AIDS: outcome of children born to HTLV-III/LAV infected mothers. Report of 15 Italian cases

The characteristics of acquired immunodeficiency syndrome (AIDS) in children have been described in several reports. The occurrence of specific anti-HTLV-III/LAV seropositivity in children born to seropositive mothers is also becoming more frequent in Italy. We report 15 cases of seropositive children born to 14 seropositive, drug-addicted mothers. Among them, 5 died of AIDS, 8 developed a variable, non-progressive AIDS-related complex (ARC), while only two remained persistently asymptomatic. Liver disease was present in 2 patients, CNS disease in 4, gastrointestinal troubles were never a major problem. Only 2 cases of HBV infection and 3 of thrombocytopenia were observed. In our experience, homosexual behaviour of the parents was never a cause of family risk. Children presented with failure to thrive and/or signs of disease usually within the first five months of life. In one family the first child was affected by fatal AIDS while the younger child showed only passive, transient immunization by maternal specific IgG. One ARC patient, observed for over 3 years, showed apparently complete healing from the disease.     

Role of HCV coinfection towards disease progression and survival in HIV-1 infected children: a follow-up study of 10 years

The present study was taken up to evaluate the pattern of disease progression and survival in a group of HIV-1 positive children, coinfected with HCV infection (n=25) in comparison to those without such coinfection (n=23). There was a significant negative correlation between the rate of decline of the CD4 + T cell percentage and the duration of the AIDS-free interval in most (80.0 per cent) of the HCV seropositive children showing such decline (r=-0.588; p=0.005). The HCV seropositive children had twofold higher risk of progression to development of AIDS than HCV seronegatives (RR=2.51; 95 per cent CI:1.34-4.69; p=0.004). There was a significant negative correlation between the rate of decline of CD4 + T cell percentage and overall survival duration for HCV seropositive group (r=-0.609; p=0.003). Moreover, children coinfected with HCV had more than twofold higher risks of death than those without HCV (RR=2.39; 95 per cent CI:1.17-4.89; p<0.01). It appears that HCV infection may be an important contributor to the rapid disease progression and increase in mortality in HCV-HIV-1 coinfected children of thalassemia major.     

Lyme borreliosis in children

A total of 27 children with clinical symptoms indicative of Lyme borreliosis are described, 21 of which were seropositive. CNS symptoms were found in 17 of the seropositive childen (81%). Of these 21, 7 were CSF negative. Another 3 (with Bell's palsy and/or aseptic meningitis) were initially CSF negative but developed specific CSF titres 80, 65 and 120 days after the first lumbar puncture, respectively. Thus, seropositive children with aseptic meningitis and without initial signs of an infectious aetiology should be checked for a neuroborreliosis even when CSF negative in the first lumbar puncture. Antibiotic therapy undertaken in 26 children showed clinical recovery (Sodium penicillin, 300,000–500,000 units/kg per day for 14 days). One developed residual hypoacusis. Comparison of enzyme-linked immunosorbent assay (ELISA) IgG values from 27 cases with those of 30 healthy controls showed that elevated ELISA titres are a good indication of the disease. However, Lyme borreliosis can only be diagnosed correctly if the clinical symptoms conform with specific titres.Abbreviations Bb Borrelia burgdorferi - CNS central nervous system - CSF cerebrospinal fluid - EBV Epstein-Barr virus - ECM erythema chronicum migrans - ELISA enzyme-linked immunosorbent assay - Ig immunoglobulin - Lb Lyme borreliosis     

Osteoporose bei juveniler idiopathischer Arthritis

In a high percentage of patients with juvenile idiopathic arthritis (JIA) a pathologic loss of bone or the failure of bone mass to increase has been described, even with new therapeutic approaches. The decrease in bone mass correlates with the duration of active disease, and to some degree with the number of joints affected. In several studies, muscle mass has been found to be the strongest predictor of bone mass. A standardized diagnostic approach to the musculoskeletal system plus prophylactic measures and therapy are therefore mandatory in all children with JIA who do not achieve rapid remission. This review describes the options for diagnosis and treatment, and they are summarized in an algorithm.     

