[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]
OPEN ACCESS / PEER-REVIEWED / RESEARCH ARTICLE
Ultrasound-guided minimally invasive autopsy as a tool for rapid post-mortem diagnosis in the 2018 Sao Paulo yellow fever epidemic: Correlation with conventional autopsy
Amaro Nunes Duarte-Neto, Renata Aparecida de Almeida Monteiro, Janaina Johnsson, Marielton dos Passos Cunha, Shahab Zaki Pour, Amanda Cartagenes Saraiva, Yeh-Li Ho, Luiz Fernando Ferraz da Silva, Thais Mauad, Paolo Marinho de Andrade Zanotto, Paulo Hilário Nascimento Saldiva, Ilka Regina Souza de Oliveira, Marisa Dolhnikoff
Published: July 22, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007625 / This is an uncorrected proof.
New strategies for collecting post-mortem tissue are necessary, particularly in areas with emerging infections. Minimally invasive autopsy (MIA) has been proposed as an alternative to conventional autopsy (CA), with promising results. Previous studies using MIA addressed the cause of death in adults and children in developing countries. However, none of these studies was conducted in areas with an undergoing infectious disease epidemic. We have recently experienced an epidemic of yellow fever (YF) in Brazil. Aiming to provide new information on low-cost post-mortem techniques that could be applied in regions at risk for infectious outbreaks, we tested the efficacy of ultrasound-guided MIA (MIA-US) in the diagnosis of patients who died during the epidemic.
In this observational study, we performed MIA-US in 20 patients with suspected or confirmed YF and compared the results with those obtained in subsequent CAs. Ultrasound-guided biopsies were used for tissue sampling of liver, kidneys, lungs, spleen, and heart. Liver samples from MIA-US and CA were submitted for RT-PCR and immunohistochemistry for detection of YF virus antigen. Of the 20 patients, 17 had YF diagnosis confirmed after autopsy by histopathological and molecular analysis. There was 100% agreement between MIA-US and CA in determining the cause of death (panlobular hepatitis with hepatic failure) and main disease (yellow fever). Further, MIA-US obtained samples with good quality for molecular studies and for the assessment of the systemic involvement of the disease. Main extrahepatic findings were pulmonary hemorrhage, pneumonia, acute tubular necrosis, and glomerulonephritis. One patient was a 24-year-old, 27-week pregnant woman; MIA-US assessed the placenta and provided adequate placental tissue for analysis.
MIA-US is a reliable tool for rapid post-mortem diagnosis of yellow fever and can be used as an alternative to conventional autopsy in regions at risk for hemorrhagic fever outbreaks with limited resources to perform complete diagnostic autopsy.
Reliable mortality information is of paramount importance to establish sound public health policies. Autopsy is an important tool not only for determining the cause of death, but also for the detection of novel diseases. In the last decades, we have been globally identifying an unprecedented number of emerging infections. Therefore, there is great interest in the development of less invasive and low-cost tools for the accurate post-mortem diagnosis in fatal cases. Minimally invasive autopsy (MIA), conceived as targeting diagnostic biopsies of key organs by needle puncture, has been proposed as an alternative to conventional autopsy (CA) for the determination of cause of death in developing countries. In this research, we tested the efficacy of MIA in the post-mortem diagnosis of 20 patients with suspected or confirmed yellow fever who died during the recent epidemic of yellow fever that occurred in Brazil. There was a perfect agreement between MIA and CA in determining the cause of death (hepatic failure) and main disease (yellow fever) in all patients with confirmed yellow fever. This finding indicates that MIA can be used as an alternative to CA in regions at risk for infectious disease outbreaks with limited resources to perform conventional autopsies.
Citation: Duarte-Neto AN, Monteiro RAdA, Johnsson J, Cunha MdP, Pour SZ, Saraiva AC, et al. (2019) Ultrasound-guided minimally invasive autopsy as a tool for rapid post-mortem diagnosis in the 2018 Sao Paulo yellow fever epidemic: Correlation with conventional autopsy. PLoS Negl Trop Dis 13(7): e0007625. https://doi.org/10.1371/journal.pntd.0007625
Editor: Christine A. Petersen, University of Iowa, UNITED STATES
Received: February 8, 2019; Accepted: July 10, 2019; Published: July 22, 2019
Copyright: © 2019 Duarte-Neto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript.
Funding: This work was funded by the Bill & Melinda Gates Foundation (https://www.gatesfoundation.org/), Fundação de Amparo à Pesquisa do Estado de São Paulo (http://www.fapesp.br/). PMdAZ was funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (http://www.cnpq.br/), process # 441105/2016-5. MdPC received a scholarship from Fundação de Amparo à Pesquisa do Estado de São Paulo, process # 2016/08204-2. MD, PHNS, and TM receive individual grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Keywords: Yellow fever; Anatomo-patology; Brazil.