International Journal of Legal Medicine

, Volume 105, Issue 6, pp 333–338 | Cite as

The potential role of bacterial toxins in Sudden Infant Death Syndrome (SIDS)

  • C. C. Blackwell
  • A. T. Saadi
  • M. W. Raza
  • D. M. Weir
  • A. Busuttil
Original Articles

Summary

Toxigenic bacteria have been implicated in some cases of Sudden Infant Death Syndrome (SIDS). Although there is not much evidence thatClostridia spp. are associated with SIDS in Britain, strains ofStaphylococcus aureus producing pyrogenic toxins have been isolated from significant numbers of these infants at autopsy. The pyrogenic toxins, produced by some strains of group AStreptococcus pyogenes as well as staphylococci, are powerful “superantigens” that have significant physiological effects including induction of fever > 38°C. In this article, interactions between genetic and environmental factors that might enhance colonization of epithelial surfaces by toxigenic staphylococci are analyzed: infant's expression of Lewisa antigen which acts as a receptor for some microorganisms; viral infections; the effect of mother's smoking on susceptibility to respiratory infection. Based on epidemiological findings and laboratory investigations, a hypothesis is proposed to explain how bacteria producing pyrogenic toxins might contribute to some cot deaths.

Key words

Bacterial-toxins SIDS 

Zusammenfassung

In einigen Fällen des Sudden Infant Death Syndrom (SIDS) wurde die Rolle Toxin bildender Bakterien diskutiert. Obwohl es keinen Beweis gibt, daß Clostridia spp. mit SIDS in Großbritanien assoziiert sind, sind von signifikanter Anzahl dieser Kinder bei der Autopsie Stämme von Stapylokkokus aureus isoliert worden, welche Fieber erzeugende Toxine produzieren. Die Fieber erzeugenden Toxine, welche von einigen Stämmen der Gruppe A Streptokkokus pyogenes produziert werden, wie auch von Staphylokkoken, sind mächtige „Superantigene”, welche signifikante physiologische Effekte haben unter Einbeziehung der Induktion von Fieber mit mehr als 38°C. In diesem Artikel werden Interaktionen zwischen genetischen und Umgebungsfaktoren erörtert, welche die Kolonisierung epithelialer Oberflächen durch Toxin bildende Staphylokkoken steigern könnten: die Expression des Lewisa Antigens des Kindes, welches als Rezeptor für einige Mikroorganismen wirksam ist; virale Infektionen; die Auswirkung des mütterlichen Rauchens auf die Empfänglichkeit für Atemwegsinfektionen. Basierend auf epidemiologischen Befunden und Laboratoriumsuntersuchungen wird eine Hypothese vorgeschlagen, wie Bakterien; welche pyrogene Toxine produzieren, zu einigen plötzlichen Kindstodesfällen beitragen könnten.

