Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2019.103
Autopsy and Case Reports
Article / Autopsy Case Report

The importance of the postmortem interval for the diagnosis of Waterhouse–Friderichsen syndrome by Neisseria meningitidis in a series of forensic cases

Guendalina Gentile; Alberto Amadasi; Paolo Bailo; Michele Boracchi; Francesca Maciocco; Matteo Marchesi; Riccardo Zoja

http://dx.doi.org/10.4322/acr.2019.103 Autops Case Rep, vol.9, n3, e2019103, 2019
PDF
PMC
Downloads: 3
Views: 1258

Abstract

The effective value of microbiological post-mortem examinations stands as fundamental in forensic cases involving microbiology. We ran these analyses on five victims, who suddenly died after showing persistent fever. The examinations were conducted between 48 hours and 10 days after death, and adrenal gland apoplexy was detected in all the cases.

Microbiological examinations identified Neisseria meningitidis, which was accountable for Waterhouse–Friderichsen syndrome. Diplococci were isolated from three cadavers that underwent forensic dissection between 2 and 3 days after death. The remaining two cadavers showed polymicrobial contamination, and a polymerase chain reaction technique was necessary to identify the pathogen.

We assumed that the microbial overlap could lead to diagnostic mistakes and conceal the identification of the lethal pathogen. Therefore, we suggest using molecular techniques for a postmortem interval (PMI) longer than 72 hours. Classical microbiological examination should be performed for PMI within 72 hours.

Keywords

Autopsy, Forensic Microbiology, Waterhouse-Friderichsen Syndrome, Post-Mortem Interval

References

Tsokos M. Postmortem measurement of serum procalcitonin concentration in Waterhouse-Friderichsen syndrome. Virchows Arch. 2002;441(6):629-31. [https://doi.org/10.1007/s00428-002-0675-0]. [PMID:12587602]

Varon J, Chen K, Sternbach GL. Rupert Waterhouse and Carl Friderichsen: adrenal apoplexy. J Emerg Med. 1998;16(4):643-7. [https://doi.org/10.1016/S0736-4679(98)00061-4]. [PMID:9696186]

Sperhake JP, Tsokos M. Pathological features of Waterhouse-Friderichsen syndrome in infancy and childhood. In: Tsokos M, editor. Forensic pathology reviews. Totowa: Humana Press; 2004. [https://doi.org/10.1007/978-1-59259-786-4_9].

Morini O, Zaccaria G. La sindrome di Waterhouse-Friderichsen: aspetti anatomo-clinici e medico legali. Arch Med Leg Ass. 1992;14:1-9.

Vella A, Nippoldt TB, Morris JC 3rd. Adrenal hemorrhage: a 25-year experience at the Mayo Clinic. Mayo Clin Proc. 2001;76(2):161-8. [https://doi.org/10.1016/S0025-6196(11)63123-6]. [PMID:11213304]

Tormos LM, Schandl CA. The significance of adrenal hemorrhage: undiagnosed Waterhouse-Friderichsen syndrome, a case series. J Forensic Sci. 2013;58(4):1071-4. [https://doi.org/10.1111/1556-4029.12099]. [PMID:23458363]

Verzeletti A, Bonfanti C, Leide A, et al. Streptococcus pneumoniae detection a long time after death in a fatal case of Waterhouse-Friderichsen syndrome. Am J Forensic Med Pathol. 2017;38(1):18-20. [PMID:28009598]

Saukko P, Knight B. Complication of injury. In: Saukko P, Knight B, editors. Knight’s forensic pathology. 3rd ed. London: Hodder Arnold; 2004. [https://doi.org/10.1201/b13642].

