A prospective study to define the normal patterns of development of mucosal immunity in 263 children provided a unique opportunity to study the mucosal immune response in an infant who unexpectedly died from sudden infant death syndrome. The subject initially had a normal pattern of mucosal immune function, which was perturbed after a transient mild upper respiratory tract infection at 3 1/2 wk of age. After the upper respiratory tract infection, there was an increase in mucosal permeability and the appearance of IgA and IgM in saliva. The unusual features in this case were the degree and the duration of the increases in salivary IgA and IgM after resolution of the illness. The marked abnormalities suggested a persistent stimulation of the mucosal immune response. The case provides informative data on potential mechanisms of sudden infant death syndrome and supports a role for involvement of upper respiratory tract infection.
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