Info

Carbon Monoxide (See "Poisoning, carbon monoxide.")

Carbon Monoxide (See "Poisoning, carbon monoxide.")

Carbon Tetrachloride (See "Poisoning, carbon tetrachloride.")

From: Handbook of Autopsy Practice, 3rd Ed. Edited by: J. Ludwig © Humana Press Inc., Totowa, NJ

Cardiomegaly (See "Cardiomyopathy,... and "Hypertrophy, cardiac.")

Cardiomyopathy, Alcoholic

NOTE: For general dissection techniques, see p. 22.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination, heart and lungs Abdominal cavity and liver

See below under "Cardiomyopathy, dilated."

Record volume of ascites. Record actual and expected weight of liver. Request iron stain (p. 172).

See below under "Cardiomyopathy, dilated."

Alcoholic cirrhosis and alcoholic cardiomyopathy rarely coexist. However, in genetic hemochromatosis,* cirrhosis and heart failure are common findings.

Cardiomyopathy, Dilated (Idiopathic, Familial, and Secondary Types) NOTE: For general dissection techniques, see p. 22.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Chest cavity Heart

Lungs

Abdominal cavity Liver

Prepare chest roentgenogram.

Record volume of pleural and pericardial effusions. Record actual and expected heart weights. Measure and record maximum internal short-axis diameter of left ventricular chamber. Record ventricular thicknesses and valvular circumferences. Note location and size of mural thrombus. Request iron stain (p. 172).

Record actual and expected weights. Request Verhoeff-van Gieson and iron stains from one lower lobe (p. 172).

Record volume of ascites. Record actual and expected weights.

Cardiomegaly; pleural or pericardial effusions;* pacemaker. Hydrothorax; hydropericardium. Cardiomegaly; biventricular hypertrophy; four-chamber dilatation; focal left ventricular fibrosis; dilated valve annuli; relatively mild coronary atherosclerosis; possible iron in cardiac myocytes; microfocal interstitial fibrosis, particularly subendocardial; myocarditis (idiopathic or drug-related). Pulmonary congestion; pulmonary edema; changes of chronic pulmonary venous hypertension; pulmonary emboli; pulmonary infarcts; bronchopneumonia. Ascites.

Chronic congestive hepatomegaly; centrilobular (zone 3) steatosis, fibrosis,

or necrosis (not true cirrhosis).

or necrosis (not true cirrhosis).

Cardiomyopathy, Hypertrophic (Idiopathic, Familial, and Secondary Types)

Synonyms: Idiopathic hypertrophic subaortic stenosis (IHSS); hypertrophic obstructive cardiomyopathy (HOCM); and many others.

NOTE: For general dissection techniques, see p. 22.

Possible Associated Conditions: See below under "Possible or Expected Findings."

Organs and Tissues

Procedures

Possible or Expected Findings

External examination Heart

Brain and spinal cord

Sample skin lesions for histologic study. Prepare chest roentgenogram. Record actual and expected weights. Record ventricular thicknesses and valvular circumferences. Determine ratio between left ventricular septal and free wall thicknesses (normal, <1.3) at basal, midventricular, and apical levels. Request amyloid stain (Congo red or sulfated alcian blue) (p. 172). For removal and specimen preparation, see pp. 65 and 67, respectively.

Lentiginosis (part of LEOPARD syndrome). Mild cardiomegaly.

Biventricular hypertrophy; disproportionate septal hypertrophy (>1.3 in 90%); gross and microscopic fibrosis; thickened anterior mitral leaflet; subaortic septal endocardial fibrotic patch (contact lesion from mitral valve); left atrial dilatation; focal septal myofiber disarray microscopically. Friedreich's ataxia.*

Cardiomyopathy, Restrictive (Non-eosinophilic and Secondary Types) NOTE: For general dissection techniques, see p. 22.

Organs and Tissues

Procedures

Possible or Expected Findings

Heart

Record actual and expected weights. Record ventricular thicknesses and valvular circumferences. Evaluate atrial size, compared to ventricular chamber size. Request amyloid stain (Congo red or sulfated alcian blue) (p. 172).

Prominent biatrial dilatation. Relatively normal ventricular size. Prominent biventricular interstitial fibrosis or amyloidosis, microscopically.

