title: Post-mortem diagnosis, of cytomegalovirus and varicella zoster virus co-infection by combined histology and tissue molecular biology, in a sudden unexplained infant death.
abstract: BACKGROUND
  An autopsy case of a two-month-old male infant who suddenly and unexpectedly died during his sleep, eight days after the onset of benign varicella.
  
  
  OBJECTIVE
  To describe post-mortem combined histological and tissue molecular biological techniques for the diagnosis of cytomegalovirus and varicella zoster virus co-infection as a cause of death.
  
  
  METHODS
  Real-time quantitative PCR and RT-PCR assays for Herpesviruses, respiratory viruses, Adenovirus, Enterovirus and Parvovirus B19 were performed on multi-organ frozen samples and paraffin-embedded tissues in combination with histology.
  
  
  RESULTS
  Cytomegalovirus and varicella zoster virus were detected by molecular biology with highest viral loads detected in the lungs (4.6×10(7) and 1.9×10(5) genome copies per million of cells, respectively). Pulmonary extensive necrotizing inflammation and immunohistochemistry correlated to virological data. Virological molecular biology was negative on paraffin-embedded tissues.
  
  
  CONCLUSIONS
  This case shows that thorough quantitative virological investigations on frozen tissues must be performed in combination with histology and immunohistochemistry for the determination of the cause of a sudden unexplained infant death.
authors.affiliation: Clinical and Molecular Virology Unit, University Hospital, Reims, France; EA-4684 Cardiovir SFR-CAP Sante, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Desmons
authors.forename: Caroline
authors.initials: C
authors.lastname: Terrade
authors.forename: Camille
authors.initials: C
authors.lastname: Boulagnon
authors.forename: Delphine
authors.initials: D
authors.lastname: Giusti
authors.forename: Yohan
authors.initials: Y
authors.lastname: Nguyen
authors.forename: Laurent
authors.initials: L
authors.lastname: Andreoletti
authors.forename: Paul
authors.initials: P
authors.lastname: Fornes
authors.forename: Beatrice
authors.initials: B
authors.lastname: Digeon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Leveque
mesh_terms: D060085:Coinfection / Q000175:diagnosis* / Q000821:virology; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D004279:DNA, Viral / Q000737:chemistry / Q000235:genetics; D003645:Death, Sudden; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006651:Histocytochemistry; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology / Q000821:virology; D008297:Male; D008969:Molecular Sequence Data; D057089:Pathology, Molecular; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA
chemical_list: D004279:DNA, Viral
keywords: Cytomegalovirus; Histopathology; Real-time PCR assay; Sudden unexpected infant death; Varicella zoster virus; Virology