine overall pathologic and etiologic diagnoses and to guide interpretation of TAC results. Results MITS specimens collected up to 3 days postmortem were adequate for histopathologic evaluation and testing. Seven different etiologic agents were detected by TAC in 10 cases. Three cases had etiologic agents detected by FFPE or other methods and not TAC; 2 were agents not present on TAC, and 2 were streptococci that may have been species other than those present on TAC. Result agreement was 43% for TAC and IHC or PCR, and 69% for IHC and PCR. Extraneous TAC results were common, especially when aspiration was present. Conclusions TAC can be performed on MITS up to 3 days after death with refrigeration and provides a sensitive method for detection of pathogens but requires careful interpretation in the context of clinicoepidemiologic and histopathologic findings. Interpretation of all diagnostic tests in aggregate to establish overall case diagnoses maximizes the utility of TAC in MITS.
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Affiliation(s)
- Jana M Ritter
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Josilene N Seixas
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edwin Walong
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Jeanette Dawa
- College of Health Sciences, University of Nairobi, Nairobi, Kenya.,Washington State University, Global Health Programs (Kenya office), Nairobi, Kenya
| | - Clayton Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Fabiana C Pimenta
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Luciana Silva-Flannery
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tiffany Jenkinson
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katie Howard
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julu Bhatnagar
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen Diaz
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M Winchell
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherif R Zaki
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya and Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Roosecelis B Martines
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Bassat Q, Varo R, Hurtado JC, Marimon L, Ferrando M, Ismail MR, Carrilho C, Fernandes F, Castro P, Maixenchs M, Rodrigo-Calvo MT, Guerrero J, Martínez A, Lacerda MVG, Mandomando I, Menéndez C, Martinez MJ, Ordi J, Rakislova N. Minimally Invasive Tissue Sampling as an Alternative to Complete Diagnostic Autopsies in the Context of Epidemic Outbreaks and Pandemics: The Example of Coronavirus Disease 2019 (COVID-19). Clin Infect Dis 2021; 73:S472-S479. [PMID: 34910176 PMCID: PMC8672745 DOI: 10.1093/cid/ciab760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Infectious diseases’ outbreak investigation requires, by definition, conducting a thorough epidemiological assessment while simultaneously obtaining biological samples for an adequate screening of potential responsible pathogens. Complete autopsies remain the gold-standard approach for cause-of-death evaluation and characterization of emerging diseases. However, for highly transmissible infections with a significant associated lethality, such as COVID-19, complete autopsies are seldom performed due to biosafety challenges, especially in low-resource settings. Minimally invasive tissue sampling (MITS) is a validated new approach based on obtaining postmortem samples from key organs and body fluids, a procedure that does not require advanced biosafety measures or a special autopsy room. Methods We aimed to review the use of MITS or similar procedures for outbreak investigation up to 27 March 2021 and their performance for evaluating COVID-19 deaths. Results After a literature review, we analyzed in detail the results of 20 studies conducted at international sites, whereby 216 COVID-19–related deaths were investigated. MITS provided a general and more granular understanding of the pathophysiological changes secondary to the infection and high-quality samples where the extent and degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related damage could be evaluated. Conclusions MITS is a useful addition in the investigation and surveillance of infections occurring in outbreaks or epidemics. Its less invasive nature makes the tool more acceptable and feasible and reduces the risk of procedure-associated contagion, using basic biosafety measures. Standardized approaches protocolizing which samples should be collected—and under which exact biosafety measures—are necessary to facilitate and expand its use globally.
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Affiliation(s)
- Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Madrid, Spain.,Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic, Institut D'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - José Guerrero
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Martínez
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marcus V G Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane-ILMD, Manaus, Brazil
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Miguel J Martinez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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12
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Mudenda V, Mumba C, Pieciak RC, Mwananyanda L, Chimoga C, Ngoma B, Mupila Z, Kwenda G, Forman L, Lapidot R, MacLeod WB, Thea DM, Gill CJ. Histopathological Evaluation of Deceased Persons in Lusaka, Zambia With or Without Coronavirus Disease 2019 (COVID-19) Infection: Results Obtained From Minimally Invasive Tissue Sampling. Clin Infect Dis 2021; 73:S465-S471. [PMID: 34910177 PMCID: PMC8672753 DOI: 10.1093/cid/ciab858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Although much has been learned about the pathophysiology of coronavirus disease 2019 (COVID-19) infections, pathology data from patients who have died of COVID-19 in low- and middle-income country settings remain sparse. We integrated minimally invasive tissue sampling (MITS) into an ongoing postmortem surveillance study of COVID-19 in deceased individuals of all ages in Lusaka, Zambia. Methods We enrolled deceased subjects from the University Teaching Hospital Morgue in Lusaka, Zambia within 48 hours of death. We collected clinical and demographic information, a nasopharyngeal swab, and core tissue biopsies from the lung, liver, and kidneys for pathologic analysis. Individuals were considered eligible for MITS if they had a respiratory syndrome prior to death or a COVID-19+ polymerase chain reaction (PCR) nasopharyngeal swab specimen. Samples were retested using quantitative reverse transcriptase PCR. Results From June to September 2020 we performed MITS on 29 deceased individuals. PCR results were available for 28/29 (96.5%) cases. Three had a COVID-19+ diagnosis antemortem, and 5 more were identified postmortem using the recommended cycle threshold cut-point <40. When expanding the PCR threshold to 40 ≤ cycle threshold (Ct) ≤ 45, we identified 1 additional case. Most cases were male and occurred in the community The median age at death was 47 years (range 40–64). Human immunodeficiency virus (HIV)/AIDS, tuberculosis, and diabetes were more common among the COVID-19+ cases. Diffuse alveolar damage and interstitial pneumonitis were common among COVID-19+ cases; nonspecific findings of hepatic steatosis and acute kidney injury were also prevalent in the COVID-19+ group. Vascular thrombi were rarely detected. Conclusions Lung abnormalities typical of viral pneumonias were common among deceased COVID-19+ individuals, as were nonspecific findings in the liver and kidneys. Pulmonary vascular thrombi were rarely detected, which could be a limitation of the MITS technique. Nonetheless, MITS offers a valuable alternative to open autopsy for understanding pathological changes due to COVID-19.
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Affiliation(s)
- Victor Mudenda
- University Teaching Hospital, Department of Pathology, Lusaka, Zambia
| | - Chibamba Mumba
- University Teaching Hospital, Department of Pathology, Lusaka, Zambia
| | - Rachel C Pieciak
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Lawrence Mwananyanda
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA.,Right to Care Zambia, Lusaka, Zambia
| | | | | | | | - Geoffrey Kwenda
- University of Zambia, School of Health Sciences, Department of Biomedical Sciences, Lusaka, Zambia
| | - Leah Forman
- Boston University School of Public Health, Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston, Massachusetts, USA
| | - Rotem Lapidot
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - William B MacLeod
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Donald M Thea
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
| | - Christopher J Gill
- Boston University School of Public Health, Department of Global Health, Boston, Massachusetts, USA
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13
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Caballero MT, Grigaites SD, De la Iglesia Niveyro PX, Esperante S, Bianchi AM, Nuño A, Valle S, Afarian G, Ferretti AJP, Baglivo SJ, De Luca J, Zea CM, Caporal P, Labanca MJ, Diamanti A, Alvarez-Paggi D, Bassat Q, Polack FP. Uncovering Causes of Childhood Death Using the Minimally Invasive Autopsy at the Community Level in an Urban Vulnerable Setting of Argentina: A Population-Based Study. Clin Infect Dis 2021; 73:S435-S441. [PMID: 34910178 PMCID: PMC8672764 DOI: 10.1093/cid/ciab838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Precise determination of the causal chain that leads to community deaths in children in low- and middle-income countries is critical to estimating all causes of mortality accurately and to planning preemptive strategies for targeted allocation of resources to reduce this scourge. Methods An active surveillance population-based study that combined minimally invasive tissue sampling (MITS) and verbal autopsies (VA) among children under 5 was conducted in Buenos Aires, Argentina, from September 2018 to December 2020 to define the burden of all causes of community deaths. Results Among 90 cases enrolled (86% of parental acceptance), 81 had complete MITS, 15.6% were neonates, 65.6% were post-neonatal infants, and 18.9% were children aged 1–5 years. Lung infections were the most common cause of death (CoD) in all age groups (57.8%). Among all cases of lung infections, acute bronchiolitis was the most common CoD in infants aged <12 months (23 of 36, 63.9%), and bacterial pneumonia was the most common cause in children aged >12 months (8 of 11, 72.7%). The most common comorbid condition in all age groups was undernutrition in 18 of 90 (20%). It was possible to find an immediate CoD in 78 of 81 subjects where MITS could be done. With this combined approach, we were able to determine that sudden infant death syndrome was overestimated in state reports. Conclusions CoD determination by a combination of MITS and VA provides an accurate estimation of the chain of events that leads to death, emphasizing possible interventions to prevent mortality in children.
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Affiliation(s)
- Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Sebastian Diaz Grigaites
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Público de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | | | - Sebastian Esperante
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | | | | | | | - Gabriela Afarian
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Público de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | | | | | | | | | - Paula Caporal
- Hospital De Niños Sup. Sor Maria Ludovica, La Plata, Argentina
| | - Maria Jose Labanca
- Hospital Italiano de Buenos Aires, Servicio de Anatomía Patológica, Buenos Aires, Argentina
| | - Adriana Diamanti
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Público de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | - Damian Alvarez-Paggi
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, CP Maputo, Mozambique.,Institución Catalana de Investigación y Estudios Avanzados (ICREA), Pg. Lluís Companys, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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14
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Letang E, Rakislova N, Martinez MJ, Carlos Hurtado J, Carrilho C, Bene R, Mandomando I, Quintó L, Nhampossa T, Chicamba V, Luis E, Ismail MR, Fernandes F, Lorenzoni C, Ferreira L, Freire M, Teresa Rodrigo-Calvo M, Guerrero J, Munguambe K, Maixenchs M, Navarro M, Casas I, Marimon L, Ferrando M, Macete E, Lacerda M, Bassat Q, Menéndez C, Ordi J. Minimally Invasive Tissue Sampling: A Tool to Guide Efforts to Reduce AIDS-Related Mortality in Resource-Limited Settings. Clin Infect Dis 2021; 73:S343-S350. [PMID: 34910173 PMCID: PMC8672756 DOI: 10.1093/cid/ciab789] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Available information on the causes of death among people living with human immunodeficiency virus (PLHIV) in low- and middle-income countries (LMICs) remains scarce. We aimed to provide data on causes of death in PLHIV from two LMICs, Brazil and Mozambique, to assess the impact of clinical misdiagnosis on mortality rates and to evaluate the accuracy of minimally invasive tissue sampling (MITS) in determining the cause of death in PLHIV. Methods We performed coupled MITS and complete autopsy on 164 deceased PLHIV (18 children, 36 maternal deaths, and 110 adults). HIV antibody levels and HIV RNA viral loads were determined from postmortem serum samples. Results Tuberculosis (22.7%), toxoplasmosis (13.9%), bacterial infections (13.9%), and cryptococcosis (10.9%) were the leading causes of death in adults. In maternal deaths, tuberculosis (13.9%), bacterial infections (13.9%), cryptococcosis (11.1%), and cerebral malaria (8.3%) were the most frequent infections, whereas viral infections, particularly cytomegalovirus (38.9%), bacterial infections (27.8%), pneumocystosis (11.1%), and HIV-associated malignant neoplasms (11.1%) were the leading cause among children. Agreement between the MITS and the complete autopsy was 100% in children, 91% in adults, and 78% in maternal deaths. The MITS correctly identified the microorganism causing death in 89% of cases. Conclusions Postmortem studies provide highly granular data on the causes of death in PLHIV. The inaccuracy of clinical diagnosis may play a significant role in the high mortality rates observed among PLHIV in LMICs. MITS might be helpful in monitoring the causes of death in PLHIV and in highlighting the gaps in the management of the infections.
