This document describes the case of a 14-year-old girl presenting with cough, fever, and white patches in her mouth for 2-3 weeks. Her history reveals recurrent respiratory infections, oral lesions, and loose stools for over a year. On examination she has pallor, lymphadenopathy, clubbing, oral thrush, and skin lesions. Tests show anemia, lymphocytosis, and positive HIV ELISA. She is diagnosed with HIV stage III. The document then discusses HIV transmission, clinical staging, diagnosis in infants, management, antiretroviral therapy, and prophylaxis for opportunistic infections.
Pre-eclampsia is a pregnancy complication characterized by new onset hypertension and involvement of other organ systems after 20 weeks of gestation. It is caused by poor remodeling of the uterine spiral arteries during placental development, resulting in reduced blood flow to the placenta. This can affect multiple maternal organ systems by damaging the endothelial cells that line blood vessels. Key signs include hypertension, proteinuria, thrombocytopenia, and elevated liver enzymes. Diagnosis is based on blood pressure readings and urine or blood tests checking for signs of kidney or liver dysfunction. Monitoring pre-eclampsia involves serial blood tests to track organ function and fetal well-being.
Pre-term, Small for gestational age and Post-term InfantLipi Mondal
Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
This document provides information on the care of low birth weight infants, including preterm babies. It discusses that low birth weight babies account for 25-35% of births in India compared to 5-7% in western countries. Preterm birth is a major cause of neonatal mortality. The document outlines the physiological handicaps that preterm infants face in various body systems like the central nervous system, respiratory system, and thermoregulation. It emphasizes the importance of monitoring preterm infants closely and providing supportive care like kangaroo mother care to improve outcomes.
Bronchiolitis is an inflammatory disease of the small airways caused primarily by Respiratory Syncytial Virus (RSV) in infants under 1 year old. It leads to obstruction of the small airways due to inflammation, mucus production, and edema. Clinically, infants present with rhinorrhea, cough, tachypnea, wheezing and respiratory distress. Chest X-ray may show hyperinflated lungs. Management is supportive with oxygen, hydration and sometimes bronchodilators. Most infants recover within 2 weeks but some may develop long-term wheezing.
Neonatal sepsis (sepsis on new born) with case presentationJOEL RAJAN U
Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Neonatal sepsis is a clinical syndrome of bacteremia and infection in infants under 4 weeks of age. Common causes are E. coli, Group B Streptococcus, and Listeria. It can be early-onset from transmission during birth or late-onset from hospital-acquired infections. Symptoms are non-specific but include respiratory distress, feeding issues, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment is antibiotics like ampicillin and gentamicin for 10-14 days along with supportive care. Prevention includes good antenatal care, treating maternal infections, early breastfeeding and infection control policies in the NICU.
Meconium aspiration syndrome occurs when meconium passes into the amniotic fluid during delivery, which can then be inhaled or aspirated by the infant. Risk factors include post-term delivery, maternal diabetes, infections, and drug use. Aspirated meconium leads to respiratory distress through lung inflammation and obstruction. Diagnosis is based on meconium staining of the infant and amniotic fluid along with signs of respiratory distress. Management involves suctioning the airways, providing respiratory support, treating acidosis and hypoglycemia, and using techniques like surfactant therapy and inhaled nitric oxide for persistent pulmonary hypertension.
Pre-eclampsia is a pregnancy complication characterized by new onset hypertension and involvement of other organ systems after 20 weeks of gestation. It is caused by poor remodeling of the uterine spiral arteries during placental development, resulting in reduced blood flow to the placenta. This can affect multiple maternal organ systems by damaging the endothelial cells that line blood vessels. Key signs include hypertension, proteinuria, thrombocytopenia, and elevated liver enzymes. Diagnosis is based on blood pressure readings and urine or blood tests checking for signs of kidney or liver dysfunction. Monitoring pre-eclampsia involves serial blood tests to track organ function and fetal well-being.
