Kusior Magdalena, Piniewska-Róg Danuta, Wojtas Marta, Sanak Marek, Maciów-Głąb Martyna, Moskała Artur
Chair and Department of Forensic Medicine, Jagiellonian University Medical College, Kraków, Poland.
Department of Internal Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, 30-688, Poland.
Forensic Sci Med Pathol. 2024 Dec 9. doi: 10.1007/s12024-024-00925-1.
The diagnosis of malaria during the autopsy of a decomposed corpse may prove challenging. Macroscopic changes are non-specific and may include, among others, cerebral oedema, pulmonary oedema, hepatosplenomegaly and, on occasion, the presence of petechiae. The most effective diagnostic tools for malaria are the examination of blood smears and the use of rapid immunochromatographic tests. As a result of the progressive putrefaction of the corpse and blood hemolysis, classical tests are no longer viable. Consequently, the sole remaining option is the utilisation of real-time reaction (RT-PCR) to ascertain the presence of plasmodium DNA in specific organs. This study concerns the diagnosis of a fatal form of cerebral malaria in a 23-year-old Caucasian male who had travelled to Africa. The autopsy was conducted at a local hospital, after which the body was embalmed and stored in cold storage for a period of 8.5 months. Subsequently, the corpse was transported to Poland, where a further forensic autopsy was conducted. A significant challenge was to confirm the presence of malaria in a corpse that had been embalmed several months prior to the investigation. Samples were obtained from internal organs for genetic analysis to determine the presence of parasite DNA. An RT-PCR test was conducted on genetic material obtained from the brain, heart, lungs, kidney, liver, and spleen. The presence of Plasmodium falciparum genetic material was identified in samples obtained from the brain, lungs, kidney, liver, and spleen. These findings substantiated the post-mortem diagnosis of a severe form of cerebral malaria, which was the underlying cause of death.
在一具已腐烂尸体的尸检过程中诊断疟疾可能颇具挑战性。宏观变化不具有特异性，可能包括脑水肿、肺水肿、肝脾肿大，偶尔还会有瘀点。疟疾最有效的诊断工具是血液涂片检查和快速免疫色谱检测。由于尸体的逐渐腐败和血液溶血，传统检测方法已不再可行。因此，唯一剩下的选择是利用实时反应（RT-PCR）来确定特定器官中疟原虫DNA的存在。本研究涉及一名前往非洲的23岁白种男性的致命性脑型疟疾的诊断。尸检在当地一家医院进行，之后尸体进行了防腐处理并冷藏保存了8.5个月。随后，尸体被运往波兰，在那里进行了进一步的法医尸检。一个重大挑战是在调查前几个月已进行防腐处理的尸体中确认疟疾的存在。从内部器官获取样本进行基因分析，以确定寄生虫DNA的存在。对从大脑、心脏、肺、肾脏、肝脏和脾脏获取的遗传物质进行了RT-PCR检测。在从大脑、肺、肾脏、肝脏和脾脏获取的样本中鉴定出了恶性疟原虫遗传物质。这些发现证实了死后诊断的严重脑型疟疾，这是死亡的根本原因。