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Affiliation(s)
- Emilio Letang
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Miguel J Martinez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Carla Carrilho
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Valéria Chicamba
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Elvira Luis
- Department of Obstetrics and Gynecology, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Fabiola Fernandes
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Luiz Ferreira
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Monique Freire
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil.,Fundação Centro de Controle de Oncologia do Amazonas, Manaus, Amazonas, Brazil
| | | | - José Guerrero
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Quique Bassat
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.,Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Clara Menéndez
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Institute for Global Health, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clínic, Universitat de Barcelona, Spain
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15
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Munguambe K, Maixenchs M, Anselmo R, Blevins J, Ordi J, Mandomando I, Breiman RF, Bassat Q, Menéndez C. Consent to minimally invasive tissue sampling procedures in children in Mozambique: A mixed-methods study. PLoS One 2021; 16:e0259621. [PMID: 34748582 PMCID: PMC8575303 DOI: 10.1371/journal.pone.0259621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Minimally invasive tissue sampling (MITS), also named minimally invasive autopsy is a post-mortem method shown to be an acceptable proxy of the complete diagnostic autopsy. MITS improves the knowledge of causes of death (CoD) in resource-limited settings. Its implementation requires understanding the components of acceptability, including facilitators and barriers in real-case scenarios. METHODS We undertook a mixed-methods analysis comparing anticipated (hypothetical scenario) and experienced (real-case scenario) acceptability of MITS among relatives of deceased children in Mozambique. Anticipated acceptability information was obtained from 15 interviews with relatives of deceased children. The interview focus was on whether and why they would allow the procedure on their dead child in a hypothetical scenario. Experienced acceptability data were obtained from outcomes of consent requested to relatives of 114 deceased children during MITS implementation, recorded through observations, clinical records abstraction and follow-up informal conversations with health care professionals and semi-structured interviews with relatives. RESULTS Ninety-three percent of relatives indicated that they would hypothetically accept MITS on their deceased child. A key reason was knowing the CoD to take preventive actions; whereas the need to conform with the norm of immediate child burial, the secrecy of perinatal deaths, the decision-making complexity, the misalignment between MITS' purpose and traditional values, lack of a credible reason to investigate CoD, and the impotency to resuscitate the deceased were identified as potential points of hesitancy for acceptance. The only refusing respondent linked MITS to a perception that sharing results would constitute a breach of confidentiality and the lack of value attached to CoD determination. Experienced acceptability revealed four different components: actual acceptance, health professionals' hesitancy, relatives' hesitancy and actual refusal, which resulted in 82% of approached relatives to agree with MITS and 79% of cases to undergo MITS. Barriers to acceptability included, among others, health professionals' and facilities' unpreparedness to perform MITS, the threat of not burying the child immediately, financial burden of delays, decision-making complexities and misalignment of MITS' objectives with family values. CONCLUSIONS MITS showed high anticipated and experienced acceptability driven by the opportunity to prevent further deaths. Anticipated acceptability identified secrecy, confidentiality and complex decision-making processes as barriers, while experienced acceptability revealed family- and health facility-level logistics and practical aspects as barriers. Health-system and logistical impediments must also be considered before MITS implementation. Additionally, the multiple components of acceptability must be taken into account to make it more consistent and transferrable.
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Affiliation(s)
- Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Maria Maixenchs
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
| | - John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Jaume Ordi
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic- Universitat de Barcelona, Barcelona, Spain
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Robert F. Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Institución Catalana de Investigación y Estudios Avanzados (ICREA), Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde de Manhiça (CISM), Cambeve, Maputo, Mozambique
- Barcelona Institute for Global Health/ Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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16
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Fitzek A, Schädler J, Dietz E, Ron A, Gerling M, Kammal AL, Lohner L, Falck C, Möbius D, Goebels H, Gerberding AL, Schröder AS, Sperhake JP, Klein A, Fröb D, Mushumba H, Wilmes S, Anders S, Kniep I, Heinrich F, Langenwalder F, Meißner K, Lange P, Zapf A, Püschel K, Heinemann A, Glatzel M, Matschke J, Aepfelbacher M, Lütgehetmann M, Steurer S, Thorns C, Edler C, Ondruschka B. Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases. Sci Rep 2021; 11:19342. [PMID: 34588486 PMCID: PMC8481286 DOI: 10.1038/s41598-021-98499-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/08/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.
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Affiliation(s)
- Antonia Fitzek
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schädler
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eric Dietz
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Ron
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Gerling
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna L. Kammal
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Lohner
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carla Falck
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dustin Möbius
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Goebels
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Lina Gerberding
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ann Sophie Schröder
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Peter Sperhake
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Klein
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Fröb
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Herbert Mushumba
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Wilmes
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Anders
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Kniep
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Heinrich
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felicia Langenwalder
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kira Meißner
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philine Lange
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- grid.13648.380000 0001 2180 3484Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Püschel
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Heinemann
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Glatzel
- grid.13648.380000 0001 2180 3484Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Matschke
- grid.13648.380000 0001 2180 3484Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Aepfelbacher
- grid.13648.380000 0001 2180 3484Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- grid.13648.380000 0001 2180 3484Institute of Medical Microbiology, Virology, and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- grid.13648.380000 0001 2180 3484Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Thorns
- grid.6363.00000 0001 2218 4662Institute of Pathology, Marienkrankenhaus, Hamburg, Germany
| | - Carolin Edler
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- grid.13648.380000 0001 2180 3484Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Caballero MT, Bianchi AM, Grigaites SD, De la Iglesia Niveyro PX, Nuño A, Valle S, Afarian G, Esperante SA, Ferretti AJP, Jares Baglivo S, De Luca J, Alvarez-Paggi D, Diamanti A, Bassat Q, Polack FP. Community Mortality Due to Respiratory Syncytial Virus in Argentina: Population-based Surveillance Study. Clin Infect Dis 2021; 73:S210-S217. [PMID: 34472572 PMCID: PMC8411253 DOI: 10.1093/cid/ciab497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Many deaths in infants from low-middle income countries (LMICs) occur at home or upon arrival to health facilities. Although acute lower respiratory tract illness plays an important role in community mortality, the accuracy of mortality rates due to respiratory syncytial virus (RSV) remains unknown. Methods An active surveillance study among children aged under 5 years old (U5) was performed in Buenos Aires, Argentina, between January and December 2019, to define the burden and role of RSV in childhood community mortality. Results A total of 63 families of children U5 participated in the study. Based on a combined approach of tissue sampling, verbal autopsies, and expert’s analysis, RSV infection was found in the causal chain of 11 from 12 cases with positive molecular biology results in respiratory samples. The estimated mortality rate due to RSV among infants was 0.27 deaths/1000 live births. The mean age of RSV-related household deaths was 2.8 months of age (standard deviation [SD] 1.7), and 8/12 were male infants (66.7%). Dying at home from RSV was associated with Streptococcus pneumoniae and/or Moraxella catarrhalis lung coinfection (75%), living in slums and settlement (odds ratio [OR], 17.09; 95% confidence interval [CI], 1.3–219.2), and other underlying comorbidities (OR, 14.87; 95% CI, 1.3–164.6). Conclusions Infant community mortality rates due to RSV are higher than those reported in industrialized countries and similar to those reported in hospital-based studies in the same catchment population.
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Affiliation(s)
- Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | - Sebastian Diaz Grigaites
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Publico de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | | | | | | | - Gabriela Afarian
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Publico de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | - Sebastian A Esperante
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | | | - Damian Alvarez-Paggi
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Adriana Diamanti
- Morgue Judicial del Instituto de Ciencias Forenses Conurbano Sur, Ministerio Publico de la Provincia de Buenos Aires, Lomas de Zamora, Argentina
| | - Quique Bassat
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), CP Maputo, Mozambique.,ICREA, Pg. Lluís Companys, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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18
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Caballero MT, Satav A, Gill CJ, Omer SB, Pieciak RC, Kazi AM, Simões EA, Polack FP. Challenges of Assessing Community Mortality Due to Respiratory Viruses in Children Aged Less Than 5 Years. Clin Infect Dis 2021; 73:S248-S254. [PMID: 34472573 PMCID: PMC8411250 DOI: 10.1093/cid/ciab487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Estimating the real impact of respiratory syncytial virus (RSV) disease is key for the development of vaccines and treatments. Ascertaining the burden of community mortality due to RSV is challenging due to the lack of primary data. Therefore, conducting observational studies to determine the factors associated with community mortality due to the virus in developing countries is important. Objective Our aim in this study was to describe the obstacles, gaps, and challenges that investigators face in low-income, vulnerable regions in 4 developing countries on 3 continents. Results The main obstacles and challenges of ascertaining community mortality due to RSV were defining strategies to consent families for testing before burial, sampling individuals at the household level, supporting bereaved parents with different cultural and religious backgrounds, establishing tailored strategies for studies in challenging settings, and integrating RSV mortality data from nasopharyngeal samples. Conclusion Detailed logistical planning based on population sociodemographic information, grief counseling, staff training, and a multidisciplinary approach with adequate laboratory infrastructure is critical to successful observational community-based RSV studies.