Pre-term, Small for gestational age and Post-term InfantLipi Mondal
Due to high risk of pregnancy there are several adverse outcome or poor perinatal outcome we can see.... So most commonly adverse out come should be known by health care providers.
This document provides information on the care of low birth weight infants, including preterm babies. It discusses that low birth weight babies account for 25-35% of births in India compared to 5-7% in western countries. Preterm birth is a major cause of neonatal mortality. The document outlines the physiological handicaps that preterm infants face in various body systems like the central nervous system, respiratory system, and thermoregulation. It emphasizes the importance of monitoring preterm infants closely and providing supportive care like kangaroo mother care to improve outcomes.
Bronchiolitis is an inflammatory disease of the small airways caused primarily by Respiratory Syncytial Virus (RSV) in infants under 1 year old. It leads to obstruction of the small airways due to inflammation, mucus production, and edema. Clinically, infants present with rhinorrhea, cough, tachypnea, wheezing and respiratory distress. Chest X-ray may show hyperinflated lungs. Management is supportive with oxygen, hydration and sometimes bronchodilators. Most infants recover within 2 weeks but some may develop long-term wheezing.
Neonatal sepsis (sepsis on new born) with case presentationJOEL RAJAN U
Newborn sepsis is a severe infection in an infant younger than 28 days old. A newborn may become infected before, during, or after birth. Newborn sepsis can be hard to diagnose. Early diagnosis and treatment are the best ways to stop sepsis.
This document discusses pneumonia in children. It provides definitions, epidemiology, risk factors, classification, etiology, clinical presentation, investigations, treatment and prevention of pneumonia. Some key points:
- Pneumonia is the leading cause of death among children under 5 globally, accounting for 16% of deaths. It occurs most frequently in developing countries.
- Risk factors include malnutrition, low birth weight, lack of breastfeeding, lack of immunization, indoor air pollution, parental smoking, and zinc deficiency.
- Clinical features depend on the causative agent. Bacterial pneumonia presents with high fever and chest pain while viral pneumonia shows low grade fever and respiratory distress.
- Investigations include chest X-ray
Neonatal sepsis is a clinical syndrome of bacteremia and infection in infants under 4 weeks of age. Common causes are E. coli, Group B Streptococcus, and Listeria. It can be early-onset from transmission during birth or late-onset from hospital-acquired infections. Symptoms are non-specific but include respiratory distress, feeding issues, and temperature instability. Diagnosis involves blood, urine and CSF cultures. Treatment is antibiotics like ampicillin and gentamicin for 10-14 days along with supportive care. Prevention includes good antenatal care, treating maternal infections, early breastfeeding and infection control policies in the NICU.
Meconium aspiration syndrome occurs when meconium passes into the amniotic fluid during delivery, which can then be inhaled or aspirated by the infant. Risk factors include post-term delivery, maternal diabetes, infections, and drug use. Aspirated meconium leads to respiratory distress through lung inflammation and obstruction. Diagnosis is based on meconium staining of the infant and amniotic fluid along with signs of respiratory distress. Management involves suctioning the airways, providing respiratory support, treating acidosis and hypoglycemia, and using techniques like surfactant therapy and inhaled nitric oxide for persistent pulmonary hypertension.
Hypothermia is a significant problem in neonates that can lead to increased mortality and morbidity. It is caused by situations that lead to excessive heat loss or poor ability to produce heat in babies. These include cold environments, wet skin, procedures like bathing, and low birth weight. Newborns are prone to hypothermia due to their large surface area and limited ability to generate heat. Prevention focuses on keeping babies warm through immediate drying and skin-to-skin contact with the mother. Treatment involves gradually rewarming the baby and minimizing further heat loss. Healthcare providers must be alert to the risks and take steps to maintain the baby's temperature within a normal range.
Approach to a child with failure to thriveSingaram_Paed
This document discusses failure to thrive (FTT) in children. It defines FTT as inadequate physical growth compared to peers. FTT can be caused by inadequate calorie intake, absorption, increased needs, or utilization. It affects 5-10% of young children. Causes include psychosocial factors, infections, gastrointestinal issues, and neurological problems. Evaluation of a child with FTT involves medical history, physical exam, lab tests, and assessing nutrition. Treatment focuses on improving the child's diet and development stimulation, caregiver skills, and treating any underlying medical issues. Regular follow up is also important.
Apgar score and Basic Neonatal Resuscitation.pdfShapi. MD
The APGAR score decides whether or not to resuscitate a new born. This presentation will help one understand the factors that are taken into consideration and how the actual resuscitation procedure is done.
This document provides an overview of neonatal infections, including epidemiology, predisposing factors, etiology, pathogenesis, clinical presentation, investigations, management, prevention, and specific infections such as sepsis, meningitis, ophthalmia neonatorum, and viral infections like cytomegalovirus, rubella, hepatitis, and HIV. Neonatal infections are a major cause of morbidity and mortality in newborns, and can be either early-onset within 3 days of birth or late-onset acquired from the environment. Bacteria are the most common cause but viruses, fungi and protozoa can also infect newborns.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
1) The study analyzed changes in organisms causing neonatal sepsis and outcomes over two time periods (1995-1998 and 2001-2006) at a tertiary care center in Northern India.
2) The incidence of bacterial sepsis increased over time, while the incidence in low birth weight infants decreased significantly. Mortality from sepsis also decreased.
3) The organisms causing sepsis changed between the periods - Klebsiella pneumoniae and Enterobacter decreased while Staphylococcus aureus increased. Non-fermenting Gram-negative bacilli emerged as new pathogens.
The document defines diarrhea and describes its causes, risk factors, classifications, and management. Diarrhea is characterized by loose or watery stools, increased stool frequency, or large stool volume. It has infectious and non-infectious causes like viruses, bacteria, antibiotics, and non-GI infections. Proper management involves oral rehydration, continued feeding, and seeking medical help for dehydration signs. Prevention relies on vaccines, handwashing, safe water, and breastfeeding.
The document discusses postnatal care of babies, with a focus on care of low birth weight babies. It covers:
1) Immediate newborn care including clearing airways, maintaining temperature, assessing Apgar scores.
2) Importance of breastfeeding and maintaining warmth.
3) Causes and risks of low birth weight (LBW) babies including preterm birth, intrauterine growth restriction.
4) Treatment of LBW babies requires intensive care until they gain adequate weight, addressing risks like infections and respiratory issues. Kangaroo mother care has helped improve LBW baby survival.
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
This document provides information and instructions on expressing and storing breast milk. It discusses why a mother may need to express breast milk, such as to provide extra milk or feed with a bottle. It then describes the process of milk expression, including hand expression and using breast pumps. It emphasizes the importance of hygiene and provides guidelines for safely storing, thawing, and handling expressed breast milk. The overall goal is to support mothers in maintaining or increasing their milk supply through proper breast milk expression and storage techniques.
This document discusses enuresis (bed-wetting) in children. It defines the different types of enuresis and describes normal bladder development and toilet training. The epidemiology of enuresis is presented, noting that prevalence is higher in boys and decreases with age. Etiology involves biological, emotional, and learning factors, with some evidence of genetic links. Evaluation includes history, exam, urinalysis and ultrasound to rule out underlying causes. Treatment begins with lifestyle changes and rewards, and may involve alarms or medications like desmopressin or imipramine if needed. The goal is to encourage dryness and self-esteem while allowing for the high rate of spontaneous remission.
This document contains growth charts published by the WHO for boys from birth to 19 years old. It includes measurements for head circumference, length/height, weight, BMI, and compares the measurements to percentiles and z-scores. The charts can be used to assess a boy's growth and development relative to other boys globally.
