MOLECULAR-IDENTIFICATION OF VIRUSES IN SUDDEN INFANT DEATH ASSOCIATEDWITH MYOCARDITIS AND PERICARDITIS

A subset of infants dying suddenly and unexpectedly have myocarditis w ith or without pericarditis found at autopsy. To address whether virus es known to cause infantile myocarditis and pericarditis might be pres ent in such infants, we examined myocardium, liver and skeletal muscle for the presence of genomic sequences from adenovirus, cytomegaloviru s, enterovirus and echovirus 22/23 in infants enrolled in a comprehens ive evaluation protocol. We studied eight infants who died suddenly an d unexpectedly with histologic evidence of myocarditis and/or pericard itis detected at postmortem examination. One infant with myocarditis a nd pericarditis had adenovirus genome detected in the myocardium. In a n additional infant with severe pericarditis alone, enterovirus genome was detected in the liver. Although echovirus 22/23 has been associat ed with myopericarditis in young infants, no previous studies have use d molecular methods to search for the genomic sequences of these virus es in clinical samples. No echovirus 22/23 genome was detected in the patients reported here. The significance of enterovirus and adenovirus genome in the tissues of two patients dying suddenly and unexpectedly remains speculative but raises the possibility that pathogenic viruse s may cause little or no clinical symptoms and yet be contributory to sudden death in young infants.