title: 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.
authors.affiliation: Council of Forensic Medicine, Department of Postmortem Microbiology, Istanbul, Turkey. Electronic address: gyagmur1970@hotmail.com.
authors.forename: Gulhan
authors.initials: G
authors.lastname: Yagmur
authors.affiliation: Council of Forensic Medicine, Department of Postmortem Microbiology, Istanbul, Turkey.
authors.forename: Nihan
authors.initials: N
authors.lastname: Ziyade
authors.affiliation: Council of Forensic Medicine, Department of Postmortem Microbiology, Istanbul, Turkey.
authors.forename: Neval
authors.initials: N
authors.lastname: Elgormus
authors.affiliation: Council of Forensic Medicine, Department of Histopathology, Istanbul, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Das
authors.affiliation: Council of Forensic Medicine, Department of Autopsy, Istanbul, Turkey.
authors.forename: M Feyzi
authors.initials: MF
authors.lastname: Sahin
authors.affiliation: Council of Forensic Medicine, Department of Histopathology, Istanbul, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Yildirim
authors.affiliation: Council of Forensic Medicine, Department of Histopathology, Istanbul, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Ozgun
authors.affiliation: Council of Forensic Medicine, Department of Histopathology, Istanbul, Turkey.
authors.forename: Arzu
authors.initials: A
authors.lastname: Akcay
authors.affiliation: Council of Forensic Medicine, Department of Histopathology, Istanbul, Turkey.
authors.forename: Ferah
authors.initials: F
authors.lastname: Karayel
authors.affiliation: Council of Forensic Medicine, Department of Autopsy, Istanbul, Turkey.
authors.forename: Sermet
authors.initials: S
authors.lastname: Koc
mesh_terms: D001921:Brain / Q000821:virology; D001923:Brain Chemistry; D003587:Cytomegalovirus / Q000235:genetics* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D004279:DNA, Viral / Q000302:isolation & purification*; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000737:chemistry / Q000382:microbiology / Q000821:virology; D008297:Male; D009205:Myocarditis / Q000821:virology; D014066:Palatine Tonsil / Q000737:chemistry / Q000821:virology; D018410:Pneumonia, Bacterial / Q000175:diagnosis; D011024:Pneumonia, Viral / Q000175:diagnosis; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D012469:Salivary Glands / Q000737:chemistry / Q000821:virology; D012793:Sialadenitis / Q000821:virology; D013398:Sudden Infant Death / Q000209:etiology*; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification
chemical_list: D004279:DNA, Viral
keywords: Autopsy; Cytomegalovirus; Paraffin embedded tissues; Post-mortem microbiology; Real-time PCR; SUDI