Jaundice in newborns, also known as neonatal jaundice, is caused by high levels of bilirubin in the bloodstream and tissues. It can be either physiological, appearing 2-3 days after birth due to the normal breakdown of red blood cells, or pathological, caused by excessive red cell breakdown or liver/bilirubin processing issues. Pathological jaundice is diagnosed based on bilirubin levels and may require treatment like phototherapy or exchange transfusions to prevent kernicterus, a potentially serious brain condition caused by high bilirubin levels. Treatment aims to lower bilirubin through phototherapy or medications while monitoring for complications.
This document discusses various causes of jaundice in pregnancy including intrahepatic cholestasis of pregnancy (ICP), viral hepatitis, acute fatty liver of pregnancy (AFLP), and more. ICP is characterized by pruritus and elevated bile acids and bilirubin. It is caused by hormonal changes that lead to bile stasis. AFLP presents late in pregnancy and can cause liver failure, coagulopathy, and hypoglycemia. Viral hepatitis, most commonly hepatitis B, presents with jaundice, nausea, and elevated transaminases. Management depends on the cause but may include drug therapy, delivery of the fetus, and supportive care.
Dr. Saurav Kumar Upadhyay presented on neutropenia and febrile neutropenia. Neutropenia is defined as a decrease in circulating neutrophils. The risk of infection increases as the absolute neutrophil count declines below 1000/cu mm and markedly increases below 500/cu mm. Febrile neutropenia refers to fever in a patient with neutropenia and is a medical emergency. Common pathogens causing infection include various bacteria, fungi, and viruses. Infection can occur at various body sites including the skin, gastrointestinal tract, lungs, and others. Evaluation of patients with suspected febrile neutropenia focuses on symptoms, physical exam including overlooked sites, and identifying potential sources of infection.
1. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages.
2. Clinical manifestations in children vary widely and can include failure to thrive, respiratory issues, gastrointestinal diseases, and neurological problems.
3. Diagnosis is made through HIV antibody testing after 18 months or virological testing before 18 months, and management includes prophylaxis, antiretroviral therapy, treating opportunistic infections, adequate nutrition, and immunization.
1. 27 million people globally were accessing antiretroviral therapy in 2021, representing 75% of all people living with HIV. There were 37.7 million people living with HIV globally in 2021, a 21% increase from 2010. 1.5 million people became newly infected with HIV in 2021.
2. In India, there were an estimated 23 lakh people living with HIV nationally in 2021. Approximately 57,550 new HIV infections occurred in 2021, representing a 48% decrease from 2010. Around 51,000 people died of AIDS-related illnesses in India in 2021.
3. Key data on HIV in India in 2021 include: prevalence of 0.67% among 15-49 year olds,
This document provides information about HIV testing and the implications of test results. It discusses the various types of HIV tests including rapid tests, ELISA, and Western blot. A positive test result means antibodies to HIV have been detected, while a negative result means antibodies were not detected, though the person could still be in the window period. Interpretation of results and the need for counseling before and after testing is emphasized. Symptoms of infection and potential complications are outlined. Treatment involves antiretroviral drugs to suppress the virus and medications to prevent opportunistic infections.
Module 4 hiv infection & art in childrenDavid Ngogoyo
This document provides an overview of managing HIV infected children. It covers the epidemiology and transmission of HIV in children, the natural progression of disease, diagnosis and staging, prevention and treatment of common HIV conditions, and antiretroviral therapy for children. Key points include mother-to-child transmission being the most common mode of transmission, diagnostic criteria involving virologic tests for children under 18 months and antibody tests after 18 months, and natural history patterns including rapid, intermediate, and slow disease progression in African children.
Hypothermia is a significant problem in neonates that can lead to increased mortality and morbidity. It is caused by situations that lead to excessive heat loss or poor ability to produce heat in babies. These include cold environments, wet skin, procedures like bathing, and low birth weight. Newborns are prone to hypothermia due to their large surface area and limited ability to generate heat. Prevention focuses on keeping babies warm through immediate drying and skin-to-skin contact with the mother. Treatment involves gradually rewarming the baby and minimizing further heat loss. Healthcare providers must be alert to the risks and take steps to maintain the baby's temperature within a normal range.
