Postmortem Mikrobiyolojik Analizler Güncel Yaklaşım

Son yüzyılda özellikle mikroorganizmaların biyolojik silah olarak kullanımının artışı ve postmortem incelemelerin otopsi olgularının tanısına katkısının tartışılmasıyla “adli mikrobiyoloji” ve buna bağlı olarak “postmortem mikrobiyoloji” de üzerinde çalışılması ve deneyimli uzmanlar yetiştirilmesi gereken alanlar olarak ortaya çıkmıştır. Postmortem mikrobiyolojik analizler, şüpheli enfeksiyonun tanısının konulması bakımından klinik ve adli otopsilerde yararlıdır. Özellikle ani bebek ve çocuk ölümü olgularında ve enfeksiyon kuşkusu olan ölümlerde hem adli soruşturmanın bir parçası olarak hem de sorumlu etkenin saptanması için postmortem mikrobiyolojik incelemelerin yapılması gerekmektedir. Ani beklenmedik ölümlerde ölüm nedeni olarak enfeksiyonların rolünün varlığı halk sağlığı ve epidemiyoloji açısından önem taşımaktadır. Postmortem mikrobiyolojik örnekleme için standart protokollerin oluşturulması adli otopsilerin kalitesini arttırmakla birlikte ölüm nedenini saptama olasılığını da arttıracaktır. Mikrobiyologlar, patologlar ve adli tıp uzmanlarının yer aldığı multidisipliner çalışmalar postmortem mikrobiyolojinin başarısını arttırmakla birlikte, bulaşıcı hastalıkların önlenmesine ve sağlıklı bir nüfusun ortaya çıkmasına katkı sağlayacaktır. Ayrıca ülkemizde de adli bilimler, mikrobiyoloji ve epidemiyoloji bilim alanlarında deneyim paylaşımı ve çalışma gruplarının oluşturulması önem arz etmektedir. Bu derleme yazıda, postmortem mikrobiyoloji ve öneminin güncel bilgiler ışığında tartışılması amaçlanmıştır. Anahtar kelimeler: Postmortem Mikrobiyoloji, Adli Mikrobiyoloji, Otopsi, Ani Ölü

Detection of Human Bocavirus DNA by Multiplex PCR Analysis: Postmortem Case Report

Background: Human bocavirus (HBoV) is a virus belonging to the Parvoviridae family, which has been newly discovered to be associated with respiratory tract infections in children. There are many reports worldwide on the endemicity of this virus. Since it is relatively new, it is not routinely detected in clinical laboratory investigations. Case Report: We demonstrated that HBoV infection caused the death of a 5-month-old girl with a history of high fever and wheezing. Human bocavirus (HBoV 1/2/3/4) was found in a nasopharyngeal swab, paraffin-embedded lung tissue and stool samples by multiplex PCR methods using postmortem microbiological analysis. Conclusion: This case suggests that lower respiratory tract infections due to HBoV may cause severe and life-threatening diseases. Postmortem microbiology is useful in both clinical and forensic autopsies, and allows a suspected infection to be confirmed. To our knowledge, this report is the first document of a HBoV postmortem case in Turkey

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery

Background: Mediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery

Evaluation of Detected Rotavirus Antigen Positivity in the Council of Forensic Medicine Postmortem Microbiology Laboratory from 2007-2011

