Clinical and autopsy diagnosis of infectious diseases at an Italian teaching hospital
Abstract number: P808
Bonadio M., Andreotti G., Pieroni G., Castagna M.
Objectives: To evaluate the frequency of autopsy diagnosis of infectious diseases and to compare clinical and autopsy findings of infectious diseases at an Italian teaching hospital
Methods: A comparison of clinical and autopsy findings of cases studied between january 2001 and march 2007 at the Department of Pathology of Pisa hospital was made. A total number of 512 autopsies were performed in adult patients; 318 patients males and 194 females; mean age 65.0 yrs ±15.4 SD. 160 patients died in medical wards, 115 in intensive care units, 88 in surgical wards and 149 in emergency department. Particularly 201 cases with clinical diagnosis and/or autopsy diagnosis of infectious conditions were evaluated.
Results: 15 (7.5%) out of 201 autopsies showed no evident findings of infectious conditions while in the clinical diagnosis an infectious disease was included. 186 (36.3%) autopsies (114 males, 72 females) out of 512, revealed findings of infectious conditions involving 1 or more site of infection. Mean age of patients with autopsy findings of infectious disease was 63.3 yrs ±14.5 SD. In 72 (38.7%) out of 186 cases with autopsy findings of infections, no infectious diseases were diagnosed pre mortem. Underdiagnosis was most common in lung infections.
In 31 cases a clinical diagnosis of sepsis or septic shock was made. In 23 of these one or more sites of infection were evidentiated at autopsy. Infectious findings at autopsy included: pneumonia (n = 120), abdominal infections (n = 27), meningitis or encephalitis (n = 8), pulmonar and/or extrapulmonary tubercolosis infections (n = 11), endocarditis (n = 15), invasive fungal infections (n = 12), AIDS/HIV (n = 3), HCV severe chronic hepatitis or cirrosis (n = 14), viral systemic infections caused by Herpesviridae (n = 8), urinary tract infections such as kidney abscess and acute pyelonephritis (n = 8).
Conclusions: These data underline the relative high frequency of infectious diseases at autopsy. The number of cases with clinically missed infectious conditions at autopsy was particularly high in lung infection and endocarditis. This fact confirms the difficulty in reaching a correct and timely diagnosis for this kind of infections in critical ill patients.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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