title: The role of postmortem studies in pneumonia etiology research.
abstract: The diagnosis of etiology in severe pneumonia remains a challenging area. Postmortem lung tissue potentially increases the sensitivity of investigations for identification of causative pathogens in fatal cases of pneumonia and can confirm antemortem microbiological diagnoses. Tissue sampling allows assessment of histological patterns of disease and ancillary immunohistochemical or molecular diagnostic techniques. It may also enhance the recognition of noninfectious conditions that clinically simulate acute pneumonia. Biobanking of lung tissue or postmortem culture isolates offers opportunities for new pathogen discovery and research into host-pathogen interactions. The Pneumonia Etiology Research for Child Health study proposes a percutaneous needle biopsy approach to obtain postmortem samples, rather than a full open autopsy. This has the advantage of greater acceptability to relatives, but risks greater sampling error. Both approaches may be susceptible to microbiological contamination or pathogen degradation. However, previous autopsy studies have confirmed the value of histological examination in revealing unsuspected pathogens and influencing clinical guidelines for the diagnosis and treatment of future pneumonia cases.
authors.affiliation: Mahidol-Oxford Research Unit, and Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. gareth@tropmedres.ac
authors.forename: Gareth D H
authors.initials: GD
authors.lastname: Turner
authors.forename: Charatdao
authors.initials: C
authors.lastname: Bunthi
authors.forename: Chizoba B
authors.initials: CB
authors.lastname: Wonodi
authors.forename: Susan C
authors.initials: SC
authors.lastname: Morpeth
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Molyneux
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: Orin S
authors.initials: OS
authors.lastname: Levine
authors.forename: David R
authors.initials: DR
authors.lastname: Murdoch
authors.forename: J Anthony G
authors.initials: JA
authors.lastname: Scott
mesh_terms: D001344:Autopsy / Q000941:ethics / Q000379:methods* / Q000592:standards; D015982:Bias; D001707:Biopsy, Needle / Q000379:methods; D002648:Child; D006801:Humans; D007150:Immunohistochemistry; D008171:Lung Diseases / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D008828:Microbiological Techniques / Q000379:methods / Q000592:standards; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods