The importance of microbiological testing for establishing cause of death in 42 forensic autopsies

Abstract

Microorganisms have always been one of the great challenges of humankind, being responsible for both high morbidity and mortality throughout history. In a forensic setting microbiological information will always be difficult to interpret due to lack of antemortem information and changes in flora postmortem. With this study we aim to review the use of microbiological procedures at our forensic institute. In a retrospective study including 42 autopsies performed at our Institute, where microbiological test had been applied, analyses were made with regard to: type of microbiological tests performed, microorganisms found, histological findings, antemortem information, C-reactive protein measurement and cause of death. Fiftyone different microorganisms were found distributed among 37 cases, bacteria being the most abundant. Nineteen of the cases were classified as having a microbiological related cause of death. C-reactive protein levels were raised in 14 cases of the 19 cases, histological findings either supported or were a decisive factor for the classification of microbiologically related cause of death in 14 cases. As a multitude of abundant microorganisms are able to cause infection under the right circumstances, all findings should be compared to anamnestic antemortem information, before conclusions are drawn. A definite list of true pathogens is nearly impossible to compile.

Autopsy Prevalence of Tuberculosis and Other Potentially Treatable Infections among Adults with Advanced HIV Enrolled in Out-Patient Care in South Africa

“…The interpretation of culture results from autopsy specimens is not straightforward and may be complicated further when the procedure is conducted many days after death, potentially providing greater opportunity for tissue autolysis and translocation of organisms to compartments they did not occupy in life [40–42]. However, there is evidence to show that the time from death to autopsy does not have a major effect on false-positive bacterial results if the body is kept refrigerated [43,44]. One study, conducted among 507 infants with sudden and unexpected deaths, even suggests that a longer interval may allow for fewer false-positive results [45]; and there are reports of pathogens recovered from bodies in states of advanced decomposition [46,47].…”

Forensic Applications of Microbiomics: A Review

“…In terms of cause of death (i.e., the disease or injury that produces physiological disruption in the body leading to death), researchers such as Christoffersen (2015) have investigated the importance of microbiological testing. Studying autopsy results ( n = 42), the author reported that the cause of death could be determined in 42% of the cases via microbiological analysis.…”

Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings

“…We describe specific protocols for different clinical scenarios, including wide sampling of fluids, tissues and swabs, as most protocols generally advocate [12,21].…”

“…Although selection of specimens in PMM should be driven by the clinical context (symptoms, presentation, presumptive diagnosis), ante-mortem information is not always available in sudden death cases, and when available sometimes does not suggest an infectious COD. On such occasions samples should be collected if macroscopic findings suggest an infection [21].…”