Miliary pattern MRSA sepsis following clandestine intravenous infusion

Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

“…The case reported by Abernathy et al [ 19 ], concerning a 44-year-old woman who developed sepsis-induced MOF following the application of an intravenous device by inexperienced personnel, is an example of the confirmative role of post- mortem cultural investigations when ante-mortem cultural data were available. Specifically, cultural assays carried out either on blood obtained ante mortem and on pericardial fluid, intravenous tubing and saline bag obtained post mortem, confirmed a Methicillin-Resistant Staphylococcus aureus (MRSA) as the causative agent of sepsis.…”

“…The pathophysiological events underlying sepsis have a strong impact on the function of each organ [ 1 , 3 , 7 ] since the organ failure induced gives rise, in most cases, to morphological alterations that can be evaluated both macroscopically and microscopically. We start by suggesting some works describing the main post-mortem macroscopic and histological changes ( Table 1 ) detected on septic organs [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ].…”

“…Brain alterations are not frequently detected, but the main findings described were oedema [ 8 , 9 , 10 ] and haemorrhages [ 17 , 19 ]. Other rare changes were reported by Sledzinska et al [ 10 ], who found transtentorial herniation with cerebral oedema, and by Garofalo et al [ 17 ], who described cases of central pontine myelinolysis and multifocal necrotizing leukoencephalopathy, together with evidence of microabscesses.…”

“…Finally, external signs may either be absent or vary significantly. As summarized by Rorat et al [ 21 ], signs that can be detected, either on skin or mucosal surfaces, include abscesses, skin discolorations, rashes, or haemorrhagic lesions [ 8 , 19 ], which might testify to the development of a DIC (Disseminated Intravascular Coagulation) or the formation of septic embolisms. Sometimes, more specific lesions might help suggest the cause of sepsis, such as the presence of vesicular and erosive lesions in TEN (Toxic Epidermal Necrolysis) and SSSS (Staphylococcal Scalded Skin Syndrome), or cutaneous cellulitis (peau d’orange) and palpable crepitation in cases of gas gangrene [ 20 ].…”

“…Along with the autopsy investigations, in some of the above-mentioned works [ 8 , 10 , 15 , 19 , 20 ], as well as in other selected works further discussed [ 22 , 23 , 24 , 25 , 26 ], the authors also performed cultural assays in order to evaluate their usefulness in a post-mortem setting ( Table 2 ).…”