Sudden death caused by myocardial tuberculosis: case report and review of the literature

A 25-year-old fit man died suddenly while playing social soccer. Autopsy revealed an infiltrative lesion involving the left ventricle with overlying pericarditis. No other significant pathologic changes were observed. Histologic examination showed necrotizing granulomatous inflammation. No acid-fast bacilli were demonstrated in the pericardial fluid or on histologic examination. The presence of Mycobacterium tuberculosis DNA complex was confirmed by use of the ligase chain reaction technique. The differential diagnosis of myocardial tuberculosis includes sarcoidosis, rheumatic fever, rheumatoid arthritis, giant-cell-containing tumors, idiopathic (giant-cell) myocarditis, and bacterial infections such as tularemia and brucellosis. This case illustrates the protean manifestations of tuberculosis and highlights the use of molecular biologic techniques in arriving at a definitive diagnosis in cases of suspected tuberculosis.     

日本结核病立法及其对我国的启示

随着结核病在全球的广泛流行，它严重危害着广大人民群众的身体健康，已经成为重大的公共卫生问题和社会问题。本文通过介绍日本在结核病方面的相关立法经验，分析我国结核病的法律现状及缺陷，探讨对我国的立法启示。     

Sudden Death from Cardiopulmonary Arrest on Arrival of a Patient with Pulmonary Tuberculosis: A Case Diagnosed by Postmortem CT and Autopsy

Sudden death due to massive hemoptysis during management of tuberculosis occurs in a considerable number of patients. However, when massive airway hemorrhage occurs in a patient in whom tuberculosis has not been confirmed and a blood is not apparent externally on the face/body, it is difficult to immediately identify the cause of death as airway obstruction by tuberculous bleeding in the airway. We encountered an 83‐year‐old Japanese woman with her medical history included treatment of tuberculosis in her 20s who was in cardiopulmonary arrest on arrival (CPAOA), and the cause of sudden death could not initially be identified. Postmortem CT (PMCT) and autopsy revealed that the cause of sudden death was airway obstruction/asphyxia by tuberculous massive airway hemorrhage. Identification of the cause of death facilitated a subsequent active contact investigation and led to prevention of secondary tuberculosis infection.     

Retrospective epidemiological analysis of occupational infection morbidity of employees in state forensic-medical expert institutions in 1990-2005

The results of a retrospective epidemiological analysis of occupational tuberculosis and hemocontact virus hepatitis morbidity among forensic-medical examiners demonstrate that tuberculosis and virus hepatitis B and C morbidity among the examiners is ten times and more higher than among RF population and has a trend to further rise. This points to necessity for urgent prophylactic measures among personnel of the state forensic-medical institutions.     

肾上腺结核猝死的法医学鉴定

通过两例肾上腺结核猝死的案例观察发现：肾上腺和肾上腺以外器官的结核病变均表现为不典型的慢性陈旧性的病理学特征。提示在法医学鉴定中,对患过结核病和“不明死因”猝死尸体剖验时肾上腺的组织病理学检验尤为重要     

Public health powers in relation to infectious tuberculosis in England and France: a comparison of approaches

This article examines the legal responses to infectious tuberculosis in England and France. Given that tuberculosis has re-emerged as a public health threat in both countries, the differing jurisprudence and legal frameworks of disease control in the two jurisdictions warrant examination. Two questions arise in that respect: firstly, what is the role of the State in the protection of public health in the context of tuberculosis, and secondly, to what extent can the law intervene to coerce individuals to undertake health measures for the protection of society at large. These issues reveal the tensions that exist between the individual and public interest. France and England differ greatly in their responses to such tensions. Paradoxically, France, that has traditionally embraced strong State intervention, has been reluctant to curtail individual freedoms for the benefit of public health. Conversely, England, that has tended to be more closely associated with liberalism, has been ready to accept and even promote restrictions to individual freedoms in the collective interest.     

Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994--CDC. Notice of final revisions to the "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in health-care facilities, 1994"

The purpose of this notice is to print the final "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 1994," and a summary of comments and responses to those comments.     

