計畫編號：DOH92-DC-1009

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秃乐
7 years ago
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1 DOH94-DC

2 ( )

3 X Pulmonary tuberculosis59-60 pneumonia abscess Septic shock viral infection6 1 viral erythrophagcytosis respiratory failure

4 acute superlative65-66 meningitis abscess

5 outbreak % 34.8% 28.8% 18.5% 12.1% 5.8% % % % % % % % % % % % % 15.6% 16.3% 8.9%

6 1 pulmonary hemorrhage2 Syncytial inflammatory cell3 1 2 interstitial inflammation 3 4

7 KeywordEpidemiologicalPathologicalforensic fatalities Since Milton Halpern, a medical examiner in New York City, recognized an outbreak of fatal malaria in intravenous drug abusers, the forensic pathologists have recognized as an informer of the infectious disease surveillance. In this project, over 9455 autopsy cases during 1999 to 2004 collected from the institute of Forensic Medicine, Ministry of Justice (Taiwan) have been established into a databank and analyzed by using retrospective study. The epidemiological data will include direct and indirect cause of death, mechanism of death, manners of death and medico-legal history especially natural cause of death including sudden death or combined with other disease in a group as well as cluster or outbreak. Manner of death of natural, accidental, suicidal, homicidal and uncertain cause of death are 28.8%, 34.8%, 12.1%, 18.5% and 5.8% of total fatalities, respectively. Approximately respiratory disease occupies 12.9% of natural cause of death. Mechanism of death including respiratory failure, neurogenic failure and cardiogenic failure in 2004 are 30.4%, 16.0% and 15.2% of total cases, respectively. In the group of natural death, cardiac disease, encephalitis, pneumonia, hepatitis or others combined with infectious diseases or illicit drugs-related infectious diseases. Many pancarditis of myocarditis-related deaths, multi-focal myocarditis or uni-focal myocarditis invade to the nerve bundle are noted. The surveillance performed by the medical examiners including sudden deaths, infectious disease with unknown cause that can play an important role in public health which conduct surveillance for fatal infectious diseases. Surveillance information of medical examiner system should be promptly disseminated of the cluster or outbreak to the public health officers and health care providers so that they

8 can take immediate actions such as disease-control efforts and is also useful to describe long-term trends and patterns in disease occurrence and distribution, to portray the natural history of certain conditions, and to evaluate control and prevention measures. The surveillance in the medico-legal cases not only has become the unique probe of infectious disease in Taiwan and but also transform it to the survey and communication tool to the worldwide infectious community. This result has established the database of the infectious disease in the lung with unique diagnosis of disease after definitely and thoroughly immunology, serology, pathology and immunohistochemical examination. In conclusion, (1) the forensic autopsy cases can provide the surveillance of infectious diseases in Taiwan, (2) the results form the case study of forensic pathology can provide the techniques of the differential diagnosis and quality assurance of the diagnosis of the high profiler-infectious disease, (3) surveillance and screening of the infectious disease can provide the control sample and the sample of the immunohistochemical study as well as the histopathological studies, (4) this study has established the surveillance in Taiwan of high risk-infectious diseases. This case databank is able to make the infectious disease investigation during the infectious disease and permission of the definite diagnosis to be possible by using the standard sample of the disease and the control of positive evidence. This databank is important for us to establish the quality assurance, quality control and its proficiency during the war of the anti-bioterrorism as well as anti-infection disease in our global village of the world.

9 ( ) 1995

10 2.6% 3.6% 8.4% 9.5% 9.8% 10.8% 1995

11 bacteria virus bronchopneumonia 2 (bronchiectasis) 3 ( ) 4 leptospirasis 1 (interstitial pneumonitis)2 Severe Acute Respiratory SyndromeSARS

12 Microsoft Access 2000

13 SPSS Base 8.0 Microsoft Excel Hematoxylin Eosin stain HE 2 Silver Stain TB Acid-Fast 3 Immunohistochemical Leptospira biflexa Mycobacterium tuberculosis Adenovirus hexon Cytomegalovirus(CMV) Legionella pneumophilarespiratory Syncytial Virus(RSV)Mycoplasma pneumoniae Biodesign

14 % 27.6% % 28.8% 18.5% 12.1% 5.8% 79 5% % % % % % %

15 % % % % % % 20% 40% 50%25%12%10%3%

16 30.0%36.9%15.8%10.8% 6.6% % 16.0%

17 15.2% 14.0% 7.9% p= % 16.8% 40.6% 37.6% 25.6% 49.4% 22.4% 57.7%

18 13.5% 11.7% 11.2% 9.3% 6.0% 5.8% 5.0% 4.9% 4.1% 3.3% 44.0% 16.1% 10.4% 5.7% 3.4% 62.4% 47.4% / 36.8% 29.8% 27.1% 24.1% 45.5% 37.2% 34.3% 32.4% 32.2% 46.8% 38.8% 34.0% 34.0% 30.8% 52.9% 49.4% 34.7% / 31.2% 28.8% 56.7% 53.8%

19 5.0% 68.4% 44.3% 43.0% 35.4% 15.6% 16.3% 8.9% % % % % % % -

20 Leptospirosis Pulmonary tuberculosis viral erythrophagcytosis Leptospirosis X 1600 Silver Stain 20%~70% 1 pulmonary hemorrhage 2 Syncytial

21 inflammatory cell interstitial inflammation 3 4 X Acute tubular necrosisatn Leptospirosis ( ) 2004

22 Pulmonary tuberculosis pneumonia abscess Septic shock T.B tubercle caseous necrosis Lang han s gant cell T.B viral infection viral erythrophagcytosis respiratory failure macrophage ( )

23 ( ) erythrophago cyosis Group 4 Phagocytosis Acetaminophen acute superlative meningitis abscess

24 ( ) ( ) fibrosis macrophang fatty degeneration

25 ( ) Patterned injury Lobar pneumonia ( ) ( ) 1

26 % FM2 ( )

27 ( ) ( ) fat emboli Zolpidem Acetaminophen

28 -

30 1. Cotran RS, Kumar V and Collins Tucker. Robbins Pathologic Basis of Disease. Chapter 7,8,13,19,30, W. B. Saunders. 6 th edition, Laupland KB et al: Invasive Group A Streptococcal Disease in Children and Association with Varicella-Zoster Virus. Infectious Pediatrics 105(5) : Shaw, KP. and Fong JM. Atypical Victims Related To Meth-amphetamine Abuse. J. Forensic Pathology Association, Shaw, KP. Chen. Li., Dong Liang Lin, Jiang-Chunn Liu, and Fong, JM. Human Methamphetamine-Related Fatalities: Epidemiological, Pathological and Toxicological Studies. International Forensic Science. P Shaw, KP, Pu CE, Lin DL, Liu JC, Fong JM. A Comparative Study of Inhalation and Self-Administration Methamphetamine-Induced Toxicities in Rats. Advances in Forensic Sciences. 1995;5: Serotec. Antigen retrieval techniques for use with formalin-fixed paraffin-embedded section. Serotec UK. P68-72, Spitz, WU. Medicolegal investigation of death. 3 rd edition. Charles. C. Thomas p75~

31 13(5):291~300, ( ) 3(2)p (1):198~208,1995

Microsoft Word - GJPHV3N2-4.doc

Microsoft Word - GJPHV3N2-4.doc On comprehensive prevention and control strategies of hand foot mouth disease Zhao-min Yang Center for Disease Control and Prevention of Shangluo City, Shangluo, Shanxi, China Received: Jul 08, 2016 Accepted: