HIV in Children


Dr. Ira Shah
Last Updated : 1st September 2012
It is the most common cause of fungal infections in HIV infected children. Oral thrush, esophageal candidiasis and systemic candidiasis are common manifestations.

Clinical features

Oral thrush :

It is one of the first clinical indicators of HIV infection in infants more than 6 months of age. Patients may have creamy white curd like patches with inflamed underlying mucosa in the oropharynx, palate and tonsils. It may also present as erythematous lesions (atrophic), hyperplastic (hypertrophic) and angular cheilitis. At times there may be nappy rash accompanying.

Esophageal candidiasis :

Esophageal candidiasis is seen in patients with low CD4 cell count (< 100/cumm), high viral load and neutropenia (< 500/cumm) (52, 53) and those with concomitant oropharyngeal candidiasis. Patients present with odynophagia, dysphagia, retrosternal pain, nausea and vomiting.

Systemic candidiasis may be seen in patients on prolonged antibiotics and can cause endophthalmitis, hepatic, splenic, renal and bone involvement. Patients present in shock and with sepsis.


Oral thrush can be diagnosed clinically. KOH preparation and culture with demonstration of budding yeast cells in wet mounts or biopsy specimen under microscope can be used for confirming the diagnosis as well as in vitro susceptibility testing can be used as a guide for antifungal treatment.

Esophageal candidiasis has classic cobblestoning appearance on barium swallow. It should be suspected in a child with oral candidiasis who has refusal to feeds, swallowing difficulty, drooling, hoarse voice or stridor. Endoscopy shows white raised plaques with extensive ulceration and biopsy will prove candida on KKOH preparation. Endoscopy is required in resistant cases to rule out other infections such as HSV, CMV, MAC and azole resistant candida.

Systemic candidiasis is diagnosed on isolation of candida from blood culture.

Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.
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