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Infectious cause of death determination using minimally invasive autopsies in developing countries
Miguel J Martínez1, Sergio Massora2, Inácio Mandomando2
1ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
Abstract:
In developing countries, the knowledge of the microorganisms causing fatal infections is critical and could help designing and implementing more effective preventive interventions and treatment guidelines. We aimed to develop and validate protocols for microbiological analysis in post-mortem samples obtained during minimally invasive autopsy (MIA) procedures and to assess their performance. Thirty MIAs performed in adults at Maputo Central Hospital in Southern Mozambique were included in the analysis. Microbiological tests included a universal screening for HIV, hepatitis B and C viruses, Plasmodium falciparum, and bacterial/fungal culture. In addition, a variety of molecular microbiology assays guided by the histological results were performed in blood, cerebrospinal fluid and a variety of tissue samples including liver, lung and central nervous system. The combination of culture-based methods together with molecular microbiological assays led to the identification of 17 out of 19 (89.5%) of the infectious deaths. Microorganisms identified included Mycobacterium tuberculosis, Toxoplasma gondii, Pneumocystis jiroveci, Cryptococcus neoformans, hepatitis B virus, human herpesvirus 8, cytomegalovirus, Streptococcus pneumoniae, Streptococcus dysgalactiae, Ryzopus oryzae, and Acinetobacter baumannii. The combination of classical cultures, serological tests and molecular assays performed in samples obtained through MIA allows the identification of most infectious agents causing death.
Insights
Identifying infectious agents causing death is crucial for public health in developing nations. Minimally invasive autopsy (MIA) with advanced microbiological analysis effectively detects these pathogens.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Accurate identification of causative agents in fatal infections is critical for effective public health strategies in developing countries.
- Minimally invasive autopsy (MIA) offers a less invasive method for post-mortem sample collection compared to traditional autopsies.
Purpose of the Study:
- To develop and validate microbiological analysis protocols for post-mortem samples from MIA procedures.
- To evaluate the performance of these protocols in identifying infectious causes of death.
Main Methods:
- Thirty MIAs were conducted on adult patients at Maputo Central Hospital, Mozambique.
- Microbiological analyses included HIV, hepatitis B/C, Plasmodium falciparum screening, bacterial/fungal cultures, and molecular assays (PCR, etc.) on blood, CSF, and tissues.
- Histological results guided the selection of molecular assays.
Main Results:
- The combined approach of culture-based and molecular methods identified the causative agents in 17 out of 19 (89.5%) infectious deaths.
- Identified pathogens included Mycobacterium tuberculosis, Toxoplasma gondii, Cryptococcus neoformans, Hepatitis B virus, and Acinetobacter baumannii, among others.
- MIA facilitated the collection of diverse samples for comprehensive etiological diagnosis.
Conclusions:
- The integrated use of classical cultures, serological tests, and molecular assays on MIA samples is highly effective for identifying infectious agents responsible for mortality.
- This approach provides valuable etiological data crucial for informing public health interventions and treatment guidelines in resource-limited settings.