Cardiomyopathy, Restrictive (With Eosinophilia)

Synonyms: Eosinophilic endomyocardial disease; hypereosinophilic syndromes; Loffler's eosinophilic endomyocarditis; Davies' endomyocardial fibrosis.

NOTE: For general dissection techniques, see p. 22.

Organs and Tissues

Procedures

Possible or Expected Findings

Heart

Other organs and tissues

Record actual and expected weights. Record ventricular thicknesses and valvular circumferences. Evaluate relative atrial and ventricular chamber sizes.

Procedures depend on expected findings or grossly identified abnormalities as listed in right-hand column.

Mural thrombus along apex and inflow tract of one or both ventricles, with extensive intact or degranulated eosinophils microscopically. Ventricular dilatation only if mitral or tricuspid valve or both are regurgitant. Conditions associated with eosinophilia, such as asthmatic bronchiolitis or Churg-Strauss syndrome (see also under "Syndrome, hypereosinophilic"); malignancies; parasitic disease; vasculitis.

Cardiomyopathy, Arrhythmogenic Right Ventricular

Synonyms: Arrhythmogenic right ventricular dysplasia; right ventricular cardiomyopathy. NOTE: For general dissection techniques, see p. 22.

Organs and Tissues

Procedures

Possible or Expected Findings

Heart

Record actual and expected weights. Record ventricular thicknesses and valvular circumferences. Evaluate pattern and extent of epicardial fat, especially over right ventricle. Take multiple samples from right ventricle for microscopic study.

Prominent right ventricular dilatation, grossly; right ventricular hypertrophy, fibrosis, and adiposity, by microscopy (excessive for patient's age and body size). Occasional left ventricular involvement. Microfocal myocarditis or epicarditis.

Carditis (See "Myocarditis.")

Chickenpox (See "Varicella.")

Chloride (See "Disorder, electrolyte(s)" and p. 114.)

Chloroma

NOTE: Follow procedures described under "Leukemia, all types or type unspecified." For gross staining of chloroma, see p. 134.

Cholangiopathy, Infantile Obstructive (See "Atresia, biliary" and "Hepatitis, neonatal.")

Cholangitis, Chronic Nonsuppurative Destructive Synonym: Primary bilary cirrhosis. NOTE: Follow procedures described under "Cirrhosis, liver."

Cholangitis, Sclerosing

Synonyms: Idiopathic sclerosing cholangitis; primary sclerosing cholangitis; secondary sclerosing cholangitis.

Possible Associated Conditions: Acquired immunodeficiency syndrome;* acute or chronic pancreatitis;* ankylosing spondylitis;* autoimmune hemolytic anemia;* autoimmune hepatitis; bronchiectasis;* chronic ulcerative colitis;* celiac disease; Crohn's disease;* eosinophilia; glomerulonephritis;* immune thrombocytopenic purpura; Peyronie's disease; pseudotumor of the orbit; retroperitoneal fibrosis;* rheumatoid arthritis;* Riedel's struma; sclerosing mediastinitis;* Sjogren's syndrome;* systemic lupus erythematosus;* systemic sclerosis;* vasculitis; and many others (the associations are not equally well documented) (1).

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Intestinal tract and pancreas Hepatoduodenal ligament

Liver

Record presence or absence of laparotomy scars and drains.

For cholangiography, see p. 56. Open duodenum anteriorly and insert catheter into papilla of Vater. After removal of liver and hepatodudenal ligament, prepare cholangiograms. Record diameter of lumens and thickness of walls at various levels of common bile duct, hepatic duct, cystic duct, and gallbladder. Record appearance of portal veins and hepatic arteries.

Prepare histologic sections of extrahepatic bile ducts and hepatoduodenal lymph nodes.

Photograph before and after slicing. Submit samples for histologic study; include sections of perihilar intrahepatic bile ducts.

Jaundice.

See above under "Possible Associated Conditions."

Sclerosis and narrowing of extrahepatic bile ducts. Choledocholithiasis; cholelithiasis; adenocarcinoma of bile ducts or gallbladder.

Other organs and tissues

Occlusion or narrowing of hepatic artery or its branches may cause ischemic cholangitis, which closely resembles primary sclerosing cholangitis (2).

Intraductal carcinoma may imitate primary sclerosing cholangitis. Lymph nodes may contain metastatic carcinoma. For possible infections, see below under "Liver." Intrahepatic sclerosing cholangitis; cholestasis; ascending cholangitis; biliary cirrhosis.

