Role of the autopsy in diagnostics and study of infections Vsevolod A. Zinserling Dr.Med.Sci, Prof

Transcription

1 Role of the autopsy in diagnostics and study of infections Vsevolod A. Zinserling Dr.Med.Sci, Prof National Medical Research Center named after V.A. Almazov, Medical Faculty of Saint Petersburg University, Center of infectious pathology at SP Botkin hjspital of infectious diseases Saint Petersburg, Russia

2 Enterprise Interest No disclosures.

3 Main aims of the autopsies in infectious pathology Macroscopical diagnostics and differential diagnostics, including that of rare diseases Comparison of clinical (incl. radiological) data and macroscopical changes Elucidation of immediate death causes Study of pathomorphism of infections, natural or induced by treatment

4 Main aims of the autopsies in infectious pathology Studies of new forms of the diseases and new illnesses Revelation of the iatrogenic pathology Collection of the specimen for the further investigations Studies of the patho- and tanatogenesis of the disease as the whole

5 More common lethal infections in which we possess certain experience in autopsy diagnostics HIV and its complications Chronic hepatitis Tuberculosis Influenza and other viral respiratory infections Pneumonias, especially lobar (croupose) Acute intestinal infections, including typhoid fever Meningitis and encephalitis

6 Most important questions to be studied on the autopsies of the deceased from HIV-infection Exact list of secondary infections and tumors with specification of their localization Evaluation of the efficacy of treatment Revealing of immediate death cause Collection of specimen for further investigations in order to study the mechanisms of the disease and its complications

7 Methods recommended for postmortem investigation Detailed histological study of all macroscopically changed and not changed organs with use of certain special staining Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to study the localization of lesions due to HIV and other viruses and some of their properties

8 Typical histological changes in lymph node in HIV infection HE IHC

9 Caverna-like lesions in the lung of deceased from HIV in AIDS stage with suspicion of tuberculosis

10 Histological changes in the same case proving the combination of aspergillosis and pneumocystosis Impregnation by Groccot HE IHC to Pneumocysta carinii (jirovici)

11 Most important questions to be studied on the autopsies of the deceased from viral hepatitis Specification of lesions character in different parts of liver Verification of extrahepatic changes and evaluation of their nature Revealing of immediate death cause Collection of specimen for further investigations in order to study the mechanisms of the disease and its complications

12 Methods recommended for postmortem investigation Detailed histological investigation with evaluation of changes in different parts of the liver and other organs, paying special attention to hepatic lymph nodes, spleen, esophagus and intestine Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to verify the etiology and study probable extrahepatic lesions

13 Liver with chronic viral hepatitis in cirrhotic stage and liver steatosis.

14 Liver with combination of chronic viral hepatitis and steatosis

15 Most important questions to be studied on the autopsies of the deceased from tuberculosis Verification of the diagnosis in clinically not clear cases Specification of localization and character of lesions More accurate definition of clinical form Evaluation of the efficacy of treatment Revealing of immediate death cause Collection of specimen for further investigations in order to study the mechanisms of the disease and its complications

16 Methods recommended for postmortem investigation Detailed histological investigation of all types of lesions with use of different stainings, Ziehl-Neelsen first of all Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to verify the probable viral complications Molecular-biological studies in order to reveal the genotype of Mycobacterium tuberculosis

17 Basal tuberculous meningitis

18 Different previously not common forms of tuberculosis

19 Ulcerous lesions of small intestine due to tuberculosis

20 Some important histological findings in modern tuberculosis

21 Most important questions to be studied on the autopsies of the deceased from influenza and other viral respiratory infections Revealing of immediate death cause Collection of specimen for further investigations in order to verify the diagnosis and study the mechanisms of the disease and its complications

22 Methods recommended for postmortem investigation Detailed histological investigation of respiratory and other organs (esp. brain) in order to reveal lesions caused by pathogens from different classes and characterize the peculiarities of inflammatory response Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to study the localization of lesions due to influenza and other viruses and some of their properties

23 Lungs of the deceased from influenza during the epidemics due to swine virus

24 Histological changes in lethal case of influenza, hallmarks of RDS and viral lesions

25 Histological picture of respiratorysyncytial infection HE IHC

26 Most important questions to be studied on the autopsies of the deceased from pneumonia Specification of localization, square and character of the lesions in lungs Verification of extrapulmonary changes and evaluation of their nature Evaluation of the efficacy of treatment Revealing of immediate death cause Collection of specimen for further investigations in order to verify the etiology and study the mechanisms of the disease and its complications

27 Methods recommended for postmortem investigation Detailed histological investigation of lungs with use of histobacterioscopic methods (specimen from parts with different appearance) and other organs, special attention to brain, heart and kidney. Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to study the localization of lesions due to reveal respiratory and other viruses and some of their properties

28 Lobar (croupose) pneumonia with expressed purulent pleuritis

29 Sublobar croupose pneumonia

30 Purulent ventriculitis with hemorrhage as lethal complication of croupose pneumococcal pneumonia

31 Variants of histological picture in croupose pneumonia HE Azur-eosine HE

32 Most important questions to be studied on the autopsies of the deceased from intestinal infections Specification of localization and character of lesions in the gut and other organs More accurate definition of clinical form Evaluation of the efficacy of treatment Revealing of immediate death cause Collection of specimen for further investigations in order to study the etiology of the case and the mechanisms of the disease and its complications

33 Methods recommended for postmortem investigation Detailed histological investigation of all parts of the intestine in order to reveal the peculiarities of inflammatory reactions and other organs with special attention to mesenteric lymph nodes, spleen and liver Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to study the localization of lesions due to intestinal and other viruses and some of their properties

34 Fibrinous-ulcerous colitis

35 Swelling of Peyer s patch in typhoid fever

36 Most important questions to be studied on autopsies of the deceased from neuroinfections Revealing of immediate death cause Collection of specimen for further investigations in order to study etiology of the case, mechanisms of the disease and its complications

37 Methods recommended for postmortem investigation Detailed histological investigation, according the rules of neuropathology with special attention to meninges and plexus chorioideus. Study of other clinically important organs Bacteriological and mycological investigation of all suspected lesions in order to clarify their etiology and certain properties of the pathogens Different virological, molecular-biological methods and immunohistochemistry in order to study the localization of lesions due to different viruses and some of their properties All investigations should be done in parallels blood cerebro-spinal fluid, lung brain matter

38 Brain changes in acute encephalitis

39 Tumor-like lesions in a child with herpes encephalitis

40 Histological changes in the same case. Cowdry type1 intranuclear inclusion on arrow.

41 Serous meningitis in a patient with HIV infection in AIDS stage

42 Histological changes in this case proving the prominent role of cryptococci in tanatogenesis

43 Acknowledgements V.E. Karev, Dr.Med.Sci V.V.Svistunov, M.D A.N. Kovalenko, Dr.Med.Sci A.M. Konstantinova, M.D D.V. Komarova M.V. Vassilyeva

44 I thank you for your attention