ABSTRACT
Post-mortem microbiology (PMM) is an important tool in forensic pathology, assisting to determine the cause and manner of death. However, there is a lack of standardisation of PMM sampling. In order to get a better insight into the methods used, the available technical options and developmental needs, ESCMID Study Group for Forensic and Postmortem Microbiology (ESGFOR) members designed a survey aimed at pathologists regarding common practices of PMM in clinical and forensic autopsies. Multiple choice questions were developed based on Cumulative Techniques and Procedures in Clinical Microbiology (Cumitech). The questionnaire was sent to pathologists mainly across Europe and Turkey using SurveyMonkey. The survey had 147 respondents. Although all pathologists were aware of the existence of PMM, 39% (19/49) of the participants were not using it. The three main indications for PMM were: (i) clinical suspicion of an infection not confirmed antemortem (83%), (ii) infectious signs at autopsy (83%) and (iii) as part of a standard protocol for foetal/perinatal or paediatric death (67%). Almost 80% of the participants using PMM stated taking 1-10 samples per case. Of the requested examinations, a general bacteriological culture (96%) and a specific polymerase chain reaction (PCR) assay for a particular infectious agent (34%) were most popular. The most frequent samples were: heart blood (66%), peripheral femoral blood (49%), spleen (64%) and lung (56%). Eighty-nine percent of the participants considered PMM a useful resource when investigating the cause of death. Although there are some common uses, this survey indicates that there is a need for improvement towards standardising sampling procedures in PMM.
Subject(s)
Diagnosis , Microbiological Techniques/methods , Microbiological Techniques/statistics & numerical data , Pathology/methods , Europe , Humans , Pathologists , Surveys and Questionnaires , TurkeyABSTRACT
The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but it is associated with severe medical and legal consequences. The diagnosis can be missed despite radiological investigations. We report a case of a 15-year-old female who presented with fever, cough, dyspnea and hemoptysis. She had a history of hydatid cyst operation 2 years ago. Post-discharge follow up occurred for two years on hospital where hydatid cyst surgery had been done. Radiological investigations were inconclusive in detecting the retained sponge despite radiopaque marker. So gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as persistent respiratory symptoms after the operation.
Subject(s)
Foreign Bodies/complications , Thorax , Adolescent , Cough/etiology , Dyspnea/etiology , Echinococcosis, Pulmonary/surgery , Female , Fever/etiology , Foreign Bodies/surgery , Hemoptysis/etiology , Humans , Pneumonia/etiology , RecurrenceABSTRACT
OBJECTIVE: Venous thromboembolism is a complex, multifactorial disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors, such as trauma and surgery. This study investigated the clinical features and most important risk factors of fatal pulmonary thromboembolism (PTE). MATERIALS AND METHODS: Forensic records stored at the Council of Forensic Medicine, Ministry of Justice in Istanbul, Turkey, from January 2010 to December 2014 were screened for deaths of confirmed PTE based on autopsy or computed tomography (CT). Massive pulmonary embolism was the main cause of death in all patients. RESULTS: The 51 cases with PTE comprised 22 (43.2%) males and 29 (56.8%) females. A diagnosis of PTE was established by autopsy in 76.6% (39/51) of the cases. Overall, 23 (45%) suffered multiple trauma and 14 (27.5%) underwent surgery. The mean time from surgery to death was 10.2 ±6.8 days. Of the trauma cases, 78% (18/23) comprised orthopaedic trauma. Death occurred in 74% of the cases after the second week following trauma. Of the trauma and surgery cases, 95.6 and 71.4% were outpatients at the time of death, respectively. The origin of the PTE was known in 34.8% and 57% of the trauma and surgery cases, respectively. The mean Injury Severity Score (ISS) was 11.3 ± 7.6. An abbreviated injury score (AIS) extremity ≥3 was seen in 23% (4/18) of the extremity trauma cases. The time to death of the patients who underwent surgery was shorter than in the patients who experienced trauma (p=0.001). CONCLUSIONS: A high ISS is not a determinant of fatal PTE. Immobilization is important in the occurrence of PTE, especially in trauma patients. Frequent follow-up after discharge should inquire about complaints related to PTE and the use of protective precautions.
Subject(s)
Pulmonary Embolism/etiology , Pulmonary Embolism/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Injury Severity Score , Male , Middle Aged , Mortality/trends , Multiple Trauma/complications , Multiple Trauma/diagnostic imaging , Multiple Trauma/mortality , Patient Discharge/trends , Pulmonary Embolism/diagnostic imaging , Risk Factors , Tomography, X-Ray Computed , Venous Thromboembolism/complications , Venous Thromboembolism/diagnostic imaging , Venous Thromboembolism/mortality , Young AdultABSTRACT
Post-mortem microbiology (PMM) is an important tool in forensic pathology, helping to determine the cause and manner of death, especially in difficult scenarios such as sudden unexpected death (SD). Currently, there is a lack of standardization of PMM sampling throughout Europe. We present recommendations elaborated by a panel of European experts aimed to standardize microbiological sampling in the most frequent forensic and clinical post-mortem situations. A network of forensic microbiologists, pathologists and physicians from Spain, England, Belgium, Italy and Turkey shaped a flexible protocol providing minimal requirements for PMM sampling at four practical scenarios: SD, bioterrorism, tissue and cell transplantation (TCT) and paleomicrobiology. Biosafety recommendations were also included. SD was categorized into four subgroups according to the age of the deceased and circumstances at autopsy: (1) included SD in infancy and childhood (0-16 years); (2) corresponded to SD in the young (17-35 years); (3) comprised SD at any age with clinical symptoms; and (4) included traumatic/iatrogenic SD. For each subgroup, a minimum set of samples and general recommendations for microbiological analyses were established. Sampling recommendations for main bioterrorism scenarios were provided. In the TCT setting, the Belgian sampling protocol was presented as an example. Finally, regarding paleomicrobiology, the sampling selection for different types of human remains was reviewed. This proposal for standardization in the sampling constitutes the first step towards a consensus in PMM procedures. In addition, the protocol flexibility to adapt the sampling to the clinical scenario and specific forensic findings adds a cost-benefit value.
