Retrospective Analysis of Histopathological and Microbiological Correlation Ofautopsy Series
Retrospective Analysis of Histopathological and Microbiological Correlation Ofautopsy Series
Retrospective Analysis of Histopathological and Microbiological Correlation Ofautopsy Series
Introduction
Abstract This retrospective observational study reviews the
macroscopic, histological and microbiological findings in
Background: In this retrospective observational study, we postmortem examinations of 125 patients who died in ICU
reviewed macroscopic postmortem examinations of clinically labeled as sepsis or septic shock.
surgical Intensive Care Unit (ICU) patients who died from
suspected sepsis or septic shock.
Methods
Methods: All 125 Patients who were admitted in the ICU
125 patients during their ICU stay who subsequently died
and subsequently died and cause of death labeled as
sepsis/septic shock. Clinical data and postmortem findings
from suspected sepsis/septic shock. The clinical records of all
were documented in all patients. patients were checked and the results of the microbiological
specimens of each patient were retrieved to confirm infection.
Results: The study included postmortem results which The postmortem examination was done in indicated cases
included gross, histopathology and microbiology. The after proper consent was performed in patients as follows: A
main causes of death as reported in the patient history vertical incision from suprasternal notch to the symphysis was
were sepsis with multiple organ dysfunction syndrome used to expose internal organs. The organs were removed in
(70%) and cardiorespiratory failure (30%). Pathologies four blocks: 1) Heart and lungs, 2) Liver and gastrointestinal
were detected in the lungs in 18 cases, kidneys/urinary tract, 3) Urogenital system, 4) Brain. Afterwards, all organs
tract 05 cases, gastrointestinal tract 02 cases, were systematically examined for macroscopic pathologies and
cardiovascular system 09 cases, liver 20 cases, spleen 01 tissue samples were taken for histological analyses and
case, central nervous system 30 cases, and pancreas 08 samples from CSF, pleural fluid, ascitic fluid, and peritoneal
cases and in 32 cases multiple organ pathology was seen fluid; pus and heart blood were subjected to culture and
like lung, brain, liver. The autopsy and microbiological microbiological examination.
examination revealed confirmatory growth and septic
focus in 40 (32%) cases only. The microbiological isolates The following variables of all study patients were extracted
were obtained from CSF, heart blood, ascitic fluid, pleural from the clinical charts as gender, age, disease status, and
and pericardial fluid and tracheal aspirates. Most common source of infection, the pathogen type cultured, presence of
isolate was Klebsiella in 25 cases. sepsis or septic shock; the number of failing organs, presence
of acute respiratory distress syndrome. Autopsy reports of all
Conclusion: Relevant postmortem findings explaining study patients were searched for pathologies of the following
death in surgical ICU patients who died because of sepsis/ organ systems: cardiovascular system, lungs, liver, kidneys and
septic shock were a continuous septic focus in urinary tract, gastrointestinal tract, spleen, pancreas, and
approximately 40%, primary CNS pathology 37.5% cardiac central nervous system. Pathologies of other organ systems
pathologies in 7.2%. The most frequently affected organs were recorded separately.
were the brain, liver, lungs. Multiple organ system was
also involved in 32 cases and disseminated fungal Postmortem findings of each organ system were entered.
infection was the cause of death in 2 cases. The weight of each organ was measured. Heart was seen
whether enlarged or not and further seen for any diffuse or
localized red-blue (yellow-tan at later stages) lesions of the
Keywords: Histopathology; Hemorrhagic infiltrations; myocardium with or without occlusion of the supplying
Encephalitis; Pathology coronary artery, dilatation of the right or left ventricular
chamber, reddened and granular pericardium optionally
accompanied by pericardial effusion, fluid collection in the localized, pale or reddish areas of the pancreatic parenchyma.
pericardial cavity and any friable, bulky or destructive Blue-black hemorrhagic areas interspersed with foci of yellow-
vegetations on cardiac valves containing fibrin, inflammatory white, chalky fat necrosis.