Tsokos M. Fatal Waterhouse-Friderichsen syndrome due to Ewingella americana infection. Am J Forensic Med Pathol. 2003;24(1):41-4. [https://doi.org/10.1097/01.PAF.0000051704.91568.A6]. [PMID:12604997]

Harris P, Bennett A. Waterhouse-Friderichsen syndrome. N Engl J Med. 2001;345(11):841. [https://doi.org/10.1056/NEJM200109133451117]. [PMID:11556316]

Miihlig K, Theile J, Dalitz E. Einseitige nebennierenblutung-ein Waterhouse-Friderichsen Syndrome? Ultraschall Med. 1995;16(6):293-6. [https://doi.org/10.1055/s-2007-1003222]. [PMID:8584912]

Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep [Internet]. 2005 [cited 2019 Mar 10];62:1-28. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm.

Saegeman V, Cohen MC, Alberola J, et al. How is post-mortem microbiology appraised by pathologists? Results from a practice survey conducted by ESGFOR. Eur J Clin Microbiol Infect Dis. 2017;36(8):1381-5. [https://doi.org/10.1007/s10096-017-2943-6]. [PMID:28236029]

Waloszczyk P, Szydłowski L. Waterhouse-Friderichsen cases in the archives of ZMS PAM-epidemiological conditions and diagnostic difficulties. Arch Med Sadowej Kryminol. 2005;55(1):7-10. [PMID:15984111]

Taha MK. Molecular detection and characterization of Neisseria meningitidis. Expert Rev Mol Diagn. 2002;2(2):143-50. [https://doi.org/10.1586/14737159.2.2.143]. [PMID:11962334]

Böhm N. Adrenal, cutaneous and myocardial lesions in fulminating endotoxinemia (Waterhouse-Friderichsen syndrome). Pathol Res Pract. 1982;174(1-2):92-105. [https://doi.org/10.1016/S0344-0338(82)80032-0]. [PMID:7134067]

Garland J, Tse R, Cala AD. Neisseria meningitidis isolated in postmortem vitreous humor in a death due to meningococcal sepsis. Am J Forensic Med Pathol. 2016;37(4):233-5. [https://doi.org/10.1097/PAF.0000000000000269]. [PMID:27584014]

Koneman EW. Neisseria. In: Koneman EW, editor. Testo atlante di Microbiologia Diagnostica. Roma: Antonio Delfino editore; 1987.

Morse SA. Gram-negative cocci and coccobacilli. In: Braude AI, editor. Medical microbiology and infectious disease. Philadelphia: WB Saunders; 1981.

Hori K, Yasoshima H, Yamada A, et al. Adrenal haemorrhage associated with Klebsiella oxytoca bacteraemia. Intern Med. 1998;37(11):990-4. [https://doi.org/10.2169/internalmedicine.37.990]. [PMID:9868968]

Morrison U, Taylor M, Sheahan DG, Keane CT. Waterhouse-Friderichsen syndrome without purpura due to Haemophilus influenzae group B. Postgrad Med J. 1985;61(711):67-8. [https://doi.org/10.1136/pgmj.61.711.67]. [PMID:3873065]

Hamilton D, Harris MD, Foweraker J, Gresham GA. Waterhouse-Friderichsen syndrome as a result of non-meningococcal infection. J Clin Pathol. 2004;57(2):208-9. [https://doi.org/10.1136/jcp.2003.9936]. [PMID:14747454]

Ip M, Teo JG, Cheng AF. Waterhouse-Friderichsen syndrome complicating primary biliary sepsis due to Pasteurella multocida in a patient with cirrhosis. J Clin Pathol. 1995;48(8):775-7. [https://doi.org/10.1136/jcp.48.8.775]. [PMID:7560209]

Maujean G, Guinet T, Fanton L, Malicier D. The interest of post-mortem bacteriology in putrified bodies. J Forensic Sci. 2013;58(4):1069-70. [https://doi.org/10.1111/1556-4029.12155]. [PMID:23551205]

 

 

 

Publication date:
07/12/2019

5d2880bf0e8825665d3fe26e autopsy Articles
Links & Downloads
2236-1960 (Electronic)
Autops Case Rep ©2024 All rights reserved.

Autops Case Rep

Share this page
Page Sections