The prevalence of atopy in children with antibodies against hepatitis A virus and hepatitis B virus

To investigate the relationship between atopy and hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, we studied 42 children who had had HAV infection (Group I), 28 children who had had HBV infection (Group II), and 31 children who were seronegative for both HAV and HBV infection (Control group). Serological tests for HAV and HBV infections (anti-HAV IgG, HBsAg, anti-HBc IgG) and allergic skin tests and specific IgE investigations for the detection of atopy were carried out. In this study, there was no significant divergence in the socio-demographic characteristics among the three groups. The rates of specific IgE positivity in children in the HAV seropositive group (11.9%) and in children in the HBV seropositive group (17.8%) were lower than in the control group (35.4%) (p = 0.03 and p = 0.22, respectively). Also, the number of children with respiratory allergic diseases (allergic rhinitis and/or asthma) both in the HAV seropositive group and in the HBV seropositive group were significantly lower than in the control group (p < 0.05). When atopy in all of the groups was evaluated, the prevalence of atopy was found to be more widespread in HAV seronegative children (Adjusted OR, 9.2; 95% CI, 1.7-48.2) and HBV seronegative children (Adjusted OR, 5.9; 95% CI, 1.1-31.8) than in HAV and HBV seropositive children, after adjustment for age, number of older siblings and education of the father. In conclusion, in this study, the prevalence of atopy in children who had had HAV or HBV infection was found to be low, and this situation was considered to be related to the relationship of HAV and HBV infections to poor hygiene and to the fact that these infections occur at early ages in Turkey.     

The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi.

AIM: To compare presentation, progress, and outcome of acute bacterial meningitis in HIV seropositive and seronegative children. METHODS: A double blind randomised placebo controlled study of the use of dexamethasone as adjuvant therapy in acute bacterial meningitis, in children aged 2 months to 13 years, was carried out from July 1997 to March 2001. A total of 598 children were enrolled, of whom 459 were tested for HIV serostatus. RESULTS: Of the 459 children, 34% were HIV seropositive. Their presentation was similar to HIV seronegative children but more were shocked on arrival at hospital (33/157 v 12/302), and more had a focus of infection (85/157 v 57/302). HIV positive children had a higher incidence of Streptococcus pneumoniae infections (52% v 32%). Sixty four cases relapsed; 67% were in HIV positive patients. The mortality in HIV positive children was 65% compared with 36% in HIV negative children. The number of survivors in each group was similar. Hearing loss was more common in HIV negative than HIV positive children (66.3% v 47.2%). Steroid therapy had no influence on meningitis in HIV positive children, but the mortality in HIV negative children was 61% in children given steroids, and 39% in those who did not receive steroids. CONCLUSION: HIV seropositive children who develop bacterial meningitis have a high mortality and are prone to recurrent disease. There is an urgent need to prevent both primary and recurrent infections.     

Cohort comparison study of children whose mothers have acquired immunodeficiency syndrome and children of well inner city mothers

The virus or viruses (human immunodeficiency virus) associated with the acquired immunodeficiency syndrome may be transmitted in utero or perinatally from an infected mother to her baby. Infected adults may remain asymptomatic for months to years, during which time a mother could transmit the virus. It is not known to what degree a mother may transmit the virus perinatally or whether postnatal transmission is possible. We studied a cohort of children whose mothers had been reported to have acquired immunodeficiency syndrome, comparing human immunodeficiency virus-seropositive with seronegative children as well as a cohort of inner city children with similar socioeconomic characteristics whose mothers are well. Three (12%) of 25 children whose mothers have acquired immunodeficiency syndrome were seropositive compared with none of 44 children whose mothers were well. The seropositive children had lower T4A:T8 lymphocyte ratios than children in the other groups. Nine children of affected mothers were young enough to have been born within their mother's incubation period and were seronegative and well. When compared with seronegative children the seropositive children did not have greater contact with their ill mothers, either in types of physical interaction or in length of time lived together. Although this study cannot preclude the possibility of postnatal nonsexual transmission, it does present evidence against it.     

Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection

In a cohort study of 305 Swedish children, repeated blood samples and structured questionnaires were obtained from 6 mo to 11 y of age. Of the 40 children seropositive for Helicobacter pylori in one or more samples, 32 (80%) had cleared the infection by 11 y of age. No association was found between H. pylori seropositivity at any time and reported antibiotic consumption, size of home and family, type of day-care, history of atopic disease, length of breastfeeding or peptic ulcer disease in the family. Girls reported more (p = 0.002) unspecified abdominal pain during childhood than boys, but the difference in H. pylori infection rate (15/150, 10% for boys and 25/144, 17% for girls) was not significantly different (p = 0.09). Unspecified abdominal pain during childhood was reported more often (OR adjusted for gender = 2.2, 95% CI = 1.0-4.4, p = 0.04) for the children seropositive at some point (17/39, 44%) than for the seronegative children (54/217, 25%). RAP at 11 y of age was more often reported by the 9/36 (25%) children seropositive at some time in life than by the 23/172 (13%) seronegatives, but the difference was not statistically significant (OR adjusted for gender = 2.0, 95% CI = 0.8-4.6, p = 0.1). The study shows that H. pylori seropositivity was associated with a parental report of unspecified abdominal pain during childhood. Also, a history of unspecified abdominal pain was more common (OR = 51.6, 95% CI = 15.6-220, p < 0.001) in children reporting RAP at 11 y of age.     

The effect of HIV infection on paediatric bacterial meningitis in Blantyre, Malawi

Aim: To compare presentation, progress, and outcome of acute bacterial meningitis in HIV seropositive and seronegative children. Methods: A double blind randomised placebo controlled study of the use of dexamethasone as adjuvant therapy in acute bacterial meningitis, in children aged 2 months to 13 years, was carried out from July 1997 to March 2001. A total of 598 children were enrolled, of whom 459 were tested for HIV serostatus. Results: Of the 459 children, 34% were HIV seropositive. Their presentation was similar to HIV seronegative children but more were shocked on arrival at hospital (33/157 v 12/302), and more had a focus of infection (85/157 v 57/302). HIV positive children had a higher incidence of Streptococcus pneumoniae infections (52% v 32%). Sixty four cases relapsed; 67% were in HIV positive patients. The mortality in HIV positive children was 65% compared with 36% in HIV negative children. The number of survivors in each group was similar. Hearing loss was more common in HIV negative than HIV positive children (66.3% v 47.2%). Steroid therapy had no influence on meningitis in HIV positive children, but the mortality in HIV negative children was 61% in children given steroids, and 39% in those who did not receive steroids. Conclusion: HIV seropositive children who develop bacterial meningitis have a high mortality and are prone to recurrent disease. There is an urgent need to prevent both primary and recurrent infections.     

Arthritis associated with inflammatory bowel disease in children

Arthritis occurred in 23 of 136 (17 per cent) children and teenagers with inflammatory bowel disease, in 18 of 86 (21 per cent) patients with ulcerative colitis, and 5 of 50 (10 per cent) with granulomatous bowel disease. Eighteen children had peripheral arthritis which characteristically affected only a few large joints and was of brief duration and benign outcome. Five boys had spondylitis which was progressive and inseparable clinically from ankylosing spondylitis. Occurrence of joint manifestations was not associated with severity of bowel disease. Anemia and growth retardation occurred frequently. Mucocutaneous lesions were associated with peripheral arthritis but not with spondylitis. No patient had iridocyclitis. The possibility of bowel disease should be considered in children presenting with arthritis, particularly if gastrointestinal complaints, mucocutaneous lesions, anemia, or growth retardation are associated with pauciarticular arthritis. Peripheral arthritis is benign and regresses with improvement of underlying bowel disease but spondylitis is progressive and requires recognition and management for prevention of deformity.     

Hepatitis B virus DNA in liver tissue of chronic HBsAg carriers in childhood and its relationship to other viral markers.