Introduction: Infectious gastroenteritis is progressing with a high morbidity and mortality in developing countries especially among children below the age of five. The viruses cause 50-75% of all infectious gastroenteritis cases. The rotaviruses, are the most common and significant cause of gastroenteritis among newborns and infants worldwide. Rotavirus infections are responsible for the death of one million children every year. Postmortem data regarding this subject are limited in our country. The aim of our study was to determine the seasonal and age distributions associated with postmortem rotavirus positivity delected in the stool samples of autopsy cases that were microbiologically sampled due to suspected infection. Materials and Methods: Two hundred and seventy two stool samples, which were sent between August 2007 and December 2011, were examined retrospectively in terms of rotavirus antigen positivity in the Department of Forensic Medicine Postmortem Microbiology Laboratory. According to the autopsy reports, lung infection and complications were the most common causes of death, and the death was primarily due to the individual’s pre-existing disease, followed its emerging complications and finally due to gastroenteritis. Two kits that detect rotavirus antigen using enzyme immunoassay technique were used to examine stool samples: Ridascreen Rotavirus kit (R-Biopharm AG, Darmstadt, Germany) for the samples between August 2007 and December 2010 and Enzyme-Linked Fluorescent Assay (ELFA; Vidas; Biomerieux, France) for the samples between December 2010 and December 2011. The distributions of rotavirus frequency according to seasons, age and sex were evaluated statistically. Results: Rotavirus antigen was detected in 47 (17.3%) of 272 samples that were examined. Rotavirus antigen positivity was observed more in the 0-2 age group (p 0.05). It was found that the percentage of rotavirus positivity was decreased in summer (17%) and autumn (12.8%) compared to the other seasons, and the highest positivity rates were seen during winter (34.1%) and spring (36.1%). Conclusion: Rotavirus gastroenteritis, which is quite common in our country, is an important health issue that causes morbidity and mortality. As the clinical signs are non-spesific for the virus, analysis of viral antigen in stool samples is important for the diagnosis in order to predict the course of the disease and particulary to determine a treatment protocol. The role of rotavirus in fatal conditions is not clear, and additional research methods are required to evaluate deaths associated with diarrhea. The studies related to pathological examinations of people who died due to rotavirus infections are limited to a few autopsy data. We believe that a better understanding of the outcome may alter the approach to these infections and to treatment

Medicolegal consequences of thoracic gossypiboma: A case report

The term gossypiboma is used to describe a retained surgical sponge after operation. It is a rare but it is associated with severe medical and legal consequences. The diagnosis can be missed despite radiological investigations. We report a case of a 15-year-old female who presented with fever, cough, dyspnea and hemoptysis. She had a history of hydatid cyst operation 2 years ago. Post-discharge follow up occurred for two years on hospital where hydatid cyst surgery had been done. Radiological investigations were inconclusive in detecting the retained sponge despite radiopaque marker. So gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as persistent respiratory symptoms after the operation. (C) 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved

How to optimise the yield of forensic and clinical post-mortem microbiology with an adequate sampling: a proposal for standardisation

Purpose: Post-mortem microbiology (PMM) is an important tool in forensic pathology, helping to determine the cause and manner of death, especially in difficult scenarios such as sudden unexpected death (SD). Currently, there is a lack of standardization of PMM sampling throughout Europe. We present recommendations elaborated by a panel of European experts aimed to standardize microbiological sampling in the most frequent forensic and clinical post-mortem situations. Methods: A network of forensic microbiologists, pathologists and physicians from Spain, England, Belgium, Italy and Turkey shaped a flexible protocol providing minimal requirements for PMM sampling at four practical scenarios: SD, bioterrorism, tissue and cell transplantation (TCT) and paleomicrobiology. Biosafety recommendations were also included. Results: SD was categorized in 4 subgroups according to the age of the deceased and circumstances at autopsy: (1) included SD in infancy and childhood (0-16 years); (2) corresponded to SD in the young (17-35 years); (3) comprised SD at any age with clinical symptoms; and (4) included traumatic/iatrogenic SD. For each subgroup, a minimum set of samples and general recommendations for microbiological analyses were established. Sampling recommendations for main bioterrorism scenarios were provided. In the TCT setting, the Belgian sampling protocol was presented as an example. Finally, regarding paleomicrobiology, the sampling selection for different types of human remains was reviewed. Conclusions: This proposal for standardization in the sampling constitutes the first step towards a consensus in PMM procedures. In addition, the protocol flexibility to adapt the sampling to the clinical scenario and specific forensic findings adds a cost-benefit value.status: publishe