I (- CONFIDENTIAL (I Jame AUTOPSY REPORT FORM Office of the chief Medical Examtner File No. 1 018-728 9 Name of Deceased Sex Date and ??rm Of Death I STEPHEN EZEKIEL JASHER Male 2012/03/15 09 20 Medical Examiner Ago Dr . Bamidelo Moagbo Year Is) Pathologist Place of Autopsy Date of Autopsy Dr. Bani dole Adeagbo 06MB Calgary Morgue - 2012/ 03/19 CAUSE OF DEATH FOR MEDICAL CERTIFICATE OF DEATH (if pending say why} - Paul (A) Bacterial Meningitis and Right Pleural Empyema IMMEDIATE CAUSE OF DEATH Antecedent causes, it any. giving rise B, DUE T0 or as a consequence of to the Immediate cause (A) above. stating the underlying cause East. DUE T0 or as a consequence of (C) Part II - other signi?cant commons contributing to the death but not causatiy related to the Immediate cause (A) above. NARRATIVE SUMMARY OF HNDINGS AND CONCLUSIONS HEATED TO DEATH: (Indudo mtevant history, laboratory and anatomlcal ?ndings) This 18 month?old previously healthy _male developed upper: respiratory tract infection two weeks ago and subsequently deteriorated. He was treated at home with herbs until his-?became unresponsive and was transported to the hospital where antimicrobial therapy was started. He continued to decline and was pronounced doad. A?topsy shows organizing acute suppurative neutrophilic inflammation of the meninges, purulent ceiebrospinal fluid, and organizing and fibrinoporulent right pleural empyema. There was no suspicions trauma and no bone fracture on skeletal radiographs. Miorobiology culture report shows gram negative bacilli and scant yeast species that are not candida albicans in the right lung and scant gram negative bacilli in tho cexohrospinal fluid. wh?te was no bacterial growth in the blood and left lung. Nasopharyngaal wash is positive for Entoroviruo or Rhinovirus (respiratory virus}. metabolic panel is negative for abnormality. Given that the microbiological culture did not produce positive culture report, most likely due to fact that the responsible organism is a finicky bacterium and might have been killed by the antimicrobial agents used during the treatment, therefore, a non?clinical research methodology to deteot nictoorganismo DNA coding was utilized and this resulted in identification of Hemophilus Influenzao in the oozebrospinal fluid. Homophilus Influenzae are 0 ortunistio atho ens: that is the usuall live in their host without causing disease, Inf-n? Opinion, Ezekiel Stephan died as a result of bacterial meninigits and right: pleural eui?pyema. - ?1:3 - and Rogula?mator Instructlamon handling Wm?oo andIhau-Iramme?m-I-gnl nuopli?. Noun ?f??wwunimm?ns an of the Ot?on o! Ihu Chiot Medical Examiner in?; 1 c? gal-Y nus my m: non of; 33mm a1! Adam any nISTanTcn IN OR IN ?mom; -. . mu armlomzmo 2012/10/31 nthCAmeImsn mm: RETMN cow FOR 11mm 2.52:; Date of this report ransom. use r. STEPHAN. Ezekiel Iasher I 1018-7289 EVIDEN OF Head and Neck No evidence of blunt force injury. 31% No evidence of blunt force injury. mm A 5 1 cm purple contusion is on the anterolatcral proximal left upper arm. RADIOGRAPHS . No evidence of fracture or suSpicious radiOpaque material identi?ed. EXAMINATION CENTRAL NERVOUS SYSTEM: The brain weighs 1155 g. The meninges are remarkable for patchy tan-yellow purulent thick accumulation on the superior and inferior surfaces of the cerebral hemispheres, anterosuperior surfaces of the cerebellar and vermis, and the brainstem. The cerebral vasculatures are congested, and the cerebral. hemispheres are symmetrical and remarkably edematous. The circle of Willis has a normal anatomic arrangement and is [ice of atherosclerosis. Coronal sections of the ?xed brain are grossly unremarkable. Lumbar puncture of the spinal canal demonstrates the presence of purulent cerebrospinal ?uid. NECK: The soft tissues of the neck, including strap muscles and large Vessels, reveal no abnormalities. The hyoid bone and larynx are intact. BODY CAVITIES: The right lower lobe pleura are remarkable for ?rm thick yellow-tan purulent material measuring up to 0.7 cm in thickness. The remaining pleural surface, pcricardia, and peritoneal surfacos are moist, smooth, glistening and remarkable for pctechiae. Multiple patchy adhesions are of the right lower lobe to the chest wall. The organs are in their normal anatomic locations. CARDIOVASCULAR: The heart" weighs 56 g. The pericardial surface is unremarkable, except for petechiae. Coronary arteries arise from normal aortic ostia, follow the usual distribution with a right dominant system, and are free of atherosclerosis. There are no occlusive thrombi. The atrial and ventricular chambers are not dilated and bear the usual position relationship. The ventricular walls are not hypertrophied. The endocardium, myocardium, and cardiac valves are STEPHAN. EzekieIJasher 1018-7239 MICROSCOPIC STUDIES - Brain: Left ?ame] and right temporal poles, and pens are with large subarachnoid sheet of organizing acute suppurative neutrophilic inflammation. No involvement. Right ?'ontal lobe and hippocampus with areas of vascular congestion exhibiting increase leukocytes and cellular margination. Cerebellum with focal subarachnoid sheet of organizing acute suppurative neutrophilic in?ammation. Lungs: Right lung lower lobe visceral pleura with adherent acute ?brinopurulcnt and Organizing in?ammation. Underlying pulmonary is unremarkable. Adjacent right parietal pleural consists of multiple small foci of organizing acute suppurative neutrophilic in?ammation. Left long with vascular congestion and without foci of acute in?ammation. These ?ndings are consistent with organizing and ?brinopurulent right pleural empyema. Bronchi: Trachea with unremarkable adjacent thyroid and parathyroid glands, node and esophagus. . - Heart: No signi?cant microscopic abnormality. Kidneys: No signi?cant microscopic abnormality. Liver: No signi?cant microscopic abnormality. Pancreas: No signi?cant microscopic abnormality. Spleen: No signi?cant microscopic abnormality. Adrenal glands: No signi?cant microscopic abnormality. Testes: No signi?cant microscopic abnormality. Gastrointestinal tract: Stomach, small and large intestines with no signi?cant microscopic abnormality. Government of Alberta Justice and Attorney General Peer Review Form . ?4mm.? --.. . . tffetheiogist ?Bitewdeagbo IPestmertmezemmetion.report .. Hummuh . a .. .. Wettepecim; A M. . . .1 ii"wea?gmgwe??cms??29mleteveqcileectee?MW.MWM. .. . i The Chief Medical Examiner must be noti?ed by the reviewing Pathologist, if there are any ?no? responses in the peer review checklist The pathologist who performed the postmortem examination is responsible for providing testimony on the autopsy. ?m Comments: cf Uta/70: Signature of Reviewing Pathoiogist Dated ?ew Bu: (wit; Name of Reviewing Pathoiogist (printed) USE if there are any "no" responses in the peer review checklist Chief Medical Examiner Noti?ed on by Date (Print name and sig?eture} - Exhibit Tag Court of Queen?s Bench CuseNo. Ollolzc H1461 v. sww?m +Cok+k 01 Marked idem. Entered Exhibit No. Submitted By Cram JO Mail. ?0 CM Date Clerk