Ferah Karayel

Postmortem diagnosis of cytomegalovirus and accompanying other infection agents by real-time PCR in cases of sudden unexpected death in infancy (SUDI)

Abstract As an opportunistic pathogen with high mortality rates, Cytomegalovirus (CMV) may lead to fatal disseminated CMV infection of the premature and newborn; thus necessitating the demonstration of CMV-DNA with clinical history and/or histopathological findings of CMV infection and defining other bacterial and viral infection agents with real-time polymerase chain reaction (RT-PCR) in udden unexpected death in infancy (SUDI) cases as we aimed in this study. 314 (144 female, 170 male) SUDI cases were prospectively investigated from January 2013 to January 2015 in Istanbul Forensic Medicine Institution. The study includes 87 tissue samples of 39 cases for post-mortem histopathological examination of interstitial pneumonia, myocarditis, meningitis, encephalitis, hepatitis, colitis or tubulointerstitial nephritis and/or accompanying chronic sialadenitis. CMV-DNA was found positive in 35 (40.2%) salivary gland, 19 (21.8%) lung, 1 (1.1%) tonsil, and 1 (1.1%) brain tissues. CMV sialadenitis and/or CMV pneumonia associated with other viral and/or bacterial agents were detected in 23 (60%) of 39 infant cases. The demonstration of CMV-DNA would significantly clarify the cause of death and collection of epidemiological data in SUDI cases with clinical history and histopathological findings of CMV infection accompanying chronic CMV sialadenitis. Furthermore, CMV suppresses the immune system, and may predispose to other bacterial and/or viral infections in these cases. Post-mortem molecular investigations are useful in explaining cause of death in SUDI with a suspicion of infection in forensic autopsies.

Maternal death due to non-traumatic fat embolism.

The aim of this report is to document a case of non-traumatic fat embolism (NTFE) and to address the need for considerition of fat embolism in suspicious deaths resulting from respiratory distress in the postpartum period. A 28-years-old woman autopsied at the Morgue Department of the Council of Forensic Medicine is included to the study. This female became unconscious and developed respiratory distress 4 h after delivery, and this was followed by respiratory arrest. External examination revealed resuscitation marks and normal postmortem changes. Light microscopy revealed massive fat embolization involving most of the alveolar capillaries on several sections. Only in one particular area was a bone marrow embolus. Pathological diagnosis of the lung was diffuse pulmonary fat embolism. There was no evidence of other organ involvement with emboli. Other visceral organs showed no striking findings other than mild congestion. The cause of death was considered to be respiratory insufficiency resulting from severe fat embolism of the lungs.

Investigation of tuberculosis prevalence by acid-fast stain, culture and real-time PCR method in forensic autopsies

Tuberculosis (TB) is still one of the most important diseases and causes of death in the world. We aimed to investigate TB prevalence in forensic autopsy cases in Turkey by the acid-fast bacilli (AFB) staining, TB culture and real-time polymerase chain reaction (RT-PCR) methods in paraffin-embedded tissues. From January 2012 to January 2015, 1676 tissue samples were examined under AFB staining and TB culture, and 85 paraffin-embedded tissue samples under RT-PCR from 14,083 prospectively-investigated forensic autopsy cases in the Istanbul Council of Forensic Medicine. Positivity with microbiological methods (AFB staining and/or TB culture and/or RT-PCR) was detected in 43 (0.3%) out of 73 (0.5%) cases in which TB was diagnosed with histopathological findings. Acid-fast bacilli were detected in 14 tissue samples by AFB staining, and a total of 11 tissue samples were found culture-positive in the Löwenstein-Jensen medium. Mycobacterium tuberculosis DNA was positive in 36 samples with RT-PCR. Eleven (15%) cases were detected as miliary tuberculosis. Microbiological sampling should accompany autopsy findings and histopathological sampling for post-mortem identification and notification of active TB during forensic autopsies. Diagnosis of TB in forensic autopsies would contribute to clarifying the cause of death and to the collection of epidemiological data in Turkey, particularly in ante-mortem undiagnosed cases.