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Published on: December 14, 2013
Identification of fungal diseases at necropsy
Tatiana Elias Colombo1, Márcia Maria Costa Nunes Soares, Solange Corrêa Garcia Pires D'Ávilla
1Laboratório de Microbiologia da Faculdade de Medicina de São José do Rio Preto, SP, Brazil.
Abstract:
The purpose of the Death Verification Service is to elucidate the causes of deaths that occur without medical assistance and of ill-defined deaths. In recent decades, the epidemiological reality of fungal infections has changed due to the rise in opportunistic infections chiefly in immunocompromised patients. A study of fungal diseases in autopsies performed in the Death Verification Service of the Medicine School in São José do Rio Preto between January 2000 and December 2009 was made. Sixty-seven cases of fungal disease, most involving men (70%), were found in 4824 autopsies. Cryptococcosis was the most prevalent (45%), followed by paracoccidioidomycosis, candidiasis, histoplasmosis, aspergillosis and mucormycosis. Associations between AIDS (n=14) and fungal diseases were identified for cryptococcosis (36%), candidiasis (28.5%) and histoplasmosis (28.5%). Pneumonia, AIDS and fungal diseases were evident in 26% of the cases, with the most prevalent etiologies being Cryptococcus neoformans (55.5%) and Histoplasma capsulatum (22%). Pneumonia alone occurred in 43% of cases, with cryptococcosis (53%) and paracoccidioidomycosis (33%) being the main infectious agents. Diabetes mellitus was associated with candidiasis in two cases and aspergillosis in one. One case of renal transplantation linked to paracoccidioidomycosis and one case of bone marrow aplasia with mucormycosis were reported. Despite the reduction in the number of autopsies over recent decades, these findings suggest that this procedure is useful to provide additional data on the etiology, underlying disease and specific risk factors, essential for quality control and to improve treatment protocols.
Insights
Autopsies revealed fungal diseases in 67 of 4824 cases, with cryptococcosis being most common. These findings highlight the importance of autopsies in identifying causes of death, especially in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Forensic Pathology
- Epidemiology
Background:
- Fungal infections are increasingly significant, particularly opportunistic infections in immunocompromised patients.
- Autopsies play a crucial role in verifying causes of death, especially for unattended and ill-defined deaths.
Purpose of the Study:
- To investigate the prevalence and types of fungal diseases identified in autopsies.
- To determine the association of fungal diseases with underlying conditions like AIDS, pneumonia, and diabetes mellitus.
Main Methods:
- Retrospective analysis of autopsy records from the Death Verification Service.
- Data collected from January 2000 to December 2009.
- Identification and categorization of fungal diseases and associated conditions.
Main Results:
- Sixty-seven cases (1.4%) of fungal disease were identified in 4824 autopsies.
- Cryptococcosis was the most prevalent fungal infection (45%), followed by paracoccidioidomycosis and candidiasis.
- Fungal diseases were associated with AIDS (14 cases), pneumonia (26% of cases with fungal disease), diabetes mellitus, renal transplantation, and bone marrow aplasia.
Conclusions:
- Autopsies remain valuable for determining the etiology of deaths, underlying diseases, and risk factors, even with declining autopsy rates.
- Findings underscore the epidemiological importance of fungal infections, particularly in vulnerable populations.
- Improved data from autopsies can enhance quality control and refine treatment strategies for fungal diseases.
