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

Abstract

Background and AimsComplete 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.MethodsA 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.ResultsThe 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.ConclusionsA 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.

Validity of a Minimally Invasive Autopsy for Cause of Death Determination in Adults in Mozambique: An Observational Study

“…Although the number of cases is limited, the two gastrointestinal infections identified as the cause of death by the CDAs were not identified by the MIAs. Sampling of stool and/or bowel mucosa could be included in the protocol in order to improve these results [12,13]. However, further studies are necessary to evaluate the usefulness of stool analysis in postmortem studies.…”

“…However, further studies are necessary to evaluate the usefulness of stool analysis in postmortem studies. Additionally, the MIA was relatively less efficient for the diagnosis of pulmonary infections, which were missed in 29.2% of the cases, reflecting the relatively lower efficiency of the needle sampling for the lung [12,13]. …”

“…The detailed MIA pathological and microbiological methods have been reported elsewhere [12,13]. In brief, the procedure includes disinfection of the surface of the body, collection of 20 ml each of blood and cerebrospinal fluid (CSF), and puncture of solid organs (liver, lungs, bone marrow, and central nervous system [CNS]) using biopsy needles (14G–16G) to collect samples for microbiological and histological analysis.…”

“…Recently, we reported the methodology of a standardized minimally invasive autopsy (MIA) [12,13]. This technique involves organ-directed sampling using biopsy needles and provides key fluids and tissue material for histological and microbiological analyses.…”

Clinico-Pathological Discrepancies in the Diagnosis of Causes of Death in Adults in Mozambique: A Retrospective Observational Study

“…This was an observational study performed from November 2013 to March 2015 at the Department of Pathology in collaboration with the Department of Internal Medicine of the Maputo Central Hospital, a 1500-bed public tertiary health care centre in Maputo city, the capital of Mozambique. The study was part of the validation of minimally invasive autopsy (MIA) against the gold standard complete autopsy [11][12][13][14]. The inclusion criteria were: 1) a complete autopsy requested by the clinician as part of the medical evaluation of the patient; 2) verbal informed consent to perform the autopsy given by the relatives; and 3) age older than 15 years.…”