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Opportunistic Infections. Prof ML Siddaraju Dept of Pediatrics Bangalore Medical College. INTRODUCTION. Opportunistic infections occur in HIV infected child due to waning immunity. It may be a presenting symptom in many children who on investigation would turn out to be HIV infected.
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Prof ML Siddaraju
Dept of Pediatrics
Bangalore Medical College
Opportunistic infections occur in HIV infected child due to waning immunity.
It may be a presenting symptom in many children who on investigation would turn out to be HIV infected.
It develops faster in children below one and half year than older children.
Prevalence of OI depends on prevalence of infection in family and in community.
RULE OF FOUR
To help the health care providers recognize the patient with symptomatic HIV infection as an aid to clinical management
Pneumocystic Carnii Pneumonia.
Lymphocytic Interstitial Pneumonia.
Recurrent bacterial and or viral infections.
Miliary ,extrapulmonary or noncavitatory TB
Herpes zoster-present or past, multidermatomal
CMV –systemic infection
Neurological Dysfunction ,Progressive neurological disease, microcephaly, loss of developmental milestones
Fever –intermittent or continuous for
> 1 month
Maternal HIV seropositivity.
H/O blood /blood product transfusion before 1985 or screened blood from an area with high HIV prevalence
Use of contaminated syringes /needle scarification/ear piercing /circumcision /tattooing using unsterile instruments.
If there is fever – other possible causes should be ruled out and treated accordingly.
Blood /mucus in the stools – indicate possibly shigella dysentery .Empirically treat with co-trimaxazole /nalidixic acid.
Patient should be daily evaluated for evidence of dehydration and other signs of improvement
A: disappearanceof fever .
B: decreased frequency of stools .
D:wt gain . 20 gm /day for >2 days .
Nutritional aspect has to bet taken care of :
A: if exclusively breast fed continue.
B: In tothers ,animal milk is as far as possible is avoided / reduced or else given in the form of curds or mixed with cereal.
C: If non vegetarian- chicken/fish/egg can be included.
D: vegetable oils are added to increase the calories .
If no improvement is noticed after 2 days child may be refered to a higher center.
Microscopic examination of stools is done to identify the causative agent –giardia / entamoeba/helminthic ova & cysts.
In the stool smear , evidence of blood & WBC’s should be looked in suggestive of bacterial infection and treated accordingly.
Are done to pinpoint exact etiopathogenesis and treated accordingly.
1.Diarrhoea > 14 Days
2.Chronic /Recurrent diarrhea.
In 1/3rd of cases etiology is cryptosporiodisis.
Majority of the cases – no specific enteric pathogen is isolated
Unrepaired mucosal damage
Episodes of acute diarrhoea to start with.
HIV + pts with persistent diarrhea with dehydration and malnutrition should be hospitalized and managed accordingly.
Assessment of dehydration – manage accordingly.
Exclusive breast feeding – inspite of risk.
Later Childs nutritional requirement should be properly met with,.
Animal milk should be fermented – curds
Curds and cereals can be mixed together
Cooked cereal with poultry products or sea food is liberally used depending upon the local availability.
Vegetable oil should also be included.
Vitamins and minerals may be supplemented.
>60/min >50/min >40/min
<2mo 2mo-12mo 1yr-5yr
Microscopic demonstration of pseudohyphae and or blastopores of
candida albicans from mouth scraping or biopsy.