Pathology of Opportunistic Infections in Children with Acquired Immune Deficiency Syndrome

Opportunistic infections (OI) were diagnosed by histology and culture of biopsy and autopsy material in 15 children with the acquired immune deficiency syndrome (AIDS). The opportunistic pathogens included Pneumocystic carinii, Toxoplasma gondii, Candida species, Aspergillus species, Mycobacterium avium-intracellulare, cytomegalovirus, and herpes simplex virus. Seven of 15 patients also had multiple systemic infections with common pathogenic bacteria. Accurate diagnosis of OI in AIDS is of importance in the decision regarding the choice of appropriate antimicrobial therapy. Careful histologic assessment of the biopsy specimens; awareness of unusual features such as paucity of organisms and inflammatory reaction, “histoid” variety of reaction, lack of granuloma formation, and resemblance to Whipple's disease in certain OI; and demonstration of causative organisms by appropriate special stains andlor culture are essential in the evaluation of these patients.     

小儿艾滋病9例

目的研究小儿艾滋病9例的临床表现、并发症及传播途径。方法回顾性分析本院2000年3月-2006年6月收治的9例艾滋病患儿流行病学资料、临床表现、实验室检查、并发症、治疗及转归情况。结果9例患儿人类免疫缺陷病毒（HIV）抗体均为阳性,分别通过母婴传播、输注感染HIV的血液或血制品传播,发病年龄1-10岁,平均潜伏期5（2-10）a。死亡6例,3例治疗中。结论儿童艾滋病常以发热伴反复咳嗽或迁延性腹泻为主要临床表现,真菌感染是儿童艾滋病的主要并发症之一。母婴垂直传播和血源性传播是儿童艾滋病的重要传播途径。     

小儿艾滋病12例

目的探讨小儿艾滋病(AIDS)的临床特点。方法对马里共和国Markala医院收治符合美国国家疾病控制中心及《诸福棠实用儿科学》诊断标准的12例AIDS患儿的临床表现、实验室检查、治疗与转归情况进行回顾性分析,以总结小儿AIDS的临床特点。结果12例均有长期反复发热史,体温38~39℃,均呈进行性消瘦,浅表淋巴结均可触及,肝、脾大。咳嗽经久不愈6例,其中肺炎3例,肺结核1例。实验室检查12例,均呈人类免疫缺陷病毒(HIV)阳性,口腔及生殖器念珠菌感染7例,支气管肺炎3例,原发肺结核1例,肺纹理增粗2例,肝功能异常3例。确诊后采用联合用药,如齐多夫定片(AZT)140 mg/(m2.次),3次/d;拉米夫定片(3TC)4 mg/(kg.次),2次/d;茚地那韦(IDV)500 mg/(m2.次),3次/d。回国前随访,死亡4例,失访2例,存活6例。结论儿童AIDS潜伏期相对较短,临床表现极不典型,病情进展快,预后较差。提高对该病的认识,可避免误诊或漏诊。实用儿科临床杂志,2006,21(19):1311     

Pathology of Suspected Acquired Immune Deficiency Syndrome in Children: A Study of Eight Cases

Biopsy and/or autopsy material from lymphoreticular and other organs was studied in 8 children with suspected acquired immune deficiency syndrome (AIDS). One or both parents of each of these children had one or more of the recognized risk factors for AIDS, such as intravenous drug abuse, prostitution, Haitian origin. The following histologic patterns were noted in the lymph nodes: (1) follicular hyperplasia with normocellular paracortex, (2) follicular hyperplasia with depletion of paracortex, and (3) atrophy of follicles with depletion of paracortex. Lymphoid interstitial pneumonitis (LIP), a previously unreported lesion in AIDS, was present in 4 cases. It is suggested that the pulmonary lymphoid lesion may be part of a more generalized lymphoid hyperplasia involving B cells. The gross and microscopic features of the thymus, available in 2 of the 8 cases, indicated that the immunologic defect in these children was not of congenital type. Pathologic findings can be helpful in the diagnosis of the syndrome when correlated with clinical and immunologic features of suspected cases and of the pulmonary lesion. The latter is of importance in deciding the type of therapy to be given for the pulmonary disease process.     