Approach to a child with failure to thriveSingaram_Paed
This document discusses failure to thrive (FTT) in children. It defines FTT as inadequate physical growth compared to peers. FTT can be caused by inadequate calorie intake, absorption, increased needs, or utilization. It affects 5-10% of young children. Causes include psychosocial factors, infections, gastrointestinal issues, and neurological problems. Evaluation of a child with FTT involves medical history, physical exam, lab tests, and assessing nutrition. Treatment focuses on improving the child's diet and development stimulation, caregiver skills, and treating any underlying medical issues. Regular follow up is also important.
Apgar score and Basic Neonatal Resuscitation.pdfShapi. MD
The APGAR score decides whether or not to resuscitate a new born. This presentation will help one understand the factors that are taken into consideration and how the actual resuscitation procedure is done.
This document provides an overview of neonatal infections, including epidemiology, predisposing factors, etiology, pathogenesis, clinical presentation, investigations, management, prevention, and specific infections such as sepsis, meningitis, ophthalmia neonatorum, and viral infections like cytomegalovirus, rubella, hepatitis, and HIV. Neonatal infections are a major cause of morbidity and mortality in newborns, and can be either early-onset within 3 days of birth or late-onset acquired from the environment. Bacteria are the most common cause but viruses, fungi and protozoa can also infect newborns.
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
1) The study analyzed changes in organisms causing neonatal sepsis and outcomes over two time periods (1995-1998 and 2001-2006) at a tertiary care center in Northern India.
2) The incidence of bacterial sepsis increased over time, while the incidence in low birth weight infants decreased significantly. Mortality from sepsis also decreased.
3) The organisms causing sepsis changed between the periods - Klebsiella pneumoniae and Enterobacter decreased while Staphylococcus aureus increased. Non-fermenting Gram-negative bacilli emerged as new pathogens.
The document defines diarrhea and describes its causes, risk factors, classifications, and management. Diarrhea is characterized by loose or watery stools, increased stool frequency, or large stool volume. It has infectious and non-infectious causes like viruses, bacteria, antibiotics, and non-GI infections. Proper management involves oral rehydration, continued feeding, and seeking medical help for dehydration signs. Prevention relies on vaccines, handwashing, safe water, and breastfeeding.
The document discusses postnatal care of babies, with a focus on care of low birth weight babies. It covers:
1) Immediate newborn care including clearing airways, maintaining temperature, assessing Apgar scores.
2) Importance of breastfeeding and maintaining warmth.
3) Causes and risks of low birth weight (LBW) babies including preterm birth, intrauterine growth restriction.
4) Treatment of LBW babies requires intensive care until they gain adequate weight, addressing risks like infections and respiratory issues. Kangaroo mother care has helped improve LBW baby survival.
This document provides information about neonatal sepsis, including its definition, classification, causes, risk factors, clinical features, diagnostic tests, management, and prevention. Some key points:
- Neonatal sepsis is a systemic bacterial infection occurring in newborns, defined as a positive blood culture within the first month of life. It is a major cause of neonatal mortality and morbidity.
- It can be classified as early-onset (before 72 hours of life) or late-onset (after 72 hours) sepsis. Early onset is usually caused by maternal genital tract bacteria, while late onset is caused by environmental and healthcare-associated bacteria.
- Risk factors include prematurity, prolonged rupture of membranes, chorio
This document provides information and instructions on expressing and storing breast milk. It discusses why a mother may need to express breast milk, such as to provide extra milk or feed with a bottle. It then describes the process of milk expression, including hand expression and using breast pumps. It emphasizes the importance of hygiene and provides guidelines for safely storing, thawing, and handling expressed breast milk. The overall goal is to support mothers in maintaining or increasing their milk supply through proper breast milk expression and storage techniques.
