f Enterotoxigenic bacteria in the sudden infant death syndrome
- Authors: W. G. Murrell*, Betty J. Stewart, Cata O'Neill§,*, S. Siarakas∥,*, S. Kariks
- *Correspondence should be sent to Dr W. G. Murrell.
- J. Med. Microbiol., August 1993 39: 114-127, doi: 10.1099/00222615-39-2-114
- Subject: Articles
- Published Online:
Faecal samples from 123 infants who died with sudden infant death syndrome (SIDS) and from a comparative group of 52 age-matched babies were analysed for toxigenic bacteria and their toxins. Serum samples from the SIDS infants were also analysed for these toxins. A significantly higher proportion of toxigenic bacteria and their toxins were found in faecal samples of SIDS babies than in samples from the comparative group. These toxins were also found in serum from the SIDS babies. Clostridium perfringens was found in 54 (45·4%) of 119 SIDS cases compared with 10 (19·6%) of 51 healthy babies (χ2 = 10·1, p < 0·01); C. difficile in 33 (27·7%) of 119 SIDS cases compared with 8 (14·8%) of 54 healthy babies (χ2 = 3·43ns, p < 0·1); Staphylococcus aureus in 12 (27·3%; 66·7% enterotoxigenic) of 44 SIDS cases compared with 12 (85·7%; non-enterotoxigenic) of 14 healthy babies (χ2 = 14·9, p < 0·001); C. botulinum in 6(5·0%) of 120 SIDS cases compared with 0 of 53 healthy babies (χ2 = 2·74, p < 0·1). Campylobacter jejuni, Yersinia enterocolitica, Vibrio parahaemolyticus, salmonellae and Bacillus cereus were not detected. Heat-labile toxin, lethal to mice (HLML) was found in 32 (27·1%) of 118 SIDS faecal samples compared with 5 (10·6%) of 47 healthy babies (χ2 = 5·24, p < 0·05); cytotoxins in 38 (30·9%) of 123 SIDS faecal samples compared with 0 of 21 of healthy babies (χ2 = 8·8, p < 0·01) and 24 (27·6%) of 87 SIDS serum samples. C. perfringens enterotoxin was detected in 33 (34·4%) of 96 SIDS faecal extracts compared with 0 of 23 of healthy babies (χ2 = 10·94, p < 0·001), and in 27 (24·5%) of 110 SIDS serum samples. C. perfringens α-toxin (presumptive) was detected in 14 (17·5%) of 80 SIDS faecal extracts compared with 0 of 17 from healthy babies (χ2 = 3·5ns, p < 0·05) and in 2 (2·3%) of 87 SIDS serum samples. C. difficile toxin was detected in four SIDS faecal samples and two serum samples. C. botulinum toxin was detected in only one of 120 SIDS faecal samples compared with none of 49 from healthy babies. Staphylococcal enterotoxins were detected in 8 (19·5%) of 41 SIDS faecal samples compared with 0 of 19 from healthy babies (χ2 = 4·278, p < 0·05), and in 4 (10·8%) of 37 SIDS serum samples. Toxigenic and non-toxigenic strains of C. perfringens and C. difficile occurred in faecal samples of both SIDS and healthy babies. Formula-fed SIDS babies had a significantly higher incidence of C. difficile (χ2 = 6·654, p < 0·01), C. perfringens (χ2 = 6·422, p < 0·05), and its enterotoxin (χ2 = 7·787, p < 0·01) in faeces, and a higher incidence (non-significant) of C. perfringens enterotoxin in their serum, faecal HLML toxin, and S. aureus and its enterotoxin, than breast-fed babies. Male SIDS babies had a significantly higher incidence of C. perfringens (χ2 = 7·687, p < 0·01) and higher incidences (non-significant) of C. perfringens enterotoxin, HLML toxin, C. difficile, and S. aureus and its enterotoxin than female babies. SIDS babies dying in winter had a significantly higher incidence of C. difficile than those dying in summer (χ2 = 5·328, p < 0·05) and spring (χ2 = 4·444, p < 0·05). C. perfringens, S. aureus and their enterotoxins occurred in more babies dying in autumn and winter than in spring and summer. The incidence of these bacteria and their toxins did not differ for position of death. These results provide some support for the idea that intestinal toxins have a pathogenic role in SIDS.
Present address: Arthur Websters Pty Ltd, Castle Hill, NSW 2154, Australia.
Present address: General Repatriation Hospital, Concord, NSW 2139, Australia.
Copyright © 1993 The Pathological Society of Great Britain and Ireland. | Published by the Society for General Microbiology
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