Infections in Children with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: An Autopsy Study of 30 Cases in South Florida, 1990-1993

Thirty autopsies performed on infants and children with HIV infection and/or AIDS were reviewed for the presence and type of infection. Twenty-six (87%) demonstrated evidence of infection in addition to HIV at the time of postmortem examination. Pathogenic bacterial infections were the most frequently encountered, seen in 15 of the cases. Nine of the 15 (60%) were due to gram-negative rods, most commonly Pseudomonas aeruginosa. Infections with gram-negative organisms often involved multiple organ systems and were frequently undiagnosed both pre -and postmortem because of variability in culture results and difficulties in identification both clinically and in tissue sections. Discussion is presented of unusual staining characteristics and filamentous morphology found with these pathogens. Other pathogenic bacteria encountered were Klebsiella pneumoniae, Escherichia coli, Enterobacter sp., and Staphylococcus. Fungal infections due to Candida species were present in nine cases (31 %) but were invasive in only two of these. One instance of Aspergillus meningo-encephalitis was noted. Proven viral infections were present in five children (three cytomegalovirus, one herpes simplex, and one adenovirus). Pneumocystis carinii pneumonia was diagnosed in five of the patients (17%), and one instance of disseminated Mycobacterium avium-intracellulare was encountered.     

Lymphadenopathic Kaposi'S Sarcoma in a Pediatric PatienT with Acquired Immune Deficiency Syndrome

A six-year-old Hispanic female with acquired immune deficiency syndrome (AIDS) and multiple opportunistic infections was found to have disseminated lymphadenopathic Kaposi's sarcoma at autopsy. She was presumed to have been infected via maternal transmission, although both HIV antibody positive parents were asymptomatic. Kaposi's sarcoma is rarely reported in pediatric AIDS, and children may not have the typical aggressive cutaneous lesions found in adults with AIDS-associated Kaposi's sarcoma.     

Autoimmune phenomena in children with Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome

We have studied sera from 44 children with Human Immunodeficiency Virus infection and Acquired Immunodeficiency Syndrome using immunoblotting, radioimmunoassay, enzymoimmunoassay and indirect immunofluorescence. We have detected a low incidence of antinuclear (2.9%), anti-reticulin (2.9%) and anti-smooth muscle (14.7%) antibodies by indirect immunofluorescence. By enzymoimmunoassay we have detected anti-dsDNA (20.5%) and anti-ENA [anti-nRNP (61.3%), anti-Sm (29.5%), anti-Ro (47.7%) and anti-La (18.1%)] antibodies. Tests for anti-dsDNA by radioimmunoassay were negative, suggesting the presence of low-avidity anti-DNA antibodies. By immunoblotting we have detected anti-C (nRNP) (33.3%), anti-BB' (Sm) (33.3%), anti-Ro (60 KD) (4.5%) and anti-La (11.3%) antibodies. The presence of anti-Ro antibodies was associated with progressive neurological disease. Long-term follow-up studies with larger numbers of patients are necessary to evaluate the clinical significance of the presence of anti-dsDNA and anti-ENA antibodies in children infected with Human Immunodeficiency Virus.     

儿童获得性免疫缺陷综合征临床特点

目的 探讨儿童获得性免疫缺陷综合征(AIDS)的病因、临床特征、诊治经过及预后,以提高对该病的认识.方法 对2001年以来在广西医科大学第一附属医院儿科住院的12例儿童AIDS或疑似AIDS的临床及实验室检查资料进行回顾性分析,以总结其临床特点.结果 12例患儿中男9例,女3例;年龄45 d-9岁;11例患儿父母血清均为人类免疫缺陷病毒(HIV)抗体阳性或疑似因AIDS死亡者;临床表现为生长发育迟缓并不同程度营养不良12例(100%),长期不规则发热、间断性咳嗽及肝脾大各10例(83.3%),迁延性腹泻及淋巴结大各8例(66.7%).全身性皮炎6例(50%),大脑发育不全4例(33.6%),口腔念珠菌感染3例(26.7%),中耳炎2例(16.7%);实验室检查:12例2次血清HIV抗体检测均呈阳性,CD4 T淋巴细胞的百分比均下降,CD4 /CD8 细胞比值均降低,肝功能检查转氨酶均升高,3例血清巨细胞病毒抗体阳性,4例血培养及1例骨髓培养出马尔尼菲青真菌,大便涂片及培养4例找到真菌.死亡1例,余病例对症治疗效果差.结论 儿童AIDS潜伏期相对较短,临床表现多样化,细胞免疫功能低下,对症治疗效果差.提高对该病的认识,可早期诊断、早治疗,延长患儿生命.     

