How does HIV in children symptoms

HIV infection in children causes immune deficiency, whereby it comes to progressive destruction of the immune system and, ultimately, AIDS in children.

HIV and AIDS can hurt all people, including the pediatric population. In most cases, children and HIV, with a certain probability, AIDS in children develops as a result of infection at birth from the mother. The first signs of HIV may show after a few months (to 1 year) after birth. Before or immediately after 3 years of age comes to the development of the next stage of the disease in a child.

Symptoms of HIV in children, the rate of infection in children and clinical manifestations differ to some extent from the disease in adults.

But, everything in order.

Morbidity

There are about 40 million HIV-infected people, of which 2.7 million are children. Only the year 2001 was characterized by the fact that at this time the virus has affected over 800 thousand children, AIDS claimed the lives of about 580000 people. The number of pediatric population in the total number of HIV infections reflects the proportion of HIV-infected women. The most affected continent is Africa, where the highest absolute and relative performance of children with AIDS to 3 million Estimate of children living in North America, points to 10000, in Western Europe – 4000. In the late 90-ies was recorded positive dynamics of the number of newly identified cases of childhood HIV infection also decreased indicators such as AIDS in children.

Etiology

The pathogen is the human immunodeficiency virus (HIV), which belongs to the genus of lentiviruses family of retroviruses. There are 2 types of virus: HIV-1 and HIV-2. In most cases infection and AIDS in children, causes of HIV-1.

Epidemiology

The infection is transmitted by sexual, vertical and parenteral. HIV infection in children characterized by the predominance of vertical transmission. The probability of transmission from an infected mother to the child in Europe is about 20-30% but may be reduced prenatal care and antiretroviral therapy to the mother and then child. Infection can occur in any pregnancy, but most often during delivery (about 2/3 cases). In exceptional cases, transmission is possible with breast feeding. The likelihood of transmission depends on various clinical, immunological, virological and obstetric factors. Most infected children in the world infected through vertical transmission.

In the mid 80-ies of children's infections had parenteral infection occurred through blood transfusion or administration of blood products, especially in the treatment of hemophilia. Careful control and technological processes for obtaining blood today has nearly eliminated this route of infection. In rare cases infection sexually transmitted, taking into account the existence of sexual violence against a child should not be excluded as child prostitution or drug addiction.

Pathogenesis

The replication of HIV leads to the progressive destruction of the immune system. The dysfunction is, as cellular and humoral immunity. In the course of HIV infection in the child (same as adult) continue to decrease in absolute and relative numbers of CD4 + lymphocytes and, as a rule, their decrease correlated with the clinical degree of infection. A deep reduction in the number of CD4 + lymphocytes is of fundamental importance for the development of major opportunistic infections, which causes of HIV infection in children. Along with these amazing insights there are many other abnormalities of cellular immunity and changes in the secretion of cytokines (for example, high levels of IL-1 and TNF). Early in HIV infection in children is manifested by polyclonal hypergammaglobulinemia. Despite this,humoral response to new antigens is insufficient, and comes to an increase in cases of severe bacterial infections.

Trappings

In children the symptoms and signs of HIV disease and opportunistic spectrum differ from the rate in adults. Many patients vertically infected children show some symptoms of HIV infection during the first year of life. Highly active antiretroviral therapy significantly improves the quality and duration of life.

Early non-specific symptoms in infant include developmental delay, lymphadenopathy, splenomegaly and hepatomegaly. In addition, children of HIV

may appear under the picture of HIV-hepatitis, which is at an older age is relatively rare. In addition, a frequent manifestation of infection in young children is diarrhea.

Diseases of the oral cavity

Lesions of the oral cavity and salivary glands in infected children are frequent. Common blood smear from the oropharynx is candidiasis, which the older children reflects the progression of the infection. Similar prognostic value has hairy leukoplakia, caused by Epstein-Barr. The disease appears of a whitish mother-of-pearl deposits on the sides of the tongue. Frequent manifestations of HIV infection in the oral cavity in children presents aphthous stomatitis and herpes simplex.

Lung disease

Pulmonary diseases have a significant proportion of HIV-infected children. The most common disease is bacterial and viral pneumonia, lymphoid interstitial pneumonia, Pneumocystis pneumonia, pulmonary tuberculosis and, rarely, some non-communicable diseases (e.g., lymphoma). Pneumonia fungal nature do not occur so often. Severe lung disease sometimes develop in systemic diseases, such as measles or chickenpox. CMV pneumonia rarely indicated in HIV-infected adults may also affect children.

A typical and very common opportunistic infection is Pneumocystis pneumonia caused by a microorganism, attributed today to fungi, Pneumocystis carinii. The disease in older children, as a rule, is characterized by the gradual beginning of a productive cough, subfebrile until the fever and shortness of breath. Many children, especially early age, the rate may vary, is developing rapidly tachypnea and fever, comes to hypoxia. A chest x-ray usually detects one sided picture of interstitial pneumonia. Disease in infancy, even with adequate treatment, is associated with a high mortality rate (50%).

For the pediatric population is a very typical disease caused by a virus Epstein-Barr, lymphoid interstitial pneumonia. The disease occurs due to infiltration of CD8 + lymphocytes. Clinically gradual start of cough and shortness of breath on exertion. Disease, usually associated with the visible lymphadenopathy and swelling of the parotid glands. Some laboratory findings (hypoxemia, hypergammaglobulinemia and high titers of antibodies against EBV), along with the x-ray image of bilateral reticulonodular reduction support the diagnosis can be definitively confirmed by biopsy of the lungs.

Bacterial pneumonia is not very different from the disease in HIV-negative children. Pathogens include encapsulated bacteria such as Haemophilus influenzae and pneumococcus (Haemophilus influenzae and Streptococcus pneumoniae).