This document discusses enuresis (bed-wetting) in children. It defines the different types of enuresis and describes normal bladder development and toilet training. The epidemiology of enuresis is presented, noting that prevalence is higher in boys and decreases with age. Etiology involves biological, emotional, and learning factors, with some evidence of genetic links. Evaluation includes history, exam, urinalysis and ultrasound to rule out underlying causes. Treatment begins with lifestyle changes and rewards, and may involve alarms or medications like desmopressin or imipramine if needed. The goal is to encourage dryness and self-esteem while allowing for the high rate of spontaneous remission.
This document contains growth charts published by the WHO for boys from birth to 19 years old. It includes measurements for head circumference, length/height, weight, BMI, and compares the measurements to percentiles and z-scores. The charts can be used to assess a boy's growth and development relative to other boys globally.
Jaundice in newborns, also known as neonatal jaundice, is caused by high levels of bilirubin in the bloodstream and tissues. It can be either physiological, appearing 2-3 days after birth due to the normal breakdown of red blood cells, or pathological, caused by excessive red cell breakdown or liver/bilirubin processing issues. Pathological jaundice is diagnosed based on bilirubin levels and may require treatment like phototherapy or exchange transfusions to prevent kernicterus, a potentially serious brain condition caused by high bilirubin levels. Treatment aims to lower bilirubin through phototherapy or medications while monitoring for complications.
This document discusses various causes of jaundice in pregnancy including intrahepatic cholestasis of pregnancy (ICP), viral hepatitis, acute fatty liver of pregnancy (AFLP), and more. ICP is characterized by pruritus and elevated bile acids and bilirubin. It is caused by hormonal changes that lead to bile stasis. AFLP presents late in pregnancy and can cause liver failure, coagulopathy, and hypoglycemia. Viral hepatitis, most commonly hepatitis B, presents with jaundice, nausea, and elevated transaminases. Management depends on the cause but may include drug therapy, delivery of the fetus, and supportive care.
Dr. Saurav Kumar Upadhyay presented on neutropenia and febrile neutropenia. Neutropenia is defined as a decrease in circulating neutrophils. The risk of infection increases as the absolute neutrophil count declines below 1000/cu mm and markedly increases below 500/cu mm. Febrile neutropenia refers to fever in a patient with neutropenia and is a medical emergency. Common pathogens causing infection include various bacteria, fungi, and viruses. Infection can occur at various body sites including the skin, gastrointestinal tract, lungs, and others. Evaluation of patients with suspected febrile neutropenia focuses on symptoms, physical exam including overlooked sites, and identifying potential sources of infection.
1. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages.
2. Clinical manifestations in children vary widely and can include failure to thrive, respiratory issues, gastrointestinal diseases, and neurological problems.
3. Diagnosis is made through HIV antibody testing after 18 months or virological testing before 18 months, and management includes prophylaxis, antiretroviral therapy, treating opportunistic infections, adequate nutrition, and immunization.
1. 27 million people globally were accessing antiretroviral therapy in 2021, representing 75% of all people living with HIV. There were 37.7 million people living with HIV globally in 2021, a 21% increase from 2010. 1.5 million people became newly infected with HIV in 2021.
2. In India, there were an estimated 23 lakh people living with HIV nationally in 2021. Approximately 57,550 new HIV infections occurred in 2021, representing a 48% decrease from 2010. Around 51,000 people died of AIDS-related illnesses in India in 2021.
3. Key data on HIV in India in 2021 include: prevalence of 0.67% among 15-49 year olds,
This document provides information about HIV testing and the implications of test results. It discusses the various types of HIV tests including rapid tests, ELISA, and Western blot. A positive test result means antibodies to HIV have been detected, while a negative result means antibodies were not detected, though the person could still be in the window period. Interpretation of results and the need for counseling before and after testing is emphasized. Symptoms of infection and potential complications are outlined. Treatment involves antiretroviral drugs to suppress the virus and medications to prevent opportunistic infections.