Schlüsselwörter

Bakterien-Toxine SIDS 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Berry PJ, Keeling JW (1989) The investigation of sudden infant death in infants. In: Anthony PP, MacSween RND (eds) Recent advances in histopathology. Churchill Livingstone, London, pp 251–279Google Scholar
  2. 2.
    Froggat P, Lynas MA, Mackenzie G (1971) Epidemiology of sudden unexpected death in infants in N. Ireland. Br J Paediatr Soc Med 25:119–134Google Scholar
  3. 3.
    Carpenter RG, Gardner A (1982) Variations in unexpected infant death rates relating to age, sex and season. Studies on medical and population subjects. HM Stationery Office, London, 45:23–31Google Scholar
  4. 4.
    Valdes-Dapena MA (1967) Sudden and unexpected death in infancy: a review of the world literature 1954–1966. Pediatrics 39:123–138PubMedGoogle Scholar
  5. 5.
    Entrup M, Brinkmann B (1990) Histologische Lungenbefunde beim plötzlichen Kindstod. Z Rechtsmed 103:425–433PubMedGoogle Scholar
  6. 6.
    Berg VS, Kijewski S (1984) Histologische Befunde an 244 Fä1len von plötzlichem Säuglingstod im norddeutschen Raum. In: Wilske J (ed) Der plötzliche Säuglingstod (SIDS). Springer, Berlin Heidelberg New York, pp 153–160Google Scholar
  7. 7.
    Bonham GS, Wilson RW (1989) Childrens health in families with cigarette smokers. Am J Publ Health 71:290–293Google Scholar
  8. 8.
    Mitchell EA (1991) Cot death: should the prone sleeping position be discouraged? J Paediatr Child Health 27:319–321PubMedGoogle Scholar
  9. 9.
    Wald N, Kiryluk S, Darby S, Doll R, Pike M, Peto R (1988) UK smoking statistics. Oxford University Press, OxfordGoogle Scholar
  10. 10.
    Scott DJ, Gardner PS, McQuillan J, Stanton AN, Downham MAPS (1978) Respiratory viruses and cot death. BMJ ii: 12–13Google Scholar
  11. 11.
    Williams AL, Uren EC, Bretherton L (1984) RSV and SIDS. BMJ 288:1491–1493PubMedGoogle Scholar
  12. 12.
    Fleming K (1992) Upper airways inflammation and detection of viral nucleic acid in SIDS. J Clin Pathol 45 (Suppl):17–19PubMedGoogle Scholar
  13. 13.
    Howatson AG (1992) Alpha interferon and enteroviral infection in SIDS. J Clin Pathol 45 (Suppl):25–28Google Scholar
  14. 14.
    Arnon SS, Midura TF, Damus K, Wood RM, Chin J (1978) Intestinal infection and toxin production byClostridium botulinum as one cause of sudden infant death syndrome. Lancet 1273–1276Google Scholar
  15. 15.
    Arnon SS, Damus K, Chin J (1981) Infant botulism: epidemiology and relation to sudden infant death syndrome. Epidemiol Rev 3:45–66PubMedGoogle Scholar
  16. 16.
    Sonnabend OAR, Sonnabend WFF, Krech U, Molz G, Sigrist TT (1985) Continuous microbiological and pathological study of 70 sudden and unexpected infant deaths: toxigenic intestinalClostridium botulinum infection in 9 cases of sudden infant death syndrome. Lancet i:237–241Google Scholar
  17. 17.
    Anonymous Editorial (1986) Infant botulism. Lancet i:1256–1257Google Scholar
  18. 18.
    Turner HD, Brett EM, Gilbert RJ, Ghosh AC, Liebeschuetz HJ (1978) Infant botulism in England. Lancet i:1277–1278Google Scholar
  19. 19.
    Arnon SS, Mills DC, Day PA, Henrickson RV, Sullivan NM, Wilkins JD (1984) Rapid death by infant rhesus monkeys injected withClostridium difficile toxins A & B: physiologic and pathologic basis. J Pediatr 104:34–40PubMedGoogle Scholar
  20. 20.
    Gurwith MJ, Langston C, Citron DM (1981) Toxin producing bacteria in infants. Lack of an association with sudden infant death syndrome. Am J Dis Child 135:1105–1106Google Scholar
  21. 21.