Cholangiocarcinoma. Evidence of cytomegalovirus or cryptosporidium infection. See above under "Possible Associated Conditions."

References

1. Lazarides KN, Wiesner RH, Porayko MK, Ludwig J, LaRusso NF. Primary sclerosing cholangitis. In: Diseases of the Liver, 8th ed. Schiff ER, Sorrell MF, Maddray WC, eds. Lippincott-Raven, Philadelphia, PA, 1999.

2. Batts KP. Ischemic cholangitis. Mayo Clin Proc 1998;73:380-385.

Cholangitis, Suppurative

Related Terms: Ascending cholangitis; obstructive suppurative cholangitis; (oriental) recurrent pyogenic cholangitis.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Blood

Heart

Hepatoduodenal ligament Liver and gallbladder

Submit sample for microbiologic study (p. 102). If infective endocarditis is suspected, follow procedures described on p. 103. For cholangiography, see p. 56. Dissect common bile duct, hepatic duct, and portal vein in situ. Record weight of liver and photograph it. Submit portion of liver for aerobic and anaerobic bacterial culture. Submit samples for histologic study and request Gram stain (p. 172).

Jaundice. Septicemia.

Infective endocarditis.*

Stricture; tumor, stones. Portal vein thrombosis; pylephlebitis. Cholangitic abscesses; cholecystitis,* cholelithiasis.* Carcinoma or other conditions causing obstruction or compression of bile ducts.

Cholecystitis

Related Terms: Acute acalculous cholecystitis; chronic cholecystitis; gallstone cholecystitis.

Possible Associated Conditions: Brucellosis;* major trauma or operation unrelated to biliary system; polyarteritis nodosa;* Salmonella typhosa infection (typhoid fever*).

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Abdominal cavity

Blood Heart

Intestine

Gallbladder;

hepatoduodenal ligament with extrahepatic bile ducts

Liver

Pancreas

Prepare roentgenogram of upper abdomen.

Submit peritoneal exudate and aspirated contents of gallbladder for aerobic and anaerobic culture. Also submit exudate from subphrenic empyema* or other intraperitoneal empyemas (abscesses). Submit sample for bacterial culture (p. 102). If endocarditis is suspected, follow procedures described on p. 103.

If biliary fistula is suspected, open stomach, duodenum, and hepatic flexure of colon in situ. Record location and size of fistula. For cholangiography, see p. 56. Open all extrahepatic bile ducts, portal vein, and hepatic artery in situ. Remove liver and gallbladder. For specimen preparation, see p. 57. Describe appearance, position, and contents of gallbladder. Record number and character of stones. For preservation of gallbladder and stones, see pp. 134 and 137.

Record size and weight. Submit samples for histologic study.

If pancreatitis is present, record whether common bile duct and pancreatic duct have a common entry.

Jaundice.

Air in biliary tract indicates biliary fistula. Gallstones

Peritonitis;* intraperitoneal empyemas (abscesses).

Septicemia.

Infective endocarditis.*

Biliary fistula, with or without gallstone ileus.

Acute or chronic cholecystitis; cholelithiasis;* cholangitis;* choledocholithiasis. Ulcers, abscesses, empyema, gangrene, or perforation of gallbladder; emphysematous cholecystitis; fistula. Hydrops or porcelain gallbladder; limey bile. Torsion of gallbladder. Portal vein thrombosis; pylephlebitis. Polyarteritis nodosa* of gallbladder. Hepatoduodenal lymphadenitis.

Suppurative cholangitis;* cholangitic abscesses; pylephlebitis; pylephlebitic abscesses; venous thromboses. Pancreatitis.*

Choledocholithiasis

NOTE: Follow procedures described under "Cholecystitis."

Cholelithiasis

NOTE: Follow procedures described under "Cholecystitis." Cholelithiasis may be associated with all types of cholecystitis, with cholesterosis of the gallbladder, and with polyps of the gallbladder. The presence of "white bile" (limey bile) indicates obstruction of the cystic duct. Record number and character of stones. To prevent the green discoloration of gallbladder mucosa, see Chapter 14, p. 134.

Cholera

Synonym: Vibrio cholerae infection; asiatic cholera.

