title: Postmortem diagnosis of infectious heart diseases: A mystifying cause of Sudden Infant Death.
abstract: Sudden infant death (SID) is an unresolved problem of high relevance and previous studies have indicated a role of viral heart infections. The diagnosis remains difficult in clinical practice using routine diagnostic tests and must be substantially improved. A prospective study based on post-mortem samples from SID victims whose heart disease was not clinically recognized was conducted for 4 years in a Tunisian University Hospital. Pediatric cases of unnatural death served as controls. Both SID victims and controls were investigated for possible coxsackievirus-B (CV-B) infection in heart tissue. During the study period, 39 cases with a male predominance (77%) were reported. There was no positive family history of coronary artery disease among the victims. In 35 cases (90%), low birth weight and/or critical development period were reported. All SID victims had complained of mild fever and insomnia for a few days preceding death, which required infectious laboratory investigations marked with an elevated white blood cell count (WBC) and C-reactive protein (CRP). The cardiac biomarkers were also elevated. The histopathological investigations of the heart tissue samples revealed signs of myocardial and pericardial inflammation. Enterovirus was detected by immunohistochemistry (IHC) and PCR from myocardial samples from 6 cases (15.3%) having myocarditis and 3 cases (7.7%) having perimyocarditis. The current study is of great interest and is aimed at urging health professionals to adopt systematically long intensive heart care in infants with underlying vulnerability as well as new diagnostic approaches including histopathology complemented with IHC and molecular pathology.
authors.affiliation: Laboratory of Transmissible Diseases LR99-ES27, Faculty of Pharmacy, Avenue Avicenne 5000, Monastir, Tunisia; University of Vermont, Department of Pathology, Division of Experimental Pathology, Burlington, USA; University of Vermont, DNA Microarray Facility, 305 Health Science Research Facility, Burlington, USA; University of Vermont, Department of Pathology, 208 South Park Drive, Suite #2, Colchester, VT 05446, USA. Electronic address: chbeli_imed@yahoo.fr.
authors.forename: Imed
authors.initials: I
authors.lastname: Gaaloul
authors.affiliation: Laboratory of Transmissible Diseases LR99-ES27, Faculty of Pharmacy, Avenue Avicenne 5000, Monastir, Tunisia.
authors.forename: Samira
authors.initials: S
authors.lastname: Riabi
authors.affiliation: University of Vermont, Department of Pathology, Division of Experimental Pathology, Burlington, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Evans
authors.affiliation: University of Vermont, DNA Microarray Facility, 305 Health Science Research Facility, Burlington, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Hunter
authors.affiliation: University of Vermont, Department of Pathology, 208 South Park Drive, Suite #2, Colchester, VT 05446, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Huber
authors.affiliation: Laboratory of Transmissible Diseases LR99-ES27, Faculty of Pharmacy, Avenue Avicenne 5000, Monastir, Tunisia.
authors.forename: Mahjoub
authors.initials: M
authors.lastname: Aouni
mesh_terms: D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003384:Coxsackievirus Infections / Q000175:diagnosis*; D004770:Enterovirus / Q000235:genetics; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007964:Leukocytosis / Q000209:etiology; D008297:Male; D009205:Myocarditis / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013398:Sudden Infant Death / Q000209:etiology*; D014416:Tunisia
chemical_list: D002097:C-Reactive Protein
keywords: Coxsackievirus B; Histopathology; Immunohistochemistry; Molecular pathology; Sudden infant death