cells, and pathogens on histology were studied. Lungs for any
Kidney for any diffuse enlargement with or without specific
frothy, blood-tinged fluid. Consolidated lung areas (increased
parenchymal pathology. Sharply demarcated, pale (yellow-
in volume) with patchy infiltrations rendering pus on
white at later stages) areas containing hemorrhagic foci with
sectioning, Fluid collection in one or both pleural cavities
or without occlusion of the supplying renal artery. Grayish-
(blood, hematothorax; pus, pleural empyema). Reddened,
white discoloration of pyelum and ureter optionally
edematous mucosa of substantial parts of the
accompanied by patchy inflammation or necrosis of the renal
tracheobronchial tree; optionally accompanied by serous or
parenchyma. Reddened, edematous mucosa of the urinary
mucous secretion. Partial or total occlusion of a pulmonary
bladder optionally accompanied by a suppurative exudate.
artery is due to a venous thrombus. Consolidated lung areas;
with hemorrhagic infiltrations. Reddened, edematous pleura Postmortem findings of the central nervous system studied
optionally accompanied by a fibrinous exudate, raised, red- like brain edema, ischemia, intracerebral hemorrhage,
blue (red-brown at later stages), wedge-shaped areas encephalitis. Swollen brain with flattened gyri, narrowed sulci
extending to the lung periphery optionally accompanied by and compressed ventricular cavities, any tentorial or foraminal
fibrinous pleuritis. Consolidated (dark blue-red) lung areas brain herniation. Diffuse or localized, pale and swollen
reduced in volume. (gelatinous or liquefied at later stages) areas of the brain
without occlusion of the supplying cerebral artery.
Liver was examined whether yellow, greasy and readily
fractured with increased weight (2000 g). Diffuse, patchy and
pale alterations localized in the central region of the liver Statistical Analysis
lobules, purulent inflammation of the extra/intrahepatic bile
ducts with or without necrotic infiltration of portal fields. The SPSS software program (SPSS 12.0.1.; SPSS, Chicago, IL)
Enlarged or tense gallbladder with bright-red to green-black was used for statistical analysis. Descriptive statistical methods
patchy discoloration and optionally fibrin-layered serosa or were applied to evaluate the frequency of pathologies of
suppurative exudate. single organ systems. In order to compare the frequency of
organ pathologies between groups, Fishers exact test was
Diffuse or localized bowel alterations with dilatation, edema used, as appropriate. P values 0.05 were considered as
and wall thickening (optionally intraluminal gas) with or indicating statistical significance. Data are given as mean
without occlusion of the supplying mesenteric artery. values SD, if not otherwise indicated.
Edematous gastric mucosa; with vascular congestion, but
maintained mucosal barrier Intraluminal blood originating
from lesions of the gastrointestinal tract. Erosions of the
Results
gastric or duodenal mucosa are equal to or greater than 0.5 Post mortem examination was done in the 125 patients of
cm in diameter. Continuous localized or diffuse inflammation which all were male except one female patient who died of
of the peritoneum with suppurative or fibrinous exudate. metastatic breast cancer. The age range was in between 26-47
Diffuse or localized bowel alterations with congestive edema, yrs. of age. Primary CNS pathology: 37.5% cardiac pathologies
wall thickening, dusky to purple-red discoloration and in 7.2%. The most frequently affected organs were the brain,
hemorrhagic lesions with or without luminal blood. liver, lungs. Multiple organ system was also involved in 32
Serous fluid collection in the abdominal cavity. Pale and cases and disseminated fungal infection was the cause of
wedge-shaped areas of the spleen; optionally accompanied by death in 2 cases, malignancy was the cause of death in 08
fibrin coverage of the splenic capsule. Enlarged and soft spleen cases (Figure 1).
with deliquescent splenic parenchyma on incision. Diffuse or
GI
Brain PM changes Lung Liver Kidney Heart Neoplasms
tract
Congestion Acute
Haemorrhage Infarct abscess edema and abscess Cirrhosis tubular Ischemia Pancreatitis CAD Cardiomyopathy Lymphoma Carcinoma
necrosis
pneumonia
14 10 3 62 19 2 20 2 2 8 7 2 5 3
Figure 1: showing the corresponding PM findings in the Figure 2: Graph showing the isolates as depicted in the
organs as tabulated in Table 1 . Table 2.
Klebsiella 21
Acinetobacter 3
Escherichia coli 4
Streptococci 2
Enterobacter 2
Burkholderia 2
Candida 2
Figure 4: Microphotograph of lung showing congestion and
Pseudomonas 2 haemorrhage.
Copyright iMedPub 3
Journal of Clinical Medicine and Therapeutics 2017
Vol.2 No.2:11