Spectrum of Lung Histopathology in Minimally Invasive Tissue Sampling (MITS) in a Community-Based Infant Mortality Surveillance in a Low- and Middle-Income Country: A Case Series.

BackgroundLower respiratory tract infections are a major cause of infant mortality, especially in low- and middle-income countries where conventional autopsies are rarely feasible. Minimally invasive tissue sampling (MITS) offers a practical and acceptable alternative for postmortem diagnosis, yet data on lung histopathological findings from community-based surveillance remain limited. This study aimed to describe lung histopathological findings in infants who underwent MITS within a low-resource community setting.MethodsA community-based mortality surveillance was conducted from November 2020 to June 2021 within a Health and Demographic Surveillance System catchment area. MITS lung tissues were collected from deceased infants younger than 6 months whose families provided consent. Lung tissue cores were processed and examined histopathologically, with hematoxylin and eosin staining performed as required to identify pathological features.ResultsHistopathological abnormalities were evident in 24 specimens, including bacterial/bronchopneumonia, diffuse alveolar damage, amniotic fluid aspiration, and so on. Two neonatal specimens exhibited bacterial pneumonia, and 2 showed bronchopneumonia without identifiable pathogens. Among stillbirths, 4 specimens demonstrated intra-alveolar squames and keratinous debris consistent with amniotic fluid aspiration. Two infants showed DAD indicative of acute respiratory distress syndrome; 1 specimen had nonspecific interstitial inflammation.ConclusionMITS proved valuable in identifying diverse lung pathologies in infants, underscoring the major contribution of respiratory disease to infant mortality in low-resource settings. These findings support MITS as a valuable tool for cause-of-death investigation, with larger studies incorporating molecular diagnostics needed to better define disease burden and guide public health action.