title: Pathological Methods Applied to the Investigation of Causes of Death in Developing Countries: Minimally Invasive Autopsy Approach.
abstract: OBJECTIVE
  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.
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Paola
authors.initials: P
authors.lastname: Castillo
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Esperança
authors.initials: E
authors.lastname: Ussene
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Mamudo R
authors.initials: MR
authors.lastname: Ismail
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Dercio
authors.initials: D
authors.lastname: Jordao
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Lucilia
authors.initials: L
authors.lastname: Lovane
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Carla
authors.initials: C
authors.lastname: Carrilho
authors.affiliation: Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
authors.forename: Cesaltina
authors.initials: C
authors.lastname: Lorenzoni
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil.
authors.forename: Marcus V
authors.initials: MV
authors.lastname: Lacerda
authors.affiliation: Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palhares
authors.affiliation: Department of Pathology, Hospital Clinic, Universitat de Barcelona, Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rodríguez-Carunchio
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
authors.forename: Miguel J
authors.initials: MJ
authors.lastname: Martínez
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Department of Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, (CISM), Maputo, Mozambique.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça, (CISM), Maputo, Mozambique.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Ordi
mesh_terms: D001344:Autopsy / Q000191:economics / Q000379:methods*; D001707:Biopsy, Needle / Q000379:methods*; D001853:Bone Marrow / Q000473:pathology; D001921:Brain / Q000473:pathology; D002423:Cause of Death; D003906:Developing Countries; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D008297:Male; D009073:Mozambique; D009206:Myocardium / Q000473:pathology; D013154:Spleen / Q000473:pathology; D014599:Uterus / Q000473:pathology