Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians
DOI: 10.1055/s-0043-1774411
Case Report

Role of Ancillary Investigations in Medicolegal Autopsy to Establish the Cause of Death and Legal Implications

Arneet Arora
1   Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Sangita Moirangthem 
1   Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Jayanthi Yadav
1   Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Suhail Alikkal
1   Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Aniket Gour 
2   Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Navinchandra M. Kaore
3   Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Sudden death in young females can have various causes and it is important to investigate the cause thoroughly. In cases with a vague history, postmortem ancillary investigation can also help to establish or rule out potential causes of death, such as underlying medical conditions or environmental factors. These investigations may include various laboratory tests, such as toxicology, histology, microbiology, and genetic analysis, as well as radiological imaging studies. This information not only helps in ascertaining the cause and manner of death but also helps in establishing the legal connotations in any medicolegal case.

This is a case of a young woman allegedly 18 years brought for a medicolegal autopsy. She had been feeling unwell for a few days before her death, experiencing vomiting, weakness, and fatigue. Although no underlying disease was diagnosed, she was advised to take a pregnancy test. Fifteen days later, she died at home continuing to feel unwell. Upon autopsy, the young woman was found to be emaciated, and revealed a male fetus, of 4 to 5 months of gestational age, in her uterus. A radiological examination of bones conducted postmortem revealed that the age of woman was approximately 15 years old. Postmortem microbiology analysis revealed the presence of the bacteria Leuconostoc mesenteroides in a blood sample collected from the subclavian vein. The pathogenicity of this bacteria in the cause of death along with the role of ancillary investigation in the light of Indian criminal law and its challenges are being discussed.

Keywords

sudden death - young female - Leuconostoc mesenteroides - postmortem ancillary investigations - Indian POCSO Act - mandatory reporting


Publication History

Received: 07 July 2023

Accepted: 12 August 2023

Article published online:
13 September 2023

© 2023. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Mazuchowski II EL, Meier PA. The modern autopsy: what to do if infection is suspected. Arch Med Res 2005; 36 (06) 713-723
    CrossrefPubMedGoogle Scholar
  • 2 Schneider V. [Value of bacteriologic studies within the scope of forensic autopsies]. Z Rechtsmed 1985; 94 (02) 81-92 (In German.) [PubMed] [Google Scholar]
    Google Scholar
  • 3 Tsokos M, Püschel K. Postmortem bacteriology in forensic pathology: diagnostic value and interpretation. Leg Med (Tokyo) 2001; 3 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 4 Traeger MS, Wiersma ST, Rosenstein NE. et al; Florida Investigation Team. First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach County, Florida, 2001. Emerg Infect Dis 2002; 8 (10) 1029-1034
    CrossrefPubMedGoogle Scholar
  • 5 Jermakow K, Rorat M. Post-mortem microbiology: retrospective analysis of infections caused by Enterococcus strains. Pathogens 2022; 11 (02) 204
    CrossrefPubMedGoogle Scholar
  • 6 Hunie M, Fenta E, Kibret S, Teshome D. The current practice of aspiration prophylaxis in obstetric anesthesia: a survey among non-physician anesthetic providers working in hospitals in Ethiopia. BMC Anesthesiol 2021; 21 (01) 256
    CrossrefPubMedGoogle Scholar
  • 7 Accessed August 24, 2023 at: https://www.indiacode.nic.in/handle/123456789/2079?sam_handle=123456789/1362
  • 8 Accessed August 24, 2023 at: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy
  • 9 Trujillo ME, Dedysh S, DeVos P. et al, Eds. Bergey's Manual of Systematics of Archaea and Bacteria. Hoboken, New Jersey: Wiley; 2015
    Google Scholar
  • 10 Menegueti MG, Gaspar GG, Laus AM, Basile-Filho A, Bellissimo-Rodrigues F, Auxiliadora-Martins M. Bacteremia by Leuconostoc mesenteroides in an immunocompetent patient with chronic Chagas disease: a case report. BMC Infect Dis 2018; 18 (01) 547
    CrossrefPubMedGoogle Scholar
  • 11 Oh K, Jung D, Ko KS, Lee H, Park J, Lee H. Bacteremia caused by Leuconostocspecies: 6-case series. Kosin Med J 2018; 33: 422
    CrossrefGoogle Scholar
  • 12 Kumudhan D, Mars S. Leuconostoc mesenteroids as a cause of post-operative endophthalmitis–a case report. [8] Eye (Lond) 2004; 18 (10) 1023-1024
    CrossrefPubMedGoogle Scholar
  • 13 Franco-Cendejas R, Colín-Castro CA, Hernández-Durán M. et al. Leuconostoc mesenteroides periprosthetic knee infection, an unusual fastidious Gram-positive bacteria: a case report. BMC Infect Dis 2017; 17 (01) 227
    CrossrefPubMedGoogle Scholar
  • 14 Bou G, Luis Saleta J, Sáez Nieto JA. et al. Nosocomial outbreaks caused by Leuconostoc mesenteroides subsp. mesenteroides. Emerg Infect Dis 2008; 14 (06) 968-971
    CrossrefPubMedGoogle Scholar
  • 15 Buu-Hoï A, Branger C, Acar JF. Vancomycin-resistant streptococci or Leuconostoc sp. Antimicrob Agents Chemother 1985; 28 (03) 458-460
    CrossrefPubMedGoogle Scholar
  • 16 Ciolli P, Parlavecchio E, Onorati E, Russo P. Gli estroprogestinici nelle teen agers. Quali Risvoli medico-legali?. [Contraception in teenagers. Medico legal implication] Minerva Ginecol 2002; 54 (02) 189-192
    PubMedGoogle Scholar
  • 17 Vidanapathirana M, Rathnaweera R, Munasinghe K, Sanjeewanee L. Study on pregnant teenagers referred by Obstetricians for medico-legal examination. Medico-Legal J Sri Lanka 2014; 1: 34-37
    CrossrefGoogle Scholar