Cargando…

A Retrospective Forensic Review of Unexpected Infectious Deaths

BACKGROUND: There exists a knowledge gap in identifying the spectrum of infectious pathogens and syndromes that lead to fulminant decline and death. The aim of this study was to better characterize patient-, pathogen-, and disease-related factors in the phenomenon of unexpected infectious deaths. ME...

Descripción completa

Detalles Bibliográficos
Autores principales: Sehgal, Prateek, Pollanen, Michael, Daneman, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441567/
https://www.ncbi.nlm.nih.gov/pubmed/30956993
http://dx.doi.org/10.1093/ofid/ofz081
_version_ 1783407566510882816
author Sehgal, Prateek
Pollanen, Michael
Daneman, Nick
author_facet Sehgal, Prateek
Pollanen, Michael
Daneman, Nick
author_sort Sehgal, Prateek
collection PubMed
description BACKGROUND: There exists a knowledge gap in identifying the spectrum of infectious pathogens and syndromes that lead to fulminant decline and death. The aim of this study was to better characterize patient-, pathogen-, and disease-related factors in the phenomenon of unexpected infectious deaths. METHODS: We conducted a population-based, retrospective cohort study of all community-based, unexpected infectious deaths in Ontario, Canada between January 2016 and December 2017. Patient-related information, infection-related information, and circumstances around the death were extracted for each case to facilitate descriptive analyses. RESULTS: Of the 7506 unexpected deaths over the study period, 418 (6%) were due to infectious diseases. Bacterial pneumonia (43%) was the most common infectious syndrome, followed by disseminated infection with no clear focus (12%), peritonitis (10%), myocarditis (6%), and pyelonephritis (5%). A pathogen was identified in 210 cases (50%), with the most common being Staphylococcus aureus (n = 35), Streptococcus pneumoniae (n = 30), Streptococcus pyogenes (n = 25), Klebsiella spp. (n = 23), and Escherichia coli (n = 19). Prodromal symptoms were present in 68% of persons before death, with a median (interquartile range) duration of only 1.0 (0.0–4.0) days; just 30% of those who died had had recent healthcare contact before their death. CONCLUSION: Infectious diseases have the capacity to cause fulminant decline and death. The most common cause of unexpected infectious death is bacterial pneumonia, with a predominance of gram-positive bacteria. Given the rapidity of these deaths, preventing a majority of them would require upstream strategies to reduce infection susceptibility and transmission.
format Online
Article
Text
id pubmed-6441567
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-64415672019-04-05 A Retrospective Forensic Review of Unexpected Infectious Deaths Sehgal, Prateek Pollanen, Michael Daneman, Nick Open Forum Infect Dis Major Articles BACKGROUND: There exists a knowledge gap in identifying the spectrum of infectious pathogens and syndromes that lead to fulminant decline and death. The aim of this study was to better characterize patient-, pathogen-, and disease-related factors in the phenomenon of unexpected infectious deaths. METHODS: We conducted a population-based, retrospective cohort study of all community-based, unexpected infectious deaths in Ontario, Canada between January 2016 and December 2017. Patient-related information, infection-related information, and circumstances around the death were extracted for each case to facilitate descriptive analyses. RESULTS: Of the 7506 unexpected deaths over the study period, 418 (6%) were due to infectious diseases. Bacterial pneumonia (43%) was the most common infectious syndrome, followed by disseminated infection with no clear focus (12%), peritonitis (10%), myocarditis (6%), and pyelonephritis (5%). A pathogen was identified in 210 cases (50%), with the most common being Staphylococcus aureus (n = 35), Streptococcus pneumoniae (n = 30), Streptococcus pyogenes (n = 25), Klebsiella spp. (n = 23), and Escherichia coli (n = 19). Prodromal symptoms were present in 68% of persons before death, with a median (interquartile range) duration of only 1.0 (0.0–4.0) days; just 30% of those who died had had recent healthcare contact before their death. CONCLUSION: Infectious diseases have the capacity to cause fulminant decline and death. The most common cause of unexpected infectious death is bacterial pneumonia, with a predominance of gram-positive bacteria. Given the rapidity of these deaths, preventing a majority of them would require upstream strategies to reduce infection susceptibility and transmission. Oxford University Press 2019-02-15 /pmc/articles/PMC6441567/ /pubmed/30956993 http://dx.doi.org/10.1093/ofid/ofz081 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Major Articles
Sehgal, Prateek
Pollanen, Michael
Daneman, Nick
A Retrospective Forensic Review of Unexpected Infectious Deaths
title A Retrospective Forensic Review of Unexpected Infectious Deaths
title_full A Retrospective Forensic Review of Unexpected Infectious Deaths
title_fullStr A Retrospective Forensic Review of Unexpected Infectious Deaths
title_full_unstemmed A Retrospective Forensic Review of Unexpected Infectious Deaths
title_short A Retrospective Forensic Review of Unexpected Infectious Deaths
title_sort retrospective forensic review of unexpected infectious deaths
topic Major Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441567/
https://www.ncbi.nlm.nih.gov/pubmed/30956993
http://dx.doi.org/10.1093/ofid/ofz081
work_keys_str_mv AT sehgalprateek aretrospectiveforensicreviewofunexpectedinfectiousdeaths
AT pollanenmichael aretrospectiveforensicreviewofunexpectedinfectiousdeaths
AT danemannick aretrospectiveforensicreviewofunexpectedinfectiousdeaths
AT sehgalprateek retrospectiveforensicreviewofunexpectedinfectiousdeaths
AT pollanenmichael retrospectiveforensicreviewofunexpectedinfectiousdeaths
AT danemannick retrospectiveforensicreviewofunexpectedinfectiousdeaths