1887

Abstract

Summary

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. was found in 54 (45.4 %) of 119 SIDS cases compared with 10 (19-6%) of 51 healthy babies ( = 101, p < 0.01); C. in 33 (27.7 %) of 119 SIDS cases compared with 8 (14.8 %) of 54 healthy babies ( = 3.43, p < 0.1); in 12 (27.3%; 66.7% enterotoxigenic) of 44 SIDS cases compared with 12 (85.7%; non-enterotoxigenic) of 14 healthy babies = 14.9, p < 0.001); C. in 6 (5.0 %) of 120 SIDS cases compared with 0 of 53 healthy babies (% = 2.74, p < 0.1). , salmonellae and 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 ( = 5.24, p < 0.05); cytotoxins in 38 (30.9%) of 123 SIDS faecal samples compared with 0 of 21 of healthy babies ( = 8.8, p < 0.01) and 24 (27.6%) of 87 SIDS serum samples. enterotoxin was detected in 33 (34.4%) of 96 SIDS faecal extracts compared with 0 of 23 of healthy babies ( = 10.94, p < 0.001), and in 27 (24.5 %) of 110 SIDS serum samples. a-toxin (presumptive) was detected in 14 (17.5%) of 80 SIDS faecal extracts compared with 0 of 17 from healthy babies ( = 3.5, p — 0.05) and in 2 (2.3 %) of 87 SIDS serum samples. toxin was detected in four SIDS faecal samples and two serum samples. 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 ( = 4.278, p < 0.05), and in 4(10.8 %) of 37 SIDS serum samples. Toxigenic and non-toxigenic strains of and occurred in faecal samples of both SIDS and healthy babies. Formula-fed SIDS babies had a significantly higher incidence of ( = 6.654, p < 0.01), ( = 6.422, p < 0.05), and its enterotoxin ( = 7.787, p < 0.01) in faeces, and a higher incidence (non-significant) of enterotoxin in their serum, faecal HLML toxin, and and its enterotoxin, than breast-fed babies. Male SIDS babies had a significantly higher incidence of ( = 7.687, p < 0.01) and higher incidences (non-significant) of enterotoxin, HLML toxin, and and its enterotoxin than female babies. SIDS babies dying in winter had a significantly higher incidence of than those dying in summer ( = 5.328, p < 0.05) and spring ( = 4.444, p < 0.05). 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.

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1993-08-01
2022-11-28
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References

  1. Arnon SS, Damus K, Midura TF, Wood RM, Chin J. Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome. Lancet 1978; 1:1273–1277
    [Google Scholar]
  2. Arnon SS, Damus K, Chin J. Infant botulism: epidemiology and relation to sudden infant death syndrome. Epidemiol Rev 1981; 3:45–66
    [Google Scholar]
  3. Arnon SS. Breast feeding and toxigenic intestinal infections: missing links in crib death?. Rev Inf Dis 1984; 6:Suppl 1S193–S201
    [Google Scholar]
  4. Trube-Becker E. Enteral bacterial infection as a possible cause of cot death. Forensic Sci 1978; 11:171
    [Google Scholar]
  5. Sonnabend OA, Sonnabend WFF, Krech U, Molz G, Sigrist T. Continuous microbiological and pathological study of 70 sudden and unexpected infant deaths: toxigenic intestinal Clostridium botulinum infection in 9 cases of sudden infant death syndrome. Lancet 1985; 1:237–241
    [Google Scholar]
  6. Laughon B, Kozakewich H, Vawter GF, Yolken R. The role of Clostridium difficile in sudden infant death syndrome. In: Tildon JT, Roeder LM, Steinschneider A. (eds) Sudden infant death syndrome New York: Academic Press; 1983557–566
