Infant mortality, microglial nodules and parotid CMV-type inclusions

Clinical and experimental aspects of breathing modulation by inflammation

Neuroinflammation is produced by local or systemic alterations and mediated mainly by glia, affecting the activity of various neural circuits including those involved in breathing rhythm generation and control. Several pathological conditions, such as sudden infant death syndrome, obstructive sleep apnea and asthma exert an inflammatory influence on breathing-related circuits. Consequently breathing (both resting and ventilatory responses to physiological challenges), is affected; e.g., responses to hypoxia and hypercapnia are compromised. Moreover, inflammation can induce long-lasting changes in breathing and affect adaptive plasticity; e.g., hypoxic acclimatization or long-term facilitation. Mediators of the influences of inflammation on breathing are most likely proinflammatory molecules such as cytokines and prostaglandins. The focus of this review is to summarize the available information concerning the modulation of the breathing function by inflammation and the cellular and molecular aspects of this process. I will consider: 1) some clinical and experimental conditions in which inflammation influences breathing; 2) the variety of experimental approaches used to understand this inflammatory modulation; 3) the likely cellular and molecular mechanisms.

Postmortem diagnosis of cytomegalovirus and accompanying other infection agents by real-time PCR in cases of sudden unexpected death in infancy (SUDI)

As an opportunistic pathogen with high mortality rates, Cytomegalovirus (CMV) may lead to fatal disseminated CMV infection of the premature and newborn; thus necessitating the demonstration of CMV-DNA with clinical history and/or histopathological findings of CMV infection and defining other bacterial and viral infection agents with real-time polymerase chain reaction (RT-PCR) in udden unexpected death in infancy (SUDI) cases as we aimed in this study.

314 (144 female, 170 male) SUDI cases were prospectively investigated from January 2013 to January 2015 in Istanbul Forensic Medicine Institution. The study includes 87 tissue samples of 39 cases for post-mortem histopathological examination of interstitial pneumonia, myocarditis, meningitis, encephalitis, hepatitis, colitis or tubulointerstitial nephritis and/or accompanying chronic sialadenitis.

CMV-DNA was found positive in 35 (40.2%) salivary gland, 19 (21.8%) lung, 1 (1.1%) tonsil, and 1 (1.1%) brain tissues. CMV sialadenitis and/or CMV pneumonia associated with other viral and/or bacterial agents were detected in 23 (60%) of 39 infant cases.

The demonstration of CMV-DNA would significantly clarify the cause of death and collection of epidemiological data in SUDI cases with clinical history and histopathological findings of CMV infection accompanying chronic CMV sialadenitis. Furthermore, CMV suppresses the immune system, and may predispose to other bacterial and/or viral infections in these cases. Post-mortem molecular investigations are useful in explaining cause of death in SUDI with a suspicion of infection in forensic autopsies.

•

CMV may lead to fatal disseminated CMV infection of the premature and newborn.

•

Our study is the first comprehensive study investigating CMV infections in SUDI.

•

CMV suppresses the immune system, and may predispose to other infections.

•

Postmortem molecular investigations are useful in explaining cause of death in SUDI.

Minor inflammatory lesions and sudden infant death: cause, coincidence, or epiphenomena?

Minor inflammatory changes are often found in tissues of infants who die suddenly. Recently it has been proposed that these infiltrates signal significant underlying infectious disease and are responsible for death. Currently there is no unanimity about the percentage of cases in which inflammatory infiltrates occur and no international consensus in regard to the minimal criteria required for their diagnosis or their significance. We recommend that the presence of minor inflammatory infiltrates should not detract from the diagnosis of sudden infant death syndrome (SIDS) until further study has determined otherwise.

A comparison of the incidence of cytomegalovirus inclusion bodies in submandibular and tracheobronchial glands in SIDS and non-SIDS autopsies

Submandibular salivary glands and tracheobronchial glands from postmortem examinations of 89 cases of sudden infant death syndrome (SIDS) and 67 age-matched control cases in which death was not due to SIDS were examined for the presence of intranuclear and intracytoplasmic inclusions characteristic of cytomegalovirus (CMV). Inclusions were identified by light microscopy and confirmed by immunohistochemistry in submandibular glands of 5 of 89 (5.6%) SIDS and 6 of 67 (8.9%) non-SIDS patients. No inclusions were found in tracheobronchial glands. No further cases were detected following immunoperoxidase studies and examination of multiple levels of inflamed submandibular glands. Brain stem glial knots were found in only one case with CMV inclusions, which was a non-SIDS case with death due to congenital immunodeficiency. We have found no difference in the incidence of CMV inclusions in the submandibular gland between SIDS and age-matched non-SIDS infants. No strong association between CMV inclusions in salivary gland and brain stem glial knots was present.