Cardiovascular disease

Cardiovascular complications of HIV infection are more common in children than in adults. Rare are caused by infectious pathogens, malnutrition, anemia, immunopathological mechanisms of toxicity of drugs, but a number of diseases of the heart research into the causes posthumously are inconclusive. The main symptoms include cardiac arrhythmias, gastric dilatation and hypokinesia, dilated cardiomyopathy, pericarditis, and rarely lymphocytic pericarditis, in exceptional cases, non-bacterial and bacterial endocarditis, and even sudden death.

Diseases of the digestive system

Severe lesions of the gastrointestinal tract are present in a large number of HIV-infected children. The most common cause of pain when swallowing and chest pain Candida esophagitis is caused by Candida fungi, especially C. Albicans. Usually, there is also stomatitis. Effect of antifungal therapy is considered to be a sufficient diagnostic criterion. Esophagitis caused by cytomegalovirus and herpes simplex virus are more rare diseases, and to a greater extent occur in severe immunodeficiency (e.g., when there is AIDS in children).

Intestinal infection leading to acute or chronic diarrhea, in most cases caused by common intestinal pathogens (Salmonella enterica, Campylobacter jejuni), partially – conditionally pathogenic microorganisms (Cryptosporidium, Isospora, Enterocytozoon bieneusi, Encephalitozoon intestinalis). Some diarrhea is caused directlyHIV infection itself (HIV enteropathy). Diarrhea can accompany treatment with Nelfinavir, which is often used in HIV-infected children.

Kidney disease and urinary tract

Urinary tract diseases are one of the main manifestations of HIV nephropathy. The most common form of irreversible glomerular lesions (focal segmental glomerulosclerosis) leading to renal failure, some children suffer from proteinuria, a relatively rare presents symptoms of hematuria and hypertension. Children taking antiretroviral drug Indinavir, are at risk of developing kidney stones.

Diseases of the Central nervous system

Disorders of the Central nervous system occur, approximately 40% of all children with AIDS. This is due partly to the fact that the HIV virus neurogenic in itself, partly to the fact that the nervous system is affected by opportunistic infections and tumors. Neurological symptoms appear at any stage of HIV infection – from initial to advanced. An important clinical fact is progressive HIV encephalopathy, which usually appears on the 2nd year of life. This disease leads to a slowing of psychomotor development, short-term memory impairment and retardation of speech development. Typical are movement disorders. The gradual progression of the disease can lead to apathy, loss of verbal skills and spasticity. The diagnosis is based mainly on clinical, morphological correlator is a diffuse process of the cerebral white matter.

Cerebral toxoplasmosis and cryptococcal meningitis – occurring in adults patients with AIDS is relatively rare among the pediatric population. Focal neurological findings, seizures and mental disorders with the findings of hypodense or isodense localization of lesions on CT in the first place, caused by primary lymphoma of the brain.

Little patient can be raised and the stroke, which is the result of inflammatory changes in the cerebral arteries. Lesion of the spinal cord (vacuolar myelopathy) and peripheral nerves (peripheral neuropathy, distal sensory polyneuropathy) in children, unlike adults, also are rare. Some neuropathy can be caused by Didanosine or Zalcitabine, myopathy may be a relatively rare late side effect of Zidovudine.

Ophthalmic diseases

Cytomegalovirus retinitis, which is common in adults among the pediatric population is rare. Describes the depigmentation of the retina as a result of treatment with Didanosine or uveitis, as a complication of receiving Rifabutin. Eyelids sometimes affects molluscum contagiosum (molluscum contagiosum).

Skin lesion

Skin diseases in HIV infection are very common in both adults and children. Normal skin conditions include seborrhoeic dermatitis, pyoderma, varicella, persistent or recurrent infection of herpes simplex, recurrent herpes zoster, ringworm, allergic rashes, etc. are Relatively less than in adults, affects the skin molluscum contagiosum and genital warts. There are known occurrences of AIDS – Kaposi's sarcoma is extremely rare in children.

Disseminated infection

Opportunistic infections occur as disseminated disease without specific symptoms. Bacteremia pneumonia or without obvious localization, and bacterial sepsis are more common compared to adult population. For diagnosis is crucial in the isolation of the pathogen from the blood.

As disseminated infection is infection with atypical mycobacteria, particularly Mycobacterium avium – intracellulare, which in healthy people often causes disease of the lungs and lymph nodes.

Patients with very deep immunodeficiency mycobacterial infections cause a picture of a febrile illness and significant weight loss. Also common is generalized cytomegalovirus infection with similar clinical results.

Other causes of febrile diseases without local findings are: disseminated tuberculosis, disseminated fungal infections (cryptococcosis and histoplasmosis).

Differential diagnosis of fever in HIV-infected children is wide enough, includes in addition to these diseases and others, such as Pneumocystis pneumonia with a negative chest x-ray or systemic b lymphoma which, as a rule, does not lead to swollen lymph glands.

Eating disorders

A common manifestation of HIV infection is weight loss. This phenomenon is caused directly by the virus or opportunistic infections or tumors. On the other hand, the use of protease inhibitors as part of antiretroviral therapy leads to the development of the so-called lipodystrophy, which is characterized mainly by deposition of fat in the neck and abdomen with weight loss in the limbs, and resembling Cushing's syndrome. Lipid metabolism disorders laboratory is manifested by hypertriglyceridemia and hypercholesterolemia.

Changes in laboratory findings

HIV infection is accompanied by pathological results in a series of laboratory tests. We are talking in particular about the highsedimentation, anemia, leukopenia with lymphopenia, and neutropenia, and sometimes thrombocytopenia. Early symptom presented by hypergammaglobulinemia, at the time, as hypogammaglobulinemia appears at the late stage of HIV infection.