    [Google Scholar]
  7. Murrell TGC, Ingham BG, Moss JR, Taylor WB. A hypothesis concerning Clostridium perfringens type-A enterotoxin (CPE) and sudden infant death syndrome (SIDS). Med Hypotheses 1987; 22:401–413
    [Google Scholar]
  8. Reid GM. Sudden infant death syndrome—the role of putre factive toxins in respiratory paralysis and cerebral coma. Med Hypotheses 1987; 22:303–307
    [Google Scholar]
  9. Morris JA, Haran D, Smith A. Hypothesis—common bacterial toxins are a possible cause of the sudden infant death syndrome. Med Hypotheses 1987; 22:211–222
    [Google Scholar]
  10. Bettelheim KA, Dwyer BW, Smith DL, Goldwater PN, Bourne AJ. Toxigenic Escherichia coli associated with sudden infant death syndrome. MedJAust 1989; 151:538
    [Google Scholar]
  11. Bettelheim KA, Goldwater PN et al. Toxigenic Escherichia coli associated with sudden infant death syndrome. Scand J Infect Dis 1990; 22:467–476
    [Google Scholar]
  12. Telford DR, Morris JA, Hughes P et al. The nasopharyngeal bacterial flora in sudden infant death syndrome. J Infect 1989; 18:125–130
    [Google Scholar]
  13. Kariks J. Chlamydia trachomatis and SIDS? (letter). MedJAust 1990; 152:384
    [Google Scholar]
  14. Lundemose JB, Lundemose AG, Gregensen M, Helweg-Larsen K, Simonsen J. Chlamydia and sudden infant death syndrome. A study of 166 SIDS and 30 control cases. Int J Leg Med 1990; 104:3–7
    [Google Scholar]
  15. Bettelheim KA, Smith H, Goldwater PN et al. Sleeping position and cot deaths. Lancet 1991; 338:192
    [Google Scholar]
  16. Stark PL, Lee A. Clostridia isolated from the faeces of infants during the first year of life. J Pediatr 1982; 100:362–365
    [Google Scholar]
  17. Murrell WG, Stewart BJ, O’Neill C, Kariks J. Abstracts of the Annual Meeting of the Australian Society of Microbiology 1986; Pll:185
    [Google Scholar]
  18. Beckwith JB. Observations of the pathological anatomy of the sudden infant death syndrome. In: Bergman AB, Beckwith JB, Ray CG. (eds) Sudden infant death syndrome: Proceedings of the second international conference on causes of sudden infant death in infants Seattle: University of Washington Press; 197083–102
    [Google Scholar]
  19. Kariks J. Is shock the mode of death in SIDS?. Med Hypotheses 1985; 18:331–349
    [Google Scholar]
  20. Holdeman LV, Cato EP, Moore WEC. Anaerobe laboratory manual, 4th edn.. Blacksburg, Virginia: Virginia Polytechnic Institute; 1977
    [Google Scholar]
  21. Anon Methods for the microbiological examination of food. Part 2. Examination for specific organisms. 1.7 Clostridium botulinum and Clostridium botulinum toxin. Standards Association of Australia Addendum No. 1 (June 1976) to AS 1766. Part 2 19762–29 to 92–32
    [Google Scholar]
  22. Murrell WG, Stewart BJ. Botulism in New South Wales, 1980-81. MedJAust 1983; 1:13–17
    [Google Scholar]
  23. Rolfe RD. Diagnosis of Clostridium d/#zc//e-associated intestinal disease. CRC Crit Rev Clin Lab Sci 1986; 24:235–261
    [Google Scholar]
  24. Taylor WI. Isolation of Shigellae, I Xylose lysine agars; new media for isolation of enteric pathogens. Am J Clin Pathol 1965; 44:A11–A15
    [Google Scholar]
  25. Baird-Parker AC. An improved diagnostic and selective medium for isolating coagulase positive staphylococci. J Appl Bacteriol 1962; 25:12–19
