SARS-CoV-2 antigen detection in deceased bodies: implications for infection prevention

Background & objectives: High transmissibility of the SARS-CoV-2 has significant implications on healthcare workers’ safety, preservation, handling, transportation and disposal of the deceased bodies. The objective of this study was to detect SARS-CoV-2 antigen in nasopharyngeal samples and its implications in handling and care of COVID-19 deceased bodies. Methods: A study was conducted at a dedicated COVID-19 centre on deceased individuals from April to December 2020. Rapid antigen test (RAT) and reverse transcription (RT)-PCR was compared on all the SARS-CoV-2 positive cadavers recruited in the study. Results: A total of 115 deceased individuals were included in the study. Of these, 79 (68.7%) were male and 36 (31.3%) were female and majority were in the age group of 51-60 yr [31 (27%)]. SARS-CoV-2 antigen test was positive in 32 (27.8%) and negative in 83 (72.1%) individuals. The mean time interval between deaths to the sample collection was 13.2 h with interquartile range of eight to 20 h. Reverse transcription (RT)-PCR was used as the reference test and 24 (20.9%) cases were true positive; 93.6 per cent [95% confidence interval (CI) 88.8-98.4%] sensitivity, 45.2 per cent (95% CI 35.5-55%) specificity, 60.2 per cent (95% CI 50.6-69.8%) positive predictive value and 88.8 per cent (95% CI 82.7-95%) negative predictive value of antigen test was computed. Interpretation & conclusions: SARS-CoV-2 antigen test was positive beyond 19 h in COVID-19 deceased individuals. Antigen test was found to be highly sensitive in the deceased. Patients, suspected of having died due to COVID-19, can be screened by this method. As infectiousness of the virus in the deceased bodies cannot be directly concluded from either the antigen or RT-PCR test, yet possible transmission cannot be completely ruled out. Strict infection control measures need to be followed during the handling and clearance of COVID-19 cadavers.

Spongiform leukoencephalopathy unveiled in an autopsy of a drug abuser

ABSTRACT Toxic leukoencephalopathy (TLE) is a rare neurological debilitating and fatal condition. It has been previously associated with exposure to leukotoxic offenders such as chemotherapy, cranial radiation, certain drugs, and environmental factors. Currently, it is a commoner white matter syndrome resulting from increased substance abuse, classically by inhaled heroin and other opioids. Herein, we report a case of fatal TLE unveiled in an autopsy of a drug abuser. A 24-year-old male was found dead on the roadside. A day before, he was located in a state of delirium. In this case, the autopsy findings and histopathology characteristics of cerebral cortex involvement particularly directed to speculate the heroine as the principal offender.

Postmortem examination in cases of custodial death in India.

Death in custody causes one of the most embarrassing situation for the law enforcement agencies and medicolegal experts. The doctors has to follow the guidelines given by National Human Rights Commission while conducting postmortem examination in such cases and many a times doctors have been blamed for giving a biased opinion under influence to protect the interests of police and jail officials. This paper discusses postmortem examination in cases of custodial deaths and incidence of custodial death in India as well as other parts of the world. The cases of custodial deaths for which autopsy was conducted at AIIMS has also been discussed.

Suicide among children and adolescents in South Delhi (1991-2000).

OBJECTIVE: Suicide among youth is of great concern and a subject requires thorough study to formulate prevention strategy. In this paper the incidence and trends of suicide among children and adolescent of South Delhi have been reported. METHODS: A retrospective analysis was carried out on 222 cases of suicidal deaths pertaining to age group of 10-18 years, the postmortem examination on the body of which were conducted in Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi during the period from 1st January 1991 to 31st December 2000. The particular of cases were analyzed according to age group, sex, method used and causes of committing suicide. RESULTS: Out of 222 cases 123(55.4%) were of girls (Female: Male 1.24:1). Commonest age group involved was 15-18 years in both the sexes. Commonest method used for committing suicide was hanging (57% in girls, 49.5% in boys) followed by poisoning (37.4% in girls, 49.5% in boys). CONCLUSION: Methods used to commit suicide are widely available and are difficult to restrict. Therefore, suicide prevention strategy based on risk factors could be more effective rather than limiting the access to methods.