The respiratory pathology in infants with sudden unexpected deaths in whom respiratory specimens were initially PCR-positive or PCR-negative for Bordetella pertussis

Abstract

Background In a previous controlled study, we investigated the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants (sudden infant death syndrome, SIDS). In this present study, we investigated further the respiratory pathology in a subset of infants in the original study. Methods Originally, there were 234 infants with SIDS and, of these, 12 had either a nasopharyngeal swab (NPS) or a tracheal swab specimen (TS) that was positive for B. pertussis by polymerase chain reaction (PCR). Here, tissue specimens from eight infants who were originally PCRpositive were compared with tissue specimens from seven infants in whom the original PCR studies were negative. Results The histopathologic diagnoses were as follows: 14 of 15 had pulmonary edema and the remaining case had early diffuse alveolar damage. Although 14 of 15 cases had some histologic or clinical evidence suggesting respiratory tract infection, the features were more consistent with a viral etiology, and in none were the findings typical of respiratory disease attributable to B. pertussis. ConclusionsThe findings in this present investigation do not support a direct role of B. pertussis at the site of infection (ciliated epithelium) in the causation of SIDS. The clinical aspects of this study were carried out in the 1990s when pertussis was widespread in Germany. Therefore, the original finding of some PCR-positive cases is not surprising. The possibility that B. pertussis infection could still be a factor in some SIDS cases, e.g., by a systemic release of toxins, cannot be definitely ruled out.

Management and prevention of pertussis infection in neonates

“…However, the same authors investigated the respiratory pathology further in these infants, concluding that a direct role of B. pertussis has not been supported in the pathogenesis of sudden infant death syndrome. Otherwise, an indirect effect of this infection (i.e., toxin release) cannot be excluded [11].…”

Epidemiología y estrategias de control para pertussis, una enfermedad resurgente

“…En los pulmones, la primera lesión causada por pertussis parece ser la hiperplasia linfoide de los nódulos linfáticos peribronquiales y traqueobronquiales. Se ha reportado que pueden ocurrir incluso necrosis y descamación de las capas superficiales epiteliales de los bronquios pequeños [50]. En la mayoría de los casos de muerte por pertussis los pacientes presentan bronconeumonía, generalmente debida a una infección secundaria.…”