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Affiliation(s)
- Mauricio T Caballero
- Fundacion INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET), Buenos Aires, Argentina
| | - Ashish Satav
- Meditation, AIDS, Health, Addiction & Nutrition (MAHAN) (MAHAN) Trust, Mahatma Gandhi Tribal Hospital Karmagram, Utavali, Tahsil, Dharni, Amravati, India
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, USA.,Section of Infectious Diseases, Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut, USA.,Yale School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Rachel C Pieciak
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Abdul Momin Kazi
- Department of Pediatrics, The Aga Khan University, Karachi, Pakistan
| | - Eric Af Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Epidemiology, Center for Global Health Colorado School of Public Health, Aurora, Colorado, USA
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19
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Möbius D, Fitzek A, Hammer N, Heinemann A, Ron A, Schädler J, Zwirner J, Ondruschka B. Ultrasound in legal medicine-a missed opportunity or simply too late? A narrative review of ultrasonic applications in forensic contexts. Int J Legal Med 2021; 135:2363-2383. [PMID: 34292383 PMCID: PMC8295453 DOI: 10.1007/s00414-021-02661-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/02/2021] [Indexed: 01/15/2023]
Abstract
Objectives Conventional autopsies remain the gold standard of postmortem healthcare quality assurance and help gathering extended knowledge on diseases. In answer to constantly declining autopsy rates non- or minimally invasive autopsy methods were introduced. Ultrasound is a well-established tool for imaging commonly used in clinical practice. This narrative review aims to summarize the current literature regarding the feasibility and validity of ultrasound in a forensic context. Material and methods A PubMed database search was carried out. Abstracts were scanned for pre-defined ex- and inclusion criteria, followed by a snowball search procedure applied to the primarily included articles. Results Forty-five publications met our inclusion criteria. The selected articles concern the feasibility of ultrasound in pre- or postmortem settings, forensic age estimation, and minimally invasive approaches. For imaging, ultrasound was deemed a reliable tool for the examination of epiphyses und superficial wounds, with limitations regarding internal organs and image quality due to postmortem changes. Ultrasound-guided minimally invasive approaches yielded higher success rates for adequate tissue sampling. Many investigations were carried out in low- and middle-income countries focusing on infectious diseases. Conclusion Ultrasound seems a promising but underutilized imaging tool in legal medicine to date. Promising approaches on its feasibility have been conducted. Especially for minimally invasive methods, ultrasound offered significant improvements on qualified biopsy sampling and thus appropriate diagnostics. Moreover, ultrasonic evaluation of epiphyses for age estimation offered valuable results. Nevertheless, further assessment of ultrasonic feasibility in forensic contexts is needed.
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Affiliation(s)
- Dustin Möbius
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Antonia Fitzek
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niels Hammer
- Institute of Macroscopic and Clinical Anatomy, University of Graz, Graz, Austria.,Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany.,Fraunhofer IWU, Dresden, Germany
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Ron
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schädler
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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20
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Rakislova N, Jordao D, Ismail MR, Mayor A, Cisteró P, Marimon L, Ferrando M, Hurtado JC, Lovane L, Carrilho C, Lorenzoni C, Fernandes F, Nhampossa T, Cossa A, Mandomando I, Navarro M, Casas I, Munguambe K, Maixenchs M, Quintó L, Macete E, Martinez M, Snow RW, Bassat Q, Menéndez C, Ordi J. Accuracy of verbal autopsy, clinical data and minimally invasive autopsy in the evaluation of malaria-specific mortality: an observational study. BMJ Glob Health 2021; 6:bmjgh-2021-005218. [PMID: 34083241 PMCID: PMC8183227 DOI: 10.1136/bmjgh-2021-005218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Global malaria mortality estimates are hindered by the low reliability of the verbal autopsy (VA) and the clinical records, the most common sources of information used to estimate malaria-specific mortality. We aimed to determine the accuracy of these tools, as well as of the minimally invasive autopsy (MIA), a needle-based postmortem sampling method, to identify malaria-specific mortality in a large series of deceased patients from Mozambique, using complete autopsy as the gold standard. METHODS Observational study that included 264 deaths, occurring at a tertiary level hospital in Mozambique, from 1 November 2013 to 31 March 2015 (17 months-long period). Clinical data were abstracted, a computer coded VA was completed using the clinical data as source of information, and an MIA followed by a complete autopsy were performed. Screening for malaria infection was conducted postmortem to all participants using molecular and histological techniques (PCR and immunohistochemistry). FINDINGS Malaria infection was considered the cause of death in 6/264 (2.3%) cases: 2/54 children (3.7%, both less than 5 years old) and 4/57 (7.0%) maternal deaths. The sensitivity and specificity of the VA, the clinical data and the MIA to identify malaria-specific deaths were 33.3% and 96.1%, 66.7% and 96.1%, and 100% and 100%, respectively. In addition, malaria was identified as a possible contributor in 14 additional patients who died of other diseases. These cases were also accurately identified by the MIA (sensitivity 82.4%, specificity 100%). INTERPRETATION The high sensitivity and specificity of the MIA in identifying malaria may help to improve current estimates of malaria-specific mortality in endemic areas.
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Affiliation(s)
- Natalia Rakislova
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Dercio Jordao
- Department of Pathology, Quelimane Central Hospital, Quelimane, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Alfredo Mayor
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pau Cisteró
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.,Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | | | - Mireia Navarro
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isaac Casas
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Khatia Munguambe
- Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Maria Maixenchs
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Llorenç Quintó
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Mikel Martinez
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Robert W Snow
- Population and Health Unit, KEMRI - Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuttfield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Quique Bassat
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Clara Menéndez
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGLOBAL, Hospital Clinic, University of Barcelona, Barcelona, Spain .,Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
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21
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Rizk SS, Elwakil WH, Attia AS. Antibiotic-Resistant Acinetobacter baumannii in Low-Income Countries (2000-2020): Twenty-One Years and Still below the Radar, Is It Not There or Can They Not Afford to Look for It? Antibiotics (Basel) 2021; 10:764. [PMID: 34201723 DOI: 10.3390/antibiotics10070764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/30/2022] Open
Abstract
Acinetobacter baumannii is an emerging pathogen, and over the last three decades it has proven to be particularly difficult to treat by healthcare services. It is now regarded as a formidable infectious agent with a genetic setup for prompt development of resistance to most of the available antimicrobial agents. Yet, it is noticed that there is a gap in the literature covering this pathogen especially in countries with limited resources. In this review, we provide a comprehensive updated overview of the available data about A. baumannii, the multi-drug resistant (MDR) phenotype spread, carbapenem-resistance, and the associated genetic resistance determinants in low-income countries (LIICs) since the beginning of the 21st century. The coverage included three major databases; PubMed, Scopus, and Web of Science. Only 52 studies were found to be relevant covering only 18 out of the 29 countries included in the LIC group. Studies about two countries, Syria and Ethiopia, contributed ~40% of the studies. Overall, the survey revealed a wide spread of MDR and alarming carbapenem-resistance profiles. Yet, the total number of studies is still very low compared to those reported about countries with larger economies. Accordingly, a discussion about possible reasons and recommendations to address the issue is presented. In conclusion, our analyses indicated that the reported studies of A. baumannii in the LICs is far below the expected numbers based on the prevailing circumstances in these countries. Lack of proper surveillance systems due to inadequate financial resources could be a major contributor to these findings.
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22
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Rodríguez-Grande C, Hurtado JC, Rodríguez-Maus S, Casas I, Castillo P, Navarro M, Rakislova N, García-Basteiro A, Carrilho C, Fernandes F, Lovane L, Jordao D, Ismail MR, Lorenzoni C, Cossa A, Mandomando I, Bassat Q, Menéndez C, Ordi J, Muñoz P, Pérez-Lago L, García de Viedma D, Martínez MJ. High within-host diversity found from direct genotyping on post-mortem tuberculosis specimens in a high-burden setting. Clin Microbiol Infect 2021; 27:1518.e5-1518.e9. [PMID: 34119641 DOI: 10.1016/j.cmi.2021.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To characterize the clonal complexity in Mycobacterium tuberculosis (MTB) infections considering factors that help maximize the detection of coexisting strains/variants. METHODS Genotypic analysis by Mycobacterial Interspersed Repetitive-Unit-Variable-Number Tandem-Repeats (MIRU-VNTR) was performed directly on 70 biopsy specimens from two or more different tissues involving 28 tuberculosis cases diagnosed post-mortem in Mozambique, a country with a high tuberculosis burden. RESULTS Genotypic data from isolates collected from two or more tissues were obtained for 23 of the 28 cases (82.1%), allowing the analysis of within-patient diversity. MIRU-VNTR analysis revealed clonal diversity in ten cases (35.7%). Five cases showed allelic differences in three or more loci, suggesting mixed infection with two different strains. In half of the cases showing within-host diversity, one of the specimens associated with clonal heterogeneity was brain tissue. CONCLUSIONS Direct MTB genotyping from post-mortem tissue samples revealed a frequent within-host Mycobacterium tuberculosis diversity, including mixed and polyclonal infections. Most of this diversity would have been overlooked if only standard analysis of respiratory specimens had been performed.
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Affiliation(s)
- Cristina Rodríguez-Grande
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juan Carlos Hurtado
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Sandra Rodríguez-Maus
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Isaac Casas
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Mireia Navarro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Alberto García-Basteiro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Anélsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Jaume Ordi
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Laura Pérez-Lago
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Darío García de Viedma
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Miguel J Martínez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic de Barcelona, Barcelona, Spain.
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Rakislova N, Hurtado JC, Palhares AEM, Ferreira L, Freire M, Lacerda M, Monteiro W, Navarro M, Casas I, Teixeira MDM, Castillo P, Rodrigo-Calvo MT, Marimon L, Guerrero J, Varo R, Delgado V, Quintó L, Marco F, Letang E, Vila J, Bassat Q, Menéndez C, Ordi J, Martínez MJ. High prevalence and mortality due to Histoplasma capsulatum in the Brazilian Amazon: An autopsy study. PLoS Negl Trop Dis 2021; 15:e0009286. [PMID: 33819269 PMCID: PMC8049479 DOI: 10.1371/journal.pntd.0009286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/15/2021] [Accepted: 03/02/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Histoplasmosis is acquired by inhalation of spores of the dimorphic fungus Histoplasma spp. Although this pathogen is distributed worldwide, it is more prevalent in the Americas. However, the real burden of histoplasmosis remains undefined in many endemic regions. METHODOLOGY We conducted a series of 61 autopsies to individuals who died in a hospital in the Brazilian Amazon focused on infectious diseases. We performed a detailed histological and microbiological evaluation with genetic characterization of Histoplasma strains with the aim to evaluate the contribution of histoplasmosis to morbidity and mortality. Additionally, we assessed the clinicopathological correlation. PRINCIPAL FINDINGS Evidence of Histoplasma infection was detected in 21 patients (34%). Eight cases were disseminated infections, all of them occurred in HIV-positive patients. Six cases were localized histoplasmosis, limited to the lungs. In seven patients Histoplasma DNA was detected by PCR in patients with no histological lesions. Histoplasma infection was detected in 38% of HIV-positive patients and was a major contributor to death in 22% of them. Lungs, liver and spleen were affected in all cases of disseminated histoplasmosis. Phylogenetic analysis of the strains suggested a high diversity of Histoplasma species circulating in the Brazilian Amazon. Histoplasmosis was clinically missed in 75% of the disseminated infections. CONCLUSIONS The high incidence of histoplasmosis, the low index of clinical suspicion, and the severity of the disseminated disease highlight the need of proactively implementing sensitive routine screening methods for this pathogen in endemic areas. Antifungal prophylaxis against Histoplasma should be encouraged in the severely immunocompromised HIV patients in these areas. In conclusion, substantial mortality is associated with disseminated histoplasmosis among HIV-positive patients in the Brazilian Amazon.
