Fatal influenza A infection with Staphylococcus aureus superinfection in a 49-year-old woman presenting as sudden death

Abstract

A fatal case of influenza A infection with Staphylococcus aureus superinfection in a previously healthy 49-year-old woman presenting as sudden, unexpected death is reported. Autopsy revealed severe necrotizing tracheobronchitis and hemorrhagic pneumonia. Microscopic examination of the trachea and bronchi showed mucosal necrosis and a dense lympho-monocytic infiltration of all layers. The lungs showed focal hemorrhagic pneumonia. No pathological changes were detectable in the myocardium. Influenza A virus was detected in bronchi and lung samples obtained during autopsy by the polymerase chain reaction (PCR) and bacterial superinfection with Staphylococcus aureus was shown by culturing from tracheal, bronchial and pulmonary swabs obtained during autopsy. PCR assays for the detection of Panton-Valentine leukocidin performed from all samples were negative. This case demonstrates the need for an interdisciplinary approach towards an organism-specific diagnosis of potentially infection-related deaths undergoing a medico-legal autopsy. With improved diagnostic possibilities such as PCR and DNA sequencing, forensic pathologists can, in close association with the field of microbiology, make a significant contribution to the detection of highly infectious agents which must be notified to the authorities. This will increase particularly the knowledge about the influence of these agents on sudden, unexpected deaths in outpatients.

Sudden adult death

“…Acute death can occur from infection [408,409]. Viral infection can be established using molecular techniques [408], but a postmortem diagnosis of bacterial infection may be difficult to establish [410][411][412].…”

Molecular detection of Leptospira interrogans in human tissues and environmental samples in a lethal case of leptospirosis

“…In forensic pathology, a culture-based microbiological diagnosis is typically complicated by the frequent contamination of postmortem samples and by the possible lack of pathogen viability [12,16]. Detection of microbial antigens and of microbe-specific antibodies may also be difficult due to postmortem alteration of antigens and antibodies [17][18][19]. Microbiological diagnosis on autoptic samples is best performed by molecular methods that allow detection of the pathogen nucleic acids.…”

Tracheobronchitis Caused by Methicillin-Resistant <i>Staphylococcus aureus</i> as a Cause of Chronic Wheezing in a Non-Ventilated Adult Patient with Tracheobronchomalacia

“…The references cited in these articles were examined to identify additional reports. We found 35 cases of tracheobronchitis in non-ventilated adults [4,5,32,33,34,35,36,37,38,39,40,41,42,43,44,45]. We excluded 19 of them since the diagnosis was not based on endoscopic findings [34,35,43,44,45].…”

“…Five cases were not from the English literature and were also excluded [5,39]. Thus 11 cases were included in our analysis (table 1) [4,32,33,36,37,38,40,41,42]. Females seem to have a higher incidence of tracheobronchitis than males (8/11, 72.7%).…”

“…Bronchoscopy was used for diagnosis of tracheobronchitis in 5/10 (50%) cases [4,36,37,38,42], laryngoscopy in 6/10 (60%) cases [33,37,40,41,42] and both methods were used in 1 case [37]. The diagnosis was based on autopsy in 1 case [32]. S. aureus was isolated in 7/9 (77.8%) cases, and only in 1 case was the agent identified as MRSA [4].…”