The possible significance of cytomegaloviral parotitis in infant and early childhood deaths.

OBJECTIVE

To determine whether cytomegaloviral (CMV) parotitis reflects a disseminated disease that increases vulnerability to unexpected death.

DESIGN

Necropsy-based cross-sectional study comparing incidences of brain stem microglial nodules and visceral lymphocytic infiltrates in patients with and without CMV parotitis.

SUBJECTS: One hundred twelve infants and young children comprising a study group of 40 individuals with CMV parotitis (including 32 whose deaths remained unexplained) and two comparison groups comprising 40 explained and 32 unexplained deaths.

MAIN OUTCOME MEASURES: Incidence and variation with age of brain stem microglial nodules and lymphocytic infiltrates in liver and kidneys.

RESULTS

Brain stem microglial nodules and lymphocytic infiltrates in liver and kidneys are strongly associated with CMV parotitis; their incidence diminishes with increasing age.

CONCLUSIONS

Disseminated disease frequently accompanies CMV parotitis in infants. The resolution of brain stem microglial nodules precedes that of parotitis. Active and previous brain stem involvement may increase vulnerability to unexpected death.