Abteilung fuer Infektions- und Tropenmedizin (AITM), Klinikum der LMU, Ludwig-Maximilians-Universitaet, Muenchen, Germany.
Malar J. 2009 Oct 28;8:244. doi: 10.1186/1475-2875-8-244.
Between 10,000 and 12,000 cases of imported malaria are notified in the European Union each year. Despite an excellent health care system, fatalities do occur. In case of advanced autolysis, the post-mortem diagnostic is impaired. Quicker diagnosis could be achieved by using rapid diagnostic malaria tests.
In order to evaluate different methods for the post-mortem diagnosis of Plasmodium falciparum malaria in non-immunes, a study was performed on the basis of forensic autopsies of corpses examined at variable intervals after death in five cases of fatal malaria (with an interval of four hours to five days), and in 20 cases of deaths unrelated to malaria. Detection of parasite DNA by PCR and an immunochromatographic test (ICT) based upon the detection of P. falciparum histidine-rich protein 2 (PfHRP2) were compared with the results of microscopic examination of smears from cadaveric blood, histopathological findings, and autopsy results.
In all cases of fatal malaria, post-mortem findings were unsuspicious for the final diagnosis, and autoptic investigations, including histopathology, were only performed because of additional information by police officers and neighbours. Macroscopic findings during autopsy were unspecific. Histopathology confirmed sequestration of erythrocytes and pigment in macrophages in most organs in four patients (not evaluable in one patient due to autolysis). Microscopy of cadaveric blood smears revealed remnants of intraerythrocytic parasites, and was compromised or impossible due to autolysis in two cases. PCR and ICT performed with cadaveric blood were positive in all malaria patients and negative in all controls.
In non-immune fatalities with unclear anamnesis, ICT can be recommended as a sensitive and specific tool for post-mortem malaria diagnosis, which is easier and faster than microscopy, and also applicable when microscopic examination is impossible due to autolysis. PCR is more expensive and time-consuming, but may be used as confirmatory test. In highly endemic areas where asymptomatic parasitaemia is common, confirmation of the diagnosis of malaria as the cause of death has to rely on histopathological findings.
每年欧盟都会通报 10000 到 12000 例输入性疟疾病例。尽管有着出色的医疗保健体系，还是会出现死亡病例。如果出现晚期自溶，尸检诊断就会受到影响。通过使用快速诊断疟疾检测，可以更快地做出诊断。
为了评估非免疫人群中死后诊断恶性疟原虫疟疾的不同方法，对五例致命性疟疾（死亡间隔 4 小时至 5 天）和 20 例与疟疾无关的死亡案例的尸体进行了法医解剖，并在死后不同时间间隔进行检查。通过聚合酶链反应（PCR）和基于恶性疟原虫高变区 2 （PfHRP2）检测的免疫层析检测（ICT）来检测寄生虫 DNA，并与尸检血液涂片的显微镜检查结果、组织病理学发现和尸检结果进行比较。
所有致命性疟疾的尸检发现都没有可疑之处，无法明确最终诊断，尸检包括组织病理学检查，只是因为警察和邻居提供了其他信息才进行的。尸检时的肉眼观察结果没有特异性。组织病理学在四名患者（由于自溶，一名患者无法评估）的大多数器官中证实了红细胞和含铁血黄素的巨噬细胞内的疟原虫。由于自溶，两名患者的尸检血液涂片显微镜检查结果不佳或无法进行。所有疟疾患者的尸检血液 PCR 和 ICT 检测均为阳性，所有对照患者均为阴性。
对于病因不明的非免疫性致死病例，ICT 可作为一种敏感和特异的尸检疟疾诊断工具，其比显微镜检查更容易、更快，而且在由于自溶导致显微镜检查无法进行时也可应用。PCR 更昂贵且耗时，但可作为确认试验。在疟疾高度流行地区，无症状寄生虫血症很常见，因此必须依靠组织病理学发现来确认疟疾是导致死亡的原因。
