Browsing by Author "Saayman, Jamie Ester"

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    Profiling Enterovirus and Parvovirus B19 in sudden and unexpected death in infancy (SUDI) at the Tygerberg Medico-legal Mortuary and the role of myocarditis as a possible cause of death
    (Stellenbosch : Stellenbosch University, 2018-03) Saayman, Jamie Ester; De Beer, Corena; Dempers, Johan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Medical Virology.
    ENGLISH SUMMARY: Background: Sudden infant death syndrome (SIDS) remains one of the leading causes of death among infants. The Triple-Risk Model has contributed to identifying modifiable risk factors that may lead to a reduction of SIDS occurrences. Cardiovascular infection contributes significantly to mortality and morbidity in children and adults. Acute myocarditis affects infants more severely than adults and has a known association with Coxsackie-B, Adeno-, parvo- B19, Epstein Barr-, Cytomegalo-, Human herpes-6 viruses. These viruses have been explored in sudden unexpected death in infancy (SUDI) and shown some association between SIDS and myocardial infection. Aim: This study aimed to describe two cardiovascular viruses in SUDI cases and to determine the association of myocarditis to these deaths. Methodology: Heart swab and tissue samples were prospectively collected from SUDI cases at the Tygerberg Medico-legal Mortuary over a one year period. The samples were collected in parallel with routine heart swabs for microbiology analysis and peripheral blood for HIV screening. The SUDI samples were additionally screened for enterovirus and parvovirus B19 by polymerase chain reaction assays. The heart tissue was processed for histological analysis. Sociodemographic information, medical history and final cause of death were obtained during the initial interview with family / caregiver(s) and from case files respectively, and potential risk factors in the SUDI population were identified from the data by statistical analysis. Results: Heart swab and tissue samples were collected from 168 and 161 SUDI cases respectively. The SUDI population consisted of 81 males and 87 females. Majority of deaths (64%) were in infants younger than 14 weeks and 67% occurred during the colder months of the year. In more than half of the cases an infectious cause of death was confirmed, while in 40% death was attributed to SIDS. There was a higher frequency of death among black infants, which is consistent with the literature, however it is not clinically relevant as it is not a representation of the general population profile in the Western Cape. The heart tissue for histology was within normal limits in all but 10 of 161 SUDI cases examined for morphological change associated with viral myocarditis, and 1 of these 10 cases was diagnosed as myocarditis as the final cause of death. The only significant risk factor identified in this population was ethnicity, but the finding was not clinically relevant. Conclusion: The results obtained from this study support the Triple-Risk Model of SIDS. The high proportion of deaths that remained unexplained (i.e. SIDS) emphasizes the need to introduce additional testing, such as molecular based tests which provide significant value when establishing a final cause of death. SIDS research in South Africa is limited and would be valuable in the forensic environment.