Myocarditis and sudden infant death syndrome.
This is a retrospective survey of findings of myocarditis in 437 infants under the age of 1 year who died suddenly and unexpectedly between 1982 and 1999, and were investigated at the Department of Forensic Medicine in Stockholm, Sweden. Myocarditis was diagnosed in 69/410 infants who died naturally (16.8%) and in 2/27 violent deaths (7.4%). In 43/410 natural deaths (10.5%) the myocarditis was an isolated finding and the only explanation for cause of death and in 26 (6.3%) there were additional possible causes of death. The myocarditis was acute in 45/69 and chronic in 24/69 natural deaths, and was found to occur as early as at a few weeks of age. No specific risk factors were found when reviewing critical time of year, age, gender, previous symptoms, sleeping position, aspiration of gastric contents and environmental factors in infant deaths with finding of myocarditis compared to 313 deaths due to sudden infant death syndrome. Myocarditis was found in 13 of 37 deaths where cultures for cytomegalovirus were positive. More than 50% of the foci of the isolated myocarditis were located in the upper part of the interventricular septum and the adjacent part of the right atrium, areas including parts of the conduction system. This localisation is significant for the cause of death when comparing deaths with myocarditis as an isolated finding to deaths with other possible causes.
Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden. petra.almqvist@rmv.se
Petra
P
Råsten-Almqvist
Staffan
S
Eksborg
Jovan
J
Rajs
D000208:Acute Disease; D002908:Chronic Disease; D003587:Cytomegalovirus / Q000302:isolation & purification; D006306:Health Surveys; D006329:Heart Conduction System / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation; D008297:Male; D009205:Myocarditis / Q000150:complications* / Q000473:pathology / Q000821:virology; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D012189:Retrospective Studies; D013398:Sudden Infant Death / Q000453:epidemiology / Q000209:etiology*; D013548:Sweden / Q000453:epidemiology