The importance of the postmortem interval for the diagnosis of Waterhouse Friderichsen syndrome by Neisseria meningitidis in a series of forensic cases

Abstract

The effective value of microbiological post-mortem examinations stands as fundamental in forensic cases involving microbiology. We ran these analyses on five victims, who suddenly died after showing persistent fever. The examinations were conducted between 48 hours and 10 days after death, and adrenal gland apoplexy was detected in all the cases. Microbiological examinations identified Neisseria meningitidis , which was accountable for Waterhouse–Friderichsen syndrome. Diplococci were isolated from three cadavers that underwent forensic dissection between 2 and 3 days after death. The remaining two cadavers showed polymicrobial contamination, and a polymerase chain reaction technique was necessary to identify the pathogen. We assumed that the microbial overlap could lead to diagnostic mistakes and conceal the identification of the lethal pathogen. Therefore, we suggest using molecular techniques for a postmortem interval (PMI) longer than 72 hours. Classical microbiological examination should be performed for PMI within 72 hours.

Fatal Waterhouse-Friderichsen syndrome in an adult due to serogroup YNeisseria meningitidis

“…The concomitant existence of PF, DIC and WFS demonstrate the pathological systemic activation of blood coagulation in the context of meningococcaemia. The WFS diagnosis is usually achieved at postmortem examination, as it happened in this case 6. Although the abdominal CT scan was performed 4 hours prior to death, it showed no signs of adrenal glands structural changes (figures 1 and 2).…”

“…The risk of WFS is higher in patients with a congenital or acquired reduction in splenic function 5. The clinical course may be fulminant, and the early identification is challenging, so the diagnosis is frequently achieved postmortem 6…”