Sudden Death in Toddlers Caused By Influenza B Infection: A Report of Two Cases and a Review of the Literature*

Abstract

Sudden fatal cases of influenza B infection in a 4-year-old girl and a 2-year-old boy are presented. Both children complained of abdominal pain without respiratory, neurologic or cardiac symptoms; additionally the girl had vomiting within 2 days of death. Autopsy revealed histological changes in the respiratory system consistent with a viral infection. Influenza B infection was identified by immunohistochemistry in the girl and real-time polymerase chain reaction in the boy. Additional testing including cultures, toxicology, and screening for metabolic disorders were negative. These cases illustrate the usefulness of viral testing, especially for influenza, in the medical legal autopsy of children even when the classic respiratory symptoms of flu are lacking.

Clinical and virological factors associated with gastrointestinal symptoms in patients with acute respiratory infection: a two-year prospective study in general practice medicine

“…Gastrointestinal (GI) symptoms, such as diarrhea, vomiting, abdominal pain and nausea are not an uncommon manifestation of an acute respiratory infection (ARI) [1][2][3][4][5][6][7][8] (Additional file 1) and have been reported as a hallmark of severe influenza in childhood [9].…”

Forensic molecular pathology of violent deaths

“…This is especially important in cases without apparent morphological evidence, which include asphyxiation, intoxication, anaphylactic shock, electrocution, hypothermia, and hyperthermia [112][113][114][115][116][117][118][119][120][121][122][123]. Moreover, in sudden death cases, minor predispositions should be very carefully assessed in consideration of such traumatic insults [124][125][126][127][128][129][130][131][132]. Thus, precise investigations of systemic stress responses to violence or environmental hazards, disorders due to intoxication, and systemic pathophysiology of fatal processes involving major life-support organs, involving the molecular pathology, are indispensable.…”

“…Another application of forensic molecular biology is the detection of pathogenic microorganisms in sudden deaths [127][128][129][130][131][132]. Such a procedure is also used to investigate foreign biological materials or microorganisms, including plankton and bacteria, which can incidentally contaminate the lung and other tissues in aspiration and drowning [4,149,150].…”

Cocoon Strategy of Vaccinations: Benefits and Limitations

“…Furthermore, sudden deaths in children caused by inluenza B virus infections were reported. The causes of deaths were determined only in an autopsy (concerning intravital diagnosis, there were no symptoms from the respiratory system but from the digestive system) [42].…”