Minimally invasive tissue sampling (MITS) is a percutaneous sampling technique that collects tissue and fluid specimens for histologic and microbiologic analysis and is used as an alternative to complete diagnostic autopsy, particularly in low- and middle-income countries where autopsy rates are limited by resource, cultural, or logistical constraints.
The study, published in Annals of Diagnostic Pathology, was conducted at Maputo Central Hospital in Mozambique and included nine adults who underwent serial MITS procedures at 24, 48, and 72 hours after death, followed by a complete diagnostic autopsy (CDA). The objective was to compare cause of death (CoD) determinations and assess the effect of postmortem interval on diagnostic performance, histologic integrity, and microbial profiles.
MITS procedures produced CoD determinations consistent with those obtained by CDA across all three postmortem intervals. Immediate and underlying CoDs identified through MITS were concordant with CDA results in eight of nine cases. Histologic assessment showed progressive autolytic changes, particularly in the liver, but the diagnostic features remained interpretable through 72 hours. Bodies were stored at 4 °C between procedures, which limited tissue degradation and allowed comparison of sequential findings within the same cases.
Microbiologic analyses demonstrated a significant increase in bacterial isolates over time, especially among Enterobacteriaceae species (p < .0001). The number of fungal and parasitic detections remained stable, while viral identifications declined with longer postmortem intervals. Aerobic bacterial families decreased after 24 hours, whereas anaerobic or facultative anaerobic bacteria increased. These results indicated that bacterial overgrowth and translocation may occur with longer intervals, and microorganisms detected only after 24 hours should be interpreted carefully when determining CoD.
In conclusion, MITS was shown to reliably determine CoD when performed with in 72 hours postmortem and could serve as a viable alternative to complete autopsy in resource-limited settings.
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