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Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach.

Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, Lorenzoni C, Lacerda MV, Palhares A, Rodríguez-Carunchio L, Martínez MJ, Vila J, Bassat Q, Menéndez C, Ordi J - PLoS ONE (2015)

Bottom Line: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain.A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses.This procedure could improve the determination of CoD in developing countries.

View Article: PubMed Central - PubMed

Affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.

ABSTRACT

Background and aims: Complete diagnostic autopsies (CDA) remain the gold standard in the determination of cause of death (CoD). However, performing CDAs in developing countries is challenging due to limited facilities and human resources, and poor acceptability. We aimed to develop and test a simplified minimally invasive autopsy (MIA) procedure involving organ-directed sampling with microbiology and pathology analyses implementable by trained technicians in low- income settings.

Methods: A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles.

Results: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs.

Conclusions: A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries.

No MeSH data available.


Related in: MedlinePlus

Representative examples of putative causes of death identified with minimally invasive autopsy sampling.A) Meningoencephalitis (hematoxylin and eosin, 200x); B) Pneumocysttis jiroveci pneumonia (hematoxylin and eosin, 200x); C) Cryptococcus neoformans infecting the lung (PAS metenamine silver stain, 200x); D) Kaposi’s sarcoma involving the lung (hematoxylin and eosin, 100x).
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pone.0132057.g004: Representative examples of putative causes of death identified with minimally invasive autopsy sampling.A) Meningoencephalitis (hematoxylin and eosin, 200x); B) Pneumocysttis jiroveci pneumonia (hematoxylin and eosin, 200x); C) Cryptococcus neoformans infecting the lung (PAS metenamine silver stain, 200x); D) Kaposi’s sarcoma involving the lung (hematoxylin and eosin, 100x).

Mentions: Table 2 shows the basic demographic data of the patients included in the study, the HIV status, the diagnoses reached in the histological evaluation of the samples obtained through the MIA, the results of the microbiological analyses and the final diagnoses obtained after combining the pathological and the microbiological results. A putative CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs. A severe disease considered as a possible CoD was identified in the histology samples in 22/30 cases (73%), with 14 cases being infectious diseases, and 8 non- communicable diseases including 4 malignant tumors. Three of the malignant tumors were of viral origin (two liver cell carcinomas, 1 Kaposi’s sarcoma) and one was a large B cell lymphoma negative for the in situ hybridization for Epstein- Barr virus. The MIA tended to yield a CoD in patients 35-year-old or younger more frequently than in those older than 35 years of age, although the difference was not statistically significant (12/17; 70.6% vs. 7/14, 50%; p = 0.288). Fig 4 shows representative examples of CoD identified through MIA sampling.


Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach.

Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, Lorenzoni C, Lacerda MV, Palhares A, Rodríguez-Carunchio L, Martínez MJ, Vila J, Bassat Q, Menéndez C, Ordi J - PLoS ONE (2015)

Representative examples of putative causes of death identified with minimally invasive autopsy sampling.A) Meningoencephalitis (hematoxylin and eosin, 200x); B) Pneumocysttis jiroveci pneumonia (hematoxylin and eosin, 200x); C) Cryptococcus neoformans infecting the lung (PAS metenamine silver stain, 200x); D) Kaposi’s sarcoma involving the lung (hematoxylin and eosin, 100x).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4488344&req=5

pone.0132057.g004: Representative examples of putative causes of death identified with minimally invasive autopsy sampling.A) Meningoencephalitis (hematoxylin and eosin, 200x); B) Pneumocysttis jiroveci pneumonia (hematoxylin and eosin, 200x); C) Cryptococcus neoformans infecting the lung (PAS metenamine silver stain, 200x); D) Kaposi’s sarcoma involving the lung (hematoxylin and eosin, 100x).
Mentions: Table 2 shows the basic demographic data of the patients included in the study, the HIV status, the diagnoses reached in the histological evaluation of the samples obtained through the MIA, the results of the microbiological analyses and the final diagnoses obtained after combining the pathological and the microbiological results. A putative CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs. A severe disease considered as a possible CoD was identified in the histology samples in 22/30 cases (73%), with 14 cases being infectious diseases, and 8 non- communicable diseases including 4 malignant tumors. Three of the malignant tumors were of viral origin (two liver cell carcinomas, 1 Kaposi’s sarcoma) and one was a large B cell lymphoma negative for the in situ hybridization for Epstein- Barr virus. The MIA tended to yield a CoD in patients 35-year-old or younger more frequently than in those older than 35 years of age, although the difference was not statistically significant (12/17; 70.6% vs. 7/14, 50%; p = 0.288). Fig 4 shows representative examples of CoD identified through MIA sampling.

Bottom Line: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain.A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses.This procedure could improve the determination of CoD in developing countries.

View Article: PubMed Central - PubMed

Affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.

ABSTRACT

Background and aims: Complete diagnostic autopsies (CDA) remain the gold standard in the determination of cause of death (CoD). However, performing CDAs in developing countries is challenging due to limited facilities and human resources, and poor acceptability. We aimed to develop and test a simplified minimally invasive autopsy (MIA) procedure involving organ-directed sampling with microbiology and pathology analyses implementable by trained technicians in low- income settings.

Methods: A standardized scheme for the MIA has been developed and tested in a series of 30 autopsies performed at the Maputo Central Hospital, Mozambique. The procedure involves the collection of 20 mL of blood and cerebrospinal fluid (CSF) and puncture of liver, lungs, heart, spleen, kidneys, bone marrow and brain in all cases plus uterus in women of childbearing age, using biopsy needles.

Results: The sampling success ranged from 67% for the kidney to 100% for blood, CSF, lung, liver and brain. The amount of tissue obtained in the procedure varied from less than 10 mm2 for the lung, spleen and kidney, to over 35 mm2 for the liver and brain. A CoD was identified in the histological and/or the microbiological analysis in 83% of the MIAs.

Conclusions: A simplified MIA technique allows obtaining adequate material from body fluids and major organs leading to accurate diagnoses. This procedure could improve the determination of CoD in developing countries.

No MeSH data available.


Related in: MedlinePlus