艾滋病并恶性肿瘤2例的影像学及解剖与病理特征

目的 探讨儿童艾滋病(AIDS)并恶性肿瘤的影像学表现与解剖、病理的相关性.方法 回顾性分析2例AIDS患儿,男、女各1例,经活检及尸体解剖、病理检查确诊并恶性肿瘤,对其影像学及解剖、病理资料进行分析.1例患儿死亡,对其尸体进行断层解剖,并做病理组织学检查.结果 男患儿活体影像扫描可见鞍上池圆形结节影,腹腔肠壁增厚,周围组织黏连;胃肠钡透显示回肠远端呈环抱球状压迹,肠壁缺损,肠管似海马状.尸体影像扫描可见鞍上池境界清楚的略高密度区,腹部影像重建显示肠管积气,结构不清,与尸体冠状解剖标本显示一致.病理证实为AIDS.女患儿活体影像扫描显示肝右叶巨大长T1长T2信号,其内可见短T1短T2信号,包膜尚清楚.病理证实为AIDS并肝母细胞瘤.结论 AIDS患儿除并非霍奇金淋巴瘤等常见肿瘤外,还可并生殖细胞瘤及肝母细胞瘤等罕见恶性肿瘤.这些原发肿瘤往往发生于AIDS患儿,其影像学表现与解剖、病理符合度高.     

Children and adolescents living with HIV and AIDS: a review

Worldwide, more than one million children are infected with human immunodeficiency virus (HIV) and in the United States it has become the sixth leading cause of death among 15-24-year-olds. Despite the trend of increasing rates of infection, advances in therapies have led to survival past 5 years of age for more than 65% of infected children. This global health threat will therefore continue to have a significant impact on child and adolescent psychiatry and psychology. This paper reviews current studies and reports on the consequences of the acquired immunodeficiency syndrome (AIDS) epidemic in the psychiatric care and development of children and adolescents infected by HIV. From a search of all the English-language-based literature on pediatric AIDS, 140 studies are reviewed which address HIV infection and its psychological and social implications. Several topics of mental health significance are examined: (1) the epidemiology of HIV, (2) neurocognitive development among those infected, (3) psychological impact of infection, and (4) the family and social context of HIV. The transition of HIV from an acute, lethal disease to a subacute, chronic disease has enormous implications for the neurocognitive and psychosocial development of children and families. As children and adolescents infected with HIV continue to live longer, normal developmental milestones and educational needs will take on new significance. Many children will continue to be adversely impacted by non-HIV factors such as poverty, inadequate medical services, and a lack of social support. This review outlines recent developments that hold promise to effectively reduce the treatment burden on the infected, their families, and health care providers and to decrease the incidence of transmission to the uninfected.     

过敏性紫癜病因及免疫发病机制

过敏性紫癜是儿童常见的全身性血管炎性疾病。该病的病因可能涉及感染、遗传、药物、疫苗等方面。IgA1糖基化异常及分子清除障碍,导致IgA1免疫复合物介导的体液免疫异常;Th2和Th17细胞异常活化,IL-6、TNF-α分泌增多,TNF样凋亡弱化因子调控的核因子-κB活化,血浆一氧化氮、内皮素水平增高等细胞免疫和炎症介质的参与,可能共同导致微血管内皮损伤,促进过敏性紫癜的发生。     