The aim of the study was to examine the state of hepatitis B virus (HBV) DNA in liver tissue of 103 children with chronic hepatitis B aged 0.5-18 years to detect free and integrated viral sequences by Southern blot hybridization. HBV DNA was found in 74 patients. Seventy-two were seropositive for hepatitis B e antigen (HBeAg) and two had anti-HBe antibodies. Integrated sequences could be demonstrated in two children. One of them had only integrated HBV DNA and was anti-HBe seropositive. The other one presented both free and integrated viral sequences and developed seroconversion from HBeAg to anti-HBe 5 months after biopsy. In 29 hepatitis B surface antigen (HBsAg) carriers, no HBV DNA could be detected in the liver. Ten were HBeAg and 19 anti-HBe seropositive. HBV DNA in serum was found in 65 of the 74 Southern blot-positive and only in two cases of the Southern blot-negative patients. In conclusion, most of the HBeAg-positive children had free HBV DNA in their liver tissue and all patients with anti-HBe except one were negative. According to our results, HBV DNA integration into the liver cell genome can occur at an early stage of chronic disease but is not a frequent event.     

Seronegative autoimmune hepatitis in childhood

Comprehensive guidelines on seropositive autoimmune hepatitis have been published for both adults and children, although these guidelines comprise only limited knowledge about seronegative autoimmune hepatitis. Autoimmune hepatitis presents as an acute or chronic progressive disease and poor outcomes are inevitable if left untreated. The absence of autoantibody positivity, hypergammaglobulinemia and lack of comprehensive algorithms makes seronegative autoimmune hepatitis a mysterious disease. In general, seronegative autoimmune hepatitis often presents with acute hepatitis, and its treatment and prognosis similar to seropositive autoimmune hepatitis. The present review focuses on the known characteristics of seronegative autoimmune hepatitis in childhood, and those of which current knowledge is vague.     

Pulmonary manifestations in HIV seropositivity and malnutrition in Zimbabwe

Over a 10 month period 184 children, aged 5 years or less, who died at home had their nutritional status and HIV serostatus established; necropsies were also carried out. The HIV antibody test was positive in 122/184 (66%). Of the HIV seropositive children Pneumocystis carinii pneumonia was present in 19 (16%), cytomegalovirus pneumonia in nine (7%), and lymphoid interstitial pneumonitis in 11 (9%). Opportunistic infection was therefore seen in 28/122 (23%) of the seropositive cases but in none of the seronegative cases. Tuberculosis was present in 8/184 (4%): 6/122 (5%) in HIV seropositive and 2/62 (3%) in seronegative children. Lung aspirate showed positive bacterial isolates in 106/ 122 (86%) of HIV seropositive and 46/62 (74%) of seronegative children with Gram negative organisms predominating in both groups. Malnutrition was common and affected 106/184 (58%); positive growth was obtained in 98 (92%) of the malnourished children irrespective of their HIV serostatus. Malnutrition was significantly associated with bacterial lung infection after adjustment for the confounding effect of HIV status. No association was found between HIV serostatus and bacterial lung infection that could not be attributed to malnutrition at the time of death. The importance of adequate nutrition in reducing the risk of bacterial infection in HIV infected children is apparent.     

Herpes zoster in children with acute lymphocytic leukemia

Herpes zoster (HZ) occurred in 25% (28/88) of a population of children with acute lymphocytic leukemia (ALL) who were seropositive for varicella zoster virus antibody before its onset; 16.5% (33/199) of the total group of children with ALL developed HZ. There were no deaths and only one significant complication, cutaneous disseminated disease, as a result of HZ. The small number of patients studied may have accounted for the failure to find a significant association between the occurrence of HZ and the type of ALL or chemotherapy protocol employed. Although HZ seemed to be more common in those patients who experience relapses of their leukemia, it did not portend a poor outcome for ALL.     

