Ventura Francesco, Bonsignore Alessandro, Portunato Federica, Orcioni Giulio Fraternali, Varnier Oliviero E, De Stefano Francesco
Department of Legal and Forensic Medicine, University of Genoa, S. Martino Hospital, Via De Toni 12, 16132 Genova, Italy.
J Forensic Leg Med. 2013 Aug;20(6):678-82. doi: 10.1016/j.jflm.2013.04.004. Epub 2013 Apr 28.
We report a fatal case of streptococcal and meningococcal meningitis in a previously healthy 2-year-old child, a simultaneous co-infection of both pathogens that is poorly reported in the reviewed literature. The lack of a clinical diagnosis in addition to the medico-legal aspects arising from possible professional liability for the emergency service doctor who had failed to recognize the child's symptoms led to a forensic autopsy within 48 h after the death. After external and internal examination, Waterhouse-Friderichsen Syndrome (WFS) was suspected. Consequently, cerebrospinal fluid, whole blood, nasal and pharyngeal swab and pleural liquid samples were selected and collected for microbiological studies. All tested samples resulted Neisseria meningitidis DNA and Streptococcus pneumoniae DNA positive. The NM genotyping Real-Time PCR resulted positive for NM serotype C. Microscopic histological study confirmed these findings. We underline that when a patient presents fever and petechiae (50-60% of patients), WFS must be considered, even when the patient has a non-toxic appearance. Due to its rapid progression and often devastating consequences, therapy should be started as soon as WFS is suspected. Emphasis should also be placed on the importance of public education programs and on broadening protection against meningitis through new vaccines. In such cases, from a forensic point of view, there is a strong need for a robust, multidisciplinary approach in order to reach the correct post-mortem diagnosis.
我们报告了一例先前健康的2岁儿童患链球菌和脑膜炎球菌性脑膜炎的致命病例，这是两种病原体的同时合并感染，在已审阅的文献中鲜有报道。除了因急诊医生未能识别患儿症状可能导致的职业责任所引发的法医学问题外，临床诊断的缺失导致在患儿死亡后48小时内进行了法医尸检。经过外部和内部检查，怀疑为华-弗综合征（WFS）。因此，选取并采集了脑脊液、全血、鼻拭子、咽拭子和胸水样本进行微生物学研究。所有检测样本均显示脑膜炎奈瑟菌DNA和肺炎链球菌DNA呈阳性。脑膜炎奈瑟菌基因分型实时聚合酶链反应结果显示C型脑膜炎奈瑟菌血清型呈阳性。显微镜组织学研究证实了这些发现。我们强调，当患者出现发热和瘀点（50%-60%的患者会出现）时，即使患者外观无中毒表现，也必须考虑WFS。由于其进展迅速且后果往往具有毁灭性，一旦怀疑为WFS，应立即开始治疗。还应强调公共教育项目的重要性以及通过新型疫苗扩大对脑膜炎的防护。在这种情况下，从法医学角度来看，迫切需要一种强有力的多学科方法来得出正确的尸检诊断。
