HIV in Children
DECEMBER 2012 NEWSLETTER
HIV IN CHILDREN
December 2012 Newsletter
Mary Christmas and Happy New Year
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GRAND ROUNDS
Case Report: - A 5 year old girl presented with fever since 2 months, pain in abdomen since 15 days, headache since 5 days, periorbital edema since 4 days and decreased urine output with bilateral otorrhoea since 3 days. On examination, she had cervical lymphadenopathy, pallor, bilateral basal crepitations and hepatomegaly. Her HIV Elisa was positive and ear swab grew pseudomonas. She was treated with intravenous fluids following which she passed urine and also received antibiotics in view of otitis media and pneumonia. However, she developed a right sided lower motor neuron facial palsy. CT brain was normal and CSF examination was also normal. She also received a blood transfusion in view of anemia. Fever responded after 4 weeks of antibiotics. Her CD4 count was 121/cumm (21%). She was started on 3 drug antiretroviral therapy (ART) with Zidovudine (AZT), Lamivudine (3TC) and Nevirapine (NVP). Two weeks after ART, she presented with vomiting since 2 days, oliguria since 1 day and loss of weight. On examination, she had bilateral foul smelling otorrhoea, Grade III dehydration, and was hypotensive (BP = 90/60 mm Hg). Her serum creatinine was 4.5 mg/dl. She also had acidosis (bicarbonate = 7 mmol/L) and hyperkalemia (serum potassium = 6 mEq/L). The child developed cardiogenic shock, pulmonary edema and inspite of ionotropes died within 5 hours. Her CD4 count this time was 5 cells/cumm.

Did the child have IRIS - immune reconstitution syndrome?

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I HAVE A 7 YEARS OLD GIRL IN MY WARD,RECENTLY DIAGNOSED WITH HIV,BUT BOTH HER PARENTS ARE NEGATIVE ACCORDING TO ELLISA
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NEW ARRIVAL
Infection in Children - Part 2

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