The aetiology of incidental pleural adhesions in medico-legal autopsies.
ESCMID eAcademy. yadav j. 03/02/23; 376572
Disclosure(s): I agree to above terms and condition and disclose that my presentation is a part of ongoing study on which I am working at present. This study was approved by the institutional ethics committee and was funded by the Science & Engineering Research Board under the Department of Science and Technology India (SERB-DST). There is no conflict of interest among co -authors regarding this presentation.
CLICK HERE TO LOGIN
RESERVED CONTENT
RESERVED CONTENT
This content is restricted to ESCMID Members and to non-members that have registered.
Learning Objectives
Abstract
References
Discussion Forum (0)
Rate & Comment (0)
To learn the use of postmortem microbiology in understanding the aetiology of incidental pleural adhesions seen in medicolwegal autopsies.
- Pleural adhesions refer to the formation of fibrotic bands that span the pleural space between the parietal and visceral layers of the pleura. The most common causes include tuberculosis, malignancy, and immunological diseases, and these conditions are often related to underlying inflammation, which can be either infectious or non-infectious. These adhesions are frequently discovered incidentally during medico-legal autopsies and may not always be associated with the cause of death. India, as an endemic country for tuberculosis, may have many unreported cases of asymptomatic pleural adhesions.
In a study conducted over a one-year period from 2022 to 2023, 373 medico-legal autopsies were performed, and 40 cases (10.72%) showed incidental pleural adhesions. Tissue and swab samples were collected from the lungs and pleura during the autopsies, taking aseptic precautions and with consent from next of kin, and were cultured for aerobic bacteria (in blood and MacConkey media) and tuberculosis using Mycobacterium growth indicator tubes (MGIT). The bacteriological culture showed positive results for aerobic bacteria in only 15 cases (37.5%), with the most frequent being E. coli, Acinetobacter, and Staphylococcus (26.6% each). Rare bacteria such as Moraxella and Stenotrophomonas maltophilia were also found. Only 3 cases tested positive for mycobacterium in the MGIT. The correlation between the microorganisms found and the underlying lung pathology and cause of death will be discussed. This study was approved by the institutional ethics committee and was funded by the Science & Engineering Research Board under the Department of Science and Technology India (SERB-DST).
This study emphasizes the importance of post-mortem microbiology in understanding the etiology and prevalence of pleural adhesions and connecting the underlying pathogenesis, even in cases where they are not the direct cause of death.
In a study conducted over a one-year period from 2022 to 2023, 373 medico-legal autopsies were performed, and 40 cases (10.72%) showed incidental pleural adhesions. Tissue and swab samples were collected from the lungs and pleura during the autopsies, taking aseptic precautions and with consent from next of kin, and were cultured for aerobic bacteria (in blood and MacConkey media) and tuberculosis using Mycobacterium growth indicator tubes (MGIT). The bacteriological culture showed positive results for aerobic bacteria in only 15 cases (37.5%), with the most frequent being E. coli, Acinetobacter, and Staphylococcus (26.6% each). Rare bacteria such as Moraxella and Stenotrophomonas maltophilia were also found. Only 3 cases tested positive for mycobacterium in the MGIT. The correlation between the microorganisms found and the underlying lung pathology and cause of death will be discussed. This study was approved by the institutional ethics committee and was funded by the Science & Engineering Research Board under the Department of Science and Technology India (SERB-DST).
This study emphasizes the importance of post-mortem microbiology in understanding the etiology and prevalence of pleural adhesions and connecting the underlying pathogenesis, even in cases where they are not the direct cause of death.
- Pleural adhesions refer to the formation of fibrotic bands that span the pleural space between the parietal and visceral layers of the pleura. The most common causes include tuberculosis, malignancy, and immunological diseases, and these conditions are often related to underlying inflammation, which can be either infectious or non-infectious. These adhesions are frequently discovered incidentally during medico-legal autopsies and may not always be associated with the cause of death. India, as an endemic country for tuberculosis, may have many unreported cases of asymptomatic pleural adhesions.
In a study conducted over a one-year period from 2022 to 2023, 373 medico-legal autopsies were performed, and 40 cases (10.72%) showed incidental pleural adhesions. Tissue and swab samples were collected from the lungs and pleura during the autopsies, taking aseptic precautions and with consent from next of kin, and were cultured for aerobic bacteria (in blood and MacConkey media) and tuberculosis using Mycobacterium growth indicator tubes (MGIT). The bacteriological culture showed positive results for aerobic bacteria in only 15 cases (37.5%), with the most frequent being E. coli, Acinetobacter, and Staphylococcus (26.6% each). Rare bacteria such as Moraxella and Stenotrophomonas maltophilia were also found. Only 3 cases tested positive for mycobacterium in the MGIT. The correlation between the microorganisms found and the underlying lung pathology and cause of death will be discussed. This study was approved by the institutional ethics committee and was funded by the Science & Engineering Research Board under the Department of Science and Technology India (SERB-DST).
This study emphasizes the importance of post-mortem microbiology in understanding the etiology and prevalence of pleural adhesions and connecting the underlying pathogenesis, even in cases where they are not the direct cause of death.
In a study conducted over a one-year period from 2022 to 2023, 373 medico-legal autopsies were performed, and 40 cases (10.72%) showed incidental pleural adhesions. Tissue and swab samples were collected from the lungs and pleura during the autopsies, taking aseptic precautions and with consent from next of kin, and were cultured for aerobic bacteria (in blood and MacConkey media) and tuberculosis using Mycobacterium growth indicator tubes (MGIT). The bacteriological culture showed positive results for aerobic bacteria in only 15 cases (37.5%), with the most frequent being E. coli, Acinetobacter, and Staphylococcus (26.6% each). Rare bacteria such as Moraxella and Stenotrophomonas maltophilia were also found. Only 3 cases tested positive for mycobacterium in the MGIT. The correlation between the microorganisms found and the underlying lung pathology and cause of death will be discussed. This study was approved by the institutional ethics committee and was funded by the Science & Engineering Research Board under the Department of Science and Technology India (SERB-DST).
This study emphasizes the importance of post-mortem microbiology in understanding the etiology and prevalence of pleural adhesions and connecting the underlying pathogenesis, even in cases where they are not the direct cause of death.
Bogen E, Pasternack M. Pleural adhesions, their incidence and significance as shown in autopsies at the Los Angeles General Hospital, 1911-1951. Dis Chest. 1954 Feb;25(2):166-71. doi: 10.1378/chest.25.2.166. PMID: 13127713.
"Histologic study of peritoneal adhesions in children and in a rat model". Pediatr. Surg. Int. 18 (8): 673–6. December 2002. doi:10.1007/s00383-002-0872-6. PMID 12598961. https://dx.doi.org/10.1007%2Fs00383-002-0872-6.
. Maskell NA, Davies CWH, Nunn AJ, et al. U.K. controlled trial of intrapleural streptokinase for pleural infection. New England Journal of Medicine. 2005;352(9):865–874.
Bielsa, S., Martín-Juan, J., Porcel, J. M., & Rodríguez-Panadero, F. (2008). Diagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions. Journal of Thoracic Oncology, 3(11), 1251-1256. https://doi.org/10.1097/JTO.0b013e318189f53d.
Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: a comprehensive review. Clin Respir J 2018;12:2309-20.
Girdhar A, Shujaat A, Bajwa A. Management of infectious processes of the pleural space: a review. Pulm Med. 2012;2012:816502. doi:10.1155/2012/816502.
Park CK, Oh HJ, Choi HY, et al. Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea. PLoS One. 2016;11(8):e0161280. Published 2016 Aug 16. doi:10.1371/journal.pone.0161280.
Li, Shuang-Jiang et al. “Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy.” Journal of thoracic disease vol. 10,1 (2018): 416-431. doi:10.21037/jtd.2017.12.70.
Hassan M, Cargill T, Harriss E, Asciak R, Mercer RM, Bedawi EO, McCracken DJ, Psallidas I, Corcoran JP, Rahman NM. The microbiology of pleural infection in adults: a systematic review. Eur Respir J. 2019 Oct 1;54(3):1900542. doi: 10.1183/13993003.00542-2019. PMID: 31248959.