NOTE: The disease may complicate anemia,* chronic atrophic gastritis, vagotomy, gastrectomy, chronic intestinal disease, and malnutrition.

(1) Collect all tissues that appear to be infected. (2) Request cultures of intestinal contents for cholera. (3) Request Gram stain (p. 172). (4) Special precautions are indicated (p. 146). (5) For serologic studies, see below under "Blood." (6) This is a reportable disease.

Organs and Tissues Procedures Possible or Expected Findings

External examination Record body weight and length and extent Early onset and prolongation of rigor mortis.

of rigor. Shriveled fingers ("washer-woman's hands")

and toes.

Vitreous Submit sample for sodium, chloride, and urea Dehydration.* (See also p. 115).

nitrogen determination (p. 85).

Blood Prepare serum for tube agglutination or enzyme-linked immunosorbent assay (ELISA) test for retrospective diagnosis or epidemiologic purposes.

Organs and Tissues

Procedures

Possible or Expected Findings

Intestinal tract

Record volume and appearance of intestinal contents. Submit samples of feces and other intestinal contents for culture and for determination of sodium, potassium, and chloride content.

Submit samples of all portions of the intestinal tract for histologic study.

Kidneys Adrenal glands Urine

Other organs and tissues

Submit samples for histologic study. Record volume and specific gravity.

Blood-stained or "rice-water type" intestinal contents. The organism may be present in pure culture.

Intact mucosa with edema of lamina propria; dilatation of capillaries and lymphatics; mononuclear infiltrates and goblet cell hyperplasia. All changes confined to small bowel. Bacteria situated on or between epithelial cells.

Tubular necrosis;* focal cortical necrosis. Lipid depletion.

Absence or minimal amount of urine suggests dehydration.*

All tissues appear abnormally dry. Lungs are usually pale and shrunken, less frequently congested.

Chondrocalcinosis (See "Pseudogout.") Chondrodysplasia

Synonyms and Related Terms: Achondroplasia; Chondrodystrophia fetalis; Ellis-van Creveld syndrome.*

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Thyroid gland

Other organs Base of skull, pituitary gland, brain, and spinal canal with cord

Bones

Record body length, length of extremities, and abnormal features. Measure head, chest, and abdominal circumferences. Prepare skeletal roentgenograms. All radiographs should be reviewed by a radiologist.

Record weight and submit sample for histologic study.

Perfuse at least one lung with formalin (p. 47). For removal and specimen preparation of brain and spinal cord, see pp. 65 and 67, respectively. For removal of pituitary gland, see p. 71. Record appearance and photograph base of skull; record size of foramen magnum. Remove middle ears (see p. 72). For removal, prosthetic repair, and specimen preparation, see p. 95.

Submit samples (especially epiphyses, if present) for histologic study.

Dwarfism;* micromelia with pudgy fingers; bulging head with saddle nose.

Chest deformities; separation of spinal ossification centers; abnormal pelvis and, in infants, ossification centers in metaphyseal ends of long bones. Atrophy.

Restrictive and obstructive lung disease (1). Growth retardation of base of skull with compression of foramen magnum. Internal hydrocephalus.* Narrow spinal canal with compression of spinal cord. (Clinically: paraplegia.) Atrophy of pituitary gland. Otitis media* (2).

Dorsolumbar kyphosis and lumbosacral lordosis; short iliac wings; short and thick tubular bones; excessive size of epiphysis in long bones; elongated costal cartilage; tibial bowing.

Decreased cartilage cell proliferation at costochondral junction and at epiphysis-diaphysis junction of long bones.

References

1. Hunter AG, Bankier A, Rogers JC, Sillence D, Scott CL Jr. Medical 2. Erdincler P, Dashti R, Kaynar MY, Canbaz B, Ciplak N, Kuday C. complications of achondroplasia: a multicenter patient review. J Med Hydrocephalus and chronically increased intracranial pressure in

Genet 1998;35:705-712. achondroplasia. Childs Nerv System 1997;13:345-348.

Chondrosarcoma (See "Tumor of bone or cartilage.") Chordoma (See "Tumor of bone or cartilage.") Chorea, Acute

Related Terms: Infectious chorea (poststreptococcal; often part of rheumatic fever); St. Vitus' dance; Sydenham's chorea.

