Performance of the minimally invasive autopsy tool for cause of death determination in adult deaths from the Brazilian Amazon: an observational study

Palhares, Antonio E. M.; Ferreira, Luíz Carlos Lima; Freire, Monique; Castillo, Paola; Martínez, Miguel J.; Hurtado, Juan Carlos; Rakislova, Natalia; Varo, Rosauro; Navarro, Mireia; Casas, Irene; Vilà, Jordi; Monteiro, Wuelton Marcelo; Sanz, Ariadna; Quintó, Llorenç; Fernandes, Fabíola; Carrilho, Carla; Menéndez, Clara; Ordï, Jaume; Bassat, Quique; Lacerda, Marcus

doi:10.1007/s00428-019-02602-z

Cited by 21 publications

(26 citation statements)

References 31 publications

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“…To our knowledge, this is the first MIA study in COVID-19 that also includes complete diagnostic autopsy performed on the same body. As in other MIAs conducted in adults in Mozambique [ 15 ] and Brazil [ 45 ], we successfully obtained the samples included in the study protocol. Contrary to several recent MIA studies in COVID-19 [ 35 , 44 , 46 ], our findings suggest that ultrasound or computed tomography guidance is not necessary to consistently and successfully obtain representative, high-quality samples [ 14 , 15 , 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our study has several strengths and limitations. The strengths include the extensive previous experience of our group in conducting MIAs in Mozambique [ 15 , 18 ] and Brazil [ 45 ]. Contrary to several studies in which the sampling was restricted to the lungs [ 37 , 38 , 40 , 41 , 43 ], we successfully sampled a wide range of organs, similarly to the MIA procedures conducted in China [ 36 ], Brazil [ 46 ], Belgium [ 35 ] and United States [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

et al. 2021

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Postmortem studies are crucial for providing insight into emergent diseases. However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges. Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases. We aimed to: a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, b) compare the performance of MIA versus complete autopsy, and c) evaluate the safety of the procedure. Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment. Samples from the lungs and key organs were successfully obtained in all cases. A complete autopsy was performed on the same body immediately after the MIA. The diagnoses of the MIA matched those of the complete autopsy. In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage. No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies. In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

et al. 2021

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“…Beginning in 2016, the CADMIA study in Mozambique and the Brazilian Amazon sampled the brain, heart, liver, spleen, kidneys, and lungs and found a high concordance rate in major diagnosis between CDA and MITS and like earlier studies, found that over time sampling technique improved and that where CDA is not possible, MITS is a valuable and robust alternative [ 10 , 11 , 27 , 30 - 32 , 70 ]. Concordance rates between CDA and MITS ranged from 68% in stillbirths to 89% in pediatric deaths with the highest concordance in deaths attributable to infectious diseases and malignant tumors [ 31 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review

Paganelli

Goco

McClure

et al. 2020

Global Health Action

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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 needlebased 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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“…This study was part of an observational study conducted at the Fundação de Medicina Tropical Dr . Heitor Vieira Dourado [ 23 ], a tertiary referral hospital specialized in the diagnosis and treatment of tropical diseases. The hospital is located in the municipality of Manaus (North East of the Amazonian State).…”

Section: Methodsmentioning

confidence: 99%

“…In this study, we explored the prevalence and mortality associated with histoplasmosis in a series of 61 complete autopsies conducted in a referral hospital located in the Brazilian Amazon [ 23 ]. We analyzed the clinical signs and symptoms, the treatments received, and the histopathological and microbiological findings of all cases of histoplasmosis.…”

Section: Introductionmentioning

confidence: 99%

High prevalence and mortality due to Histoplasma capsulatum in the Brazilian Amazon: An autopsy study

et al. 2021

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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. In conclusion, substantial mortality is associated with disseminated histoplasmosis among HIV-positive patients in the Brazilian Amazon. 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.

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Performance of the minimally invasive autopsy tool for cause of death determination in adult deaths from the Brazilian Amazon: an observational study

Cited by 21 publications

References 31 publications

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review

High prevalence and mortality due to Histoplasma capsulatum in the Brazilian Amazon: An autopsy study

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