tetano
Editor, Senior Moderator
Leg Med (Tokyo)
. 2023 Nov 27:66:102361.
doi: 10.1016/j.legalmed.2023.102361. Online ahead of print. Dying at home during the SARS-CoV-2 endemic: The importance of defining the exact mechanism of death
Francesco Angiola[SUP] 1 [/SUP], Giorgia Franchetti[SUP] 1 [/SUP], Clara Cestonaro[SUP] 1 [/SUP], Jacopo Agnolucci[SUP] 1 [/SUP], Renzo Giordano[SUP] 1 [/SUP], Guido Viel[SUP] 2 [/SUP]
Affiliations
Introduction: Coronavirus Disease 2019 (COVID-19) has become endemic in Europe thanks to the presence of less deadly and more infectious variants and to the existence of a significant portion of unvaccinated people among the general population. SARS-Cov-2 related deaths are probably going to fade in the next years, but Covid-19 should still be considered a potential cause of death in the out-of-hospital setting in the next future.
Material and methods: Three (3) cases of unexpected death at home are here presented. Each case has been investigated with the same methodological approach: death scene investigation (DSI), complete autopsy with histology, immunohistochemistry, RNA in situ hybridization for SARS-CoV-2 spike protein in lung tissue, toxicology and microbiology.
Results and discussion: All three cases had a COVID + post-mortem nasopharyngeal swab. Histology and immunohistochemistry revealed a SARS-CoV-2 lung involvement in only two of the cases (Cases 2 and 3), while a septic bacterial pneumonia was found in Case 1, where RNA-in situ hybridization for viral spike protein showed no reactivity in pneumocytes. The integration of all postmortem evidence allowed to attribute a different role of SARS-Cov-2 in the determinism of the death.
Conclusion: In the current post-pandemic context, SARS-CoV-2 remains a possible cause of death when investigating out-of-hospital unexpected deaths. Since a positive post-mortem swab does not automatically imply a COVID-19-related death, histology and immunohistochemistry are helpful for identifying SARS-CoV-2 lung involvement and, therefore, its potential active role in the determinism of death.
Keywords: COVID-19; Cause of death, immunohistochemistry; Death at home; Endemic; Forensic pathology.
. 2023 Nov 27:66:102361.
doi: 10.1016/j.legalmed.2023.102361. Online ahead of print. Dying at home during the SARS-CoV-2 endemic: The importance of defining the exact mechanism of death
Francesco Angiola[SUP] 1 [/SUP], Giorgia Franchetti[SUP] 1 [/SUP], Clara Cestonaro[SUP] 1 [/SUP], Jacopo Agnolucci[SUP] 1 [/SUP], Renzo Giordano[SUP] 1 [/SUP], Guido Viel[SUP] 2 [/SUP]
Affiliations
- PMID: 38039658
- DOI: 10.1016/j.legalmed.2023.102361
Introduction: Coronavirus Disease 2019 (COVID-19) has become endemic in Europe thanks to the presence of less deadly and more infectious variants and to the existence of a significant portion of unvaccinated people among the general population. SARS-Cov-2 related deaths are probably going to fade in the next years, but Covid-19 should still be considered a potential cause of death in the out-of-hospital setting in the next future.
Material and methods: Three (3) cases of unexpected death at home are here presented. Each case has been investigated with the same methodological approach: death scene investigation (DSI), complete autopsy with histology, immunohistochemistry, RNA in situ hybridization for SARS-CoV-2 spike protein in lung tissue, toxicology and microbiology.
Results and discussion: All three cases had a COVID + post-mortem nasopharyngeal swab. Histology and immunohistochemistry revealed a SARS-CoV-2 lung involvement in only two of the cases (Cases 2 and 3), while a septic bacterial pneumonia was found in Case 1, where RNA-in situ hybridization for viral spike protein showed no reactivity in pneumocytes. The integration of all postmortem evidence allowed to attribute a different role of SARS-Cov-2 in the determinism of the death.
Conclusion: In the current post-pandemic context, SARS-CoV-2 remains a possible cause of death when investigating out-of-hospital unexpected deaths. Since a positive post-mortem swab does not automatically imply a COVID-19-related death, histology and immunohistochemistry are helpful for identifying SARS-CoV-2 lung involvement and, therefore, its potential active role in the determinism of death.
Keywords: COVID-19; Cause of death, immunohistochemistry; Death at home; Endemic; Forensic pathology.