39755. Infectious Causes of Unexplained Deaths from a Medical Examiner’s Office
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Posters
  • Lynda Yu IDWeek Poster PDF.pdf (140.3 kB)
  • Background:

    Medical examiners’ offices certify approximately 20% of all deaths in the US.  Violent deaths, unnatural deaths, deaths in custody, sudden and unexpected deaths, apparent natural deaths not under the care of a physician, and deaths with potential public health significance are within their purview.  Infection causes a significant minority of these cases; little is known about these lethal infections and their epidemiology.

    Methods:

    All autopsies from District 9 in Central Florida from 1 Jan 2005-1 July 2011 were surveyed; all cases in which infection was the primary or contributing cause of death were reviewed in detail.

    Results:

    6,777 cases were autopsied; infection was the cause or a significant contributing factor in 228 (3.4 %).  In 183 cases, microbiologic data (immediately premortem or from the autopsy) were available.  S. aureus accounted for 35% of cases in which an organism was identified; S. pneumoniae 10%, Bhemolytic streptococci (A, B, C combined) 10%, and RSV 7%.  Pulmonary infections account for 53% of fatal infections, cardiac (endocarditis, myocarditis) for 15% and GI and CNS infections 8% each.  31 of 228 (13.6%) were less than 2 years old.  Of those over 2 years , 35/197 (15.4%) were HIV-infected.  ME cases with an infectious cause of death were more likely to be male, drug using or homeless as compared to the general Central Florida population. Reasons for failure to assess care in a timely fashion varied, but the most commonly cited was underestimating the severity of the illness.

    Conclusion:

    Infections caused or were a major contributing factor in 3.4% of all unexplained deaths.  S. aureus and streptococci accounted for over half of these; pulmonary infections were most frequent.  Poor socioeconomic circumstances were often associated with infection related death outside of the medical system.

    Lynda Yu, B.S., UCF School of Medicine, Orlando, FL, Jan Garavaglia, M.D., District 9 Medical Examiners Office, Orlando, FL and Mark R. Wallace, MD, Infectious Diseases, Orlando Health, Orlando, FL

    Disclosures:

    L. Yu, None

    J. Garavaglia, None

    M. R. Wallace, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.