Integrated autopsy, histopathological, and microbiological evaluation of infection-attributed infant deaths

Cause-of-death attribution in infant deaths associated with infections frequently requires integrated interpretation of clinical findings, autopsy observations, histopathology, and postmortem microbiology within a medico-legal framework. This study aimed to evaluate multidomain diagnostic variabilities across clinical, histopathological, and microbiological domains in infant deaths attributed to infection. This retrospective autopsy-based study included 360 infant deaths aged 0-24 months evaluated by the First Forensic Medicine Specialization Board of the Council of Forensic Medicine of Türkiye between 2019 and 2023. Clinical records, autopsy findings, histopathological examinations, microbiological analyses, and final board-level cause-of-death determinations were systematically reviewed. Concordance analyses were performed across the diagnostic frameworks of the respiratory and gastrointestinal systems. Respiratory-system-associated infections represented the most frequent board-level classification (173/360, 48.1%), followed by sepsis (126/360, 35.0%). Pulmonary inflammation and injury-related patterns constituted the predominant histopathological component, most commonly including interstitial inflammatory pulmonary changes (95/340, 27.9%) and lobular/bronchopneumonic patterns (64/340, 18.8%). Culture-based microbiology demonstrated pathogen detection in 22/116 cases (19.0%), whereas tracheal polymerase chain reaction positivity was identified in 54/101 cases (53.5%). Clinicopathological alignment between clinical presentation and organ-based histopathology was observed in 37.2% of cases. Diagnostic variability in attribution to death reached 72.0% in respiratory-system and 86.3% in the gastrointestinal-system. Infant deaths attributed to infections frequently demonstrate marked variability between clinical presentation, histopathological findings, and microbiological results. Our findings support an integrative forensic interpretation rather than reliance on isolated diagnostic modalities in postmortem infectious disease evaluation.