Sudden death and hydatid cyst: A medicolegal study
Introduction
Echinococcosis, also known as hydatid disease, is a human infection that is caused by the larval stage of Echinococcocus granulosus. It is a parasite disease which is common in several regions of the world, e.g., the Mediterranean countries, the Middle East, South America, East Africa, as well as some areas in Canada and Australia [1]. In Tunisia, Hydatidosis is an endemic disease as the annual average incidence within the general population is estimated to be 1.67 cases per 100.000 inhabitants per year (Ministry of Public Health, unpublished data). This infection is characterized by its high clinical latency. Patients are generally asymptomatic during long periods [2], [3]. The natural history of the disease can be enameled by several complications. Sudden death is the most dreadful one. The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The role of the hydatid cyst in the mechanism of death is sometimes difficult to determine, especially in the presence of a macroscopically intact cyst. In fact, the presence of microcracking, which is highlighted by the histologic exam, can implicate the cyst in the mechanism of death especially when no other cause of the death is found.
The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease and to discuss the mechanism of death.
Section snippets
Materials and methods
This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017).
A data collection sheet was used based on deceased’s families, judicial investigation data, external body examinations and autopsies. In each case, we have studied the following variables:
- -
Epidemiological criteria: age, sex, origin, medical history
- -
Cases characteristics
During the study period, we performed a total of 7808 autopsies. In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period.
Of the 26 victims, 13 (50%) were men. The mean age was 43 years. Most victims were from rural zones (18 cases). The majority of victims were jobless (nine cases) and in seven cases were farmers. A summary of cases characteristics is shown in Table 1.
Death circumstances
Of the 26 cases, only 17 presented
Discussion
This is a retrospective descriptive study conducted in the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia). We performed a total of 7808 autopsies over a period of 27 years (from 1990 until 2017). During this period, hydatid cysts were observed during autopsy of sudden death in 26 cases, which corresponds to 0.33% of the total of autopsies in this period. A Tunisian study performed in the Forensic Medicine Department of the Charles Nicolle Hospital (Tunis)
Conclusion
Hydatid disease may remain asymptomatic. The liver localization is the most common one. When we find a hydatid cyst at autopsy, his implication in the death is not in all cases certain especially when death is attribute to anaphylaxis.
Declaration of interest
The authors declare that they have no conflict of interest.
References (50)
Hydatid disease: a review and update
Curr. Anaesth. Crit. Care
(2004)Economic effects of echinococcosis
Acta Trop.
(2003)- et al.
Echinococcosis
Lancet
(2003) - et al.
Retrospective surgical incidence and case distribution of cystic echinococcosis in Jordan between 1994 and 2000
Acta Trop.
(2003) - et al.
Pericardial hydatid cyst presenting with cardiac tamponade
Can. J. Cardiol.
(2006) - et al.
Le kyste hydatique du foie
J. Chir.
(2004) - et al.
Posttraumatic free intraperitoneal rupture of liver cystic echinococcosis: a case series and review of literature
Am. J. Surg.
(2007) - et al.
Anaphylactic shock caused by nonruptured hydatid cyst of the liver
J. Gastrointest. Surg.
(2008) - et al.
Immediate anaphylactic death following antibiotics injection: splenic eosinophilia easily revealed by pagoda red stain
Forensic Sci. Int.
(2008) - et al.
Chirurgie des kystes hydatiques cardiaques. Trente-neuf ans d’expérience
Ann. Cardiol. Angeiol. (Paris)
(2008)
Sudden death due to an unrecognized cardiac hydatid cyst
J. Forensic Sci.
An analysis of possible mechanisms of unexpected death occurring in hydatid disease (echinococcosis)
J. Forensic Sci.
Sudden death due to hydatid disease: a six-year study in the northern part of Tunisia
J. Forensic Sci.
Sudden death due to hydatid cyst: thirty-four medicolegal autopsy cases
Am. J. Forensic Med. Pathol.
Anaphylactic shock as the only clinical manifestation of hepatic hydatid disease
Int. J. Dermatol.
Non-ruptured hydatid cyst can lead to death by spread of cyst content into bloodstream: an autopsy case
Eur. J. Gastroenterol. Hepatol.
Treatment of hydatid cyst of the liver: where is the evidence?
World J. Surg.
Kystes hydatiques du foie
EMC – Hépatol.
Hormonal and immunological mechanisms mediating sex differences in parasite infection
Parasite Immunol.
Mort subite par kyste hydatique dans le centre tunisien : à propos de 34. [Thèse de doctorat en médecine]
Actualités épidémiologiques de l’hydatidose en Tunisie
Med. Mal. Infect.
Connaissances, comporetements et implications sur la transmission de l'hydatidose en Tunisie
Knowl. Behav. Implications Hydatidosis
L’abattage clandestin en Tunisie: enquête sur les connaissances et les pratiques des bouchers face à l’hydatidose
Bull. la Société Pathol. Exot.
Sudden death due to hydatid cyst rupture located in right ventricle
Am. J. Forensic Med. Pathol.
Cited by (6)
Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective
2022, Journal of Forensic and Legal MedicineCitation Excerpt :Between 1 and 8% of infected individuals may suffer cyst rupture into the peritoneal cavity, releasing highly antigenic hydatid scolices.148 This may result in rapid death from anaphylaxis or delayed death from sepsis and multiorgan failure.149 Macroscopically, hydatid cysts are readily identifiable having a wall composed of three layers: the pericyst derived from host fibroblastic response, the intermediate laminated membrane, and the inner germinal layer.150
Pulmonary Parasitic Embolization Caused by Micro Ruptured Hydatid Cyst: An Autopsy Case
2023, Duzce Medical JournalA 43-year-old male with acute right upper quadrant pain and skin rash
2023, Acta Gastro-Enterologica BelgicaThe effect of PVP application on Mebendazole release from electrospun nanofibers, kinetic study and thermodynamic analysis
2021, Journal of the Iranian Chemical SocietyCystic echinococcosis in humans in Turkey
2021, Mikrobiyoloji Bulteni