Immune Capacities in Children with Growth Hormone Deficiency

Since accumulated evidence from laboratory animals suggests the importance of growth hormone (GH) in the development of the immune system, we performed immunological studies in nineteen patients with GH deficiency. The absolute number of peripheral blood lymphocytes and serum immunoglobulin concentration of nineteen patients were compared with those of thirty age-matched controls. Lymphocyte transformation capacities of four patients were compared with those of six controls using phytohemag-glutinin-P (PHA-P) and concanavalin-A (Con-A). Lymphocyte subpopulations of five patients were compared with those of twenty-four controls. Delayed skin hypersensitivity test against four different antigens were performed in five patients. The results show that the immunological functions of GH deficient patients were within the normal range. If our patients' disorder originated from trauma or asphyxia at the time of delivery, a discrepancy between our results and those observed in laboratory animals suggest that the effects of GH produced during gestation may have been sufficient to develop immunological functions in man. (Acta Paediatr Jpn 23(2): 185–190 1981)     

艾滋病并肺结核患儿的临床及X线特点

目的探讨儿童艾滋病并肺结核的临床及X线特点。方法对已确诊的19例艾滋病并肺结核患儿的临床资料及X 线表现进行分析。结果小儿艾滋病并肺结核最常见的临床表现为咳嗽、长期不规则发热、盗汗和气促。胸部X线多为多发片状阴影、两肺粟粒结节样阴影及肺门纵隔淋巴结大。单发片状阴影常常发展为双侧多发片状阴影。结论小儿艾滋病并肺结核胸部X线多表现为片状模糊阴影,粟粒结节样阴影,肺门纵隔淋巴结大。随访复查X线胸片表现常有发展变化。X线胸片检查对本病诊断起着重要作用。     

缺铁性贫血患儿T辅助细胞的免疫与调控

为研究缺铁性贫血患儿T辅助细胞 (TH)的细胞调控及免疫功能。对 2 0 0 2年 1月至 2 0 0 2年 1 2月住院患儿进行TH 细胞检测 ,同时设正常健康儿童 2 8人为对照组。对两组儿童应用ELISA法检测白细胞介素 2 (IL 2 )及γ干扰素 (INF γ)水平 ,用单细胞内染色法检测TH1、TH2 百分率。结果 :缺铁贫血患儿IL 2 ( 1 6 55± 2 87ug L)水平明显降低 ,与对照组IL 2 ( 2 4 73± 4 37ug L)比较差异有显著意义 (t =8 6 2 ,P <0 0 1 ) ;INF γ( 4 75 6± 2 7 1pg mL)水平也明显降低 ,与对照组IFNγ( 6 54 0 7± 1 4 6 4pg mL)比较 ,差异有极其显著性意义 (t =7 4 2 ,P <0 0 1 ) ;缺铁性贫血患儿TH1百分率( 1 2 2 4± 2 51 % )亦明显低于对照组TH1百分率 ( 1 6 6 7± 2 73% ) ,经t检验差异亦有极显著意义 (t=6 89,P <0 0 1 ) ;缺铁性贫血患儿TH2 百分率明显升高 (t=5 37,P <0 0 5)。结果表明 :缺铁贫血患儿机体TH1细胞数量及功能低下 ,TH1 TH2 值下降 ,TH1、TH2 极化异常 ,导致细胞毒性T细胞 (CTL)介导的细胞免疫功能受到抑制     

儿童体位性心动过速综合征的发病机制

体位性心动过速综合征是一种与体位有明确关系的窦性心动过速,特征性临床表现为当患者体位由平卧位转为直立时,于10 min内心率增加≥30次.min-1,或心率最大值≥120次.min-1。体位性心动过速的发病机制目前尚未明了,可能主要与中心血容量改变、自主神经及肌肉泵功能障碍、血管内皮功能异常以及基因变异等有关。     

Evaluation and Treatment of Children with Primary Immune Deficiency in the Emergency Department

The potential for morbidity and mortality in patients who have PID with febrile and nonfebrile illness is extremely high. Familiarity with the clinical manifestations of PID and collaboration with a pediatric immunologist are prerequisites for optimal short-term care of these complex patients. Conservative management with empiric broad-spectrum antimicrobials, early and aggressive surgical debridement of abscesses, and admission at a tertiary pediatric care center are often indicated.