Corena de Beer
Stellenbosch University, South Africa
Title: Laboratory investigations in cases of Sudden and Unexpected Death in Infancy (SUDI) in the Tygerberg Medico-legal Mortuary, Cape Town, South Africa
Biography
Biography: Corena de Beer
Abstract
Sudden and unexpected death in infancy (SUDI) is an under-researched field in South Africa. Identifying causes of death remains challenging despite full medico-legal investigations inclusive of autopsy, scene visit and ancillary studies. Viral and bacterial infections have been implicated repeatedly as risk factors for SUDI, but no standard laboratory investigation protocol exist in South Africa. A total of 148 SUDI cases from the Tygerberg Medico-legal Mortuary were collected over a one year period and investigated for respiratory viruses. Samples were collected from the lungs for viral and bacterial culture as part of the institutional SUDI investigation protocol. Two additional molecular assays were performed on nucleic acids extracted from lung tissue to screen for respiratory viruses and individual results were compared with routine histology on lung sections. Agreement between positive viral results and severe interstitial pneumonitis in a small number of cases suggested infection as the cause of death. Disagreement between viral results and histology occurred often and caused doubt on the cause of death in many cases. Demographic information confirmed several risk factors that correspond with the literature. Molecular assays produced higher positive yields for respiratory viruses than routine shell vial culture, but the agreement with interstitial pneumonitis was still suboptimal. Careful interpretation of molecular assays is necessary, due to latent or non-pathogenic viral loads of identified viruses. Agreement between molecular assays was also not significant and reconfirmed the need for different approaches in order to formulate an optimal screening protocol in determining the cause of death in SUDI cases.
