1 / 40

Respiratory Diseases in HIV-infected Children - Part 1- Upper Respiratory Infection and Pneumonia

Respiratory Diseases in HIV-infected Children - Part 1- Upper Respiratory Infection and Pneumonia. HAIVN Harvard Medical School AIDS Initiative in Vietnam. Learning Objectives. By the end of this session, participants should be able to:

rosamund
Télécharger la présentation

Respiratory Diseases in HIV-infected Children - Part 1- Upper Respiratory Infection and Pneumonia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Respiratory Diseasesin HIV-infected Children- Part 1- Upper Respiratory Infection and Pneumonia HAIVN Harvard Medical School AIDS Initiative in Vietnam

  2. Learning Objectives By the end of this session, participants should be able to: • Identify the most common causes of respiratory disease in HIV patients • Describe how to manage ear infections • Explain how to clinically diagnose and treat: • Bacterial pneumonia • Viral pneumonia • Fungal pneumonia

  3. What are Common Respiratory Syndromes in HIV infected Children? • Upper respiratory infections: • Ear infections • Sinusitis • Lower respiratory infections: • Pneumocystis jiroveci pneumonia (PCP) • Bacterial pneumonia • Pulmonary tuberculosis • Viral pneumonia • Fungal pneumonia

  4. Bệnh cảnh nhập việnở BV Nhi Đồng 1 – khảo sát năm 2006 n = 134 50% trẻnhậpviệnvìbệnhcảnhhôhấp Bs. Trương Hữu Khanh NĐ1

  5. Upper Respiratory Infections

  6. Ear Infections

  7. Sinusitis (1) • Pathology:

  8. Sinusitis (2) • Symptoms: • Fevers, poor feeding • Nasal congestion, purulent nasal discharge • Cough for >10-14 days, or high fever to 39oC and purulent discharge for 3-4 days, indicate bacterial sinusitis • Treatment:

  9. Pharyngitis • Usually caused by virus or Bacteria: Group A streptococcus • Symptoms: • Fever • With/without rash • Sore throat • Large tonsils and lymph node on the neck

  10. Pharyngitis • Acute pharyngitis caused by Strep.

  11. Lower Respiratory Infections

  12. Lower Respiratory Infections • Pneumonia is the number one cause of deaths in children worldwide: • Responsible for nearly 1 in 5 deaths, for an estimated 1.8 million deaths annually • Most cases are in Africa and South East Asia • Incidence may be higher where there is high prevalence of HIV • Occurs more often and more severe, with higher mortality rates, in HIV-infected children

  13. Pneumonia – Etiology by Age TB? LIP?

  14. Pneumonia – Diagnosis

  15. Bacterial Pneumonia

  16. Bacterial Respiratory Infections • Bacterial pneumonias were more common in HIV-infected children than HIV-uninfected: * Madhi SA et al, Clin Infect Dis 2000;31:170.

  17. Bacterial Pneumonia in HIV-infected Patients Compared to non-HIV infected: • More frequent, more severe, more likely to be fatal • Caused by a wider variety of organisms, including resistant ones • More likely to be polymicrobial • More often accompanied by bacteremia

  18. Bacterial Pneumonia – Clinical Presentation • Onset usually acute • High fevers, rigors, chills • Cough productive of sputum • Tachypnea, dyspnea • Chest pain • May have poor feeding, nausea/vomiting • Rales often present on lung exam

  19. Bacterial Pneumonia – CXR (1) • Often seen: • Lobar infiltrate • Bronchoalveolar infiltrate • Parapneumonic effusions • Pleural effusions

