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Contact Info
Infectious Disease Epidemiology, Prevention and Control Division
651-201-5414
IDEPC Comment Form

Contact Info

Infectious Disease Epidemiology, Prevention and Control Division
651-201-5414
IDEPC Comment Form

MED-X Protocol for Evaluating an Infectious Cause of Death

This job aid is intended for medical examiners, coroners, and forensic pathologists. It serves as a reminder to consider infectious causes of death in certain situations, and it provides a practical guide to specimen collection and testing.

1.0 Case Identification

Antemortem and/or postmortem signs and symptoms indicating a possible infectious disease related death are determined by the investigator and/or ME. 

1.1 If applicable, request available lab results from antemortem sampling.

1.2 Decide to conduct an autopsy or not based on the report from the death scene investigator and resources available.

If no autopsy done, skip to 4.0 Case Reporting.

To determine if it is a potentially infectious death, use this checklist as a guide.

Download PDF version formatted for print:
Checklist of Antemortem and Postmortem Signs and Symptoms (PDF)

  1. Fever
  2. Acute encephalopathy or new onset seizures
  3. Acute flaccid paralysis or polyneuropathy
  4. New-onset jaundice
  5. Acute diarrhea
  6. New rash or soft tissue lesion
  7. Unexplained death
    • Death of an individual <50 years of age where:
      • the past medical history, circumstances, and scene investigation provide inadequate diagnostic insight to establish the cause of death, and
      • investigators have been unable to identify one of the signs/symptoms listed above in the absence of a specific etiology.
    • This category includes infants with a SIDS-like presentation.

To determine if it is a potentially infectious death, use this checklist as a guide.

Download PDF version formatted for print:
Checklist of Pathologic Syndromes (PDF)
 

  1. Neurologic
    • Encephalitis
    • Meningitis (including hemorrhagic)
  2. Respiratory
    • Pharyngitis, epiglottitis or other upper airway infection
    • Bronchitis or bronchiolitis, acute
    • Pneumonia
    • Diffuse alveolar damage
    • Mediastinitis, hemorrhagic
  3. Cardiac
    • Myocarditis
    • Endocarditis
  4. Gastrointestinal
    • Acute hepatitis or fulminant hepatic necrosis
    • Colitis
  5. Dermatologic
    • Diffuse rash
    • Soft tissue lesion
  6. Multi-system
    • Lymphadenitis
    • Sepsis syndrome
  7. None of the above pathologic syndromes

2.0 Lab Specimens and Testing

2.1 If an autopsy is done, collect specimens and submit them for appropriate testing.

If an autopsy is done, collect specimens and submit them for appropriate testing.

Download PDF version formatted for print:
Table 3: Specimens and Testing (PDF)
 

SpecimenPossible TestingDescriptionContainer
BloodBacterial culture5ml aerobic & anaerobicUse local lab
SerumSerologic assays/Tox10mlMarble top vacutainer
NP SwabViral Culture1 swabViral transport
UrineCulture/ Antigen tests20mlOrange top, sterile
Fresh or frozen tissue from affected organsViral culture or PCR1cm cubes (can keep refrigerated up to 4 days)Clean vials
Formalin-fixed tissuesHisto-pathology, IHC, In situ hybridization PCRAll organsOrange top, sterile
Paraffin-embedded tissuesHisto-pathology, IHC, ISH, PCRAffected organs 

2.2 Collect additional specimens based on antemortem signs and symptoms, and pathologic syndromes.

Collect additional specimens based on antemortem signs and symptoms, and pathologic syndromes.

Download PDF version formatted for print:
Table 4: Additional Specimens and Testing (PDF)
 

SyndromeSpecimenDescriptionContainer
RespiratoryDeep lung swab1 swab each lungBacterial & viral transport
NeurologicCSF10mlPurple top or sterile container
GastrointestinalStool Clean vial
DermatologicSkin/soft tissue swab or tissue sample Bacterial & viral transport or clean vial

3.0 Review Findings

3.1 Review lab results from the local testing laboratories.

3.2 Based on the lab results, decide if further testing is needed at MDH and/or CDC.

  • For cases with no organism-specific etiology, MDH may follow-up with the case as a part of the Unexplained Death Program.

4.0 Case Reporting

4.1 Notify MDH of cases meeting criteria from the Case Definition on at least a monthly basis and report any helpful follow-up findings.

4.2 Methods of Reporting:

  1. ME site fills out Case Report Form and sends to MDH
  2. ME site notifies MDH of cases and MDH will fill out Case Report Form
  3. MDH conducts case identification at ME site
     
  • Case Reporting
    There are three methods of case reporting and each ME office can determine which works best for you.
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Last Updated: 03/27/2025