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Affiliation(s)
- Natalia Rakislova
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Luiz Ferreira
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Brazil
| | - Monique Freire
- Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Brazil
- Fundação Centro de Controle de Oncologia do Amazonas, Manaus, Brazil
| | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Wuelton Monteiro
- Universidade do Estado do Amazonas, Manaus, Brazil
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Brazil
| | - Mireia Navarro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marcus de Melo Teixeira
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasilia, Brazil
| | - Paola Castillo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Lorena Marimon
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - José Guerrero
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Vima Delgado
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Marco
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Emilio Letang
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jordi Vila
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Miguel J. Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
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24
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Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, Menéndez C, Rakislova N, Bassat Q. The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review. Glob Health Action 2021; 13:1792682. [PMID: 32713325 PMCID: PMC7480574 DOI: 10.1080/16549716.2020.1792682] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low- and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. OBJECTIVE The aim of this narrative review is to describe historical use and evolution of needle-based postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. METHODS Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. RESULTS A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. CONCLUSIONS Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.
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Affiliation(s)
| | | | | | - Kathryn K Banke
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Dianna M Blau
- Centers for Disease Control and Prevention , Atlanta, GA, USA
| | - Robert F Breiman
- Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, GA, USA
| | - Clara Menéndez
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal Department of Pathology Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
| | - Quique Bassat
- ISGlobal Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona , Barcelona, Spain
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25
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Brook OR, Piper KG, Mercado NB, Gebre MS, Barouch DH, Busman-Sahay K, Starke CE, Estes JD, Martinot AJ, Wrijil L, Ducat S, Hecht JL. Feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients. Abdom Radiol (NY) 2021; 46:1263-71. [PMID: 32939636 DOI: 10.1007/s00261-020-02753-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022]
Abstract
Objectives To determine the feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients. Methods 60 patients who expired between 04/22/2020–05/06/2020 due to COVID-19 were considered for inclusion in the study, based on availability of study staff. Minimally invasive ultrasound-guided autopsy was performed with 14G core biopsies through a 13G coaxial needle. The protocol required 20 cores of the liver, 30 of lung, 12 of spleen, 20 of heart, 20 of kidney, 4 of breast, 4 of testis, 2 of skeletal muscle, and 4 of fat with total of 112 cores per patient. Quality of the samples was evaluated by number, size, histology, immunohistochemistry, and in situ hybridization for COVID-19 and PCR-measured viral loads for SARS-CoV-2. Results Five (5/60, 8%) patients were included. All approached families gave their consent for the minimally invasive autopsy. All organs for biopsy were successfully targeted with ultrasound guidance obtaining all required samples, apart from 2 patients where renal samples were not obtained due to atrophic kidneys. The number, size, and weight of the tissue cores met expectation of the research group and tissue histology quality was excellent. Pathology findings were concordant with previously reported autopsy findings for COVID-19. Highest SARS-CoV-2 viral load was detected in the lung, liver, and spleen that had small to moderate amount, and low viral load in was detected in the heart in 2/5 (40%). No virus was detected in the kidney (0/3, 0%). Conclusions Ultrasound-guided percutaneous post-mortem core biopsies can safely provide adequate tissue. Highest SARS-CoV-2 viral load was seen in the lung, followed by liver and spleen with small amount in the myocardium. Electronic supplementary material The online version of this article (10.1007/s00261-020-02753-7) contains supplementary material, which is available to authorized users.
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26
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Saegeman V, Cohen MC, Burton JL, Martinez MJ, Rakislova N, Offiah AC, Fernandez-Rodriguez A. Microbiology in minimally invasive autopsy: best techniques to detect infection. ESGFOR (ESCMID study group of forensic and post-mortem microbiology) guidelines. Forensic Sci Med Pathol 2021; 17:87-100. [PMID: 33464531 PMCID: PMC7814172 DOI: 10.1007/s12024-020-00337-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 12/20/2022]
Abstract
This manuscript aims to: 1) provide specific guidelines on PMM techniques in the setting of minimally invasive autopsy (MIA), both for pathologists collecting samples and for microbiologists advising pathologists and interpreting the results and 2) introduce standardization in PMM sampling at MIA. Post-mortem microbiology (PMM) is crucial to identify the causative organism in deaths due to infection. MIA including the use of post-mortem (PM) computed tomography (CT) and PM magnetic resonance imaging (MRI), is increasingly carried out as a complement or replacement for the traditional PM. In this setting, mirroring the traditional autopsy, PMM aims to: detect infectious organisms causing sudden unexpected deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical diagnostic errors. Meaningful interpretation of PMM results requires careful evaluation in the context of the clinical history, macroscopic and microscopic findings.
These guidelines were developed by a multidisciplinary team with experts in various fields of microbiology and pathology on behalf of the ESGFOR (ESCMID – European Society of Clinical Microbiology and Infectious Diseases - Study Group of Forensic and Post-mortem Microbiology, in collaboration with the ESP -European Society of Pathology-) based on a literature search and the author’s expertise. Microbiological sampling methods for MIA are presented for various scenarios: adults, children, developed and developing countries. Concordance between MIA and conventional invasive autopsy is substantial for children and adults and moderate for neonates and maternal deaths. Networking and closer collaboration among microbiologists and pathologists is vital to maximize the yield of PMM in MIA.
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Affiliation(s)
- Veroniek Saegeman
- Clinical Laboratory, Sint-Niklaas, and Infection Control Department, AZ Nikolaas, University Hospitals Leuven, Moerlandstraat 1Herestraat 49, 91003000, Leuven, Belgium
| | - Marta C Cohen
- FT. Histopathology Department. Western Bank, Sheffield Children's Hospital NHS, Sheffield, S10 2TH, UK
| | | | - Miguel J Martinez
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Department of Microbiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
- Department of Pathology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Amaka C Offiah
- Department of Oncology and Metabolism, Department of Radiology, Academic Unit of Child Health, Sheffield Children's NHS FT, University of Sheffield, Sheffield, UK
| | - Amparo Fernandez-Rodriguez
- Microbiology Laboratory, Biology Department, Instituto Nacional de Toxicología y Ciencias Forenses, Las Rozas de Madrid, Madrid, Spain.
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de Souza PMM, Gerson G, Dias JS, de Melo DN, de Souza SG, Ruiz EM, Fernandes Tavora FR, Cavalcanti LPDG. Validation of verbal autopsy and nasopharyngeal swab collection for the investigation of deaths at home during the COVID-19 pandemics in Brazil. PLoS Negl Trop Dis 2020; 14:e0008830. [PMID: 33147211 PMCID: PMC7641351 DOI: 10.1371/journal.pntd.0008830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Pedro Mansueto Melo de Souza
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
- Universidade Estadual do Ceará, Fortaleza, Ceará, Brasil
- * E-mail:
| | - Gunter Gerson
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
- Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | - Josebson Silva Dias
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
| | - Deborah Nunes de Melo
- Serviço de Verificação de Óbitos Dr. Rocha Furtado, Fortaleza, Ceará, Brasil
- Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
| | | | | | - Fabio Rocha Fernandes Tavora
- Universidade Federal do Ceará, Fortaleza, Ceará, Brasil
- Brown University, Providence, Rhode Island, United States of America
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Salzberg NT, Sivalogan K, Bassat Q, Taylor AW, Adedini S, El Arifeen S, Assefa N, Blau DM, Chawana R, Cain CJ, Cain KP, Caneer JP, Garel M, Gurley ES, Kaiser R, Kotloff KL, Mandomando I, Morris T, Nyamthimba Onyango P, Sazzad HMS, Scott JAG, Seale AC, Sitoe A, Sow SO, Tapia MD, Whitney EA, Worrell MC, Zielinski-Gutierrez E, Madhi SA, Raghunathan PL, Koplan JP, Breiman RF. Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites. Clin Infect Dis 2020; 69:S262-S273. [PMID: 31598664 PMCID: PMC6785672 DOI: 10.1093/cid/ciz599] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24–36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia.
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Affiliation(s)
- Navit T Salzberg
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | | | - Quique Bassat
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.,Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud, Spain
| | - Allan W Taylor
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sunday Adedini
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Chawana
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Kevin P Cain
- US Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya
| | - J Patrick Caneer
- Public Health Informatics Institute, The Task Force for Global Health, Atlanta, Georgia, USA
| | - Mischka Garel
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Emily S Gurley
- icddr,b, Dhaka, Bangladesh.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Reinhard Kaiser
- US Centers for Disease Control and Prevention-Sierra Leone, Freetown, Sierra Leone
| | - Karen L Kotloff
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saude, Ministerio de Saude, Maputo, Mozambique
| | - Timothy Morris
- Public Health Informatics Institute, The Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Hossain M S Sazzad
- University of New South Wales, Sydney, Australia.,PEI, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - J Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anna C Seale
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.,KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Antonio Sitoe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Samba O Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Milagritos D Tapia
- Department of Pediatrics, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ellen A Whitney
- International Association of National Public Health Institutes, US Office at Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Mary Claire Worrell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey P Koplan
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
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Rakislova N, Fernandes F, Lovane L, Jamisse L, Castillo P, Sanz A, Marimon L, Jesri S, Ferrando M, Delgado V, Novela O, Muiuane V, Ismail MR, Lorenzoni C, Blau DM, Bassat Q, Menéndez C, Zaki SR, Carrilho C, Ordi J. Standardization of Minimally Invasive Tissue Sampling Specimen Collection and Pathology Training for the Child Health and Mortality Prevention Surveillance Network. Clin Infect Dis 2020; 69:S302-S310. [PMID: 31598667 PMCID: PMC6785668 DOI: 10.1093/cid/ciz565] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
Background Minimally invasive tissue sampling (MITS) is a simplified postmortem examination technique that has shown to be an adequate approach for cause of death investigation in low-resource settings. It requires relatively low level of infrastructures and can be performed by health professionals with no background in pathology. A training program has been developed for the Child Health and Mortality Prevention Surveillance (CHAMPS) network to guarantee standardization of specimen collection techniques, procedures, and laboratory methods. Methods The training program has included assessment of the site capacities and training on a standardized protocol of MITS sampling and histological processing. The project has also introduced a program of training for trainers for the personnel from Mozambique. To guarantee the adequacy of the procedure in each site, a trainer accompanied the local teams when the activities started. Training outcomes were assessed by evaluating the quality of the samples obtained and the quality of the slides produced locally. Results Between June 2016 and October 2018, the laboratories of 7 sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) have been evaluated and upgraded. Training has been delivered to 63 staff members from all sites. More than 600 MITS procedures have been performed. The quantity of tissue obtained in the MITS by the local teams was sufficient or abundant in 73%, and 87% of the slides were considered as technically acceptable or excellent. Conclusions Satisfactory standardization of MITS and histology procedures has been achieved across all CHAMPS sites through organized capacity-building plans.
