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

Abstract

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.

Pathological, Bacteriological and Virological Findings in Sudden and Unexpected Deaths in Young Dogs

“…Infections are reported in the literature as an important cause of SUID, followed by metabolic or molecular disorders [ 2 , 3 , 4 , 5 ]. The main pathogens reported in SUID cases are as follows: Staphylococcus aureus , Escherichia coli , Streptococcus pyogenes , Streptococcus agalactiae , Streptococcus pneumoniae , Group B Streptococci (GBS), Respiratory Syncytial Virus (RSV), Cytomegalovirus (CMV) and Adenovirus [ 2 , 6 , 7 ]. However, a broad range of pathogens has been reported in the literature as being causes or a co-factors in SUID, such as Parvovirus B19, Epstein-Barr virus, Influenza A virus and Mycobacterium tuberculosis [ 2 , 6 , 8 , 9 ].…”

Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

“…Despite the high mortality rate of the more invasive forms16, the impact of CMV infections on the morbidity and mortality of SLE patients is still poorly documented. However, in clinical practice, CMV has been associated with vasculopathies, Raynaud's phenomenon17, fevers of undetermined origin, pneumonia, myocarditis, nephritis, meningoencephalitis as well as the appearance of antiphospholipid antibodies18.…”

“…However, in clinical practice, CMV has been associated with vasculopathies, Raynaud's phenomenon17, fevers of undetermined origin, pneumonia, myocarditis, nephritis, meningoencephalitis as well as the appearance of antiphospholipid antibodies18. Invasive forms have been documented mainly through biopsies (or necropsies) in which the goal was the detection of inclusion bodies or immunohistochemistry markers in tissue16. In general, in transplantation medicine, pp65 antigenemia is less sensitive in relation to RT-PCR, especially in invasive gastrointestinal disease or in the presence of neutropenia.…”

Detection of Cytomegalovirus in Intestinal Tissue of Infants with Necrotizing Enterocolitis or Spontaneous Intestinal Perforation

“…Similar autopsy findings of disseminated CMV infection have been seen among infants with sudden unexplained death. 39 Platelet counts were significantly lower among infants whose intestinal tissue contained CMV, and thrombocytopenia could serve as an indication for CMV testing in patients with NEC or SIP. However, although both infants with NEC with unsuspected disseminated infection were thrombocytopenic, only 1 had a positive urine CMV PCR, and the other was negative.…”