Organs and Tissues

Procedures

Possible or Expected Findings

Brain and spinal cord

Other organs

For removal and specimen preparation, see pp. 65 and 67, respectively. Submit sample of cerebral tissue for microbiologic study (p. 102). Procedures depend on expected findings or grossly identified abnormalities as listed in right-hand column.

Morphologic changes largely unknown. Degenerative processes of basal ganglia.

Manifestations of carbon monoxide poisoning;* diphtheria;* hyperthyroidism;* idiopathic hypocalcemia; pertussis;* pregnancy; rheumatic fever;* systemic lupus erythematosus.*

Chorea, Hereditary

Synonyms: Chronic progressive chorea; Huntington's chorea; Huntington's disease.

NOTE: Huntington's disease maps to the short arm of chromosome 4. The gene is widely expressed but of unknown function; it contains a CAG repeat sequence, which is expanded (range, 37 to 86) in patients with Huntington's disease. A sensitive diagnostic test is based on the determination of this CAG sequence, which can be done on fresh-frozen tissue or blood (1). In the absence of genetic confirmation, sampling of organs and tissues cannot be excessive because a complex differential diagnosis must be resolved.

Organs and Tissues

Procedures

Possible or Expected Findings

Brain and spinal cord

Other organs

For removal and specimen preparation, see pp. 65 and 67, respectively. Place fresh cerebral tissue in deep freeze for further study.

Samples should include peripheral nerves (p. 79), adrenal glands, skeletal muscle (p. 80), and bone marrow (p. 96). (See also above under "Note").

Mild to severe cerebral atrophy. Atrophy of head of caudate nucleus, putamen, and globus pallidus (due to neuronal loss and gliosis).

Respiratory and other intercurrent infections.

Reference

1. Lowe J, Lennox G, Leigh PN. Disorders of movement and system degenerations. In: Greenfield's Neuropathology, vol. 2. Graham BI, Lantos PL, eds. Arnold, London, 1997, pp. 281-366.

Choriomeningitis, Lymphocytic (See "Meningitis.")

Chylothorax

Related Terms: Congenital chylothorax.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Chest cavity

Prepare chest roentgenogram. Puncture pleural cavity and submit fluid for microbiologic study (p. 102). Record volume of exudate or transudate and submit sample for determination of fat and cholesterol content. If infection is suspected (extremely rare in true chylothorax), submit sample for microbiologic study.

Pleural effusion.*

Chylous pleural effusions have high fat content. Nonchylous milky effusions—for instance, in tuberculosis* and rheumatoid arthritis*—have high cholesterol and low fat content. Tumor of pleura, lung, or chest wall; lymphangiomatosis (1).

Organs and Tissues

Procedures

Possible or Expected Findings

Thoracic duct Skeletal system

For lymphangiography and for dissection of the thoracic duct, see p. 34. Prepare skeletal roentgenogram and, if abnormalities are present, sample bone for histologic study.

Surgical or other traumatic lesions of thoracic duct. Tumor in posterior mediastinum. Massive osteolysis in Gorham's syndrome (2).

Cirrhosis, Liver

NOTE: All types of cirrhosis are included here (alcoholic, autoimmune, biliary, cryptogenic, pigment [hemochromatosis], cirrhosis with viral hepatitis, and other types).

If the cause or underlying condition is known, see also under the appropriate heading, such as alcoholic liver disease, aranti-trypsin deficiency, sclerosing cholangitis, or viral hepatitis. If the patient had undergone liver transplantation, see also under that heading.

References

1. Moerman P, van Geet C, Devlieger H. Lymphangiomatosis of the body wall: a report of two cases associated with chylothorax and fatal outcome. Pediatr Pathol Lab Med 1997;17:617-624.

2. Riantawan P, Tansupasawasdikul S, Subhannachart P. Bilateral chylothorax complicating massive osteolysis (Gorham's syndrome). Thorax 1996;51:1277-1278.

Organs and Tissues

Procedures

Possible or Expected Findings

External examination

Blood

Abdominal and chest cavity

Lungs Diaphragm Gastrointestinal tract

Record body weight and length, nutritional state, distribution of hair, type of skin pigmentation, appearance of breasts and hands, and abdominal circumference. Prepare sections of skin and breast tissue.