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Affiliation(s)
- Natalia Rakislova
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Luisa Jamisse
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Paola Castillo
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Susan Jesri
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Melania Ferrando
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Vima Delgado
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Obdeningo Novela
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Venceslau Muiuane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud, Madrid, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Sherif R Zaki
- Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic, University of Barcelona, Barcelona, Spain
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30
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Garcia-Basteiro AL, Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, Quintó L, Jordao D, Ismail MR, Lorenzoni C, Carrilho C, Sanz A, Rakislova N, Mira A, Alvarez-Martínez MJ, Cossa A, Cobelens F, Mandomando I, Vila J, Bassat Q, Menendez C, Ordi J, Martínez MJ. Performance of the Xpert MTB/RIF Ultra Assay for Determining Cause of Death by TB in Tissue Samples Obtained by Minimally Invasive Autopsies. Chest 2020; 159:103-107. [PMID: 32663500 PMCID: PMC7803937 DOI: 10.1016/j.chest.2020.06.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/29/2020] [Accepted: 06/25/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Alberto L Garcia-Basteiro
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Isaac Casas
- Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Aurea Mira
- Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain, Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Moçambique
| | - Miriam J Alvarez-Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Anélsio Cossa
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Inácio Mandomando
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain, Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Moçambique
| | - Jordi Vila
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu,University of Barcelona, Barcelona, Spain
| | - Clara Menendez
- Centro de Investigaçãoem Saúde de Manhiça (CISM), Maputo, Mozambique; ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
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31
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Karat AS, Omar T, Tlali M, Charalambous S, Chihota VN, Churchyard GJ, Fielding KL, Martinson NA, McCarthy KM, Grant AD. Lessons learnt conducting minimally invasive autopsies in private mortuaries as part of HIV and tuberculosis research in South Africa. Public Health Action 2019; 9:186-190. [PMID: 32042614 DOI: 10.5588/pha.19.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/03/2019] [Indexed: 11/10/2022] Open
Abstract
Current estimates of the burden of tuberculosis (TB) disease and cause-specific mortality in human immunodeficiency virus (HIV) positive people rely heavily on indirect methods that are less reliable for ascertaining individual-level causes of death and on mathematical models. Minimally invasive autopsy (MIA) is useful for diagnosing infectious diseases, provides a reasonable proxy for the gold standard in cause of death ascertainment (complete diagnostic autopsy) and, used routinely, could improve cause-specific mortality estimates. From our experience in performing MIAs in HIV-positive adults in private mortuaries in South Africa (during the Lesedi Kamoso Study), we describe the challenges we faced and make recommendations for the conduct of MIA in future studies or surveillance programmes, including strategies for effective communication, approaches to obtaining informed consent, risk management for staff and efficient preparation for the procedure.
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Affiliation(s)
- A S Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - T Omar
- Division of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - M Tlali
- The Aurum Institute, Johannesburg, South Africa
| | - S Charalambous
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - V N Chihota
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - G J Churchyard
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K L Fielding
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N A Martinson
- Perinatal HIV Research Unit, and South African Medical Research Council Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.,Johns Hopkins University Center for TB Research, Baltimore, MD, USA.,Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa
| | - K M McCarthy
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Public Health, Surveillance and Response, National Institute for Communicable Disease of the National Health Laboratory Service, Johannesburg, South Africa
| | - A D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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32
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Caballero MT, Bianchi AM, Nuño A, Ferretti AJP, Polack LM, Remondino I, Rodriguez MG, Orizzonte L, Vallone F, Bergel E, Polack FP. Mortality Associated With Acute Respiratory Infections Among Children at Home. J Infect Dis 2019; 219:358-364. [PMID: 30165655 PMCID: PMC6325348 DOI: 10.1093/infdis/jiy517] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background Numerous deaths in children aged <5 years in the developing world occur at home. Acute respiratory infections (ARIs) are thought to play an important role in these deaths. Risk factors and pathogens linked to fatal episodes remain unclear. Methods A case-control study among low-income children aged <5 years was performed in Buenos Aires, Argentina, to define risk factors and viral pathogens among those who died of ARI at home. Results A total of 278 families of children aged <5 years (of whom 104 died and 174 were healthy controls) participated in the study. A total of 87.5% of ARI-associated deaths occurred among infants aged <12 months. The estimated mortality rate due to ARI among infants was 5.02 deaths/1000 live births. Dying at home from ARI was associated with living in a crowded home (odds ratio [OR], 3.73; 95% confidence interval [CI], 1.41-9.88), having an adolescent mother (OR, 4.89; 95% CI, 1.37-17.38), lacking running water in the home (OR, 4.39; 95% CI, 1.11-17.38), incomplete vaccinations for age (OR, 3.39; 95% CI, 1.20-9.62), admission to a neonatal intensive care unit (OR, 7.17; 95% CI, 2.21-23.27), and no emergency department visit during the ARI episode (OR, 72.32; 95% CI, 4.82-1085.6). The at-home death rate due to respiratory syncytial virus infection among infants was 0.26 deaths/100 live births and that due to influenza was 0.07 deaths/1000 live births. Conclusions Social vulnerabilities underlie at-home mortality due to ARI. Mortality rates due to RSV and influenza virus infection are high among infants at home and are similar to those reported for hospitalized children.
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Affiliation(s)
| | | | - Alejandra Nuño
- Secretaria de Salud de Lomas de Zamora, Buenos Aires, Argentina
| | | | | | - Ines Remondino
- Secretaria de Salud de Florencio Varela, Buenos Aires, Argentina
| | | | | | | | - Eduardo Bergel
- Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
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33
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Palhares AEM, Ferreira L, Freire M, Castillo P, Martínez MJ, Hurtado JC, Rakislova N, Varo R, Navarro M, Casas I, Vila J, Monteiro WM, Sanz A, Quintó L, Fernandes F, Carrilho C, Menéndez C, Ordi J, Bassat Q, Lacerda M. Performance of the minimally invasive autopsy tool for cause of death determination in adult deaths from the Brazilian Amazon: an observational study. Virchows Arch 2019; 475:649-658. [PMID: 31201504 PMCID: PMC6861203 DOI: 10.1007/s00428-019-02602-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/01/2019] [Accepted: 06/06/2019] [Indexed: 01/19/2023]
Abstract
The uncertainty about the real burden of causes of death (CoD) is increasingly recognized by the international health community as a critical limitation for prioritizing effective public health measures. The minimally invasive autopsy (MIA) has shown to be a satisfactory substitute of the complete diagnostic autopsy (CDA), the gold standard for CoD determination in low- and middle-income countries. However, more studies are needed to confirm its adequate performance in settings with different epidemiology. In this observational study, the CoD obtained with the MIA were compared with the clinical diagnosis and the results of the CDA in 61 deaths that occurred in an infectious diseases referral hospital in Manaus, Brazilian Amazon. Concordance between the categories of diseases obtained by the three methods was evaluated by the Kappa statistic. Additionally, we evaluated discrepancies between clinical and complete diagnostic autopsy diagnoses. The MIA showed a substantial concordance with the CDA (Kappa = 0.777, 95% CI 0.608-0.946), and a perfect or almost perfect coincidence in specific diagnosis (ICD-10 code) between MIA and CDA was observed in 85% of the cases. In contrast, the clinical diagnosis showed a fair concordance with the CDA (Kappa = 0.311, 95% CI 0.071-0.552). Major clinico-pathological discrepancies were identified in 49% of cases. In conclusion, the MIA showed a substantial performance for CoD identification. Clinico-pathological discrepancies remain high and justify the need for post-mortem studies, even in referral hospitals. The MIA is a robust substitute of the CDA for CoD surveillance and quality improvement of clinical practice in low- and middle-income settings.
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Affiliation(s)
| | - Luiz Ferreira
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
| | - Monique Freire
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
| | - Paola Castillo
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Department of Pathology, Hospital Clinic - Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Department of Microbiology, Hospital Clinic - Universitat de Barcelona, 08036, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Department of Microbiology, Hospital Clinic - Universitat de Barcelona, 08036, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Department of Pathology, Hospital Clinic - Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), 1929, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Isaac Casas
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Jordi Vila
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Department of Microbiology, Hospital Clinic - Universitat de Barcelona, 08036, Barcelona, Spain
| | - Wuelton M Monteiro
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
- National Council for Scientific and Technological Development (CNPq, Brasilia, Brazil) fellow, Brasília, Brazil
| | - Ariadna Sanz
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, 1653, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, 1653, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, 1653, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, 1653, Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), 1929, Maputo, Mozambique
| | - Jaume Ordi
- ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
- Department of Pathology, Hospital Clinic - Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), 1929, Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Passeig de Lluís Companys 23, 08010, Barcelona, Spain
- Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu - Universitat de Barcelona, 8950, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
| | - Marcus Lacerda
- Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
- National Council for Scientific and Technological Development (CNPq, Brasilia, Brazil) fellow, Brasília, Brazil
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Feroz A, Ali AS, Ibrahim MN, McClure EM, Tikmani SS, Reza S, Abbasi Z, Raza J, Yasmin H, Bano K, Zafar A, Siddiqi S, Goldenberg RL, Saleem S. Perceptions of health professionals regarding minimally invasive tissue sampling (MITS) to identify the cause of death in stillbirths and neonates: results from a qualitative study. Matern Health Neonatol Perinatol 2019; 5:17. [PMID: 31666979 PMCID: PMC6814094 DOI: 10.1186/s40748-019-0112-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of MITS, it is important to understand health professionals’ attitudes and perceptions related to MITS. Methods A qualitative study was conducted at the National Institute of Child Health (NICH), Karachi, Pakistan. Focus group discussions (FGDs) and Key-informant interviews (KIIs) were conducted with health professionals including doctors, nurses, trainees, clinicians, bioethics experts and public health experts to explore their perceptions and views on acceptability of MITS. Data were analyzed using NVivo 10 software. Results A total of 12 interviews (FGDs = 4; KIIs = 8) were conducted. Four overarching themes were identified: (I) acceptability of MITS; (II) perceived benefits of the MITS procedure; (III) factors facilitating the implementation of MITS; and (IV) health system requirements for implementing the MITS procedure. Generally, MITS was considered as a positive development for the health system. Diagnostic accuracy and identification of less common causes of death were highlighted as two main benefits of the MITS procedure. The study highlighted a number of facilitators for the acceptability of MITS including effective counseling, building trust with parents, fast procedure time, and approaching families within a few hours of death. In addition, lack of skilled staff, poorly equipped healthcare facilities and the potential high cost to conduct MITS were identified as challenges for the implementation of MITS. Conclusions This formative research provided a unique opportunity to explore health professionals’ views and attitudes towards the MITS procedure. Such insights are crucial to ensure successful implementation and integration of a new technique into the existing health system. The research identified the factors influencing the acceptability of MITS among health professionals in Pakistan. The study also informed factors that could help facilitate the implementation of the MITS procedures in the context of Pakistan and similar settings.
