Autopsy findings and histopathological changes in aluminum phosphide-related death: a systematic literature review and meta-analysis

Abstract Backgrounds Aluminum phosphide (AIP)-related death, whether suicidal or homicidal, is a major global health problem, especially within agricultural countries in which it is commonly used as a pesticide. While toxicological analysis is the primary identification method, autopsy findings and histopathological changes might serve as valuable early identification clues. Herein, this review aimed to systematically review the possible and the most common autopsy findings as well as histopathological changes in AIP-related death as identified through post-mortem examination. Main body A literature search was conducted in three databases (Scopus, PubMed, and ScienceDirect). Possible findings were evaluated qualitatively and quantitatively using single-arm meta-analysis to identify the most common findings. In this study, ten observational studies with 2,450 autopsies were included. The autopsy results consistently showed multi-organ congestion, with respiratory system congestion being the most common [prevalence: 99% (95% CI: 0.97–1.00)]. Additional findings were a distinct garlicky odor, froth in the mouth or nostrils, and discoloration. In the histopathological examination, widespread congestion was observed in the liver, lungs, kidneys, spleen, and brain, along with focal myocardial necrosis and gastric mucosal necrosis. Conclusions Multiorgan congestion was the most prevalent finding in AIP-related death. Histopathological analysis revealed widespread congestion and necrosis. These findings highlight the systemic nature of AIP-induced fatalities and provide crucial forensic insights for early post-mortem identification in clinical practice.