Molecular bacteriology and the autopsy

Abstract

In 1996 the UNEX study was set up in the United States to use molecular techniques on patients who had died unexpectedly from a presumed bacterial infection. The patients selected were those with a pre-mortem clinical diagnosis of infection. Samples were aseptically collected from up to a dozen normally sterile sites at post mortem. Blood and bowel contents were not examined but abscess material, CSF and tissue were collected. The samples were examined by routine culture and 16SRNA which was sequenced. The outcomes of the US study were published in 2002 and some of the US states have continued to examine selected autopsies for bacterial causes of death driven by concerns regarding possible bioterrorism. In Queensland between 2002 and 2005 a UNEX trial was set up and two illustrative cases will be presented. Problems with this technique include the costs and the time to complete testing. A review of literature and current and possible future practices will be discussed.