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Affiliation(s)
- Anam Feroz
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Anum Shiraz Ali
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | | | | | - Shiyam Sunder Tikmani
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sayyeda Reza
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Zahid Abbasi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Jamal Raza
- 2National Institute of Child Health, Karachi, Pakistan
| | - Haleema Yasmin
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Khadija Bano
- 4Department of Obstetrics and Gynecology, Jinnah Post-graduate Medical Center, Karachi, Pakistan
| | - Afia Zafar
- 5Department of Pathology & Laboratory Medicine, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Sameen Siddiqi
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
| | - Robert L Goldenberg
- 6Department of Obstetrics and Gynecology, Columbia University, New York, USA
| | - Sarah Saleem
- 1Department of Community Health Sciences, The Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800 Pakistan
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35
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Garcia-Basteiro AL, Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, Quintó L, Jordao D, Ismail MR, Lorenzoni C, Carrilho C, Sanz A, Rakislova N, Mira A, Alvarez-Martínez MJ, Cossa A, Cobelens F, Mandomando I, Vila J, Bassat Q, Menendez C, Ordi J, Martínez MJ. Unmasking the hidden tuberculosis mortality burden in a large post mortem study in Maputo Central Hospital, Mozambique. Eur Respir J 2019; 54:13993003.00312-2019. [PMID: 31346005 PMCID: PMC6769353 DOI: 10.1183/13993003.00312-2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/17/2019] [Indexed: 01/21/2023]
Abstract
Sensitive tools are needed to accurately establish the diagnosis of tuberculosis (TB) at death, especially in low-income countries. The objective of this study was to evaluate the burden of TB in a series of patients who died in a tertiary referral hospital in sub-Saharan Africa using an in-house real time PCR (TB-PCR) and the Xpert MTB/RIF Ultra (Xpert Ultra) assay. Complete diagnostic autopsies were performed in a series of 223 deaths (56.5% being HIV-positive), including 54 children, 57 maternal deaths and 112 other adults occurring at the Maputo Central Hospital, Mozambique. TB-PCR was performed in all lung, cerebrospinal fluid and central nervous system samples in HIV-positive patients. All samples positive for TB-PCR or showing histological findings suggestive of TB were analysed with the Xpert Ultra assay. TB was identified as the cause of death in 31 patients: three out of 54 (6%) children, five out of 57 (9%)maternal deaths and 23 out of 112 (21%) other adults. The sensitivity of the main clinical diagnosis to detect TB as the cause of death was 19.4% (95% CI 7.5–37.5) and the specificity was 97.4% (94.0–99.1) compared to autopsy findings. Concomitant TB (TB disease in a patient dying of other causes) was found in 31 additional cases. Xpert Ultra helped to identify 15 cases of concomitant TB. In 18 patients, Mycobacterium tuberculosis DNA was identified by TB-PCR and Xpert Ultra in the absence of histological TB lesions. Overall, 62 (27.8%) cases had TB disease at death and 80 (35.9%) had TB findings. The use of highly sensitive, easy to perform molecular tests in complete diagnostic autopsies may contribute to identifying TB cases at death that would have otherwise been missed. Routine use of these tools in certain diagnostic algorithms for hospitalised patients needs to be considered. Clinical diagnosis showed poor sensitivity for the diagnosis of TB at death. This study shows the usefulness of molecular assays in ascertaining TB diagnosis at death. It questions the information of clinical diagnoses obtained from hospital registries as a reliable tool for TB mortality estimation.http://bit.ly/2KrzTBJ
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Affiliation(s)
- Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Contributed equally to this work and share primary authorship
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Contributed equally to this work and share primary authorship
| | - Paola Castillo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Dept of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Contributed equally to this work and share primary authorship
| | - Fabiola Fernandes
- Dept of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Dept of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Isaac Casas
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dercio Jordao
- Dept of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Dept of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Dept of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique.,Ministry of Health - National Cancer Control Programme, Mozambique
| | - Carla Carrilho
- Dept of Pathology, Faculty of Medicine/Eduardo Mondlane University and Maputo Central Hospital, Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Dept of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Aurea Mira
- Biomedical Diagnostic Centre (CDB), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miriam J Alvarez-Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Anélsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Frank Cobelens
- Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Inácio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Ministério da Saúde, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Dept, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Contributed equally to this work and share senior authorship
| | - Clara Menendez
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Contributed equally to this work and share senior authorship
| | - Jaume Ordi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Dept of Pathology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Contributed equally to this work and share senior authorship
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain .,Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.,Contributed equally to this work and share senior authorship
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Ordi J, Castillo P, Garcia-Basteiro AL, Moraleda C, Fernandes F, Quintó L, Hurtado JC, Letang E, Lovane L, Jordao D, Navarro M, Bene R, Nhampossa T, Ismail MR, Lorenzoni C, Guisseve A, Rakislova N, Varo R, Marimon L, Sanz A, Cossa A, Mandomando I, Maixenchs M, Munguambe K, Vila J, Macete E, Alonso PL, Bassat Q, Martínez MJ, Carrilho C, Menéndez C. Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study. PLoS One 2019; 14:e0220657. [PMID: 31490955 PMCID: PMC6730941 DOI: 10.1371/journal.pone.0220657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact. Aim We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses. Methods One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification. Results Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0–37), 18% (95% CI: 2–52) for invasive fungal infections, 25% (95% CI: 5–57) for bacterial sepsis, 34% (95% CI: 16–57), for tuberculosis, and 46% (95% CI: 19–75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236). Conclusions Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy.
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Affiliation(s)
- Jaume Ordi
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Paola Castillo
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alberto L. Garcia-Basteiro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Amsterdam Institute for Global Health and Development (AIGHD), Academic Medical Center, Amsterdam, The Netherlands
| | - Cinta Moraleda
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Emili Letang
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Service of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Natalia Rakislova
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Lorena Marimon
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Department of Microbiology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Pedro L. Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ICREA, Catalan Institution for Research and Advanced Studies, Barcelona, Spain
- Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Miguel J. Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud, Madrid, Spain
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Duarte-Neto AN, Monteiro RAA, Johnsson J, Cunha MDP, Pour SZ, Saraiva AC, Ho YL, da Silva LFF, Mauad T, Zanotto PMA, Saldiva PHN, de Oliveira IRS, Dolhnikoff M. Ultrasound-guided minimally invasive autopsy as a tool for rapid post-mortem diagnosis in the 2018 Sao Paulo yellow fever epidemic: Correlation with conventional autopsy. PLoS Negl Trop Dis 2019; 13:e0007625. [PMID: 31329590 DOI: 10.1371/journal.pntd.0007625] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 08/01/2019] [Accepted: 07/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background New strategies for collecting post-mortem tissue are necessary, particularly in areas with emerging infections. Minimally invasive autopsy (MIA) has been proposed as an alternative to conventional autopsy (CA), with promising results. Previous studies using MIA addressed the cause of death in adults and children in developing countries. However, none of these studies was conducted in areas with an undergoing infectious disease epidemic. We have recently experienced an epidemic of yellow fever (YF) in Brazil. Aiming to provide new information on low-cost post-mortem techniques that could be applied in regions at risk for infectious outbreaks, we tested the efficacy of ultrasound-guided MIA (MIA-US) in the diagnosis of patients who died during the epidemic. Methodology/principal findings In this observational study, we performed MIA-US in 20 patients with suspected or confirmed YF and compared the results with those obtained in subsequent CAs. Ultrasound-guided biopsies were used for tissue sampling of liver, kidneys, lungs, spleen, and heart. Liver samples from MIA-US and CA were submitted for RT-PCR and immunohistochemistry for detection of YF virus antigen. Of the 20 patients, 17 had YF diagnosis confirmed after autopsy by histopathological and molecular analysis. There was 100% agreement between MIA-US and CA in determining the cause of death (panlobular hepatitis with hepatic failure) and main disease (yellow fever). Further, MIA-US obtained samples with good quality for molecular studies and for the assessment of the systemic involvement of the disease. Main extrahepatic findings were pulmonary hemorrhage, pneumonia, acute tubular necrosis, and glomerulonephritis. One patient was a 24-year-old, 27-week pregnant woman; MIA-US assessed the placenta and provided adequate placental tissue for analysis. Conclusions MIA-US is a reliable tool for rapid post-mortem diagnosis of yellow fever and can be used as an alternative to conventional autopsy in regions at risk for hemorrhagic fever outbreaks with limited resources to perform complete diagnostic autopsy. Reliable mortality information is of paramount importance to establish sound public health policies. Autopsy is an important tool not only for determining the cause of death, but also for the detection of novel diseases. In the last decades, we have been globally identifying an unprecedented number of emerging infections. Therefore, there is great interest in the development of less invasive and low-cost tools for the accurate post-mortem diagnosis in fatal cases. Minimally invasive autopsy (MIA), conceived as targeting diagnostic biopsies of key organs by needle puncture, has been proposed as an alternative to conventional autopsy (CA) for the determination of cause of death in developing countries. In this research, we tested the efficacy of MIA in the post-mortem diagnosis of 20 patients with suspected or confirmed yellow fever who died during the recent epidemic of yellow fever that occurred in Brazil. There was a perfect agreement between MIA and CA in determining the cause of death (hepatic failure) and main disease (yellow fever) in all patients with confirmed yellow fever. This finding indicates that MIA can be used as an alternative to CA in regions at risk for infectious disease outbreaks with limited resources to perform conventional autopsies.
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Bunei M, Muturi P, Otiato F, Njuguna HN, Emukule GO, Otieno NA, Dawa J, Chaves SS. Factors Influencing Acceptance of Post-Mortem Examination of Children at a Tertiary Care Hospital in Nairobi, Kenya. Ann Glob Health 2019; 85:95. [PMID: 31276331 DOI: 10.5334/aogh.2504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Clinical autopsies are not often part of routine care, despite their role in clarifying cause of death. In fact, autopsy rates across the world have declined and are especially low in sub-Saharan Africa. OBJECTIVES We set out to identify factors associated with acceptance of pediatric autopsies among parents of deceased children less than five years old, and examined local preferences for minimally invasive tissue sampling (MITS) procedures during post-mortem (PM) examinations. METHODS From December 2016 to September 2017, we contacted 113 parents/next of kin who had been previously approached to consent to a PM examination of their deceased child as part of a Kenyan study on cause of death. Interviews occurred up to three years after the death of their child. FINDINGS Seventy-three percent (83/113) of eligible study participants were enrolled, of whom 62/83 (75%) had previously consented to PM examination of their child. Those who previously consented to PM had higher levels of education, were more likely employed, and had more knowledge about certain aspects of autopsies than non-consenters. The majority (97%) of PM consenters did so because they wanted to know the cause of death of their child, and up to a third believed autopsy studies helped advance medical knowledge. Reasons for non-consent to PM examination included: parents felt there was no need for further examination (29%) or they were satisfied with the clinical diagnosis (24%). Overall, only 40% of study participants would have preferred MITS procedures to conventional autopsy. However, 81% of autopsy non-consenters would have accepted PM examination if it only involved MITS techniques. CONCLUSION There is potential to increase autopsy rates by strengthening reasons for acceptance and addressing modifiable reasons for refusals. Although MITS procedures have the potential to improve autopsy acceptance rates, they were not significantly preferred over conventional autopsies in our study population.
