Post-Mortem Investigations for the Diagnosis of Sepsis: A Review of Literature

Abstract

To date, sepsis is still one of the most important causes of death due to the difficulties concerning the achievement of a correct diagnosis. As well as in a clinical context, also in a medico-legal setting the diagnosis of sepsis can reveal challenging due to the unspecificity of the signs detected during autopsies, especially when no ante-mortem clinical data, laboratory, and cultural results are available. Thus, a systematic review of literature was performed to provide an overview of the main available and updated forensic tools for the post-mortem diagnosis of sepsis. Moreover, the aim of this review was to evaluate whether a marker or a combination of markers exist, specific enough to allow a correct and definite post-mortem diagnosis. The review was conducted searching in PubMed and Scopus databases, and using variable combinations of the keywords “post mortem sepsis diagnosis”, “macroscopic signs”, “morphology”, “histology”, “immunohistochemical markers”, “biochemical markers”, and “forensic microbiology”. The article selection was carried out following specific inclusion and exclusion criteria. A total of 44 works was identified, providing data on morphological aspects of the organs examined, histological findings, immunohistochemical and biochemical markers, and cultural assays. The review findings suggested that the post-mortem diagnosis of sepsis can be achieved by a combination of data obtained from macroscopic and microscopic analysis and microbial investigations, associated with the increased levels of at least two of three biochemical and/or immunohistochemical markers evaluated simultaneously on blood samples.

Pathological Findings in COVID-19 as a Tool to Define SARS-CoV-2 Pathogenesis. A Systematic Review

“…The negativity reported in some cases could be explained by: 1) the early “window” period in which RT-PCR cannot detect the RNA; 2) the different clinical and biological evolution of the infection in the late phase resulting in subjects both negative or continuously positive; 3) the immune interindividual variability and the different virus haplotype ( Sessa F. et al, 2020 ; Carter et al, 2020 ; Kucirka et al, 2020 ; Lescure et al, 2020 ; Norsa et al, 2020 ; Shen et al, 2020 ; Yi, 2020 ). Other factors affecting the RT-PCR results can be the sampling technique and post-mortem tissue degradation ( Ventura Spagnolo et al, 2019b ; Stassi et al, 2020 ; Youd and Moore, 2020 ). Moreover, this investigation was performed on other organs, resulting in positivity in the heart, liver, spleen, kidney, and testis of few cases ( Wichmann et al, 2020 ; Bradley et al, 2020 ; Sekulic et al, 2020 ; Menter et al, 2020 ; Hanley et al, 2020b ; Tian et al, 2020b ; Lindner et al, 2020 ; Iuga et al, 2020 ], supporting that the SARS-CoV-2 might determine a direct effect not only on respiratory tissue.…”

Fatal Pediatric Streptococcal Infection: A Clinico—Pathological Study

“…Morphological features observed at autopsy in septic deaths are discussed and listed in two recent publications. 25 , 26 …”

An Insight into the Role of Postmortem Immunohistochemistry in the Comprehension of the Inflammatory Pathophysiology of COVID-19 Disease and Vaccine-Related Thrombotic Adverse Events: A Narrative Review

“…In light of this, an accurate comprehension of the pathophysiological mechanisms underlying the evolution of COVID-19 disease, especially in critical patients, is of utmost importance in order to find effective treatment strategies. To this end, a multidisciplinary approach is needed, comprehensive of clinical, biochemical, radiologic, biomolecular, and forensic investigations, each representing a piece of the whole puzzle [ 50 , 51 , 52 ].…”