Infectious cause of death determination using minimally invasive autopsies in developing countries.
In developing countries, the knowledge of the microorganisms causing fatal infections is critical and could help designing and implementing more effective preventive interventions and treatment guidelines. We aimed to develop and validate protocols for microbiological analysis in post-mortem samples obtained during minimally invasive autopsy (MIA) procedures and to assess their performance. Thirty MIAs performed in adults at Maputo Central Hospital in Southern Mozambique were included in the analysis. Microbiological tests included a universal screening for HIV, hepatitis B and C viruses, Plasmodium falciparum, and bacterial/fungal culture. In addition, a variety of molecular microbiology assays guided by the histological results were performed in blood, cerebrospinal fluid and a variety of tissue samples including liver, lung and central nervous system. The combination of culture-based methods together with molecular microbiological assays led to the identification of 17 out of 19 (89.5%) of the infectious deaths. Microorganisms identified included Mycobacterium tuberculosis, Toxoplasma gondii, Pneumocystis jiroveci, Cryptococcus neoformans, hepatitis B virus, human herpesvirus 8, cytomegalovirus, Streptococcus pneumoniae, Streptococcus dysgalactiae, Ryzopus oryzae, and Acinetobacter baumannii. The combination of classical cultures, serological tests and molecular assays performed in samples obtained through MIA allows the identification of most infectious agents causing death.
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain. Electronic address: myoldi@clinic.ub.es.
Miguel J
MJ
Martínez
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Sergio
S
Massora
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Inácio
I
Mandomando
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
Esperança
E
Ussene
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
Dercio
D
Jordao
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
Lucilia
L
Lovane
Department of Molecular Microbiology, University Hospital Sant Joan de Deu, Barcelona, Spain.
Carmen
C
Muñoz-Almagro
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
Paola
P
Castillo
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Alfredo
A
Mayor
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
Cristina
C
Rodriguez
Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
Miriam
M
Lopez-Villanueva
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
Mamudo R
MR
Ismail
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
Carla
C
Carrilho
Department of Pathology, Maputo Central Hospital, Maputo, Mozambique.
Cesaltina
C
Lorenzoni
Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, Amazonas, Brazil.
Marcus V G
MVG
Lacerda
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Quique
Q
Bassat
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Clara
C
Menéndez
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Pathology, Hospital Clinic, Universitat de Barcelona, Spain.
Jaume
J
Ordi
ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Department of Clinical Microbiology, Hospital Clinic, Universitat de Barcelona, Spain.
Jordi
J
Vila
D000293:Adolescent; D000328:Adult; D000368:Aged; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D003141:Communicable Diseases / Q000175:diagnosis*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D009073:Mozambique; D055815:Young Adult
Microbiological studies; Minimally invasive autopsy