    Cooperstock MS, Steffen E, Yolken R, Onderdonk A (1982)Clostridium difficile in normal infants and sudden infant death syndrome: an association with infant formula feeding. Pediatrics 70:91–95PubMedGoogle Scholar
  22. 22.
    Morris JA, Haran D, Smith A (1987) Hypothesis: common bacterial toxins are a possible cause of the sudden infant death syndrome. Med Hypotheses 22:211–222PubMedGoogle Scholar
  23. 23.
    Telford DR, Morris JA, Hughes P, Conway AR, Lee S, Barson AJ, Drucker DB (1989) The nasopharyngeal bacterial flora in the sudden infant death syndrome. J Infect 18:125–130PubMedGoogle Scholar
  24. 24.
    Bohach GA, Fast DJ, Nelson RD, Schlievert PM (1990) Staphylococcal and streptococcal pyrogenic toxins involved in toxic shock syndrome and related illnesses. Crit Rev Microbiol 17:251–272PubMedGoogle Scholar
  25. 25.
    Race RR, Sanger R (1968) Blood Groups in Man, 5th edn. Blackwell Scientific Publications, Oxford, pp 291–330Google Scholar
  26. 26.
    Haverkorn MK, Goslings WRO (1969) Streptococci, ABO blood groups and secretor status. Am J Hum Genet 21:360–375PubMedGoogle Scholar
  27. 27.
    Blackwell CC, Weir DM, James VS, Todd WTA, Banatvala N, Chaudhuri AKR, Gray HG, Thomson EJ, Fallon RJ (1990) Secretor status, smoking and carriage ofNeisseria meningitidis. Epidemiol Infect 104:203–209PubMedGoogle Scholar
  28. 28.
    Burford-Mason AP, Welsby JCP, Willoughby JMT (1988) Oral carriage ofCandida albicans. ABO blood group and secretor status in healthy individuals. J Med Vet Mycol 26:49–56PubMedGoogle Scholar
  29. 29.
    Aly FZ, Blackwell CC, Mackenzie DAC, Weir DM, Elton RA, Sofaer JA, Clarke BF (1991) Chronic atrophic oral candidiasis among patients with diabetes mellitus — the role of secretor status. Epidemiol Infect 106:355–363PubMedGoogle Scholar
  30. 30.
    Aly FZM, Blackwell CC, Mackenzie DAC, Weir DM, Clarke BF (1992) Factors influencing oral carriage of yeasts among individuals with diabetes mellitus. Epidemiol Infect 109:507–518PubMedGoogle Scholar
  31. 31.
    Raza MW, Blackwell CC, Molyneaux P, James VS, Ogilvie MM, Inglis JM, Weir DM (1991) Association between secretor status and respiratory viral illness. BMJ 303:815–818PubMedGoogle Scholar
  32. 32.
    Blackwell CC, James VS, Davidson S, Wyld R, Brettle RP, Robertson RJ, Weir DM (1991) Secretor status and heterosexual transmission of HIV. BMJ 303:825–826Google Scholar
  33. 33.
    Blackwell CC, Saadi AT, Raza MW, Stewart J, Weir DM (1992) Susceptibility to infection in relation to sudden infant death syndrome. J Clin Pathol 45 (Suppl): 20–24PubMedGoogle Scholar
  34. 34.
    Issit PD (1985) Applied blood group serology, 3rd edn Montgomery, Miami pp 169–191.Google Scholar
  35. 35.
    Watkins WM, Greenwell P, Yates AD, Johnson PH (1988) Regulation of expression of carbohydrate blood group antigens. Biochimie 70:1597–1611PubMedGoogle Scholar
  36. 36.
    Black-well CC (1989) The role of ABO blood groups and secretor status in host defences. FEMS Microbiol Immunol 47: 341–350Google Scholar
  37. 37.
    May SJ, Blackwell CC, Weir DM (1989) Lewisa blood group antigen of non-secretors: a receptor for Candida blastospores. FEMS Microbiol Immunol 45:407–410Google Scholar
  38. 38.
    Tosh FD, Douglas LJ (1991) Effect of blood group and secretor status on the adhesion ofCandida albicans to mucosal surfaces. In: Umbay ET et al (eds) Candida and Candida mycosis. Plenum Press, New York, pp 127–130Google Scholar
  39. 39.
