Morphological criteria for diagnosing the immediate causes of death in patients with generalized forms of meningococcal infection

Abstract

The aim of the study was to clarify the morphological criteria for diagnosing Waterhouse-Friderichsen syndrome, infectious toxic shock, and cerebral edema in generalized forms of meningococcal infection. The study was based on a morphological analysis of 35 archived fatal cases of patients with meningococcal infection. According to the study results, the morphological criterion of Waterhouse-Friderichsen syndrome as an immediate cause of death in generalized forms of meningococcal infection is the presence of hemorrhages involving more than 30% of the adrenal cortex. The morphological criterion of infectious toxic shock as an immediate cause of death in generalized forms of meningococcal infection is the presence of congested capillaries occupying more than 40% of the volume of the interalveolar septa of the lungs. The presence in patients with generalized forms of meningococcal infection of adrenal hemorrhages involving more than 30% of the adrenal cortex and congested capillaries occupying more than 40% of the volume of the interalveolar septa of the lungs indicates that the immediate cause of death is a combination of Waterhouse–Friderichsen syndrome and infectious toxic shock. Cerebral edema as an immediate cause of death is considered an independent cause in patients with generalized forms of meningococcal infection when the patient presents with a strangulation groove, bradycardia, adrenal hemorrhages involving less than 30% of the adrenal cortex, and a capillary volume fraction in the lungs ranging from 25% to 40%.