    [Google Scholar]
  26. Kobayashi T, Enomoto S, Sakazaki R, Kuwahara S. A new selective medium for pathogenic vibrios: TCBS agar (modified Nakanishi’s agar). Jpn J Bacteriol 1963; 18:387–391
    [Google Scholar]
  27. Anon Methods for the microbiological examination of food. Part 2. Examination for specific organisms. 1.6 Bacillus cereus. Standards Association of Australia Addendum No. 1 (June 1976) to AS1766. Part 2 19762–25 to 2–28
    [Google Scholar]
  28. Schiemann DA. Synthesis of a selective agar medium for Yersinia enterocolitica. Can J Microbiol 1979; 25:1298–1304
    [Google Scholar]
  29. Anderson JM, Baird-Parker AC. A rapid and direct plate method for enumerating Escherichia coli biotype 1 in food. J Appl Bacteriol 1975:39111–117
    [Google Scholar]
  30. Bolton FJ, Robertson L. A selective medium for isolating Campylobacter jejuni/ coli. J Clin Pathol 1982; 35:472–476
    [Google Scholar]
  31. Harmon SM, Kautter DA, Peeler JT. Improved medium for enumeration of Clostridium perfringens. Appl Microbiol 1971; 22:688–692
    [Google Scholar]
  32. George WL, Sutter VL, Citron D, Finegold SM. Selective and differential medium for isolation of Clostridium difficile. J Clin Microbiol 1979; 9:214–219
    [Google Scholar]
  33. Mills DC, Midura TF, Arnon SS. Improved selective medium for the isolation of lipase-positive Clostridium botulinum from feces of human infants. J Clin Microbiol 1985; 21:947–950
    [Google Scholar]
  34. Steel RGD, Torrie JH. Principles and procedures of statistics. A biometrical approach, 2nd edn.. London: McGraw-Hill International; 1981495–502
    [Google Scholar]
  35. Brown DF, Twedt RM. Assessment of the sanitary effectiveness of holding temperatures on beef cooked at low temperatures. Appl Microbiol 1972; 24:559–603
    [Google Scholar]
  36. Rey CR, Walker HW, Rohrbaugh PL. The influence of temperature on growth, sporulation, and heat resistance of spores of six strains of Clostridium perfringens. J Milk Food Technol 1975; 38:461–165
    [Google Scholar]
  37. Smith LDS. Factors involved in the isolation of Clostridium perfringens. J Milk Food Technol 1972; 35:71–76
    [Google Scholar]
  38. Cato EP, George WL, Finegold SM. Genus Clostridium prazmouwski. In: Sneath PHA, Mair NS, Sharpe ME, Holt JG. (eds) Bergey’s Manual of systematic bacteriology, vol 2 Baltimore: Williams and Wilkins; 19861141–1200
    [Google Scholar]
  39. Bowman RA, Riley TV. Isolation of Clostridium difficile from stored specimens and comparative susceptibility of various tissue culture cell lines to cytotoxin. FEMS Microbiol Lett 1986; 34:31–35
    [Google Scholar]
  40. Traci PA, Duncan CL. Cold shock lethality and injury in Clostridium perfringens. Appl Microbiol 1974; 28:815–821
    [Google Scholar]
  41. Berry PR, Rodhouse JC, Hughes S, Bartholomew BA, Gilbert RJ. Evaluation of ELISA, RPLA, and Vero cell assays for detecting Clostridium perfringens enterotoxin in faecal specimens. J Clin Pathol 1988; 41:458–461
    [Google Scholar]
  42. Harmon SM, Kautter DA. Evaluation of a reversed passive latex agglutination test kit for Clostridium perfringens enterotoxin. J Food Protect 1986; 49:523–525
    [Google Scholar]
  43. Duncan CL, Strong DH. Experimental production of diarrhoea in rabbits with Clostridium perfringens. Can J Microbiol 1969; 15:765–770