    Van't Wout J, Burnette WN, Mar VL, Razdzinski E, Wright SD, Tuomanen E (1992) Role of carbohydrate recognition domains of pertussis toxin in adherence ofBordetella pertussis to human macrophages. Infect Immun 60:3303–3308PubMedGoogle Scholar
  40. 40.
    Saadi AT, Blackwell CC, Raza MW, James VS, Stewart J, Elton RA, Weir DM (1993) Factors enhancing adherence of toxigenic staphylococci to epithelial cells and their possible role in sudden infant death syndrome. Epidemiol Infect (in press)Google Scholar
  41. 41.
    Plotkowski M-C, Puchelle E, Beck G, Jaquet J, Hannoun C (1984) Adhence of type 1Streptococcus pneumoniae tp tracheal epithelium of mice infected with influenza A/PRB virus. Am Rev Respir Dis 134:1040–1044Google Scholar
  42. 42.
    Raza MW, Ogilvie MM, Blackwell CC, Stewart J, Elton RA, Weir DM (1991) Infection with respiratory syncytial virus enhances binding ofNeisseria meningitidis to HEp-2 cells. 120th meeting Society for General Microbiology, Nottingham, UK. Abstract Booklet, p 29Google Scholar
  43. 43.
    Raza MW, Ogilvie MM, Blackwell CC, Stewart J, Elton RA, Weir DM (1993) Effect of respiratory syncytial virus infection on binding ofNeisseria meningitidis and type bHaemophilus infuenzae to human epithelial cell line (HEp-2). Epidemiol Infect (in press)Google Scholar
  44. 44.
    McDonald KL, Osterholm MT, Hedberg CW, Schrock CG, Petrson GF, Jentzen HM, Leonard SA, Schlievert PM (1987) Toxic shock syndrome. A newly recognised complication of influenza and influenza-like illness. JAMA 257:1053–1058PubMedGoogle Scholar
  45. 45.
    Noah ND (1989) Cyclic patterns and predictibility in infection. Epidemiol Infect 102:175–190PubMedGoogle Scholar
  46. 46.
    Blackwell CC, Tzanakski G, Kremstinou J, Weir DM, Vakalis N, Elton RA, Mentis A (1992) Factors affecting carriage of Neisseria meningitidis among Greek military recruits. Epidemiol Infect 108:441–448PubMedGoogle Scholar
  47. 47.
    Musher DM, Fainstein V (1989) Adherence ofStaphylococcus aureus to pharyngeal cells from normal subjects, smokers, staphylococcal carriers and patients with viral infection. In: Jeljaszewicz J (ed) Staphylococci and staphylococcal infections. Zentrabl Bakt Suppl 10:1011–1016Google Scholar
  48. 48.
    Ramirez-Ronda CH, Fuxench-Lopez A, Nevarez M (1981) Increased bacterial colonisation during viral illness. Arch Intern Med 141:1599–1603PubMedGoogle Scholar
  49. 49.
    Arnon SS (1989) Breast feeding and toxigenic intestinal infections: missing links in crib death? Rev Infect Dis Suppl 6: S193-S201Google Scholar
  50. 50.
    Ponsoby A-L, Dwyer T, Gibbons LE, Cochrane JA, Jones ME, McCall MJ (1990) Thermal environment and SIDS: casecontrol study. BMJ 304:277–282Google Scholar
  51. 51.
    Flemming PJ, Gilbert R, Azaz Y, Berry PJ, Rudd PJ, Stewart A, Hall E (1990) Interaction between bedding and sleeping position in the SIDS: a population based case-control study. BMJ 301:85–89PubMedGoogle Scholar
  52. 52.
    Sunderland R, Emery JL (1981) Febrile convulsions and cot death. Lancet ii: 176–178Google Scholar
  53. 53.
    Guntheroth WG (1989) Interleukin-1 as intermediary causing prolonged sleep apnoea and SIDS during respiratory infections. Med Hypotheses 28:121–123PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • C. C. Blackwell
    • 1
  • A. T. Saadi
    • 1
  • M. W. Raza
    • 1
  • D. M. Weir
    • 1
  • A. Busuttil
    • 2
  1. 1.Department of Medical Microbiology, Department of PathologyUniversity of Edinburgh, Medical SchoolEdinburghUK
  2. 2.Forensic Medicine Unit, Department of PathologyUniversity of Edinburgh, Medical SchoolEdinburghUK

Personalised recommendations