  20. Bacterial Pneumonia – CXR (2)

  21. Bacterial Pneumonia – CXR (3)

  22. Bacterial Pneumonia – CXR (4)

  23. Bacterial Pneumonia – CXR (5)

  24. Bacterial Pneumonia – Treatment

  25. Viral Respiratory Infections

  26. Viral Respiratory Infections (1) • Most viral infections manifest no differently in HIV-negative children than in HIV-positive children until HIV disease is advanced • RSV, influenza, parainfluenza, coronaviruses, rhinovirus, are similar except: • Virus is excreted for longer • For RSV, influenza and parainfluenza, wheezing is less frequent • Bacterial co-infections are more frequent • Hospitalization and mortality rates are higher

  27. Viral Respiratory Infections (2) • Outcomes are worse with certain infections: • Measles, varicella, CMV, adenovirus • CMV pneumonia is present in advanced HIV infection, usually as a co-pathogen, especially in infants and young children

  28. Viral Respiratory Infections (3) • Diagnosis: • RSV: bronchiolitis • Influenza: seasonal, with local circulation • CMV: severe pneumonia. CXR with bilateral infiltrates, CMV IgM+, PCR+ with high titer • Treatment: mostly supportive • Influenza: oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (IV), amantadine, rimantadine • CMV: gancyclovir IV

  29. Fungal Pneumonia

  30. Fungal Pneumonia • Difficult to diagnose clinically • Diagnosis requires microbiology, specific testing • Sputum or bronchoalveolar stain and culture, biopsy • Fungal pneumonia in the immunocompromosed patients is often part of a systemic, multi-organ infection • Cryptococcosis with meningitis • Penicilliummarneffei with skin lesions, splenomegaly • CXR reveals no typical findings • Treatment according to etiology

  31. Pneumonia – IMCI

  32. Pneumonia – Criteria for Admission • Moderate to severe pneumonia, with respiratory distress and hypoxemia (SpO2 <90%) • 8 signs of respiratory distress • Tachypnea, respiratory rate, breaths/min • Age 0–2 months: .60 • Age 2–12 months: .50 • Dyspnea • Retractions (suprasternal, intercostals, or subcostal) • Grunting • Nasal flaring • Apnea • Altered mental status • Pulse oximetry measurement ,90% on room air • Age 1–5 Years: .40 • Age .5 Years: .20

  33. Case Study

  34. Linh, Girl (1) • A 17 month old girl with fever and dyspnea is transferred to your clinic • PM: 10 days prior to the admission, patient presented fever (38), productive cough, dyspnea. The fever and dyspnea went worse with time. The child had no vomiting or convulsion. The patient had been treated at provincial hospital for 4 days without improvement.

  35. Linh, Girl (2) • Both parent are HIV positive, not yet on ART • The child was not on PMCTC; TB vaccination at 1 months • PE: • alert, no fever, non-productive cough • Blue lips while crying, subcostal withdrawing, BR: 70 per min, Sp02 : 82% no oxygen • Lung: moist rales, sound breath decreased on the left lung • Heart: HR: 155 per min, regular • Oral thrush • Abdomen: soft, hepatomegaly, 4cm subcostal • HIV ELISA: Positive

  36. Linh, Girl (3) At admission • What do you see on CRX? • Opaque entire left lung, mediasternal shift • What is your clinical diagnosis: • Bacterial pneumonia • Pleural effusion • Tuberculosis • PCP

  37. Linh, Girl (4) • What possible diagnostic tests are necessary? • WBC: 15 G/l • Thoracentesis: pus fluid • Pleural fluid culture: Staphyloccocusaureus, TB PCR neagative • PCR for TB from gastric lavage: negative • What is the diagnosis? • Pneumonia and empyema • What is the best treatment plan? • Pleural drainage • Antibiotics: Vancomycin, Ceftriaxone, Amikacin

  38. Linh, Girl (5) • The patient got better after 7 days treatment (no fever, no dyspnea) and after two weeks patient was discharged • HIV + confirmed, initiated ARV After 7 days treatment At the timing of discharge

  39. Key Points • Otitis media is common in children with HIV and should be treated with a long course of antibiotics to prevent complications • Recurrent bacterial pneumonia is common in HIV infected children

  40. Thank you! Questions?

More Related