Prepare skeletal roentgenograms

Submit samples for bacterial culture (p. 102) and for biochemical or immunologic study, depending on expected underlying disease (see above under "Note"). Record volume and character of ascites. Culture exudate.

Record volume and character of pleural effusions. For lymphangiography, see p. 34. For arteriography and for cholangiography, see p. 56. Record appearance and contents of extrahepatic bile ducts. If liver transplantation had taken place, see also under that heading. Remove esophagus together with stomach. Clamp midportion of stomach and remove together with esophagus for demonstration of varices (p. 53). Record appearance of varices and preserve specimen, particularly in cases where attempts had been made to sclerose the varices. Perfuse one lung with formalin (p. 47).

Record defects and presence of dilated lymphatics.

Record estimated volume of blood in gastrointestinal tract. Submit samples of abnormal lesions for histologic study

Jaundice; spider nevi; pectoral alopecia and loss or abnormal distribution of pubic hair; gynecomastia; white nail beds; clubbing of fingers. Diffuse or nodular (e.g., cervical) lipomatosis (Madelung collar) in alcoholism. Xanthelasmas and vitiligo in primary biliary cirrhosis. Skin pigmentation of hemochromatosis.* Bruises and hemorrhages. Hypertrophic osteoarthropathy* of tibia and fibula; osteomalacia;* osteoporosis.* Septicemia; hyperbilirubinemia. Viral antigens and/or antibodies.

Ascites; spontaneous bacterial peritonitis. Hydrothorax.

Dilatation of abdominal lymphatics and thoracic duct. Strictures, stones, or tumors in secondary biliary cirrhosis; portal or splenic vein thrombosis; thrombosis of surgical anastomosis. A peritoneovenous shunt may be in place.

Esophageal* or gastric varices, or both, with or without evidence of rupture and hemorrhage. Gastroesophageal mucosal tears in Mallory-Weiss syndrome. (See also below under "Gastrointestinal tract.")

Manifestations of portopulmonary hypertension.

Gastrointestinal hemorrhage.* Gastric varices.

Peptic ulcers.* Crohn's disease* or chronic ulcerative colitis in primary sclerosing cholangitis.* Portal hypertensive gastropathy.

Organs and Tissues

Procedures

Possible or Expected Findings

Liver and gallbladder

Spleen Pancreas

Urine

Testes and prostate Brain

Eyes

Record size and weight of liver and average size of regenerative nodules of liver. Describe appearance and contents of gallbladder. Prepare frontal or horizontal slices of liver (p. 56). If there is evidence of tumor(s), see under "Tumor of the liver." For macroscopic iron stain, see p. 133.

Freeze hepatic tissue for possible biochemical or histochemical study. Request van Gieson's stain, PAS stain with diastase digestion, and Gomori's iron stain (p. 172). If hepatitis B virus infection is suspected, request immunostains for B antigens. For preparation for electron microscopic study, see p. 132.

Record size and weight.

Prepare pancreatogram (p. 57) and dissect pancreatic ducts.

Chemical study is feasible.

Record weights of testes. Submit samples of testes and prostate for histologic study.

For removal and specimen preparation, see p. 65.

For removal and specimen preparation, see p. 85.

Cirrhosis. Cholelithiasis.* Hepatocellular carcinoma. Hemosiderosis. An intrahepatic portal-caval shunt may be in place.

Hepatitis B or other viral antigens.

Congestive splenomegaly. Chronic pancreatitis, particularly with alcoholic cirrhosis. Urobilinuria; aminoaciduria. Atrophy of testes and prostate.

Hepatic encephalopathy. Histologic changes, primarily in cerebral cortex, putamen, globus pallidus, and cerebellum. Yellow sclerae. Cataracts in galactosemia.*

Clonorchiasis

Synonyms: Clonorchis sinensis infection; Chinese or oriental liver fluke infection; Opisthorchis sinensis infection (1). NOTE: (1) Collect all tissues that appear to be infected. (2) Culture methods are not generally available. However, aerobic and anaerobic cultures may be indicated in patients who die of superimposed sepsis. (3) Request Gram stain (p. 172); parasites can be identified with hematoxylin and eosin stain. (4) No special precautions are indicated. (5) Serologic studies are not available. (6) This is not a reportable disease.

Organs and Tissues

Procedures

Possible or Expected Findings

Blood

Submit sample for anaerobic and aerobic culture

Septicemia.

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