Gu Q, Deng X, Li Z, Wang J, Hu C, Lei S, Cai X. The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion. Int J Gen Med. 2021 Apr 20;14:1429-1435. doi: 10.2147/IJGM.S299606. PMID: 33907447; PMCID: PMC8068496.
Nikolaos I Kanellakis et al. The bacteriology of pleural infection (TORPIDS): an exploratory metagenomics analysis through next generation sequencing. The Lancet Microbe. Vol 3, Issue 4, E294-E302, 2022. DOI:https://doi.org/10.1016/S2666-5247(21)00327-X.
Weerakkody Y, Bell D, Knipe H, Pleural adhesions. Reference article, Radiopaedia.org (Accessed on 26 Feb 2023) https://doi.org/10.53347/rID-35730.
Bapti Roy, Hui Juin Shak, Y. C. Gary Lee,Pleural Fluid investigations for pleural infections Journal of Laboratory and Precision Medicine 2021;6:12 http://dx.doi.org/10.21037/jlpm-
"Histologic study of peritoneal adhesions in children and in a rat model". Pediatr. Surg. Int. 18 (8): 673–6. December 2002. doi:10.1007/s00383-002-0872-6. PMID 12598961. https://dx.doi.org/10.1007%2Fs00383-002-0872-6.
. Maskell NA, Davies CWH, Nunn AJ, et al. U.K. controlled trial of intrapleural streptokinase for pleural infection. New England Journal of Medicine. 2005;352(9):865–874.
Bielsa, S., Martín-Juan, J., Porcel, J. M., & Rodríguez-Panadero, F. (2008). Diagnostic and Prognostic Implications of Pleural Adhesions in Malignant Effusions. Journal of Thoracic Oncology, 3(11), 1251-1256. https://doi.org/10.1097/JTO.0b013e318189f53d.
Bedawi EO, Hassan M, Rahman NM. Recent developments in the management of pleural infection: a comprehensive review. Clin Respir J 2018;12:2309-20.
Girdhar A, Shujaat A, Bajwa A. Management of infectious processes of the pleural space: a review. Pulm Med. 2012;2012:816502. doi:10.1155/2012/816502.
Park CK, Oh HJ, Choi HY, et al. Microbiological Characteristics and Predictive Factors for Mortality in Pleural Infection: A Single-Center Cohort Study in Korea. PLoS One. 2016;11(8):e0161280. Published 2016 Aug 16. doi:10.1371/journal.pone.0161280.
Li, Shuang-Jiang et al. “Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing video-assisted thoracoscopic lung cancer lobectomy.” Journal of thoracic disease vol. 10,1 (2018): 416-431. doi:10.21037/jtd.2017.12.70.
Hassan M, Cargill T, Harriss E, Asciak R, Mercer RM, Bedawi EO, McCracken DJ, Psallidas I, Corcoran JP, Rahman NM. The microbiology of pleural infection in adults: a systematic review. Eur Respir J. 2019 Oct 1;54(3):1900542. doi: 10.1183/13993003.00542-2019. PMID: 31248959.
Gu Q, Deng X, Li Z, Wang J, Hu C, Lei S, Cai X. The Intrapleural Bridge Connection is One of the Reasons for Unknown Localized Pleural Adhesion. Int J Gen Med. 2021 Apr 20;14:1429-1435. doi: 10.2147/IJGM.S299606. PMID: 33907447; PMCID: PMC8068496.
Nikolaos I Kanellakis et al. The bacteriology of pleural infection (TORPIDS): an exploratory metagenomics analysis through next generation sequencing. The Lancet Microbe. Vol 3, Issue 4, E294-E302, 2022. DOI:https://doi.org/10.1016/S2666-5247(21)00327-X.
Weerakkody Y, Bell D, Knipe H, Pleural adhesions. Reference article, Radiopaedia.org (Accessed on 26 Feb 2023) https://doi.org/10.53347/rID-35730.
Bapti Roy, Hui Juin Shak, Y. C. Gary Lee,Pleural Fluid investigations for pleural infections Journal of Laboratory and Precision Medicine 2021;6:12 http://dx.doi.org/10.21037/jlpm-
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}