[Pathologico-anatomic findings in sudden, unexpected death in children and adults with influenza A infection]

Reappraisal of the SIDS enigma: an epidemiological and clinicopathological approach

The possibility that most cases of sudden infant death syndrome (SIDS) are caused by a transmissible agent is explored. A hypothesis of causation is developed using pathological and epidemiological data and our microbiological findings. The nature and distribution of vascular damage together with the consistent finding of liquid blood, in addition to the epidemiological features of SIDS, form the basis of the hypothesis that a bacterial toxin is a likely single cause of most cases of the syndrome. Future research ideas and a new definition of SIDS are proposed.

[Histologic findings in the lung in sudden infant death]

The lungs of 79 children who had died between the ages of 1 week and 2 years old were histologically examined. 59 of these children could be categorized as cases of Sudden Infant Death because of the history and postmortem findings. In the remaining 20 cases a definite cause of death could be established. This is the same collective on which the histological investigations of the lymphatic tissue has been carried out. Morphological changes which are typical for a virus pneumonia were found in a substantially higher frequency in the cases of Sudden Infant Death than in the control cases. The validity of these findings and their possible significance for the cause of death are discussed.

Pulmonary lymphatics in SIDS--a comparative morphometric study

Pulmonary lymphatics in a group of SIDS cases were compared with a control group of a similar age distribution. The causes of death in the controls were known to be associated with varying degrees of pulmonary edema. The surface areas of pleural, interstitial, peribronchial, periarterial and perivenous lymphatics were planimetrically measured. The data were statistically tested. The tests showed that the pulmonary lymphatics of the SIDS group were significantly more distended than those of the control group as expressed by highly significant differences in their surface areas. On the whole 2142 lymphatics were measured; 1255 in the SIDS group, which consisted of slides from 10 cases and 887 in the control group which consisted of slides from 11 controls. Although the sample size imposes a limit on the general applicability of the results, the clear distinction between the two groups as shown by the tests do indicate a possible feature of SIDS--lymphatic stasis--which might be secondary to some impairment of lymphatic drainage. This in turn could induce subtle fibrotic changes in the connective tissue framework of these lungs. The results are presented in the light of the forensic significance of the signs of asphyxia frequently found in SIDS and the diagnostic difficulties encountered in differentiating between SIDS and mechanical asphyxia e.g. due to smothering.

[Selective detection of cytomegalovirus by in situ hybridization]

In two SIDS autopsy cases, in situ hybridization with biotin-labeled DNA probes was used to demonstrate a specific cytomegalovirus (CMV) infection in paraffin-embedded tissue sections. This technique represents a rapid, specific, and highly sensitive tool for the detection of CMV infections and is recommended for routine examination in other suspected viral infections, particularly in cases connected with SIDS.