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Pediatric Case Presentation

Pediatric Case Presentation. BOGNON TANGUY Care Unit Children Exposed or Infected by HIV/AIDS Military Teaching Hospital - Cotonou - BENIN. History of present illness. Date of presentation: December 27 th 2002 5 and 1/2 months old girl (born july 10 th 2002) Presented with:

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Pediatric Case Presentation

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  1. Pediatric Case Presentation BOGNON TANGUY Care Unit Children Exposed or Infected by HIV/AIDS Military Teaching Hospital - Cotonou - BENIN

  2. History of present illness • Date of presentation: December 27th 2002 • 5 and 1/2 months old girl (born july 10th 2002) • Presented with: • Impaired development, anormal behaviors • Cutaneous lesions • Anorexia • No cough, no fever • Benn unwell since 2 months old

  3. Past Medical History • Mother 42 years, HIV +ve, seeking children since 15 years • Received NVP for PMTCT • Birth weigh: 2040 g • Baby admitted more than 10 times for various medical conditions and has been given: Nystatine, Cotrimaxozole, Amoxicillin, Vitamins, • First child • Father HIV status not known

  4. Physical examination at entry • Weigh: 2220g; height: 57 cm; CP: 34 cm; BP: 5.7 cm • Very sick looking • Oral and cutaneous thrush • Encephalopathy • Bilateral keratitis and dry eye (seen by ophtalmologist) • PGL and hepatomegaly • CBC: HB=5.7 g/dl • CXR normal, • No LP, EEG and RMI

  5. Diagnosis • 5 ½ month baby with perinatal HIV infection • IO: esophageal candidiasis, • Anemia • Encephalopathy • Severely immunocompromised - CD4<15% • Stage 4 WHO, Stage C CDC classification

  6. Child management 1st week • Medications • Cotrimoxazole high dose 15 days followed by prophylaxis • Fluconazole 14 days, consolidation nystatine 2 months • Ocular topics (antibiotics and others) for 3 weeks • Enteral nutrition by nasogastric sonde(tube) for 10 days • Blood transfusion: 2 times during the first week

  7. Child Management cont’d 2nd Week (6 months old) • CD4: 799 ; 12% • Hb: 8 g/dl • Started HAART: D4T+3TC+NFV • Giving during first day by nasogastric tube • Well tolerated • Medications: iron, folates, • Nutritional assistance: advice, nutritional supplements, polyvitamins • Appointment for Psychosocial care

  8. Follow up 1 month 3 weeks ART - 7 months old • No thrush, better looking • Oral nutrition was perfect • Weight: 2550 g • Neurological examination • Encephalopathy slightly improved • Beginning of functional reeducation • Exit with follow up visit plan • Every week for 2 weeks • Every 2 weeks for a month • Visit at 6 months, and every 3 months

  9. Follow up 7 months 6 months ART - 1 years old • Better looking • Weight: 4750 g • Height: 72 cm; CP: 42 cm; BP: 12.5 cm • Neurologic examination: better, able to pursue vision, hold head, normal tone of arms and legs • CD4: 19% (985), Hb: 10.2 g/dl • RX: change D4T to AZT (stock rupture) • Medications are adapted to weight

  10. Follow up 1 year and later • 18 months • Improvement of psychomotor development: • Can Walk • Weight: 11 kg • seen 13/06/05 (3 years, 2yrs and half of ART) • Weight: 15 kg • Cd4: 1795 (26%) • Hb: 12 g/dl

  11. The well being • January 3rd, 2005 • Weight 16,3 kg • Excellent conditions • Good adherence • Lab test for ART long-term toxicity was ok • Entered school: Kindergarten • Good mark for the first quarter • Last seen -Weight 26 kgs , Height 134cm -HB 12g/dl, CD4 654(30%), VL 2442 • Schooling; 3rd level at primary school

  12. About the mother • Psychosocial care from the beginning • Appointment with adult physician when baby has 6 months follow up • CD4: 280 • Cotrimoxazole • Started HAART one year ago • Father still not coming • Mothers concerns: • school, disclosing status to teacher, and fertility, …. • Last seen October 2008:going well on HAART

  13. What do we learn • We can do some things for babies infected from mothers • Improvement of follow up after birth • In an area viral load or PCR DNA not available: CD4 when available is useful when symptoms appear • This baby’s care involved • Pediatrician, ophthalmologist, psychologist and social worker, and kinesitherapist

  14. Questions about this case • Even though, successful case • Compliance with school • Long term ART toxicity ……

  15. Thanks for attention

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