Tuberculosis and sudden death in Baghdad

Tuberculosis deaths represent a recognizable proportion of all medicolegal statistics in and around Baghdad. Out of the total number of autopsies performed at the Medicolegal Institute at Baghdad, Iraq, in the years, 1948, 1953, 1958, 1963, 1968, 1973, and 1978, 168 sudden deaths were attributed to tuberculosis. Bilateral pulmonary tuberculosis was the principle lesion in the majority of the victims. Tuberculosis cavitation was the major finding in 126 cases, followed by advanced pulmonary TB without cavitation in 25. There was no gross abnormality, except for a histological basis of pulmonary TB associated with miliary TB involving hepatic, renal, meningeal, and mesenteric organs in the remaining 17 autopsies. The abrupt and suspicious deaths in older people, especially during cold months, is more likely due to TB. Autopsy should be performed in all cases of sudden and suspicious deaths. Histological study of different body organs, whether death is attributed by the investigative authority or not related to TB, should be required in all medicolegal autopsies, in order to obtain a true picture of TB as a natural cause of death.     

Through the Quarantine Looking Glass: Drug-Resistant Tuberculosis and Public Health Governance, Law, and Ethics

The incident in May-June 2007 involving a U.S. citizen traveling internationally while infected with drug-resistant tuberculosis involved the U.S. federal government's application of its quarantine and isolation powers. The incident and the isolation order raised numerous important issues for public health governance, law, and ethics. This article explores many of these issues by examining how the exercise of quarantine powers provides a powerful lens through which to understand how societies respond to and attempt to govern threats posed by dangerous, contagious pathogens. The article considers historical aspects of governmental power to quarantine and isolate individuals and groups; analyzes the current state of quarantine and isolation law in the United States in light of the recent incident with drug-resistant tuberculosis; and explores global aspects of public health governance and law highlighted by this incident.     

Analysis of pathological and non-pathological human skeletal remains by FT-IR spectroscopy

In this study, we report the chemical analyses of various non-pathological, tuberculosis and syphilis infected bone samples from different burial environments by Fourier transform infrared spectroscopy (FT-IR), in the framework of a general study of diagenesis. Dating human skeletal remains is one of the most important and yet unreliable aspects of forensic anthropology. In this paper, a new method has been suggested, using the crystallinity index and carbonate-phosphate index as a means of distinction between recent and archaeological, anthropological bone samples. Pathological bone samples were analyzed with the same method to see if changes in crystallinity interfere with the process of dating.     

United Kingdom: HIV status,psychiatric problems of asylum seeker did not stop removal

In November 2002, the High Court of Justice rejected an application for judicial review of a decision to remove an Ivoirian asylum seeker to France, despite her HIV status, tuberculosis, psychiatric condition, and attempted suicides. The Court argued that removal to France would not necessarily result in a return to Ivory Coast or in poorer health care.     

Use of radiographs in the forensic autopsy

The X-ray examination of corpses is a most useful tool in the field of medicolegal diagnostics. Sometimes the cause of death can already be seen before autopsy. The following modes of application are reviewed: search for foreign bodies, identification of poison, air-embolism, pneumothorax, air-filled lungs and gastro-intestinal organs in new-borns, diagnosis of tuberculosis in corpses, visibility of hidden fractures, structure of bones as a factor of biomechanical load capacity, identification and determination of age and experimental research with corpses.     

63例监管场所非暴力性死亡的法医学分析

目的通过收集监管场所非暴力性死亡的案例,分析其法医学特点和相关影响因素。方法收集某鉴定中心2000—2015年间所受理的监管场所在押人员非暴力性死亡案例63例,对其致死性疾病的类型、发病季节、既往病史、临床表现、处理措施及病程进行回顾性分析。结果监管场所因病死亡者以男性居多,高发于中青年人群;主要致死性疾病以心源性死亡居于首位(50.8%),慢性炎性疾病包括胃肠道穿孔、肺结核病、肺炎、肝炎和胰腺炎等数量也较多。夏季是发病高峰,猝然发作的症状为睡眠中急骤发病、突然晕倒,慢性起病的以呕吐、腹痛、乏力、胸闷、气短、发热、纳差等最为常见。结论监管场所的管理制度、监管场所条件、医疗水平和相关知识等仍有改善空间,进行鉴定时需注意健康资料收集、尸体解剖、组织学检查和毒物检验等。     

Canada: national summit on "Global health is a human right"!

Held in Ottawa on 21-22 May 2003, a national summit on "Global Health is a Human Right!" brought together 86 people representing over 60 Canadian civil society groups interested in joint advocacy on realizing the human right to health in developing countries. The summit focused particularly on addressing the global crises of communicable diseases such as HIV/AIDS, tuberculosis, and malaria.     

