Exclusive: Guillain-Barré Syndrome — Rare ‘Clinical Autopsy’ Performed On 1st Person To Die Amid Pune Outbreak

The clinical autopsy was performed at a government facility in Solapur, to ascertain the cause of death and the progression of disease.

The procedure was performed at Solapur's Dr Vaishampayan Memorial Government Medical College on Monday.

Source : https://vmgmc.edu.in/

Guillain-Barré Syndrome (GBS): A rare clinical autopsy — apart from the usual medicolegal post-mortem exam — has been carried out on the body of the 40-year-old man who is believed to be the first fatality amid the ongoing Guillain-Barré Syndrome (GBS) outbreak in Pune, ABP Live has learnt. The procedure was performed at Dr Vaishampayan Memorial Government Medical College (VMGMC) in Maharashtra’s Solapur district — where the man hailed from — on Monday, Dr Sanjiv Shamrao Thakur, the dean of the facility, said while speaking exclusively to ABP Live.

“The patient was treated and died in a private hospital but was brought to our medical college for post-mortem. Most post-mortems are medico-legal, generally speaking, but, in this case of death by GBS, it was decided to also carry out a clinical autopsy to ascertain the cause of death and the progression of disease,” Dr Thakur said. According to the doctor, while medico-legal autopsies are the norm in India, clinical autopsies are a rarity. 

The deceased was a 40-year-old who worked in the Singhagad area of Pune, and had gone back to Solapur after developing severe gastrointestinal distress. GBS is an immunological nerve disorder, and as many as 110 cases of the condition had been reported in Pune by Monday (Tuesday figures yet to be updated by the state medical authorities).

An investigation — including a household survey in the affected areas in and around Singhagad — is underway to determine the cause of the outbreak.

Medico-Legal Autopsy Vs Clinical Autopsy

Most of the autopsies performed globally are either medico-legal or clinical, based on the purpose for which the procedure is being performed. 

The primary aim of an autopsy is to ascertain the exact cause of death.  Medico-legal autopsies are conducted in cases of non-natural, un-witnessed or suspicious deaths, in accordance with the laws of the land. A clinical autopsy (loosely known as a pathological autopsy) is primarily for medical research, to further consolidate/affirm the cause of death or otherwise, and for academic purposes.

“While a medico-legal autopsy only requires a forensic expert, a clinical autopsy — especially in such cases where an outbreak is happening — requires the participation of not just the forensic expert, but also that of a microbiologist, and a pathologist. Accordingly, we had two forensic experts, two microbiologists, and a pathologist oversee the entire procedure and extraction process,” Dr Thakur told ABP Live. He added that the clinical autopsy was required to rule out the emergence of any other disease while an outbreak was already ongoing.

“Though the medico-legal post-mortem established death due to progression of GBS as the cause prime facie, we proceeded with the clinical autopsy due to the seriousness of the matter at the moment,” Dr Sanjiv Thakur said.

Dr Thakur said the GBS diagnosis was also confirmed by the reports of the electromyography (EMG) during the patient’s treatment.
Electromyography is a diagnostic procedure that measures the electrical activity in muscles and the nerves that control them. It’s used to help detect neuromuscular abnormalities, such as nerve or muscle dysfunction.  

For the clinical autopsy, the medical professionals collected blood samples, the intestinal secretions of the deceased for culture sensitivity, the cerebro-spinal fluid, and also the organs like brain, heart, lungs, brain stem etc — to be sent to the National Institute of Virology (NIV), Pune. “The National Institute of Virology will carry out tests and, through histopathological examination, determine whether the cause of death was GBS, “ Dr Thakur said, adding that it will be three weeks before the result arrives.

The writer is a senior independent journalist.