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.
SperhakeJP, TsokosM. Pathological features of Waterhouse-Friderichsen syndrome in infancy and childhood. In: TsokosM, editor. Forensic pathology reviews. Totowa: Humana Press; 2004. [https://doi.org/10.1007/978-1-59259-786-4_9].
MoriniO, ZaccariaG. La sindrome di Waterhouse-Friderichsen: aspetti anatomo-clinici e medico legali. Arch Med Leg Ass. 1992;14:1-9.
VerzelettiA, BonfantiC, LeideA, 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]
CohnAC, MacNeilJR, ClarkTA, 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.