A Retrospective Forensic Review of Sudden Unexpected Infectious Deaths in Ontario
CCCF ePoster library. Sehgal P. Nov 8, 2018; 233337; 79
Dr. Prateek Sehgal
Dr. Prateek Sehgal
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Rate & Comment (0)


The phenomenon of sudden and unexpected death has largely been characterized for primary cardiac or respiratory death. There remains a subset of the population that decline abruptly and unexpectedly primarily due to infectious pathogens. This has resulted in a knowledge gap in identifying the spectrum of pathogens and clinical syndromes which may lead to fulminant decline and death potentially even before exposure to a healthcare setting.



The aim of this study was to better characterize and understand patient, pathogen, and disease-related factors in the phenomenon of sudden, unexpected infectious deaths.



We carried out a population-based, retrospective cohort study of all community sudden infectious deaths in Ontario, Canada between January 1, 2016 to December 31, 2017. Autopsy records were extracted from the Ontario Forensics Pathology Service (OFPS) which encompassed a catchment population of 14 million within the provinces of Ontario and northeastern Manitoba in Canada. We collected patient-related information, infection-related information, and circumstances around death for each case to carry out descriptive analyses.



Of the 7506 cases of sudden or unexpected death over the 2-year study period, we identified 418 cases (6%) related to infectious diseases. Patients with sudden infectious deaths had similar age distribution in comparison to patients with sudden deaths from other causes [median age (IQR) age of 55 (45 – 64) vs. 54 (41 – 64), p = 0.27] while having a less pronounced male gender predominance (60% males vs. 68% males, p = 0.001). Bacterial pneumonia (43%) was the most common infectious cause of sudden death population-wide followed by septic shock (12%), peritonitis (10%), myocarditis (6%), and pyelonephritis/abscess (5% each). A causative pathogen was isolated in 210 cases (50%) with Staphylococcus aureus (N = 35) being the most commonly cultured organism, followed by Streptococcus pneumoniae (N = 30), Streptococcus pyogenes (N = 25), Klebsiella pneumoniae (N = 21), and Escherichia coli (N = 19). The majority of deaths were pronounced at the patient's residence (63%) while a minority were pronounced in the Emergency Department (18%) and shortly after hospital admission (19%). 68% of patients exhibited prodromal symptoms prior to death with a median (IQR) length of 1.0 (0.0-4.0) days and 30% of patients had recent healthcare contact prior to their demise.



Infectious diseases have the potential to cause rapid and fulminant clinical decline. The most common etiology of sudden infectious death within our population was bacterial pneumonia and, predominantly, gram positive bacteria. Our study highlights potential opportunities for intervention given a number of patients had recent healthcare contact prior to their death and the most frequent cause of death was via common community infections and pathogens. However, given the rapidity of disease progression, prevention will require upstream strategies to prevent infection transmission such as through further vaccine development.


    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Save Settings