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Minimally Invasive Postmortem Intestinal Tissue Sampling in Malnourished and Acutely Ill Children Is Feasible and Informative.
Feutz, Erika; Voskuijl, Wieger; Finch, Peter J; Liu, Ta-Chiang; Bandsma, Robert H J; Tarr, Phillip I; Moxon, Christopher Alan; VanBuskirk, Kelley; Lawrence, Sarah; Umutesi, Grace; Tickell, Kirkby D; Berkley, James A; Walson, Judd L; Kamiza, Steve; Denno, Donna M.
Afiliación
  • Feutz E; Department of Global Health, University of Washington, Seattle, Washington, USA.
  • Voskuijl W; Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
  • Finch PJ; Amsterdam Institute for Global Health and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
  • Liu TC; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Bandsma RHJ; The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
  • Tarr PI; Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Moxon CA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.
  • VanBuskirk K; Hospital for Sick Children, Translational Medicine Program and Centre for Global Child Health, Toronto, Canada.
  • Lawrence S; The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya.
  • Umutesi G; Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
  • Tickell KD; Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi.
  • Berkley JA; Wellcome Centre for Integrative Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
  • Walson JL; Malawi-Liverpool Wellcome Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
  • Kamiza S; Department of Global Health, University of Washington, Seattle, Washington, USA.
  • Denno DM; Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Clin Infect Dis ; 73(Suppl_5): S382-S389, 2021 12 15.
Article en En | MEDLINE | ID: mdl-34910181
BACKGROUND: Intestinal disorders such as environmental enteric dysfunction (EED) are prevalent in low- and middle-income countries (LMICs) and important contributors to childhood undernutrition and mortality. Autopsies are rarely performed in LMICs but minimally invasive tissue sampling is increasingly deployed as a more feasible and acceptable procedure, although protocols have been devoid of intestinal sampling to date. We sought to determine (1) the feasibility of postmortem intestinal sampling, (2) whether autolysis precludes enteric biopsies' utility, and (3) histopathologic features among children who died during hospitalization with acute illness or undernutrition. METHODS: Transabdominal needle and endoscopic forceps upper and lower intestinal sampling were conducted among children aged 1 week to 59 months who died while hospitalized in Blantyre, Malawi. Autolysis ratings were determined for each hematoxylin and eosin slide, and upper and lower intestinal scoring systems were adapted to assess histopathologic features and their severity. RESULTS: Endoscopic and transabdominal sampling procedures were attempted in 28 and 14 cases, respectively, with >90% success obtaining targeted tissue. Varying degrees of autolysis were present in all samples and precluded histopathologic scoring of 6% of 122 biopsies. Greater autolysis in duodenal samples was seen with longer postmortem interval (Beta = 0.06, 95% confidence interval, 0.02-0.11). Histopathologic features identified included duodenal Paneth and goblet cell depletion. Acute inflammation was absent but chronic inflammation was prevalent in both upper and lower enteric samples. Severe chronic rectal inflammation was identified in children as young as 5.5 weeks. CONCLUSIONS: Minimally invasive postmortem intestinal sampling is feasible and identifies histopathology that can inform mortality contributors.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Desnutrición Tipo de estudio: Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Child / Humans / Infant Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Desnutrición Tipo de estudio: Prognostic_studies Aspecto: Determinantes_sociais_saude Límite: Child / Humans / Infant Idioma: En Revista: Clin Infect Dis Asunto de la revista: DOENCAS TRANSMISSIVEIS Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos