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Obiagwu PN. Gross motor developmental delay in human immunodeficiency virus-infected children under 2 years of age. Ann Afr Med 2020; 18:185-190. [PMID: 31823952 PMCID: PMC6918795 DOI: 10.4103/aam.aam_7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Human immunodeficiency virus (HIV) infection has significant effects on child development. We report the outcome of gross motor developmental assessment in HIV-infected children <2 years compared with that of uninfected children. Materials and Methods: Every child <2 years of age presenting for the first time to the pediatric outpatient department of the hospital over 3 months was studied. Each child had a physical examination with gross motor milestone assessment, as well as initial double rapid HIV antibody tests with confirmatory tests for those with positive or discordant results. Children with evidence of motor delay were booked for reassessment after 1 month. The milestone performance criteria of the Multicenter Growth Reference Study of the World Health Organization were used as a standard. Results: One hundred and eight children were studied. Male-to-female ratio was 1:1. Fourteen children (13.0%) were HIV infected. Nine children (8.3%) had delayed development of gross motor milestones, of which five were HIV infected and four were uninfected (P = 0.001). Each motor milestone was attained at a significantly later mean age by the HIV-infected children when compared to the uninfected. Evidence of delay in gross motor milestones was apparent by the first 6 months of life. Conclusions: A tendency to poorer motor development is apparent in young children infected by HIV and can manifest as early as the first 6 months of life. Routine HIV screening as well as early developmental assessment of all children should be encouraged.
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Affiliation(s)
- Patience Ngozi Obiagwu
- Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
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Epidemiologic and clinical findings of children with acquired immunodeficiency syndrome in four provinces of Iran. Wien Med Wochenschr 2019; 170:212-217. [PMID: 31410715 DOI: 10.1007/s10354-019-0703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The human immunodeficiency virus (HIV) is still a remarkable challenge throughout the world, especially in developing countries. Despite the fact that HIV in children is becoming one of the most challenging diseases, it seems that pediatric AIDS in Iran is an unknown disease and there is a lack of studies about it. The aim of this study was to describe the characteristics of HIV-positive children who referred to the hospitals of Tehran, Kermanshah, Kurdistan, and Qom provinces of Iran. MATERIALS AND METHODS This study was a retrospective investigation of medical records among 61 children with a diagnosis of HIV who were admitted to the children's hospitals in the four provinces of Iran during a 3-year period (2013-2016). RESULTS The frequency of HIV in the center of Iran (Tehran and Qom provinces) was higher (N = 37, 61%). Most of the infected patients were between 5 and 15 years old, 52% were male, and 93% had a history of HIV in their family. Median age at diagnosis of HIV was 2 years. Most of the hospitalized patients were discharged and only two patients (3%) died due to HIV infection. The vast majority of patients (93%) were infected through maternal transmission and a low percentage (29%) were diagnosed before 1 year of age. All of them were in the third stage of the disease. All patients had a positive HIV PCR test. HIV EIA was positive in the majority of cases (98%). A history of addiction in the family was demonstrated in 22 cases (36%). Weight loss (N = 51, 84%), prolonged fever (N = 50, 81%), and respiratory infection (N = 26, 47%) were the most common symptoms. CONCLUSION This study demonstrated a high frequency of pediatric HIV among children aged 5-15 years in four provinces of Iran. Novel strategies to prevent and eliminate mother-to-child transmission of HIV, diagnostic facilities, and treatment of infected mothers during pregnancy in our country are highly recommended.
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Maniar JK. Horizontal transmission of HIV-1 infection in a child: With phylodynamic evidence-case study. Indian J Sex Transm Dis AIDS 2019; 40:73-76. [PMID: 31143866 PMCID: PMC6532492 DOI: 10.4103/ijstd.ijstd_4_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Mother-to-child transmission is the predominant mode of transmission of HIV infection in children. Occasionally, horizontal transmission has also been reported. We report a child who was diagnosed HIV positive at the age of 3.5 years born to HIV-negative mother. Based on the available histories, no alternative modes of HIV transmission could be implicated. However, the paternal grandmother of the child was found to be HIV infected. To explore the likelihood that this HIV-infected relative was the most likely source from which this child acquired HIV infection postnatally, Bayesian phylodynamic analysis of the HIV of the child and parental grandmother was performed, which showed evidence of linkage of HIV transmission from an HIV-infected paternal grandmother to a child living with her through unknown route. Studies to identify modes of nonvertical HIV transmission may be useful in devising strategies to avert such nonvertical infections.
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Affiliation(s)
- Janak Keshavlal Maniar
- Department of Infectious Diseases and HIV Medicine, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
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Sarkar S, Selvaraj K, Krishnamurthy S, Balasundaram A, Lakshminarayanan S. Caregivers' perspectives on disclosure, care, and treatment among pediatric HIV/AIDS patients in South India: A qualitative study. Ind Psychiatry J 2018; 27:219-225. [PMID: 31359975 PMCID: PMC6592199 DOI: 10.4103/ipj.ipj_54_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rollout of antiretroviral therapy (ART) has helped to achieve the increased life span among pediatric HIV patients. The psychosocial aspects of parents or caregivers can affect the treatment adherence in children and the disease outcome. AIMS AND OBJECTIVES This study aims at understanding the perspectives on disclosure of HIV status, stigma, antiretroviral treatment, and compliance among caregivers of children attending ART clinic in South India and to explore the barriers to treatment-seeking behavior. MATERIALS AND METHODS This facility-based qualitative study was carried out among caregivers of pediatric HIV patients <15 years of age. In-depth interview was conducted on caregivers after informed consent in the absence of the child, focusing on stigma, disclosure of HIV status to children, adherence, and coping strategies followed by the parents. The complete interviews were transcribed in English, and content analysis was done to identify the emergence of codes. Interview was conducted among mothers of affected child. The disease status of the children was known only to the parents and not to the children themselves (excepting one) or siblings. Parents intended to keep it confidential for the affected children as long as possible. Nevertheless, to maintain adherence and to prevent disclosure of HIV status, mothers traveled to this ART center from very far places, medical records were hidden, and tablets were removed from the strips and said to be medicines for energy and protection. CONCLUSION Mothers of HIV-positive children faced many difficulties to prevent the disclosure of the diagnosis from the affected children and others, which is not very conducive to adherence to the ART regimen. Effective disclosure strategies to manage this emotionally vulnerable group are an urgent need.
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Affiliation(s)
- Sonali Sarkar
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kalaiselvi Selvaraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India.,Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Abyramy Balasundaram
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subitha Lakshminarayanan
- Department of Community Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Clinical characteristics of pediatric HIV-1 patients treated with first-line antiretroviral therapy in Vietnam: a nested case-control study. Int J Public Health 2017; 62:113-119. [PMID: 28160044 DOI: 10.1007/s00038-016-0937-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Over the past decades, Vietnam has made great strides in reducing the rate of mortality in HIV-related deaths, due to increased access of antiretroviral therapy (ART); however, given the significantly high level of treatment failure (TF), it is essential to identify markers that describe the failure of ART in HIV-1 infected children. METHODS A nested case-control study was conducted with clinical data collected from 101 HIV-infected children [26 TF and 75 treatment success (TS)] at National Hospital of Pediatrics, Vietnam (2008-2012). RESULTS The results showed that certain factors including height, weight, vaccination with Hepatitis B, and platelet were significantly different between TF and TS before starting the treatment. In addition, age to start the treatment, CD4 percentage, and opportunistic infection were found to significantly predict treatment outcome most frequently, implying the importance of clinical markers in the treatment response by Cox regression analysis. CONCLUSIONS There is an inherent complexity within clinical markers that is challenging to determine HIV-pediatric failure and further research is needed to build a complete picture to guide clinical, evidence-based practice.
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Suri D, Sharma A, Bhattad S, Rawat A, Arora S, Minz RW, Singh S. Arthritis in childhood human immunodeficiency virus infection predominantly associated with human leukocyte antigen B27. Int J Rheum Dis 2016; 19:1018-1023. [PMID: 27456089 DOI: 10.1111/1756-185x.12947] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Children with human immunodeficiency virus (HIV) infection usually present with recurrent and unusual infections. Although reported among adults, arthritis as a predominant presentation in children with HIV is rare. Reactive arthritis is considered to be the most common musculoskeletal manifestation in adults with HIV infection. However, in children, septic or HIV-related arthritis has been described. We report four children having arthritis with HIV disease and their long-term outcome; out of which three had human leukocyte antigen (HLA)-B27-related arthritis. It is important to be aware of arthritic presentation of HIV disease in children to prevent delay in diagnosis and initiation of appropriate therapy. METHODS Clinical profile of children with HIV infection who presented with arthritis and registered at the Pediatric Immunodeficiency Clinic at PGIMER, Chandigarh were reviewed and analyzed. RESULTS A total of 796 children with HIV infection are registered in the Pediatric Immunodeficiency Clinic since January 1994. Among these, four children had arthritis, and it was the presenting manifestation in two of them. HLA-B27 related arthritis was noted in three children, while one had HIV-associated arthritis. None of the children had septic arthritis. Arthritis resolved on treatment with antiretroviral therapy (ART) in two children, while others responded to anti-inflammatory agents and the joint symptoms remained quiescent on follow-up with a total follow-up period of 21.5 patient years. CONCLUSIONS Clinicians must be aware of the arthritic presentation of childhood HIV infection. High degree of suspicion must be entertained to screen for HIV infection in children with arthritis, especially in those with reactive arthritis.
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Affiliation(s)
- Deepti Suri
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Avinash Sharma
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sagar Bhattad
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amit Rawat
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Arora
- Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ranjana W Minz
- Department of Immuno-Pathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Allergy-Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Shahrin L, Leung DT, Matin N, Kawser CA, Pervez MM, Chisti MJ. Clinical profile of hospitalized HIV-infected children in Bangladesh, a low-HIV-prevalence country. Paediatr Int Child Health 2014; 34:133-7. [PMID: 24164974 DOI: 10.1179/2046905513y.0000000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Bangladesh has a low HIV prevalence and data on the risk factors and clinical presentation of HIV-infected children are lacking. OBJECTIVE To describe the clinical characteristics of hospitalized HIV-infected children in Bangladesh and determine the factors associated with a low CD4 count. METHODS An anonymous, retrospective review was undertaken of the medical records of all patients admitted to the HIV unit of the iccdr,b Dhaka Hospital between February 2009 and July 2012. Demographic, clinical and laboratory data were extracted from the electronic medical record system. HIV-infected children with a low absolute CD4 count (<200 cells/μl) were compared with HIV-infected children with a CD4 count ≧200 cells/μl. RESULTS Of 266 HIV-infected patients, 24 were children (9%), 13 (54%) of whom were male. Ages ranged from 2 to 17 years (median 7). Of the 21 (88%) children who acquired the infection by vertical transmission, median age at diagnosis was 5·2 years, and the parents of 19 (79%) reported a history of external migration. Children commonly presented with prolonged fever (n = 14, 58%), recurrent cough (n = 14, 58%), failure to thrive (n = 11, 46%) and recurrent diarrhoea (n = 4, 17%). Six (25%) patients had tuberculosis, four (16·7%) had herpes zoster and four (16·7%) were diagnosed with Pneumocystis jirovecii pneumonia. One child died during hospitalization. Children with a low CD4 count (<200 cells/μl) more often had severe wasting (95% CI 1·2-453·97) and severe under-nutrition (95% CI 1·39-196·25) than those with a higher CD4 count*. CONCLUSION The majority of HIV-infected children presenting to an inpatient speciality ward in Dhaka acquired HIV through vertical transmission, and most of the parents had a history of external migration. Further studies are needed to determine the optimal strategy for preventing mother-to-child transmission and for early identification and treatment of HIV-infected children in this low-prevalence country.
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Fru FS, Chiabi A, Nguefack S, Mah E, Takou V, Bogne JB, Lando M, Tchokoteu PF, Mbonda E. Baseline demographic, clinical and immunological profiles of HIV-infected children at the Yaounde Gynaeco-Obstetric and Pediatric hospital, Cameroon. Pan Afr Med J 2014; 17:87. [PMID: 25452833 PMCID: PMC4247732 DOI: 10.11604/pamj.2014.17.87.3264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/28/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Approximately 2.5 million children below 15 years are infected with the HIV virus, with 90% in sub-Saharan Africa. The Yaounde Gynaeco-obstetric and Pediatric hospital has been a treatment center for HIV since 2006. The aim of this study was to analyze the baseline demographic, clinical and immunologic characteristics of the children with the HIV infection in this hospital. Methods It was a retrospective, cross- sectional and analytic study, carried out between January and April 2011 which included 61 HIV positive children aged 0-15 years. The socio-demographic, clinical and immunologic data were obtained from their medical records. Results Most (52.5%) of the children studied were above 60 months of age with a mean age of 71 months. Most (57.4%) were females. Mother-to-child transmission was the principal mode of contamination in 88.5% of cases. More than half of their mothers (55.7%) did not receive antiretroviral prophylaxis during pregnancy and labor. Common clinical findings included prolonged fever (44.6%), malnutrition (37.6%), lymphadenopathy (34.4%), respiratory tract infections (34.4%) and diarrhea (24.5%). Diagnosis was confirmed by HIV serology for most of the patients (93.4%). Polymerase chain reaction served as method of diagnosis in only 6.6% of the cases. HIV 1 was the predominant viral type. More than half of the children (52.5%) were seen at an advanced stage of the disease. Conclusion HIV screening during pregnancy and prevention of mother-to-child transmission should be reinforced in this context, and fathers of HIV-infected children should be encouraged to go for HIV testing.
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Affiliation(s)
| | - Andreas Chiabi
- Yaounde Gynaeco-Obstetric and Pediatric Hospital/Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Séraphin Nguefack
- Yaounde Gynaeco-Obstetric and Pediatric Hospital/Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Evelyn Mah
- Yaounde Gynaeco-Obstetric and Pediatric Hospital/Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | - Virginie Takou
- Yaounde Gynaeco-Obstetric and Pediatric Hospital, Cameroon
| | | | - Marie Lando
- Yaounde Gynaeco-Obstetric and Pediatric Hospital, Cameroon
| | | | - Elie Mbonda
- Yaounde Gynaeco-Obstetric and Pediatric Hospital/Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
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Agrawal A, Thora S, Agrawal R. HIV Seropositivity in Hospitalized Children on Clinically Directed Selective Screening: An Experience from Central India. PEDIATRIC ONCALL 2013. [DOI: 10.7199/ped.oncall.2013.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ram M, Gupte N, Nayak U, Kinikar AA, Khandave M, Shankar AV, Sastry J, Bollinger RC, Gupta A. Growth patterns among HIV-exposed infants receiving nevirapine prophylaxis in Pune, India. BMC Infect Dis 2012; 12:282. [PMID: 23114104 PMCID: PMC3556061 DOI: 10.1186/1471-2334-12-282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 10/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background India has among the highest rates of infant malnutrition. Few studies investigating the growth patterns of HIV-exposed infants in India or the impact of timing of HIV infection on growth in settings such as India exist. Methods We used data from the Six Week Extended Nevirapine (SWEN) trial to compare the growth patterns of HIV-infected and HIV-exposed but uninfected infants accounting for timing of HIV infection, and to identify risk factors for stunting, underweight and wasting. Growth and timing of HIV infection were assessed at weeks 1, 2, 4, 6, 10, 14 weeks and 6, 9, 12 months of life. Random effects multivariable logistic regression method was used to assess factors associated with stunting, underweight and wasting. Results Among 737 HIV-exposed infants, 93 (13%) were HIV-infected by 12 months of age. Among HIV-infected and uninfected infants, baseline prevalence of stunting (48% vs. 46%), underweight (27% vs. 26%) and wasting (7% vs. 11%) was similar (p>0.29), but by 12 months stunting and underweight, but not wasting, were significantly higher in HIV-infected infants (80% vs. 56%, 52% vs. 29%, p< 0.0001; 5% vs. 6%, p=0.65, respectively). These differences rapidly manifested within 4–6 weeks of birth. Infants infected in utero had the worst growth outcomes during the follow-up period. SWEN was associated with non-significant reductions in stunting and underweight among HIV-infected infants and significantly less wasting in HIV-uninfected infants. In multivariate analysis, maternal CD4 < 250, infant HIV status, less breastfeeding, low birth weight, non-vaginal delivery, and infant gestational age were significant risk factors for underweight and stunting. Conclusion Baseline stunting and underweight was high in both HIV-infected and uninfected infants; growth indices diverged early and were impacted by timing of infection and SWEN prophylaxis. Early growth monitoring of all HIV-exposed infants is an important low-cost strategy for improving health and survival outcomes of these infants. Trial Registration NCT00061321
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Affiliation(s)
- Malathi Ram
- Johns Hopkins Bloomberg School of Public Health, Dept, of International Health/GDEC, Suite W5506, 615 N, Wolfe Street, Baltimore, MD 21205, USA.
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HIV infection presenting with stroke and epilepsia partialis continua. Indian Pediatr 2012; 49:589. [DOI: 10.1007/s13312-012-0104-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Opportunistic infections in HIV infected children. Indian J Pediatr 2011; 78:471-2. [PMID: 21424704 DOI: 10.1007/s12098-011-0403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
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Mukherjee A, Lodha R, Kabra SK. Changing trends in childhood tuberculosis. Indian J Pediatr 2011; 78:328-33. [PMID: 21161446 DOI: 10.1007/s12098-010-0298-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 11/12/2010] [Indexed: 12/26/2022]
Abstract
Several changes have been observed in the epidemiology, clinical manifestations, diagnostic modalities and treatment of tuberculosis. Emergence of HIV epidemic and drug resistance have posed significant challenges. With increase in the number of diseased adults and spread of HIV infection, the infection rates in children are likely to increase. It is estimated that in developing countries, the annual risk of tuberculosis infection in children is 2.5%. Nearly 8-20% of the deaths caused by tuberculosis occur in children. Extra pulmonary tuberculosis has increased over last two decades. HIV infected children are at an increased risk of tuberculosis, particularly disseminated disease. In last two decades, drug resistant tuberculosis has increased gradually with emergence of MDR and XDR-TB. The rate of drug resistance to any drug varied from 20% to 80% in different geographic regions. Significant changes have occurred in TB diagnostics. Various diagnostic techniques such as fluorescence LED microscopy, improved culture techniques, antigen detection, nucleic acid amplification, line probe assays and IGRAs have been developed and evaluated to improve diagnosis of childhood tuberculosis. Serodiagnosis is an attractive investigation but till date none of the tests have desirable sensitivity and specificity. Tests based on nucleic acid amplification are a promising advance but relatively less experience in children, need for technical expertise and high cost are limiting factors for their use in children with tuberculosis. Short-course chemotherapy for childhood tuberculosis is well established. Directly observed treatment strategy (DOTS) have shown encouraging result. DOTS plus strategy has been introduced for MDR TB.
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Affiliation(s)
- Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Abba K, Sinfield R, Hart CA, Garner P. Pathogens associated with persistent diarrhoea in children in low and middle income countries: systematic review. BMC Infect Dis 2009; 9:88. [PMID: 19515227 PMCID: PMC2709113 DOI: 10.1186/1471-2334-9-88] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 06/10/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Persistent diarrhoea in children is a common problem in low and middle income countries. To help target appropriate treatment for specific pathogens in the absence of diagnostic tests, we systematically reviewed pathogens most commonly associated with persistent diarrhoea in children. METHODS We sought all descriptive studies of pathogens in the stool of children with diarrhoea of over 14 days duration in low and middle income countries with a comprehensive search of the MEDLINE, EMBASE, LILACS and WEB OF SCIENCE databases. We described the study designs and populations, assessed the quality of the laboratory tests, and extracted and summarised data on pathogens. For Escherichia coli, we calculated high and low prevalence estimates of all enteropathic types combined. Results across studies were compared for geographical patterns. RESULTS Nineteen studies were included. Some used episodes of diarrhoea as the unit of analysis, others used children. The quality of reporting of laboratory procedures varied, and pathogens (particularly E. coli types) were classified in different ways. As there were no apparent regional differences in pathogen prevalence, we aggregated data between studies to give a guide to overall prevalence. Enteropathic E. coli types were commonly found in children with persistent diarrhoea (up to 63%). Various other organisms, including viruses, bacteria and parasites, were detected but across all studies their prevalence was under 10%. However, these pathogens were also found in similar frequencies in children without diarrhoea. CONCLUSION A number of pathogens are commonly associated with persistent diarrhoea in children, but in children without diarrhoea the pathogens are found with similar frequencies. New research with carefully selected controls and standardised laboratory investigations across countries will help map causes and help explore effective options for presumptive treatment.