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Roberts DJ, Njuguna HN, Fields B, Fligner CL, Zaki SR, Keating MK, Rogena E, Walong E, Gachii AK, Maleche-Obimbo E, Irimu G, Mathaiya J, Orata N, Lopokoiyit R, Michuki J, Emukule GO, Onyango CO, Gikunju S, Owuor C, Muturi PK, Bunei M, Widdowson MA, Mott JA, Chaves SS. Comparison of Minimally Invasive Tissue Sampling With Conventional Autopsy to Detect Pulmonary Pathology Among Respiratory Deaths in a Resource-Limited Setting. Am J Clin Pathol 2019; 152:36-49. [PMID: 31006817 DOI: 10.1093/ajcp/aqz016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES We compared minimally invasive tissue sampling (MITS) with conventional autopsy (CA) in detection of respiratory pathology/pathogens among Kenyan children younger than 5 years who were hospitalized with respiratory disease and died during hospitalization. METHODS Pulmonary MITS guided by anatomic landmarks was followed by CA. Lung tissues were triaged for histology and molecular testing using TaqMan Array Cards (TACs). MITS and CA results were compared for adequacy and concordance. RESULTS Adequate pulmonary tissue was obtained by MITS from 54 (84%) of 64 respiratory deaths. Comparing MITS to CA, full histologic diagnostic concordance was present in 23 (36%) cases and partial concordance in 19 (30%), an overall 66% concordance rate. Pathogen detection using TACs had full concordance in 27 (42%) and partial concordance in 24 (38%) cases investigated, an overall 80% concordance rate. CONCLUSIONS MITS is a viable alternative to CA in respiratory deaths in resource-limited settings, especially if combined with ancillary tests to optimize diagnostic accuracy.
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Affiliation(s)
| | - Henry N Njuguna
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Sherif R Zaki
- Division of High-Consequence Pathogens and Pathology, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | - M Kelly Keating
- Division of High-Consequence Pathogens and Pathology, Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | | | | | | | | | - Gideon O Emukule
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Clayton O Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stella Gikunju
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Owuor
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | | | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sandra S Chaves
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA
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40
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Hurtado JC, Castillo P, Fernandes F, Navarro M, Lovane L, Casas I, Quintó L, Marco F, Jordao D, Ismail MR, Lorenzoni C, Martinez-Palhares AE, Ferreira L, Lacerda M, Monteiro W, Sanz A, Letang E, Marimon L, Jesri S, Cossa A, Mandomando I, Vila J, Bassat Q, Ordi J, Menéndez C, Carrilho C, Martínez MJ. Mortality due to Cryptococcus neoformans and Cryptococcus gattii in low-income settings: an autopsy study. Sci Rep 2019; 9:7493. [PMID: 31097746 PMCID: PMC6522501 DOI: 10.1038/s41598-019-43941-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/03/2019] [Indexed: 01/14/2023] Open
Abstract
Cryptococcosis is a major opportunistic infection and is one of the leading causes of death in adults living with HIV in sub-Saharan Africa. Recent estimates indicate that more than 130,000 people may die annually of cryptococcal meningitis in this region. Although complete diagnostic autopsy (CDA) is considered the gold standard for determining the cause of death, it is seldom performed in low income settings. In this study, a CDA was performed in 284 deceased patients from Mozambique (n = 223) and Brazil (n = 61). In depth histopathological and microbiological analyses were carried out in all cases dying of cryptococcosis. We determined the cryptococcal species, the molecular and sero-mating types and antifungal susceptibility. We also described the organs affected and reviewed the clinical presentation and patient management. Among the 284 cases included, 17 fatal cryptococcal infections were diagnosed. Cryptococcus was responsible for 16 deaths among the 163 HIV-positive patients (10%; 95%CI: 6-15%), including four maternal deaths. One third of the cases corresponded to C. gattii (VGI and VGIV molecular types, Bα and Cα strains) and the remaining infections typed were caused by C. neoformans var. Grubii (all VNI and Aα strains). The level of pre-mortem clinical suspicion was low (7/17, 41%), and 7/17 patients (41%) died within the first 72 hours of admission. Cryptococcosis was responsible for a significant proportion of AIDS-related mortality. The clinical diagnosis and patient management were inadequate, supporting the need for cryptococcal screening for early detection of the disease. This is the first report of the presence of C. gattii infection in Mozambique.
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Affiliation(s)
- Juan Carlos Hurtado
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Isaac Casas
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Francesc Marco
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Luiz Ferreira
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil.,Instituto de Pesquisas Leônidas & Maria Deane, Fiocruz, Manaus, Brazil
| | - Wuelton Monteiro
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado, Manaus, Amazonas, Brazil
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Emilio Letang
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Hospital del Mar. Service of Infectious Diseases, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - Lorena Marimon
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Susan Jesri
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Jordi Vila
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Jaume Ordi
- Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Miguel J Martínez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. .,Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
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41
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Camelo-Castillo A, Henares D, Brotons P, Galiana A, Rodríguez JC, Mira A, Muñoz-Almagro C. Nasopharyngeal Microbiota in Children With Invasive Pneumococcal Disease: Identification of Bacteria With Potential Disease-Promoting and Protective Effects. Front Microbiol 2019; 10:11. [PMID: 30745895 PMCID: PMC6360994 DOI: 10.3389/fmicb.2019.00011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/07/2019] [Indexed: 01/26/2023] Open
Abstract
Background and Aims: The risk of suffering from some infectious diseases can be related to specific microbiota profiles. Specifically, the nasopharyngeal microbiota could play a role as a risk or protective factor in the development of invasive disease caused by S. pneumoniae. Methodology: We analyzed the nasopharyngeal microbiota of children with invasive pneumococcal disease (IPD) and that of healthy controls matched by age, sex, and seasonality from Catalonia, Spain. Epidemiological, microbiological and clinical variables were considered to compare microbiota profiles, analyzed by sequencing the V1-V4 region of the 16S rRNA gene. Results: Twenty-eight children with IPD (median age 43 months) and 28 controls (42.6 months) were included in the study. IPD children presented a significantly higher bacterial diversity and richness (p < 0.001). Principal coordinate analysis revealed three different microbiota profiles: microbiota A, dominated by the genus Dolosigranulum (44.3%); Microbiota B, mostly represented by Streptococcus (36.9%) and Staphylococcus (21.3%) and a high diversity of anaerobic genera including Veillonella, Prevotella and Porphyromonas; and Microbiota C, mainly containing Haemophilus (52.1%) and Moraxella (31.4%). The only explanatory factor for the three microbiotas was the classification of children into disease or healthy controls (p = 0.006). A significant negative correlation was found between Dolosigranulum vs. Streptococcus (p = 0.029), suggesting a potential antagonistic effect against pneumococcal pathogens. Conclusions: The higher bacterial diversity and richness in children with IPD could suggest an impaired immune response. This lack of immune competence could be aggravated by breastfeeding <6 months and by the presence of keystone pathogens such as Porphyromonas, a bacterium which has been shown to be able to manipulate the immune response, and that could favor the overgrowth of many proteolytic anaerobic organisms giving rise to a dramatic dysbiosis. From an applied viewpoint, we found suggestive microbiota profiles associated to IPD or asymptomatic colonization that could be used as disease biomarkers or to pave the way for characterizing health-associated inhabitants of the respiratory tract. The identification of beneficial bacteria could be useful to prevent pneumococcal infections by integrating those microorganisms in a probiotic formula. The present study suggests not only respiratory tract samples, but also breast milk, as a potential source of those beneficial bacteria.
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Affiliation(s)
- Anny Camelo-Castillo
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Desirée Henares
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Network of Epidemiology and Public Health, CIBERESP, Barcelona, Spain
| | - Pedro Brotons
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Network of Epidemiology and Public Health, CIBERESP, Barcelona, Spain
| | - Antonio Galiana
- Department of Microbiology, Hospital de Alicante, Alicante, Spain
| | | | - Alex Mira
- Network of Epidemiology and Public Health, CIBERESP, Barcelona, Spain.,Center for Advanced Research in Public Health, FISABIO Foundation, Valencia, Spain
| | - Carmen Muñoz-Almagro
- Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Network of Epidemiology and Public Health, CIBERESP, Barcelona, Spain.,School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
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Njuguna HN, Zaki SR, Roberts DJ, Fligner CL, Keating MK, Rogena E, Walong E, Gachii AK, Maleche-Obimbo E, Irimu G, Mathaiya J, Orata N, Lopokoiyit R, Maina J, Emukule GO, Onyango CO, Gikunju S, Owuor C, Kinuthia P, Bunei M, Fields B, Widdowson MA, Mott JA, Chaves SS. Determining the Cause of Death Among Children Hospitalized With Respiratory Illness in Kenya: Protocol for Pediatric Respiratory Etiology Surveillance Study (PRESS). JMIR Res Protoc 2019; 8:e10854. [PMID: 30632968 PMCID: PMC6705666 DOI: 10.2196/10854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/02/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, where the burden of respiratory disease-related deaths is the highest, information on the cause of death remains inadequate because of poor access to health care and limited availability of diagnostic tools. Postmortem examination can aid in the ascertainment of causes of death. This manuscript describes the study protocol for the Pediatric Respiratory Etiology Surveillance Study (PRESS). OBJECTIVE This study protocol aims to identify causes and etiologies associated with respiratory disease-related deaths among children (age 1-59 months) with respiratory illness admitted to the Kenyatta National Hospital (KNH), the largest public hospital in Kenya, through postmortem examination coupled with innovative approaches to laboratory investigation. METHODS We prospectively followed children hospitalized with respiratory illness until the end of clinical care or death. In case of death, parents or guardians were offered grief counseling, and postmortem examination was offered. Lung tissue specimens were collected using minimally invasive tissue sampling and conventional autopsy where other tissues were collected. Tissues were tested using histopathology, immunohistochemistry, and multipathogen molecular-based assays to identify pathogens. For each case, clinical and laboratory data were reviewed by a team of pathologists, clinicians, laboratorians, and epidemiologists to assign a cause of and etiology associated with death. RESULTS We have enrolled pediatric cases of respiratory illness hospitalized at the KNH at the time of this submission; of those, 14.8% (140/945) died while in the hospital. Both analysis and interpretation of laboratory results and writing up of findings are expected in 2019-2020. CONCLUSIONS Postmortem studies can help identify major pathogens contributing to respiratory-associated deaths in children. This information is needed to develop evidence-based prevention and treatment policies that target important causes of pediatric respiratory mortality and assist with the prioritization of local resources. Furthermore, PRESS can provide insights into the interpretation of results using multipathogen testing platforms in resource-limited settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10854.
