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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

dc.contributor.advisorDe Beer, Corenaen_ZA
dc.contributor.advisorDempers, Johanen_ZA
dc.contributor.authorSaayman, Jamie Esteren_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Division Medical Virology.en_ZA
dc.date.accessioned2018-02-18T11:29:34Z
dc.date.accessioned2018-04-09T06:56:39Z
dc.date.available2018-02-18T11:29:34Z
dc.date.available2018-04-09T06:56:39Z
dc.date.issued2018-03
dc.identifier.urihttp://hdl.handle.net/10019.1/103439
dc.descriptionThesis (MMedSc)--Stellenbosch University, 2018.en_ZA
dc.description.abstractENGLISH 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.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Agtergrond: Skielike sterfte in babas (SIDS, SUDI of “wiegiedood”) is steeds een van die hoofoorsake van dood by babas. Die Triple-Risk Model het bygedra tot die identifisering van sekere risikofaktore wat kan lei tot 'n vermindering in wiegiedood gevalle. Kardiovaskulêre infeksie dra aansienlik by tot mortaliteit en morbiditeit in kinders en volwassenes. Akute miokarditis affekteer babas meer ernstig as volwassenes en het 'n bekende assosiasie met Coxsackie-B, Adeno-, parvo-B19, Epstein Barr-, Cytomegalo-, Human herpes-6 virusse. Hierdie virusse is ondersoek in skielike sterftes in babas en het 'n assosiasie tussen wiegiedood en miokardiale infeksie getoon. Doel: Hierdie studie het twee kardiovaskulêre virusse in SUDI-gevalle ondersoek en die bydrae van miokarditis tot hierdie sterftes geëvalueer. Metodes: Deppers en weefsel van die hart is prospektief versamel van SUDI-gevalle by die Tygerberg Mediesgeregtelike Lykshuis oor 'n een jaar tydperk. Hierdie monsters is versamel bo en behalwe die roetine hart deppers vir mikrobiologiese kweking en perifere bloed vir MIV-sifting. Die SUDI monsters is addisioneel getoets vir enterovirus en parvovirus B19 deur middel van ʼn polimerase kettingreaksie metode. Die hartweefsel is geprosesseer vir histologiese analise. Sosiodemografiese inligting, mediese geskiedenis en finale oorsaak van dood is verkry tydens die oorspronklike onderhoud met familie / versorger(s) en gevalle lêers onderskeidelik, en potensiële risikofaktore in die SUDI studiegroep is met statistiese analise geïdentifiseer. Resultate: Deppers en weefsel van die hart is onderskeidelik van 168 en 161 SUDI gevalle versamel. Die studiegroep het 81 seuntjies en 87 dogtertjies ingesluit. Die meerderheid sterftes (64%) het voorgekom in babas jonger as 14 weke en 67% van die gevalle het gedurende die kouer maande van die jaar voorgekom. In meer as die helfte van die gevalle is 'n infektiewe oorsaak van dood bevestig, terwyl die oorsaak van dood in 40% aan SIDS toegeskryf is. Daar was meer swart babas wat gesterf het en hoewel hierdie neiging ooreenstem met die literatuur, is dit nie verteenwoordigend van die algemene bevolking in die Wes-Kaap nie en dus nie klinies relevant nie. Morfologiese veranderinge in die hartweefsel van die gevalle was binne normale perke in 151 van 161 gevalle. In die 10 gevalle met abnormale histologie, het die veranderinge gedui op virale miokarditis, maar die finale oorsaak van dood is in slegs 1 geval as miokarditis gediagnoseer. Gevolgtrekking: Die bevindings van die studie ondersteun die Triple-Risk Model van SIDS. Die hoë persentasie onverklaarbare sterftes (d.w.s. SIDS) beklemtoon die noodsaaklikheid om addisionele analises, soos molekulêre toetse in te sluit in die bepaling van die oorsaak van dood om meer lig te werp op die tipe sterftes. Sulke navorsing in Suid Afrika is uiters beperk en sal ʼn waardevolle bydrae kan lewer in die forensiese veld.af_ZA
dc.format.extentxii, 83 pages ; illustrationsen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.subjectEnterovirus diseasesen_ZA
dc.subjectParvovirus diseasesen_ZA
dc.subjectSudden infant death syndromeen_ZA
dc.subjectMyocarditisen_ZA
dc.subjectInfants -- Deathen_ZA
dc.subjectCardiovascular diseasesen_ZA
dc.subjectUCTD
dc.titleProfiling 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 deathen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch Universityen_ZA


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