Carfora Anna, Campobasso Carlo Pietro, Cassandro Paola, La Sala Francesco, Maiellaro Alfonso, Perna Antonio, Petrella Raffaella, Borriello Renata
Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania "L. Vanvitelli", Via L. Armanni, 5, 80138, Naples, Italy.
Department of Experimental Medicine, Forensic Toxicology Unit, University of Campania "L. Vanvitelli", Via L. Armanni, 5, 80138, Naples, Italy.
Forensic Sci Int. 2019 Apr;297:e1-e7. doi: 10.1016/j.forsciint.2019.01.044. Epub 2019 Feb 7.
The study reports the environmental, toxicological and histopathological forensic investigations applied on three victims of accidental death (father, mother and son), due to the fall in a volcanic pothole, during the touristic visit of the "Solfatara park", near Naples (Italy). At autopsy greenish skin discolouration was observed and all bodies showed the classical signs of asphyxial deaths, such as cyanosis and hemorrhagic pulmonary edema. Focal micro-hemorrhages were found in the brain at intracranial and subpial levels. The hemogasanalysis and spectrophotometric test on blood for Methemoglobin (MetHb), Carboxyhemoglobin (HbCO) and Sulfhemoglobin (SHb) showed pCO, SHb and MetHb above the physiological levels. On biological specimens, toxicological analyses performed by GC/MS revealed high concentrations of hydrogen sulfide (HS) and of thiosulfate (TS), its main metabolite. The monitoring of toxic gases on the death scene showed an unsafe environment, into the pothole, able to cause the sudden loss of consciousness of the victims with subsequent asphyxiation (knockdown effect). In particular, at the bottom of the hole, the maximum levels of HS and carbon dioxide (CO) were 2200 ppm and 98% respectively. For the family members, the cause of the death was assessed as acute poisoning by HS and CO. The fatalities, happened in quick succession as for a domino effect, were pretty similar to the asphyxial deaths by confined spaces, frequently observed in occupational setting. Fatalities secondary to accidental volcanic gases inhalation, such as HS and CO in geothermal areas, have been already described but often without a forensic approach. To the best of our knowledge this is the first case that reports the accidental poisoning by volcanic gases involving three people, with different caracteristic of age and sex, allowing the correlation between toxicological and pathological results with the true levels of asphyxiating gas, measured on the death scene.
该研究报告了对三名意外死亡受害者（父亲、母亲和儿子）进行的环境、毒理学和组织病理学法医调查。这三名受害者在意大利那不勒斯附近的“索尔法塔拉公园”旅游参观期间，坠入一个火山坑而死亡。尸检时观察到皮肤呈绿色变色，所有尸体均显示出窒息死亡的典型体征，如发绀和出血性肺水肿。在颅内和软脑膜水平的脑组织中发现了局灶性微出血。血液中高铁血红蛋白（MetHb）、碳氧血红蛋白（HbCO）和硫血红蛋白（SHb）的血气分析和分光光度测试显示，pCO、SHb和MetHb高于生理水平。对生物样本进行的气相色谱/质谱毒理学分析显示，硫化氢（HS）及其主要代谢产物硫代硫酸盐（TS）浓度很高。对死亡现场有毒气体的监测表明，火山坑内的环境不安全，能够导致受害者突然失去意识并随后窒息（击倒效应）。特别是在坑底，HS和二氧化碳（CO）的最高水平分别为2200 ppm和98%。对于这三名家庭成员，死亡原因被评估为HS和CO急性中毒。这些死亡事件接连迅速发生，如同多米诺骨牌效应，与在职业环境中经常观察到的密闭空间窒息死亡非常相似。地热区域中因意外吸入火山气体（如HS和CO）导致的死亡已有报道，但往往缺乏法医鉴定方法。据我们所知，这是第一例报告涉及三名年龄和性别特征不同的人员因火山气体意外中毒的案例，该案例使得毒理学和病理学结果能够与在死亡现场测量的窒息性气体真实水平相关联。
