Original communication Cerebrospinal fluid PCR analysis and biochemistry in bodies with severe decomposition Cristian Palmiere a, * , Jessica Vanhaebost b , Francesco Ventura c , Alessandro Bonsignore c , Luca Reggiani Bonetti d a University Center of Legal Medicine, Lausanne University Hospital, Rue du Bugnon 21,1011 Lausanne, Switzerland b Service d'Anatomie Pathologique et M edecine L egale, Cliniques Universitaires Saint-Luc, Universit e Catholique de Louvain, Bruxelles, Belgium c Dipartimento di Medicina Legale, Universit a degli Studi di Genova, Genova, Italy d Dipartimento di Patologia e Medicina Legale, Universit a degli Studi di Modena e Reggio Emilia, Modena, Italy article info Article history: Received 1 July 2014 Received in revised form 28 November 2014 Accepted 13 December 2014 Available online 20 December 2014 Keywords: Postmortem microbiology Neisseria meningitidis Cerebrospinal fluid Decompositional changes Postmortem biochemistry abstract The aim of this study was to assess whether Neisseria meningitidis, Listeria monocytogenes, Streptococcus pneumoniae and Haemophilus influenzae can be identified using the polymerase chain reaction technique in the cerebrospinal fluid of severely decomposed bodies with known, noninfectious causes of death or whether postmortem changes can lead to false positive results and thus erroneous diagnostic infor- mation. Biochemical investigations, postmortem bacteriology and real-time polymerase chain reaction analysis in cerebrospinal fluid were performed in a series of medico-legal autopsies that included noninfectious causes of death with decomposition, bacterial meningitis without decomposition, bacterial meningitis with decomposition, low respiratory tract infections with decomposition and abdominal infections with decomposition. In noninfectious causes of death with decomposition, postmortem investigations failed to reveal results consistent with generalized inflammation or bacterial infections at the time of death. Real-time polymerase chain reaction analysis in cerebrospinal fluid did not identify the studied bacteria in any of these cases. The results of this study highlight the usefulness of molecular approaches in bacteriology as well as the use of alternative biological samples in postmortem biochemistry in order to obtain suitable information even in corpses with severe decompositional changes. © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. 1. Introduction Although the diagnostic value of postmortem bacteriology has been controversially discussed in the field of clinical pathology, numerous cases of forensic interest have been reported in the literature demonstrating the usefulness and reliability of such investigations. 1 Postmortem microbiology analyses in blood, cerebrospinal fluid and tissue samples are routinely performed in cases of sudden, unexpected deaths involving infants, young children and young adults. However, theoretical and practical aspects concerning blood, cerebrospinal fluid and tissue sampling as well as the interpretation of results obtained from specimens collected during autopsy typically concern non-putrefied bodies. 2 Bacterial meningitis in children is associated with significant morbidity and mortality worldwide. In countries where the Hae- mophilus influenzae type B vaccine is widely used, Streptococcus pneumoniae is the most common cause of bacterial meningitis in young children. 3 Following S. pneumoniae, Neisseria meningitidis is the second most common cause of meningitis worldwide, partic- ularly in younger children and adolescents, with almost all cases occurring in subjects who were previously asymptomatic carriers of the bacterium in the upper respiratory tract. 4e6 The diagnosis of meningococcal infection in the postmortem setting can be reliably established by both culture and/or poly- merase chain reaction (PCR) technique in numerous biological samples collected during autopsy such as cardiac blood, cerebro- spinal fluid, biopsies of skin lesions and throat swabs. 6 However, most cases with postmortem diagnoses of meningococcal infection described in the literature pertain to corpses with a relatively short * Corresponding author. Centre Universitaire Romand de M edecine L egale, 21 rue du Bugnon,1011, Lausanne, Suisse, Switzerland. Tel.: þ41 21 314 49 61, þ41 79 556 69 89 (mobile); fax: þ41 21 314 70 90. E-mail address: cristian.palmiere@chuv.ch (C. Palmiere). Contents lists available at ScienceDirect Journal of Forensic and Legal Medicine journal homepage: www.elsevier.com/locate/jflm http://dx.doi.org/10.1016/j.jflm.2014.12.012 1752-928X/© 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Journal of Forensic and Legal Medicine 30 (2015) 21e24