Thesis (MScMedSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Sudden Unexpected Death in Infancy (SUDI) refers to any such sudden demise in a
child. If the child dies while asleep within the first year of life, and if no conclusive
cause of death can be ascertained by means of complete autopsy and investigation into
the circumstances surrounding death, including visit of the death scene, such a case is
classified as one of Sudden Infant Death Syndrome (SIDS). By South African law, a
full medico-legal autopsy is mandated in cases where the cause of death is not evident
– including cases of possible SIDS.
There can be little doubt that viral infection can be a cause of death in cases of
supposed SUDI. At the Tygerberg medico-legal (forensic) laboratory, the evaluation
of lung tissue for the presence of fatal viral lung infections forms part of the
institutional protocol for the examination of SUDI cases. Lung samples of these SUDI
cases are routinely tested for the presence of Cytomegalovirus (CMV), adenovirus
and respiratory syncytial virus (RSV) by means of shell vial cultures. In a
retrospective pilot study of 366 SUDI case files from Tygerberg Hospital, Western
Cape, from 2004 – 2006, it was evident that in only 13.9% of possible SIDS cases,
positive results for one or more of the aforementioned viruses were obtained.
We hypothesise that the current method of virus detection, together with other factors
such as the interval between death and post mortem examination, transport time of the
specimens to the laboratory etc. might not be optimal to give a realistic picture of
death in infancy caused by viral pulmonary infection. As other test modalities exist
for the diagnosis of pulmonary viral infections, these methods were compared in
terms of positive yield and association with viral pneumonitis, keeping the cost and
time needed for each assay in mind.
A total of 82 samples were collected over an 8 month period and routine shell vial
cultures were done, followed by real-time Polymerase Chain Reaction (PCR) and
immunohistochemical (IHC) staining of the lung sections with consensus pathology
opinion. As expected, the real-time PCR method was much more better suited for
identifying positive samples than shell vials (35% vs. 3.7% respectively). IHC
staining also aided the pathologist in diagnosing viral infections microscopically. We
expect the findings to be instrumental in streamlining not only our institutional SIDS investigation protocol, but also the development of a standardised national SIDS
investigation protocol. / AFRIKAANSE OPSOMMING: “Sudden Unexpected Death in Infancy” (SUDI) verwys na enige skielike sterfte van
‘n kind. Indien die kind sterf tydens sy/haar slaap periode en geen oortuigende
oorsaak van dood bepaal kan word deur middel van ’n volledige nadoodse ondersoek
en ondersoek na die omstandighede tydens die dood, insluitend ’n besoek aan die
doodstoneel nie, word so ’n geval as Wiegiedood (SIDS) geklassifiseer. SuidAfrikaanse wetgewing vereis ’n volledige medies-geregtelike nadoodse ondersoek in
gevalle waar die oorsaak van dood onbekend is – insluitend gevalle van moontlike
Wiegiedood.
Daar is min twyfel dat virusinfeksie ‘n oorsaak van, of bydraende faktor tot dood kan
wees in gevalle van moontlike SUDI. By die Tygerberg forensiese laboratorium vorm
die evaluasie van long weefsel vir die teenwoordigheid van dodelike virusinfeksies
deel van die institusionele protokol vir die ondersoek van SUDI gevalle. Long
monsters van hierdie SUDI gevalle ondergaan roetine toetse vir die teenwoordigheid
van sitomegaalvirus, respiratoriese sinsitialevirus en adenovirus deur middel van
selkulture (“shell vial cultures”). In ‘n retrospektiewe steekproef van 366 SUDI
gevalle by Tygerberg Hospitaal, Wes-Kaap van 2004 – 2006, is bevind dat in slegs
13.9% van moontlike SUDI gevalle die teenwoordigheid van een of meer van
bogenoemde virusse bevestig kon word. Ons hipotese is dat hierdie metode van virus
deteksie, tesame met ander faktore soos die tydsinterval tussen dood en nadoodse
ondersoek, tyd om monsters na die laboratorium te vervoer ens. moontlik nie optimaal
is om ‘n realistiese beeld van dood in babas as gevolg van pulmonale virusinfeksie te
gee nie. Aangesien ander toets modaliteite bestaan vir die diagnose van pulmonale
virusinfeksies, is hierdie metodes vergelyk in terme van positiewe opbrengs en
assosiasie met virale pneumonitis, teen ’n agtergrond van die koste en tyd benodig per
toets.
’n Totaal van 82 monsters is oor ‘n 8 maande periode versamel en roetine selkulture is
gedoen, gevolg deur “real-time” Polimerase Ketting Reaksie (PKR), asook
immunohistochemiese (IHC) kleuring van long snitte met patologiese verslae. Soos
vermoed, is gevind dat die real-time PKR metode baie meer akkuraat is om positiewe
monsters te identifiseer as roetine selkulture (35% vs 3.7% onderskeidelik). IHC kleuring het ook mikroskopiese diagnose van virale infeksies deur die patoloog
vergemaklik. Ons verwag dat hierdie bevindinge grootliks kan bydra in die
vaartbelyning van ons institusionele SIDS ondersoek protokol, asook in die
ontwikkeling van ’n gestandaardiseerde nasionale SIDS ondersoek protokol.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/6488 |
| Date | 03 1900 |
| Creators | Burger, Marilize Cornelle |
| Contributors | De Beer, Corena, Dempers, Johan J., University of Stellenbosch. Faculty of Health Sciences. Dept. of Pathology. Medical Virology. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 109 p. : ill. |
| Rights | University of Stellenbosch |
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