Myocarditis Presenting as Sudden Death in Infants and Children: A Single Centre Analysis by ESGFOR Study Group

Background Acute myocarditis is an inflammatory disease of the heart mostly diagnosed in young people, which can present as sudden death. The etiology includes infectious agents (mostly viruses), systemic diseases and toxins. We aim to characterize infants and children with myocarditis at post-mortem presenting as sudden deaths. Methods Retrospective evaluation of 813 post-mortems in infants and children dying suddenly and unexpectedly between 2009–2019. Data retrieved included histological features, microbiology and clinical history. Results 23 of 813 post-mortems reviewed corresponded to acute myocarditis and 1 to dilated cardiomyopathy related to remote Parvovirus infection. PCR identified enterovirus (7), parvovirus (7 cases, 2 also with HHV6 and 1 case with EVB), Influenza A (1), Parainfluenza type 3 (1). Two cases corresponded to hypersensitivity myocarditis, 1 was Group A Streptococcus and 5 idiopathic myocarditis. Enterovirus was frequent in infants (7/10), and in newborns was associated with meningoencephalitis or congenital myocarditis. More than 50% were less than 2 years of age and all remained clinically unsuspected. Conclusion Myocarditis represents almost 3% of all sudden pediatric deaths. Enterovirus and parvovirus were the most common viruses. This retrospective analysis showed that patients experienced viral symptoms but remained unsuspected, highlighting the need for more clinical awareness of myocarditis.

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Induction of cyclophilin A by influenza A virus infection facilitates group A Streptococcus coinfection

Cell Reports ◽

10.1016/j.celrep.2021.109159 ◽

2021 ◽

Vol 35 (7) ◽

pp. 109159

Author(s):

Xiaoyuan Bai ◽

Wenxian Yang ◽

Xiaohan Luan ◽

Huizi Li ◽

Heqiao Li ◽

...

Keyword(s):

Virus Infection ◽

Influenza A Virus ◽

Influenza A ◽

Group A Streptococcus ◽

Cyclophilin A ◽

Group A ◽

Influenza A Virus Infection

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Certification of Vehicular Hyperthermia Deaths in the Pediatric Population

Academic Forensic Pathology ◽

10.23907/2016.061 ◽

2016 ◽

Vol 6 (4) ◽

pp. 657-662

Author(s):

Reade A. Quinton

Keyword(s):

Ambient Temperature ◽

Cause Of Death ◽

Pediatric Population ◽

Clinical History ◽

Infants And Children ◽

Manner Of Death ◽

Autopsy Findings ◽

Scene Investigation ◽

Medical Examiners ◽

In Infants And Children

The investigation of vehicular hyperthermia deaths in infants and children requires coordination between the autopsy, clinical history, and scene investigation. Unfortunately, autopsy findings can be limited or nonspecific, clinical history may be unavailable, and details concerning ambient temperature and vehicular temperature may be vague. In cases where hyperthermia is established as the cause of death, the certification of manner of death can be challenging and inconsistent among medical examiners. This article provides an overview of vehicular hyperthermia deaths and the certification of cause and manner of death in these cases.

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The novel influenza a (H1N1) infection in infants and children

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v8i4.4705 ◽

1970 ◽

Vol 8 (4) ◽

pp. 84-90

Author(s):

Musa Mohd. Nordin

Keyword(s):

Influenza A ◽

Infants And Children ◽

The Novel ◽

H1n1 Infection ◽

Medical Sciences ◽

Influenza A H1n1 ◽

Spanish Flu ◽

Novel Influenza A ◽

In Infants And Children

During the 1918 Spanish Flu pandemic, often described as the most devastating epidemic in recorded history, 1 in 5 person was infected and an estimated 50 million lives were lost. The disease was so widespread and pervasive that even the children had a tune which they skipped rope to: I had a little bird, its name was Enza, I opened the window and In-Flu-Enza. DOI: 10.3329/bjms.v8i4.4705 Bangladesh Journal of Medical Sciences Vol.8(4); October 2009 pp84-90

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Genome Sequence of a Nephritogenic and Highly Transformable M49 Strain of Streptococcus pyogenes

Journal of Bacteriology ◽

10.1128/jb.00672-08 ◽

2008 ◽

Vol 190 (23) ◽

pp. 7773-7785 ◽

Cited By ~ 89

Author(s):

W. Michael McShan ◽

Joseph J. Ferretti ◽

Tadahiro Karasawa ◽

Alexander N. Suvorov ◽

Shaoping Lin ◽

...

Keyword(s):

Streptococcus Pyogenes ◽

Group A Streptococcus ◽

Genetic Material ◽

Model Organism ◽

Nudix Hydrolase ◽

History Of ◽

Group A ◽

Short Palindromic Repeat ◽

Post Streptococcal Glomerulonephritis ◽

Type 3

ABSTRACT The 1,815,783-bp genome of a serotype M49 strain of Streptococcus pyogenes (group A streptococcus [GAS]), strain NZ131, has been determined. This GAS strain (FCT type 3; emm pattern E), originally isolated from a case of acute post-streptococcal glomerulonephritis, is unusually competent for electrotransformation and has been used extensively as a model organism for both basic genetic and pathogenesis investigations. As with the previously sequenced S. pyogenes genomes, three unique prophages are a major source of genetic diversity. Two clustered regularly interspaced short palindromic repeat (CRISPR) regions were present in the genome, providing genetic information on previous prophage encounters. A unique cluster of genes was found in the pathogenicity island-like emm region that included a novel Nudix hydrolase, and, further, this cluster appears to be specific for serotype M49 and M82 strains. Nudix hydrolases eliminate potentially hazardous materials or prevent the unbalanced accumulation of normal metabolites; in bacteria, these enzymes may play a role in host cell invasion. Since M49 S. pyogenes strains have been known to be associated with skin infections, the Nudix hydrolase and its associated genes may have a role in facilitating survival in an environment that is more variable and unpredictable than the uniform warmth and moisture of the throat. The genome of NZ131 continues to shed light upon the evolutionary history of this human pathogen. Apparent horizontal transfer of genetic material has led to the existence of highly variable virulence-associated regions that are marked by multiple rearrangements and genetic diversification while other regions, even those associated with virulence, vary little between genomes. The genome regions that encode surface gene products that will interact with host targets or aid in immune avoidance are the ones that display the most sequence diversity. Thus, while natural selection favors stability in much of the genome, it favors diversity in these regions.

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