Logo of jclinpathJournal of Clinical PathologyVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Clin Pathol. 1995 Oct; 48(10): 929–932.
PMCID: PMC502949

Lethal synergy between toxins of staphylococci and enterobacteria: implications for sudden infant death syndrome.


AIM--To test the hypothesis that lethal synergy occurs between toxin preparations of nasopharyngeal staphylococci and enterobacteria from sudden infant death syndrome (SIDS) victims and matched healthy infants. METHODS--SIDS and matched healthy babies were studied if both staphylococcal and enterobacterial strains were isolated from the nasopharynx. The lethality of toxin preparations from each bacterial isolate (separately and combined) was assessed over a range of dilutions using the chick embryo assay system. RESULTS--Staphylococci and enterobacteria were isolated together from the nasopharynx of seven SIDS babies but from only one normal healthy infant. Enterobacterial toxins were lethal at high dilutions. Staphylococcal toxins were less toxic. Simultaneous testing in the chick assay of staphylococcal and enterobacterial toxins, from each baby, at non-lethal concentrations enhanced lethality levels by 177 to 1011% compared with lethality expected by an additive effect alone. CONCLUSIONS--Synergy occurs between the toxins of nasopharyngeal staphylococci and enterobacteria. This combination of strains is more likely to occur in the nasopharynx of SIDS victims than that of healthy infants.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (786K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bentele KH, Albani M. Are there tests predictive for prolonged apnoea and SIDS? A review of epidemiological and functional studies. Acta Paediatr Scand Suppl. 1988;342:1–21. [PubMed]
  • Brooks JG. Apnea of infancy and sudden infant death syndrome. Am J Dis Child. 1982 Nov;136(11):1012–1023. [PubMed]
  • Williams AL. Sudden infant death syndrome. Aust N Z J Obstet Gynaecol. 1990 May;30(2):98–107. [PubMed]
  • Beckwith JB. The sudden infant death syndrome. Curr Probl Pediatr. 1973 Jun;3(8):1–36. [PubMed]
  • Valdes-Dapena MA. Sudden and unexpected death in infancy: a review of the world literature 1954-1966. Pediatrics. 1967 Jan;39(1):123–138. [PubMed]
  • Williams AL, Uren EC, Bretherton L. Respiratory viruses and sudden infant death. Br Med J (Clin Res Ed) 1984 May 19;288(6429):1491–1493. [PMC free article] [PubMed]
  • Milner AD. Recent theories on the cause of cot death. Br Med J (Clin Res Ed) 1987 Nov 28;295(6610):1366–1368. [PMC free article] [PubMed]
  • Li DK, Daling JR. Maternal smoking, low birth weight, and ethnicity in relation to sudden infant death syndrome. Am J Epidemiol. 1991 Nov 1;134(9):958–964. [PubMed]
  • Kandall SR, Gaines J, Habel L, Davidson G, Jessop D. Relationship of maternal substance abuse to subsequent sudden infant death syndrome in offspring. J Pediatr. 1993 Jul;123(1):120–126. [PubMed]
  • Morris JA, Haran D, Smith A. Hypothesis: common bacterial toxins are a possible cause of the sudden infant death syndrome. Med Hypotheses. 1987 Feb;22(2):211–222. [PubMed]
  • Jakeman KJ, Rushton DI, Smith H, Sweet C. Exacerbation of bacterial toxicity to infant ferrets by influenza virus: possible role in sudden infant death syndrome. J Infect Dis. 1991 Jan;163(1):35–40. [PubMed]
  • Telford DR, Morris JA, Hughes P, Conway AR, Lee S, Barson AJ, Drucker DB. The nasopharyngeal bacterial flora in the sudden infant death syndrome. J Infect. 1989 Mar;18(2):125–130. [PubMed]
  • McKendrick N, Drucker DB, Morris JA, Telford DR, Barson AJ, Oppenheim BA, Crawley BA, Gibbs A. Bacterial toxins: a possible cause of cot death. J Clin Pathol. 1992 Jan;45(1):49–53. [PMC free article] [PubMed]
  • Lee S, Barson AJ, Drucker DB, Morris JA, Telford DR. Lethal challenge of gnotobiotic weanling rats with bacterial isolates from cases of sudden infant death syndrome (SIDS). J Clin Pathol. 1987 Dec;40(12):1393–1396. [PMC free article] [PubMed]
  • Drucker DB, Aluyi HS, Morris JA, Telford DR, Gibbs A. Lethal synergistic action of toxins of bacteria isolated from sudden infant death syndrome. J Clin Pathol. 1992 Sep;45(9):799–801. [PMC free article] [PubMed]
  • Drucker DB, Aluyi HA, Morris JA, Telford DR, Oppenheim BA, Crawley BA. Possibility of separating toxins from bacteria associated with sudden infant death syndrome using anion exchange chromatography. J Clin Pathol. 1992 Sep;45(9):802–805. [PMC free article] [PubMed]
  • Wieneke AA. The detection of enterotoxin and toxic shock syndrome toxin-1 production by strains of Staphylococcus aureus with commercial RPLA kits. Int J Food Microbiol. 1988 Aug;7(1):25–30. [PubMed]
  • Law D, Ganguli LA, Donohue-Rolfe A, Acheson DW. Detection by ELISA of low numbers of Shiga-like toxin-producing Escherichia coli in mixed cultures after growth in the presence of mitomycin C. J Med Microbiol. 1992 Mar;36(3):198–202. [PubMed]
  • Eichhorn EA. A TECHNIQUE FOR THE INTRAVENOUS INOCULATION OF CHICK EMBRYOS. Science. 1940 Sep 13;92(2385):245–246. [PubMed]
  • Marrack P, Kappler J. The staphylococcal enterotoxins and their relatives. Science. 1990 May 11;248(4956):705–711. [PubMed]
  • Holland IB, Kenny B, Blight M. Haemolysin secretion from E coli. Biochimie. 1990 Feb-Mar;72(2-3):131–141. [PubMed]
  • Bettelheim KA, Goldwater PN, Dwyer BW, Bourne AJ, Smith DL. Toxigenic Escherichia coli associated with sudden infant death syndrome. Scand J Infect Dis. 1990;22(4):467–476. [PubMed]
  • Schlievert PM. Alteration of immune function by staphylococcal pyrogenic exotoxin type C: possible role in toxic-shock syndrome. J Infect Dis. 1983 Mar;147(3):391–398. [PubMed]
  • Beezhold DH, Best GK, Bonventre PF, Thompson M. Synergistic induction of interleukin-1 by endotoxin and toxic shock syndrome toxin-1 using rat macrophages. Infect Immun. 1987 Dec;55(12):2865–2869. [PMC free article] [PubMed]
  • Lundemose JB, Smith H, Sweet C. Cytokine release from human peripheral blood leucocytes incubated with endotoxin with and without prior infection with influenza virus: relevance to the sudden infant death syndrome. Int J Exp Pathol. 1993 Jun;74(3):291–297. [PMC free article] [PubMed]
  • Hinder F, Schmidt A, Gong JH, Bender A, Sprenger H, Nain M, Gemsa D. Influenza A virus infects macrophages and stimulates release of tumor necrosis factor-alpha. Pathobiology. 1991;59(4):227–231. [PubMed]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...