Signs and symptoms

Case study

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• PH : know case HIV (vertical infection)

HIV PCR positive

RAD

• PE : BT 38.0, PR 120, RR 36• Weight : 9 kgs• GA : active, not pale, no jaundice, dyspnea,

intercostal retraction• HEENT : mild injected pharynx and tonsils, tonsil

1+• Lungs : rhonchi, coarse crepitation• Abd. : soft• Heart : no murmur• Dx : HIV with RAD

• CXR : patchy infiltration entired right lung

Case study

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• PE : BT 38.0, PR 120, RR 34• GA : A Thai male child, dyspnea, tachypnea, not pale• HEENT : mild injected pharynx, mucous rhinorrhea • Heart : normal S1S2, no murmur• Lungs : equal breath sound, generalized fine crepitation• Abd. : soft, not tender, no distension, no

hepatosplenomegaly• Skin : no rash• Dx : Pneumonia

Signs and Symptoms

• Infants, physical examination at birth is normal • Initial symptoms may be subtle

• Symptoms found more commonly in children than adults • hepatosplenomegaly • failure to thrive • recurrent diarrhea • interstitial pneumonia • oral thrush

• Symptoms found more commonly in children than adults• recurrent bacterial infections • chronic parotid swelling • lymphocytic interstitial pneumonitis • early onset of progressive neurologic deterioration

HIV classification system

• categorize the stage of pediatric disease • clinical status • degree of immunologic impairment

Opportunistic infections

Pneumocystis carinii (jiroveci) pneumonia (PCP)

• acute onset of fever • tachypnea • dyspnea • marked hypoxemia • Chest x-ray findings most commonly consist o

f interstitial infiltrates or diffuse alveolar disease, which rapidly progresses.

Pneumocystis carinii (jiroveci) pneumonia (PCP)

• most common opportunistic infection in the pediatric population

• peak incidence of PCP occurs at age 3–6 mo • highest mortality rate in children <1 yr of age

Atypical mycobacterial infection

• Mycobacterium avium-intracellulare complex (MAC)

• fever, malaise, weight loss, and night sweats • diarrhea, abdominal pain, and rarely intestinal

perforation or jaundice (due to biliary tract obstruction by lymphadenopathy) may also be present

Oral candidiasis

• most common fungal infection seen in HIV-infected children

• anorexia, dysphagia, vomiting, and fever

Viral infections

• especially with the herpesvirus group

• HSV causes recurrent gingivostomatitis

Respiratory viruses

• respiratory syncytial virus (RSV) and adenovirus

• prolonged symptoms and persistent viral shedding

Central Nervous System

• incidence of CNS involvement in perinatally infected children is 50–90% in developing countries

• loss or plateau of developmental milestones

• cognitive deterioration • impaired brain growth resulting in acquired

microcephaly • symmetric motor dysfunction

Central Nervous System

• Encephalopathy • initial manifestation of the disease or may present

much later when severe immune suppression occurs

• cerebral atrophy• increased ventricular size • basal ganglia calcifications

Central Nervous System

• CNS lymphoma may present with a new onset of focal neurologic findings, headache, seizures, and mental status changes

• CNS toxoplasmosis is exceedingly rare in young infants, but may occur in HIV-infected adolescents

Respiratory Tract

• Otitis media and sinusitis are very common

• Common groups• S. pneumoniae, H. influenzae, Moraxella

catarrhalis

Respiratory Tract

• LIP • common chronic lower respiratory tract abnormality • chronic process with nodular lymphoid hyperplasia in the

bronchial and bronchiolar epithelium • tachypnea, cough, and mild to moderate hypoxemia with

normal auscultatory findings or minimal rales • Progressive disease may be accompanied by digital clubbing

and symptomatic hypoxemia

• pneumonia • S. pneumoniae is the most common bacterial pathogen • P. aeruginosa

Cardiovascular System

• dilated cardiomyopathy

• left ventricular hypertrophy

• congestive heart failure

• Hemodynamic instability • Gallop rhythm with tachypnea • hepatosplenomegaly

Gastrointestinal and Hepatobiliary Tract

• erythematous or pseudomembranous candidiasis

• periodontal disease • salivary gland disease • Bacteria

• Salmonella, Campylobacter, MAC

• protozoa • Giardia, Cryptosporidium, Isospora, microsporidia

• fungi • Salmonella, Campylobacter, MAC

Gastrointestinal and Hepatobiliary Tract

• most common symptoms of gastrointestinal disease are chronic or recurrent diarrhea with malabsorption, abdominal pain, dysphagia, and failure to thrive

• Chronic liver inflammation • Cryptosporidial cholecystitis is associated with

abdominal pain, jaundice, and elevated gamma GT

• portal hypertension and liver failure • Pancreatitis

Skin Manifestations

• Seborrheic dermatitis or eczema

• Recurrent or chronic episodes of HSV, herpes zoster, molluscum contagiosum, flat warts, anogenital warts, and candidal infections are common

• Allergic drug eruptions are also common

Hematologic and Malignant Diseases

• Anemia occurs in 20–70% of HIV-infected children, more commonly in children with AIDS

• Leukopenia occurs in almost ⅓ of untreated HIV-infected children

• Non-Hodgkin lymphoma, primary CNS lymphoma, and leiomyosarcoma are the most commonly reported neoplasms among HIV-infected children

• Kaposi sarcoma