MED-X Protocol for Evaluating an Infectious Cause of Death - Minnesota Dept. of Health

MED-X Protocol for Evaluating an Infectious Cause of Death

This job aid is intended for medical examiners, coroners, and forensic pathologists. It serves as a reminder to consider infectious causes of death in certain situations, and it provides a practical guide to specimen collection and testing.

1.0 Case Identification

Antemortem and/or postmortem signs and symptoms indicating a possible infectious disease related death are determined by the investigator and/or ME. 

1.1 If applicable, request available lab results from antemortem sampling.

1.2 Decide to conduct an autopsy or not based on the report from the death scene investigator and resources available.

If no autopsy done, skip to 4.0 Case Reporting.

Table 1: Checklist of Antemortem and Postmortem Signs and Symptoms

To determine if it is a potentially infectious death, use this checklist as a guide.

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Checklist of Antemortem and Postmortem Signs and Symptoms (PDF)

  1. Fever
  2. Acute encephalopathy or new onset seizures
  3. Acute flaccid paralysis or polyneuropathy
  4. New-onset jaundice
  5. Acute diarrhea
  6. New rash or soft tissue lesion
  7. Unexplained death
    • Death of an individual <50 years of age where:
      • the past medical history, circumstances, and scene investigation provide inadequate diagnostic insight to establish the cause of death, and
      • investigators have been unable to identify one of the signs/symptoms listed above in the absence of a specific etiology. 
    • This category includes infants with a SIDS-like presentation.
Table 2: Checklist of Pathologic Syndromes

To determine if it is a potentially infectious death, use this checklist as a guide.

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Checklist of Pathologic Syndromes (PDF)

  1. Neurologic
    • Encephalitis
    • Meningitis (including hemorrhagic)
  2. Respiratory
    • Pharyngitis, epiglottitis or other upper airway infection
    • Bronchitis or bronchiolitis, acute
    • Pneumonia
    • Diffuse alveolar damage
    • Mediastinitis, hemorrhagic
  3. Cardiac
    • Myocarditis
    • Endocarditis
  4. Gastrointestinal
    • Acute hepatitis or fulminant hepatic necrosis
    • Colitis
  5. Dermatologic
    • Diffuse rash
    • Soft tissue lesion
  6. Multi-system
    • Lymphadenitis
    • Sepsis syndrome
  7. None of the above pathologic syndromes

2.0 Lab Specimens and Testing

2.1 If an autopsy is done, collect specimens and submit them for appropriate testing.

Table 3: Specimens and Testing

If an autopsy is done, collect specimens and submit them for appropriate testing.

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Table 3: Specimens and Testing (PDF)

Specimen Possible Testing Description Container
Blood Bacterial culture 5ml aerobic & anaerobic Use local lab
Serum Serologic assays/Tox 10ml Marble top vacutainer
NP Swab Viral Culture 1 swab Viral transport
Urine Culture/ Antigen tests 20ml Orange top, sterile
Fresh or frozen tissue from affected organs Viral culture or PCR 1cm cubes (can keep refrigerated up to 4 days) Clean vials
Formalin-fixed tissues Histo-pathology, IHC, In situ hybridization PCR All organs Orange top, sterile
Paraffin-embedded tissues Histo-pathology, IHC, ISH, PCR Affected organs  

2.2 Collect additional specimens based on antemortem signs and symptoms, and pathologic syndromes.

Table 4: Additional Specimens and Testing

Collect additional specimens based on antemortem signs and symptoms, and pathologic syndromes.

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Table 4: Additional Specimens and Testing (PDF)

Syndrome Specimen Description Container
Respiratory Deep lung swab 1 swab each lung Bacterial & viral transport
Neurologic CSF 10ml Purple top or sterile container
Gastrointestinal Stool   Clean vial
Dermatologic Skin/soft tissue swab or tissue sample   Bacterial & viral transport or clean vial

3.0 Review Findings

3.1 Review lab results from the local testing laboratories.

3.2 Based on the lab results, decide if further testing is needed at MDH and/or CDC. 

  • For cases with no organism-specific etiology, MDH may follow-up with the case as a part of the Unexplained Death Program.

4.0 Case Reporting

4.1 Notify MDH of cases meeting criteria from the Case Definition on at least a monthly basis and report any helpful follow-up findings.

4.2 Methods of Reporting:

  1. ME site fills out Case Report Form and sends to MDH
  2. ME site notifies MDH of cases and MDH will fill out Case Report Form
  3. MDH conducts case identification at ME site
  • Case Reporting
    There are three methods of case reporting and each ME office can determine which works best for you.

Updated Sunday, 13-Jan-2019 13:52:17 CST