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Affiliation(s)
- Henry N Njuguna
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sherif R Zaki
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | | | - M Kelly Keating
- Infectious Disease Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | | | | | | | | | - Gideon O Emukule
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Clayton O Onyango
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Stella Gikunju
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Collins Owuor
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | | | - Barry Fields
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marc-Alain Widdowson
- Division of Global Health Protection, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joshua A Mott
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sandra S Chaves
- Influenza Program, Centers for Disease Control and Prevention, Nairobi, Kenya.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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43
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Fernandes F, Castillo P, Bassat Q, Quintó L, Hurtado JC, Martínez MJ, Lovane L, Jordao D, Bene R, Nhampossa T, Ritchie PS, Bandeira S, Sambo C, Chicamba V, Mocumbi S, Jaze Z, Mabota F, Ismail MR, Lorenzoni C, Sanz A, Rakislova N, Marimon L, Cossa A, Mandomando I, Vila J, Maixenchs M, Munguambe K, Macete E, Alonso P, Menéndez C, Ordi J, Carrilho C. Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy. Hum Pathol 2018; 85:184-193. [PMID: 30496801 PMCID: PMC6478426 DOI: 10.1016/j.humpath.2018.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022]
Abstract
Although autopsy diagnosis includes routinely, a thorough evaluation of all available pathological results and also of any available clinical data, the contribution of this clinical information to the diagnostic yield of the autopsy has not been analyzed. We aimed to determine to which degree the use of clinical data improves the diagnostic accuracy of the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), a simplified pathological postmortem procedure designed for low-income sites. A total of 264 coupled MIA and CDA procedures (112 adults, 57 maternal deaths, 54 children, and 41 neonates) were performed at the Maputo Hospital, Mozambique. We compared the diagnoses obtained by the MIA blind to clinical data (MIAb), the MIA adding the clinical information (MIAc), and the CDA blind to clinical information (CDAb), with the results of the gold standard, the CDA with clinical data, by comparing the International Classification of Diseases, Tenth Revision codes and the main diagnostic classes obtained with each evaluation strategy (MIAb, MIAc, CDAb, CDAc). The clinical data increased diagnostic coincidence to the MIAb with the gold standard in 30 (11%) of 264 cases and modified the CDAb diagnosis in 20 (8%) of 264 cases. The increase in concordance between MIAb and MIAc with the gold standard was significant in neonatal deaths (κ increasing from 0.404 to 0.618, P = .0271), adult deaths (κ increasing from 0.732 to 0.813, P = .0221), and maternal deaths (κ increasing from 0.485 to 0.836, 0.;P < .0001). In conclusion, the use of clinical information increases the precision of MIA and CDA and may strengthen the performance of the MIA in resource-limited settings. The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively. The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance. The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings.
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Affiliation(s)
- Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Paola Castillo
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique; ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010 Barcelona, Spain; Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, 8950 Barcelona, Spain; Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Juan Carlos Hurtado
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, 1100 Maputo, Mozambique
| | | | | | - Sónia Bandeira
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Calvino Sambo
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Valeria Chicamba
- Department of Pediatrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Zara Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, 1100 Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
| | - Ariadna Sanz
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | | | - Jordi Vila
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, 1100 Maputo, Mozambique; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain.
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, 1100 Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, 1100 Maputo, Mozambique
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Hurtado JC, Quintó L, Castillo P, Carrilho C, Fernandes F, Jordao D, Lovane L, Navarro M, Casas I, Bene R, Nhampossa T, Santos Ritchie P, Bandeira S, Sambo C, Chicamba V, Mocumbi S, Jaze Z, Mabota F, Ismail MR, Lorenzoni C, Guisseve A, Rakislova N, Marimon L, Castrejon N, Sanz A, Cossa A, Mandomando I, Munguambe K, Maixenchs M, Muñoz-Almagro C, Macete E, Alonso P, Vila J, Bassat Q, Menéndez C, Martínez MJ, Ordi J. Postmortem Interval and Diagnostic Performance of the Autopsy Methods. Sci Rep 2018; 8:16112. [PMID: 30382145 PMCID: PMC6208334 DOI: 10.1038/s41598-018-34436-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022] Open
Abstract
Postmortem studies, including the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), an innovative approach to post-mortem sampling and cause of death investigation, are commonly performed within 24 hours after death because the quality of the tissues deteriorates over time. This short timeframe may hamper the feasibility of the procedure. In this study, we compared the diagnostic performance of the two postmortem procedures when carried out earlier and later than 24 hours after death, as well as the impact of increasing postmortem intervals (PMIs) on the results of the microbiological tests in a series of 282 coupled MIA/CDA procedures performed at the Maputo Central Hospital in Mozambique between 2013 and 2015. 214 procedures were conducted within 24 hours of death (early autopsies), and 68 after 24 hours of death (late autopsies). No significant differences were observed in the number of non-conclusive diagnoses (2/214 [1%] vs. 1/68 [1%] p = 0.5645 for the CDA; 27/214 [13%] vs. 5/68 [7%] p = 0.2332 for the MIA). However, increasing PMIs were associated with a raise in the number of bacteria identified (rate: 1.014 per hour [95%CI: 1.002–1.026]; p = 0.0228). This increase was mainly due to rising numbers of bacteria of the Enterobacteriaceae family and Pseudomonas genus strains. Thus, performing MIA or CDA more than 24 hours after death can still render reliable diagnostic results, not only for non-infectious conditions but also for many infectious diseases, although, the contribution of Enterobacteriaceae and Pseudomonas spp. as etiological agents of infections leading to death may be overestimated.
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Affiliation(s)
- Juan Carlos Hurtado
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Llorenç Quintó
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Paola Castillo
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fabiola Fernandes
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Dercio Jordao
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Lucilia Lovane
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
| | - Mireia Navarro
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Isaac Casas
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Rosa Bene
- Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Sónia Bandeira
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Calvino Sambo
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Valeria Chicamba
- Department of Pediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - Sibone Mocumbi
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Zara Jaze
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Flora Mabota
- Department of Gynecology and Obstetrics, Maputo Central Hospital, Maputo, Mozambique
| | - Mamudo R Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cesaltina Lorenzoni
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Assucena Guisseve
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Natalia Rakislova
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Lorena Marimon
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Natalia Castrejon
- Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Ariadna Sanz
- Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Anelsio Cossa
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Khátia Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Carmen Muñoz-Almagro
- Department of Molecular Microbiology, University Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Faculty of Medicine, Univesitat Internacional de Catalunya, Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pedro Alonso
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Jordi Vila
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,ICREA, Catalan Institution for Research and Advanced Studies, Pg. Lluís Companys 23, 08010, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Miguel J Martínez
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.,Department of Microbiology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain. .,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
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45
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Saieg MA. Cytology techniques for minimally invasive molecular autopsies: An opportunity not to be missed. Cancer Cytopathol 2018; 126:829-830. [DOI: 10.1002/cncy.22045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 01/19/2023]
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46
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Meilia PDI, Freeman MD, Herkutanto, Zeegers MP. A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice. Forensic Sci Med Pathol 2018; 14:460-8. [PMID: 30276619 DOI: 10.1007/s12024-018-0031-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/06/2022]
Abstract
The scope, roles, and tasks of forensic medicine and forensic medical experts currently vary widely between countries and legal systems, which has resulted in barriers to organization, standard setting, and quality assurance for practice in forensic medicine, including for reporting. The legal fact finder is thus confronted with variability in the quality, structure, and content of forensic medical reports. We sought to define and categorize the scope, methods, and practices that fall under the description of forensic medicine, the various issues encountered in current forensic medical practice, and the potential role of evidence-based practice in forensic medicine. We searched electronic databases and reviewed relevant articles, as well as conducting personal correspondences with forensic medical practitioners around the world, to obtain a description of current forensic medical practice. The terms forensic medicine, legal medicine, medical jurisprudence, medico-legal services, forensic pathology, and clinical forensic medicine are used with mixed interpretations in different countries. The systems and services rendered are not uniform either. The methods used by forensic medical practitioners are not always evidence-based, or based on standardized methods, and vary greatly between experts and centers. There are also no universally accepted guidelines to prepare a standard and admissible report. The lack of a uniform system in forensic medicine creates difficulties in assessing the development and performance of forensic medicine as a distinct discipline. To prepare evidence-based forensic medical reports, generally accepted guidelines are necessary.
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Abstract
There is a disease epidemiological transition occurring in Africa, with increasing incidence of noninfectious diseases, superimposed on a health system historically geared more toward the management of communicable diseases. The persistence and sometimes emergence of new pathogens allows for the occurrence of coinfections and comorbidities due to both infectious and noninfectious diseases. There is therefore a need to rethink and restructure African health systems to successfully address this transition. The historical focus of more health resources on infectious diseases requires revision. We hypothesise that the growing burden of noninfectious diseases may be linked directly and indirectly to or further exacerbated by the existence of neglected tropical diseases (NTDs) and other infectious diseases within the population. Herein, we discuss the health burden of coinfections and comorbidities and the challenges to implementing effective and sustainable healthcare in Africa. We also discuss how existing NTD and infectious disease intervention programs in Africa can be leveraged for noninfectious disease intervention. Furthermore, we explore the potential for new technologies-including artificial intelligence and multiplex approaches-for diagnosis and management of chronic diseases for improved health provision in Africa.
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Affiliation(s)
- Derick Nii Mensah Osakunor
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
| | | | - Francisca Mutapi
- Centre for Infection, Immunity and Evolution, Institute of Immunology and Infection Research, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
- National Institute for Health Research, Global Health Research Unit Tackling Infections to Benefit Africa, University of Edinburgh, Ashworth Laboratories, Edinburgh, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Goldenberg RL, Muhe L, Saleem S, Dhaded S, Goudar SS, Patterson J, Nigussie A, McClure EM. Criteria for assigning cause of death for stillbirths and neonatal deaths in research studies in low-middle income countries. J Matern Fetal Neonatal Med 2018; 32:1915-1923. [PMID: 30134756 DOI: 10.1080/14767058.2017.1419177] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Accurate knowledge regarding cause of death (COD) for stillbirths and neonatal deaths is crucial, especially in low-income countries, in order for public health and medical officials to choose appropriate interventions likely to reduce these deaths. To date, many of the COD studies in these areas have relied only on obstetric or neonatal clinical information and the determination of COD is likely to be inaccurate. Information related to infectious COD is especially lacking. Thus, without more sophisticated testing, data as currently collected only provide a very weak approximation of the COD and may well lead to adoption of interventions of limited usefulness. In this commentary, we propose recommendations regarding the type of data needed to determine with reasonable accuracy the COD for stillbirths and neonatal deaths in low-resource settings. Using these data, and a method to determine the degree of certainty, we then propose definitions for the most common COD. Our goal is to reduce subjectivity and provide more specificity for the tests used in existing classification systems so that the methodology of COD determination is transparent and able to be replicated over time and from location to location.
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Affiliation(s)
| | - Lulu Muhe
- b Addis Ababa University , Addis Ababa , Ethiopia
| | - Sarah Saleem
- c Department of Community Health Sciences , Aga Khan University , Karachi , Pakistan
| | | | | | - Janna Patterson
- e Bill & Melinda Gates Foundation , Seattle , Washington , USA
| | - Assaye Nigussie
- e Bill & Melinda Gates Foundation , Seattle , Washington , USA
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Hurtado JC, Carrilho C, Mandomando I, Martínez MJ. Fatal multi-drug-resistant Acinetobacter baumannii pneumonia in Maputo, Mozambique: A case report. Enferm Infecc Microbiol Clin 2018; 37:485-487. [PMID: 30082104 DOI: 10.1016/j.eimc.2018.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/14/2018] [Accepted: 06/17/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Juan Carlos Hurtado
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Miguel J Martínez
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clinic of Barcelona, Universitat de Barcelona, Spain.
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