    [Google Scholar]
  44. Stark RL, Duncan CL. Biological characteristics of Clostridium perfringens type A enterotoxin. Infect Immun 1971; 4:89–96
    [Google Scholar]
  45. Stelma GN, Wimsatt JC, Kauffman PE, Shah DB. Radio immunoassay for Clostridium perfringens enterotoxin and its use in screening isolates implicated in food-poisoning outbreaks. J Food Protect 1983; 46:1069–1073
    [Google Scholar]
  46. van Damme-Jongsten M, Wernars K, Watermans S. Cloning and sequencing of the Clostridium perfringens enterotoxin gene. Antonie van Leeuwenhoek 1989; 56:181–190
    [Google Scholar]
  47. Delmee M, Verellen G, Avesani V, Francois G. Clostridium difficile in neonates: serogrouping and epidemiology. Eur J Pediatr 1988; 147:36–40
    [Google Scholar]
  48. Snyder ML. The normal faecal flora of infants between two weeks and one year of age. J Infect Dis 1940; 66:1–16
    [Google Scholar]
  49. Lindsay JA, Sleigh RW, Ghitgas C, Davenport JB. Purification and properties of an enterotoxin from a coatless spore mutant of Clostridium perfringens type A. Eur J Biochem 1985; 149:287–293
    [Google Scholar]
  50. Murrell WG, Ouvrier RA, Stewart BJ, Dorman DC. Infant botulism in a breast-fed infant from rural New South Wales. MedJAust 1981; 1:583–585
    [Google Scholar]
  51. Stark PL, Lee A, Parsonage BD. Colonization of the large bowel by Clostridium difficile in healthy infants: quantitative study. Infect Immun 1982; 35:895–899
    [Google Scholar]
  52. Cooperstock MS, Steffen E, Yolken R, Onderdonk A. Clo stridium difficile in normal infants and sudden infant death syndrome: an association with infant formula feeding. Pediatrics 1982; 70:91–95
    [Google Scholar]
  53. Mardh PA, Helin I, Colleen I, Oberg M, Holst E. Clostridium difficile toxin in faecal specimens of healthy children and children with diarrhoea. Acta Paediatr Scand 1982; 71:275–278
    [Google Scholar]
  54. Torres JF, Cedillo R, Sanchez J, Sillman C, Giono S, Munoz O. Prevalence of Clostridium difficile and its cytotoxin in infants in Mexico. J Clin Microbiol 1984; 20:274–275
    [Google Scholar]
  55. Gurwith MJ, Langston C, Citron DM. Toxin-producing bacteria in infants. Lack of an association with sudden infant death syndrome. Am J Dis Child 1981; 135:1104–1106
    [Google Scholar]
  56. Daubener W, Leiser E, von Eichelstreiber C, Hadding V. Clostridium difficile toxins A and B inhibit human immune response in vitro. Infect Immun 1988; 56:1107–1112
    [Google Scholar]
  57. Wilkins T, Krivan H, Stiles B, Carman R, Lyerly D. Clostridial toxins active locally in the gastrointestinal tract. In: CIBA Foundation Symposium 112. Microbial toxins and dia-rrhoeal disease London: Pitman; 1985230–241
    [Google Scholar]
  58. Wada N, Nishida N, Iwaki S et al. Neutralising activity against Clostridium difficile toxin in the supernatants of cultured colostral cells. Infect Immun 1980; 29:545–550
    [Google Scholar]
  59. Simhon A, Yolken RH, Mata L. S-IgA cholera toxin and rotavirus antibody in human colostrum. Acta Paediatr Scand 1979; 68:161–164
    [Google Scholar]
  60. Stoliar OA, Kaniecki-Green E, Pelley RP, Klaus MH, Car penter CCJ. Secretory IgA against enterotoxins in breast-milk. Lancet 1976; 1:1258–1261
    [Google Scholar]
  61. Arnold RR, Mills DC, Amon SS. Natural secretory IgA antibodies to Clostridium botulinum in human milk whey. Abstract. 13th International Congress of Microbiology Boston: 198234
