Published online Mar 6, 2019. doi: 10.12998/wjcc.v7.i5.636
Peer-review started: December 20, 2018
First decision: January 5, 2019
Revised: January 14, 2019
Accepted: January 29, 2019
Article in press: January 30, 2019
Published online: March 6, 2019
In fatal cases of meningococcal septicemia, bacteriological diagnosis may not be straightforward due to postmortem replication and relocation of endogenic microflora. In medicolegal practice, aside from routine autopsy and histopathology, also other diagnostic methods, such as microbiological tests, immunohistochemistry and polymerase chain reaction (PCR), are used to examine body fluids and tissues.
We present the case of sudden death in a 2-year-old child. The patient died approximately 30 min after hospital admission before any routine diagnostic procedures were undertaken. Presence of whole-body rash and fulminant course of the disease raised suspicion of meningococcal septicemia. An autopsy was performed seven days after death when the body showed the signs of late postmortem decomposition. No etiological factor of septicemia could be identified based on macro- and microscopic findings. However, PCR demonstrated the presence of genetic material of group W Neisseria meningitidis in patient’s cerebrospinal fluid and blood.
Microbiological PCR should be conducted postmortem whenever a specific etiological factor could not be identified with conventional methods.
Core tip: We present the case of a 2-year-old patient who died suddenly with the signs of meningococcal septicemia. No etiological factor of the septicemia could be identified based on macro- and microscopic findings during an autopsy carried out seven days postmortem. However, the genetic material of group W Neisseria meningitidis was detected in cerebrospinal fluid samples based on polymerase chain reaciton (PCR). Our observations imply that microbiological PCR can be helpful in medicolegal practice, especially when an autopsy is delayed and the results of conventional bacteriological examination are unavailable or seem controversial.