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Affiliation(s)
- Katharine Abba
- International Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Rebecca Sinfield
- Arrowe Park Hospital, Arrowe Park Road, Upton, Wirral, Merseyside, CH49 5PE, UK
| | | | - Paul Garner
- International Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Abba K, Sinfield R, Hart CA, Garner P. Antimicrobial drugs for persistent diarrhoea of unknown or non-specific cause in children under six in low and middle income countries: systematic review of randomized controlled trials. BMC Infect Dis 2009; 9:24. [PMID: 19257885 PMCID: PMC2653038 DOI: 10.1186/1471-2334-9-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 03/03/2009] [Indexed: 11/20/2022] Open
Abstract
Background A high proportion of children with persistent diarrhoea in middle and low income countries die. The best treatment is not clear. We conducted a systematic review to evaluate the effectiveness of antimicrobial drug treatment for persistent diarrhoea of unknown or non-specific cause. Methods We included randomized comparisons of antimicrobial drugs for the treatment of persistent diarrhoea of unknown or non-specific cause in children under the age of six years in low and middle income countries. We searched the electronic databases MEDLINE, EMBASE, LILACS, WEB OF SCIENCE, and the Cochrane Central Register of Controlled Trials (CENTRAL) to May 2008 for relevant randomized or quasi randomized controlled trials. We summarised the characteristics of the eligible trials, assessed their quality using standard criteria, and extracted relevant outcomes data. Where appropriate, we combined the results of different trials. Results Three trials from South East Asia and one from Guatemala were included, all were small, and three had adequate allocation concealment. Two were in patients with diarrhoea of unknown cause, and two were in patients in whom known bacterial or parasitological causes of diarrhoea had been excluded. No difference was demonstrated for oral gentamicin compared with placebo (presence of diarrhoea at 6 or 7 days; 2 trials, n = 151); and for metronidazole compared with placebo (presence of diarrhoea at 3, 5 and 7 days; 1 trial, n = 99). In one small trial, sulphamethoxazole-trimethoprim appeared better than placebo in relation to diarrhoea at seven days and total stool volume (n = 55). Conclusion There is little evidence as to whether or not antimicrobials help treat persistent diarrhoea in young children in low and middle income countries.
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Affiliation(s)
- Katharine Abba
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK.
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Singh S, Jat KR, Minz RW, Arora S, Suri D, Sehgal S. Clinical profile of 516 children affected by HIV in a tertiary care centre in northern India: 14 years of experience. Trans R Soc Trop Med Hyg 2009; 103:627-33. [PMID: 19217132 DOI: 10.1016/j.trstmh.2009.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 12/30/2008] [Accepted: 01/06/2009] [Indexed: 11/26/2022] Open
Abstract
Increasing numbers of children affected by HIV are being recognised in northern India. The present study aimed to evaluate the clinical profile of 516 children affected by HIV at the Pediatric Allergy and Immunology Unit, Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India, during the period January 1994 to May 2008. In total, 454 children (327 boys and 127 girls) infected by HIV were analysed. The median age at presentation was 54 months. Of these children, 401 (88.3%) acquired the infection vertically and 26 (5.7%) acquired it through transfusion of blood/blood products. Moreover, 156 children (34.4%) were asymptomatic at presentation to hospital. Common clinical features included fever (36.6%), respiratory infections (31.7%), lymphadenopathy (30.0%), hepatosplenomegaly (21.8%) and diarrhoea (18.1%); 299 children (65.9%) were malnourished. Triple drug antiretroviral therapy was initiated in 205 children. Children receiving such therapy showed significant improvement in clinical and immunological parameters. Furthermore, follow-up rates improved markedly following free supply of the drug. Therapy was very well tolerated. To conclude, physicians looking after children need to be familiar with the varying clinical presentation of HIV infection. To the best of our knowledge, this is the largest paediatric series on HIV infection from a single centre from any developing country.
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Affiliation(s)
- Surjit Singh
- Advanced Pediatric Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Abstract
A 13-yr-old girl born to healthy parents presented with cough, fever, easy fatiguability, photosensitivity and alopecia. She had clubbing and diffuse crackles in the chest on examination. Her CT scan of the chest showed evidence of bronchiectasis with consolidation. Investigations for tuberculosis and collagen vascular disease were negative. In due course she developed features of raised intracranial tension. Her blood for HIV ELISA was positive with CD4 counts of 17/ microL. Her CSF, sputum, blood and urine specimen were all positive for Cryptococcus neoformans on culture. HIV was not considered initially because of her atypical presentation. There was no history of sexual abuse, her parents were healthy and she did not receive any blood transfusion in the past.
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Affiliation(s)
- Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Elizabeth KE. HIV infection in children. Indian J Pediatr 2007; 74:592; author reply 592. [PMID: 17595508 DOI: 10.1007/s12098-007-0102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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