DOH94-DC 1034 1 1 94 9412 31
... 1-3 4-7 8-10 11-12 13-27 2 8 29-30 3 1 3 2 3 3 3 4 ( ) 3 5 3 6 3 7 3 8 3 9 4 0 4 1
4 2 4 3 4 4 4 5 2 4 6 2-14 4 7 15-24 4 8 25-44 4 9 45-64 5 0 65 5 1 5 2 5 3 5 4 55-57 5 8 X Pulmonary tuberculosis59-60 pneumonia abscess Septic shock viral infection6 1 viral erythrophagcytosis respiratory failure
6 2 6 3 6 4 acute superlative65-66 meningitis abscess 6 7 6 8 6 9 7 0 7 1 7 2 7 3 7 4 7 5 76-77 7 8 78
outbreak 7706 72.3% 34.8% 28.8% 18.5% 12.1% 5.8% 48 4.3% 47 4.0% 30 3.1% 51 3.6% 55 3.8% 79 5.0% 150 13.5% 120 10.1% 170 17.5% 245 17.4% 317 22.0% 311 19.7% 15.6% 16.3% 8.9%
1 pulmonary hemorrhage2 Syncytial inflammatory cell3 1 2 interstitial inflammation 3 4
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
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.
1996 1993 ( ) 1995
2.6% 3.6% 8.4% 9.5% 9.8% 10.8% 1995
bacteria virus bronchopneumonia 2 (bronchiectasis) 3 ( ) 4 leptospirasis 1 (interstitial pneumonitis)2 Severe Acute Respiratory SyndromeSARS
Microsoft Access 2000
SPSS Base 8.0 Microsoft Excel - 1 - 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
9455 1115 1189 972 1407 1444 1579 72.3% 27.6% 2.6 34.8% 28.8% 18.5% 12.1% 5.8% 79 5% 46 14.2% 40 12.2% 23 8.7% 49 12.3% 53 12.3% 76 16.1%
91 27.7% 68 20.9% 76 28.7% 120 30.2% 148 34.3% 141 29.8% 20% 40% 50%25%12%10%3%
30.0%36.9%15.8%10.8% 6.6% 2 45-64 25-44 65 2-14 41.3 0.5 43.1 0.6 35.9 1.0 24 25 30.4% 16.0%
15.2% 14.0% 7.9% p=0.000 34.0% 16.8% 40.6% 37.6% 25.6% 49.4% 22.4% 57.7%
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%
5.0% 68.4% 44.3% 43.0% 35.4% 15.6% 16.3% 8.9% 150 13.57% 120 10.1% 170 17.5% 245 17.4% 317 22.0% 311 19.7% -
Leptospirosis Pulmonary tuberculosis viral erythrophagcytosis Leptospirosis X 1600 Silver Stain 20%~70% 1 pulmonary hemorrhage 2 Syncytial
inflammatory cell 3 1 2 interstitial inflammation 3 4 X Acute tubular necrosisatn Leptospirosis ( ) 2004
Pulmonary tuberculosis pneumonia abscess Septic shock T.B tubercle caseous necrosis Lang han s gant cell T.B 04-03-85 viral infection viral erythrophagcytosis respiratory failure macrophage 05-07-15 (03-01-91)
(03-11-11) erythrophago cyosis Group 4 Phagocytosis Acetaminophen 05-17-83 acute superlative meningitis abscess 05-19-36
(03-11-30) (03-11-67) fibrosis macrophang fatty degeneration
(04-10-00) Patterned injury Lobar pneumonia (05-00-75) (05-02-29) 1
2 3 05-17-66 30% 05-15-59 FM2 (03-02-26)
(05-07-41) (03-10-82) fat emboli Zolpidem Acetaminophen 05-16-15
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