Investigation of tuberculosis prevalence by acid-fast stain, culture and real-time PCR method in forensic autopsies

Abstract

Tuberculosis (TB) is still one of the most important diseases and causes of death in the world. We aimed to investigate TB prevalence in forensic autopsy cases in Turkey by the acid-fast bacilli (AFB) staining, TB culture and real-time polymerase chain reaction (RT-PCR) methods in paraffin-embedded tissues. From January 2012 to January 2015, 1676 tissue samples were examined under AFB staining and TB culture, and 85 paraffin-embedded tissue samples under RT-PCR from 14,083 prospectively-investigated forensic autopsy cases in the Istanbul Council of Forensic Medicine. Positivity with microbiological methods (AFB staining and/or TB culture and/or RT-PCR) was detected in 43 (0.3%) out of 73 (0.5%) cases in which TB was diagnosed with histopathological findings. Acid-fast bacilli were detected in 14 tissue samples by AFB staining, and a total of 11 tissue samples were found culture-positive in the Löwenstein-Jensen medium. Mycobacterium tuberculosis DNA was positive in 36 samples with RT-PCR. Eleven (15%) cases were detected as miliary tuberculosis. Microbiological sampling should accompany autopsy findings and histopathological sampling for post-mortem identification and notification of active TB during forensic autopsies. Diagnosis of TB in forensic autopsies would contribute to clarifying the cause of death and to the collection of epidemiological data in Turkey, particularly in ante-mortem undiagnosed cases.