Respiratory protective devices--NIOSH. Notice of proposed rulemaking

This proposed rule addresses NIOSH's and the Department of Labor/Mine Safety and Health Administration's (MSHA) certification requirements for respiratory protective devices. Specifically, the proposal would replace existing MSHA regulations with new public health regulations, while also upgrading current testing requirements for particulate filters. This action is the first of a series of modulates which will, over the next several years, upgrade current respirator requirements. This modular approach will allow improvements to be implemented on a priority basis as well as facilitate adaptation to new requirements by the manufacturers and users of respirators. Except for the particulate-filter requirements, most requirements of existing regulations would be incorporated into the new regulations without change. The proposed testing requirements for particulate filters would significantly improve the current approach to evaluating the effectiveness of an air-purifying respirator's filter to remove toxic particulates from the ambient air, updating existing provisions to be consistent with two decades of advances in respiratory protection technology. The certification of air-purifying respirators under these proposed requirements would also enable respirator users to select from a broader range of certified respirators that meet the current performance criteria recommended by CDC for respiratory devices used in health-care settings for protection against Mycobacterium tuberculosis, the infectious agent that causes tuberculosis (TB). This Notice also announces an informal public meeting on the proposed rule, as indicated below. Elsewhere in this issue of the Federal Register, MSHA is publishing a proposal to remove existing regulations at 30 CFR part 11, which would be made obsolete by a final rule resulting from this proposed rule.     

TB-related sudden death (TBRSD) due to myocarditis complicating miliary TB: a case report and review of the literature

TB-related sudden death (TBRSD) is rarely reported in the literature and in the majority of cases is due to bronchopneumonia and hemoptysis. Cardiac complications of tuberculosis causing sudden death can take many forms and are rarer still, with only a handful of cases reported. We describe a case of a previously fit and healthy 20-year-old Asian female who, after returning from a holiday in India, collapsed while getting off a bus. At postmortem, the only macroscopic finding of note was a localized area of fibrosis on the anterior wall of the left ventricle. Microscopic examination of this area showed Langhans giant cells; noncaseating epithelioid granulomas and acid-fast bacilli were demonstrated on Ziehl Nielsen staining. In addition, the lungs, liver, and kidneys contained multiple noncaseating granulomas. The case serves to highlight the protean nature in the presentation of this disease and the importance of postmortem histology in autopsy work.     

Sudden death from tubercular myocarditis

Tuberculous myocarditis is a rare finding. We present the case of a 33-year-old woman who was in good health and who died suddenly at home. Autopsy and histopathologic examinations revealed granulamatous lesions in the myocardium, lungs, lymph nodes, liver, and spleen. No fast acid bacilli were demonstrated on histological examination. The presence of a Mycobacterium tuberculosis DNA complex was identified using a polymerase chain reaction (PCR) on formalin-fixed paraffin-embedded histological samples. An HIV test carried out on the blood obtained during the autopsy was negative according to the DNA amplification technique (PCR) and enzyme-linked immunosorbent assay serological test. We hypothesize that the mechanism of death was severe ventricular arrhythmia due to granulomatous proliferation in the structures of the interventricular septum.     

Detention and the Evolving Threat of Tuberculosis: Evidence, Ethics, and Law

The issue of detention as a public health control measure has attracted attention recently. This is because the threat of strains of tuberculosis that are resistant to a wider range of drugs has been identified, and there is renewed concern that public health is threatened. This paper considers whether involuntary detention is justified where voluntary measures have failed or where a patient poses a danger, albeit uncertain, to the public. We discuss the need for strengthening evidence-based assessments of public health risk and suggest that we should reflect more profoundly on the philosophical foundations upon which our policies and practices are grounded.     

Biosafety considerations for autopsy

An autopsy may subject prosectors and others to a wide variety of infectious agents, including bloodborne and aerosolized pathogens such as human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. Other hazards include toxic chemicals (e.g., formalin, cyanide, and organophosphates) and radiation from radionuclides used for patient therapy and diagnosis. These risks can be substantially mitigated through proper assessment, personal protective equipment, appropriate autopsy procedures, and facility design.     

Forensic evaluation of sudden death due to tuberculosis

Abstract:  The emergence of drug-resistant tuberculosis (TB) poses a major threat to TB control efforts. We report a case of a 50-year-old man with pulmonary TB. The scene investigation had initially suspected for homicide; however, the result of medico-legal autopsy demonstrated natural cause of death. Statistical data suggest that the rates of national mortality by respiratory TB decreased in the last decades in Hungary; however, an increasing TB mortality was detected in the capital Budapest. Facing a new mortality trend in TB, the forensic scene investigation and determination of manner of death represent new challenges for practitioners.