Contractures in patients with Williams syndrome

Williams syndrome is a multisystem disorder, including a characteristic facies and habitus. Intellectual, neurologic, and cardiovascular dysfunction occur; vascular disease may be progressive. Joint contractures affected 10 of a group of 20 children and young adults. In 3 of 10 patients, the contractures were severe enough to interfere with daily activities; in 3 the effect was only moderate. The contractures developed in early childhood and usually did not improve or worsen with time. Large and small joints were affected and usually were symmetrical. Their occurrence did not correlate with vascular disease. The contractures could not be attributed to a neurologic cause.     

Study on some hepatic functions and prevalence of hepatitis B surface antigenaemia in Egyptian children with schistosomal hepatic fibrosis

Several different hepatic parenchymal lesions, including chronic hepatitis and cirrhosis, have been increasingly reported in children with schistosomal hepatic fibrosis (SHF) despite the known mesenchymal nature of the disease. The prevalence of persistent hepatitis (B) surface (HBs) antigenaemia and some hepatic functions have been determined in 52 children with SHF as well as in 100 age-matched healthy children. High prevalence of chronic HBs antigenaemia (58 per cent) has been demonstrated in children with SHF, but only in 2 per cent of the normal children. This denotes that children with SHF represent a dangerous reservoir for hepatitis B infection to the community. Serum alanine transferase (ALT) was higher than normal in 58 per cent of HBS seropositive patients and in none of the seronegative patients. This points to the risk of continual hepatic parenchymal injury to the HBs seropositive patients with schistosomiasis.     

Pulmonary manifestations in HIV seropositivity and malnutrition in Zimbabwe

Accepted 3 September 1996
Over a 10 month period 184 children, aged 5 years or less, who died at home had their nutritional status and HIV serostatus established; necropsies were also carried out. The HIV antibody test was positive in 122/184 (66%). Of the HIV seropositive children Pneumocystis carinii pneumonia was present in 19 (16%), cytomegalovirus pneumonia in nine (7%), and lymphoid interstitial pneumonitis in 11 (9%). Opportunistic infection was therefore seen in 28/122 (23%) of the seropositive cases but in none of the seronegative cases. Tuberculosis was present in 8/184 (4%): 6/122 (5%) in HIV seropositive and 2/62 (3%) in seronegative children. Lung aspirate showed positive bacterial isolates in 106/122 (86%) of HIV seropositive and 46/62 (74%) of seronegative children with Gram negative organisms predominating in both groups. Malnutrition was common and affected 106/184 (58%); positive growth was obtained in 98 (92%) of the malnourished children irrespective of their HIV serostatus. Malnutrition was significantly associated with bacterial lung infection after adjustment for the confounding effect of HIV status. No association was found between HIV serostatus and bacterial lung infection that could not be attributed to malnutrition at the time of death. The importance of adequate nutrition in reducing the risk of bacterial infection in HIV infected children is apparent.

     

Fetal AIDS syndrome score. Correlation between severity of dysmorphism and age at diagnosis of immunodeficiency

To objectively evaluate the fetal acquired immunodeficiency syndrome, we have developed a scoring system based on the presence of the characteristic features that we have previously reported. Using this scoring system, 37 children seropositive for the human immunodeficiency virus were classified into three groups: dysmorphologically severely affected (12 children); moderately affected (15 children); and mildly affected (ten children). There was a statistically significant correlation between the severity of the dysmorphic features and both the presence of opportunistic infections within the first year of life and the age at onset of symptoms associated with immune dysfunction, with the more severely stigmatized children manifesting symptoms at a younger age. There was no correlation, however, between severity of the dysmorphic features and presence of opportunistic infections at the time of our examination. We conclude that this scoring system may be useful in presymptomatic identification of severely dysmorphic human immunodeficiency virus-infected infants.     

Screening for celiac disease in diabetic children from Iran

Celiac disease has been shown to be associated with type 1 diabetes mellitus. We conducted this study to determine the frequency of celiac disease in a group of Iranian diabetic children. Ninety-six patients with type 1 diabetes mellitus were tested for anti-tissue transglutaminase antibodies. Six patients (6.25%) were seropositive, and histopathological changes were compatible with celiac disease in intestinal biopsy.