Brainstem Encephalitis as a Cause of Sudden Infant Death Syndrome

Sudden unexpected infant death or sudden infant death syndrome (SIDS) are terms used for children younger than 1 year of age who die suddenly without an obvious cause before investigation. SIDS often occurs during sleep and affects nearly 3500 children in the US each year. Despite many measures taken to prevent the illness, the incidence remains unchanged since the year 2000. In this issue of JAMA Neurology, Ramachandran et al report an investigation of 64 cases of SIDS. The authors found elevated levels of neopterin in the cerebrospinal fluid of 6 cases. Because the major source of neopterin is activated macrophages, it is suggestive of neuroinflammation. In 1 of these 6 cases of SIDS with neuroinflammation, they identified human parechovirus 3 by metagenomic next-generation sequencing (mNGS). This patient was 11 days old and died suddenly while asleep after a 2-day history of fever, poor feeding, and fussiness. The virus was found in the cerebrospinal fluid, hippocampus, medulla oblongata, and liver. Unfortunately, due to excessive freeze artifact, microscopic examination of the brainstem could not be conducted. It is interesting, however, that the virus was found in the brainstem by mNGS. The authors hypothesized that the infection of the brainstem may have caused autonomic dysfunction leading to death. This region has vital respiratory centers including the pre-B ötzinger complex and associated pathways. Once these pathways are interrupted, it can lead to lack of respira...
Source: JAMA Neurology - Category: Neurology Source Type: research