1.Post mortem computed tomography (PMCT) guided lung biopsy: A preliminary case report
Abdul Hadi, D ; Mansharan Kaur, C.S. ; Effat, O. ; Siew, S.F.
Tropical Biomedicine 2019;36(4):850-854
Tuberculosis (TB) is a highly infectious disease on the rise caused by the organism
Mycobacterium tuberculosis and health care workers working in emergency departments,
medical wards and autopsy rooms are in danger of contacting this disease. We present a case
of a 42 year old man found dead under a pedestrian bridge with no medical history available.
Post mortem computed tomography showed multiple cavities involving upper lobes of both
lungs and areas of consolidation in both lung fields raising the suspicion of pulmonary
tuberculosis. This was followed by a computed tomography guided lung biopsy and a limited
conventional autopsy done in situ in a special high risk autopsy suite with appropriate
ventilation. This case highlights the importance of cross sectional imaging which can be
coupled with image guided biopsy in cases of infectious disease to reduce the risk of
transmission to health care workers.
2.Post-mortem pulmonary tuberculosis: comparison of available diagnostic methods
Chainchel Singh, M.K. ; Johari, B. ; Naik, V.R. ; Lai, P.S. ; Siew, S.F.
Tropical Biomedicine 2023;40(No.2):165-169
Tuberculosis (TB) caused by Mycobacterium tuberculosis remains a serious public health threat with
the World Health Organisation (WHO) reporting 5.8 million cases and 1.3 million deaths in the year
2020 due to TB. TB can be diagnosed by imaging, histopathological and bacteriological methods with
culture remaining the gold standard. This study was performed to look at the sensitivity and specificity
of post-mortem computed tomography (PMCT) imaging when compared to culture in diagnosing
pulmonary tuberculosis. This was a retrospective comparative study looking at post mortem cases
where lung tissue samples sent for TB culture at Hospital Kuala Lumpur were compared against PMCT
imaging. Exclusion criteria included contaminated samples, decomposed cases, immunocompromised
subjects and those below 18 years of age. Subjects included 80 medico-legal autopsy cases at the
National Institute of Forensic Medicine, Hospital Kuala Lumpur, Malaysia who had whole body PMCT
done in accordance with the Institute’s protocol and tissue samples sent for bacteriology culture for
tuberculosis. PMCT findings were positively associated with acid-fast organisms in 23.5 out of 33 cases
(71.2%). Our study also showed that PMCT had a sensitivity of 71.3% and specificity of 54.3% (95% CI:
39.5–68.4) in diagnosing TB based on the protocol set in this study. This study showed that there was
relatively good agreement between radiological PMCT findings and bacterial culture, suggesting that
radiological examination is a relatively reliable tool for preliminary screening and possible diagnosis of
TB prior to a postmortem examination which would be beneficial in reducing the risk of transmission
of TB to health workers during autopsy.
3.Identification of skin bacterial profiles of early deceased bodies and the relation to post-mortem interval
Chong, C.K. ; Emamjomeh, M. ; Joseph, N. ; Siew, S.F. ; Maeda, T. ; Mustapha, N.A. ; Hoshiko, Y. ; Muthanna, A. ; Amin-Nordin, S.
Tropical Biomedicine 2024;41(No.1):109-117
Post-mortem microbiology (PMM) is an important tool in identifying possible causes of sudden
unexpected death, as an infectious cause is highly suspected. However, contamination is a major problem
in microbiology, and this has increased the difficulty determining the true pathogen that contributes to
death in post-mortem cases. Skin commensals are common contaminants in blood cultures. This study
was conducted to investigate the skin flora on early deceased bodies and observe the bacteria detected
at different post-mortem intervals (PMIs). As blood is usually drawn from the neck and femoral sites for
PMM examination, the two body sites were chosen as the sampling sites. Skin swab samples from the
neck and femoral (n=80) of each early deceased body were collected by sterile cotton swabs. DNA was
extracted from the swabs and then subjected to high-throughput 16S rRNA sequencing by using the
Illumina MiSeq platform. Staphylococcus was found to be the most dominant genus in both neck and
femoral sites. LEfSe results showed that Cutibacterium is significantly different at the neck site while
Corynebacterium is more abundant at femoral site. There are significant differences at genus level
between PMI<5H and PMI>5H at both neck and femoral sites. The findings of the present study may
act as a reference for microbiologists and forensic pathologists when mixed growth or contamination
occurs in post-mortem blood cultures.