    [Google Scholar]
  62. Amon SS, Chin J. The clinical spectrum of infant botulism. Rev Infect Dis 1979; 1:614–624
    [Google Scholar]
  63. Pottgen P, Hillegass LM. Botulism and sudden infant death. Lancet 1977; 1:147–148
    [Google Scholar]
  64. Hobbs JR. Primary immune paresis. In: Adinolfi M. (ed) Immunology and development (Clinics in Developmental Medicine No 34) London: Heinemann; 1969114–158
    [Google Scholar]
  65. Clausen CR, Ray CG, Hebestreit N, Eggleston P. Studies of the sudden infant death syndrome in King County, Washington. IV Immunologic studies. Pediatrics 1973; 52:45–51
    [Google Scholar]
  66. Amon SS, Mills DC, Day PA, Henrickson RV, Sullivan NM, Wilkins TD. Rapid death of infant rhesus monkeys injected with Clostridium difficile toxins A and B: physiologic and pathologic basis. J Pediatr 1984; 104:34–40
    [Google Scholar]
  67. Coombs RRA, McLaughlan P. The modified anaphylactic hypothesis for sudden infant death syndrome. In: Tildon JT, Roeder LM, Steinschneider A. (eds) Sudden infant death syndrome New York: Academic Press; 1983531–538
    [Google Scholar]
  68. Perrin DG, Cutz E, Becker LE, Bryan AC, Madapallimatum A, Sole M J. Sudden infant death syndrome: increased carotid-body dopamine and noradrenaline content. Lancet 1984; 2:535–537
    [Google Scholar]
  69. Lack EE, Perez-Atayde AR, Young JB. Carotid bodies in sudden infant death syndrome: a combined light microscopic, ultrastructural, and biochemical study. Pediatr Pathol 1986; 6:335–350
    [Google Scholar]
  70. Kariks J. Cardiac lesions in sudden infant death syndrome. Forensic Sci Int 1988; 39:211–225
    [Google Scholar]
  71. Valdes-Dapena MA. Sudden and unexpected death in infancy: a review of the world literature 1954-1966. Pediatrics 1967; 39:123–138
    [Google Scholar]
  72. Valdes-Dapena MA. Sudden infant death syndrome: a review of the medical literature 1974-79. Pediatrics 1980; 66:597–614
    [Google Scholar]
  73. Tonkin S. Epidemiology of SIDS in Auckland, New Zealand. In: Robinson RR. (ed) “SIDS 1974”. Proceedings of the Francis E. Camps International Symposium on Sudden and Unexpected Deaths in Infancy Toronto: Canadian Foundation for the Study of Infant Deaths; 1974169–175
    [Google Scholar]
  74. Dwyer T, Ponsonby AL. Sudden infant death syndrome— insights from epidemiological research. J Epidemiol Community Health 1992; 46:98–102
    [Google Scholar]
  75. Beal S. Sudden infant death syndrome related to sleeping position and bedding. MedJAust 1991; 155:507–508
    [Google Scholar]
  76. Dwyer T, Ponsonby AL, Gibbons LE, Newman NM. Prone sleeping position and SIDS: Evidence from recent case- control and cohort studies in Tasmania. J Paediatr Child Health 1991; 27:340–343
    [Google Scholar]
  77. Paul WE. Fundamental Immunology. , 2nd edn.. New York: Raven Press; 1989836
    [Google Scholar]
  78. Trinea JC. (ed) CSL Veterinary handbook. Blackburn, Vic.: Dominican Press; 197949–53
    [Google Scholar]
  79. Tannock GW. Effect of dietary and environmental stress on the gastrointestinal microbiota. In: Hentges DJ. (ed) Human intestinal microflora in health and disease New York: Academic Press; 1983517–539
    [Google Scholar]
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