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

Paola Castillo, Esperança Ussene, Mamudo R Ismail, Dercio Jordao, Lucilia Lovane, Carla Carrilho, Cesaltina Lorenzoni, Marcus V Lacerda, Antonio Palhares, Leonardo Rodríguez-Carunchio, Miguel J Martínez, Jordi Vila, Quique Bassat, Clara Menéndez, Jaume Ordi, Paola Castillo, Esperança Ussene, Mamudo R Ismail, Dercio Jordao, Lucilia Lovane, Carla Carrilho, Cesaltina Lorenzoni, Marcus V Lacerda, Antonio Palhares, Leonardo Rodríguez-Carunchio, Miguel J Martínez, Jordi Vila, Quique Bassat, Clara Menéndez, Jaume Ordi

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Procedures for the collection of…
Fig 1. Procedures for the collection of cerebrospinal fluid (A), peripheral blood (B), liver (C), lung (D), spleen (E), and the central nervous system biopsy (F) (designed by Xabier Sagasta).
Fig 2. Representative image of the samples…
Fig 2. Representative image of the samples obtained from the central nervous system (A), liver (B), bone marrow (C) and lungs/heart and kidney (D) in the minimally invasive autopsy procedure.
Fig 3. Median area of tissue for…
Fig 3. Median area of tissue for histological evaluation obtained from each organ in mm2.
Fig 4. Representative examples of putative causes…
Fig 4. 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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