Module 4 hiv infection & art in childrenDavid Ngogoyo
This document provides an overview of managing HIV infected children. It covers the epidemiology and transmission of HIV in children, the natural progression of disease, diagnosis and staging, prevention and treatment of common HIV conditions, and antiretroviral therapy for children. Key points include mother-to-child transmission being the most common mode of transmission, diagnostic criteria involving virologic tests for children under 18 months and antibody tests after 18 months, and natural history patterns including rapid, intermediate, and slow disease progression in African children.
Early diagnosis of HIV in infants is crucial because HIV progresses rapidly in infants and mortality is high without treatment. By age 1, one-third of infected infants will have died, and by age 2 half will have died. Early initiation of antiretroviral therapy (ART) in infected infants under 12 weeks of age can reduce mortality by 76% and HIV progression by 75%. The goals of early infant diagnosis are to identify infected infants before clinical disease develops so interventions and ART can begin. Diagnosis is typically done through RNA or DNA PCR testing of dried blood spots or whole blood samples at ages 6 weeks, 10 weeks, 14 weeks, and later intervals. Point-of-care testing using p24 antigen detection is also possible
The document discusses HIV/AIDS in children. It defines HIV as a virus that infects and weakens the immune system, and AIDS as the syndrome that occurs when the immune system is severely damaged by HIV. HIV is usually transmitted from mother to child during pregnancy, childbirth or breastfeeding. Children with HIV may show no symptoms for years but can eventually develop infections like pneumonia or develop AIDS. There are screening tests to detect HIV in children but no vaccine or cure currently exists. Antiretroviral treatment can slow disease progression.
This document provides an overview of laboratory diagnosis of AIDS, including:
1) The structure of HIV and the humoral and cellular immune response to HIV are described.
2) Diagnosis of AIDS involves antibody detection using screening tests like ELISA and confirmatory tests like Western blot. Antigen detection tests like p24 antigen capture and PCR are also used.
3) Laboratory monitoring of anti-retroviral therapy includes measuring CD4+ T cell counts, HIV RNA levels, and testing for HIV drug resistance.
1. Specific tests for diagnosing HIV infection include detecting viral antigens like p24, isolating the live virus, detecting viral nucleic acids through PCR, and detecting antibodies through ELISA and Western blot tests.
2. ELISA and rapid tests are used as initial screening tests to detect antibodies, while Western blot is a supplemental test used to confirm positive ELISA results.
3. In addition to specific tests, nonspecific tests like complete blood counts can provide clues about HIV infection by detecting signs of immune deficiency like low CD4+ T cell and platelet counts.
HIV infection
Mode of transmission, pathogenesis, clinical manifestations, laboratory diagnosis, treatment, prevention, prognosis, scope of AIDS vaccine.
This document provides information about HIV/AIDS, including:
- It defines endemic, epidemic, and pandemic, with AIDS classified as a pandemic.
- As of 2003, it was estimated that 40 million people worldwide were living with HIV/AIDS, with 25-28.2 million in Sub-Saharan Africa.
- HIV attacks and destroys CD4 cells, weakening the immune system and leaving the body vulnerable to opportunistic infections over time without treatment.
- HIV is transmitted through direct contact with infected bodily fluids like blood, semen, vaginal fluids. It cannot be transmitted by casual contact.
- Prevention strategies include blood screening, education on safer sex practices, STI treatment, and preventing mother
The document outlines the management of HIV infected children. It discusses the epidemiology and transmission of HIV in children in Kenya. It describes the natural disease progression of HIV in children as either rapid, intermediate, or slow progression. It also covers the diagnosis of pediatric HIV using clinical, laboratory, and immunological criteria, as well as the WHO and CDC clinical staging systems for HIV in children.
Started in 1988, World AIDS Day is not just about raising money, but also about increasing awareness, fighting prejudice and improving education. World AIDS Day is important in reminding people that HIV has not gone away, and that there are many things still to be done. ~avert.org
The document provides information on paediatric HIV including:
- The natural history of paediatric HIV infection fits into 3 categories from rapid to long term progression.
- Over 90% of the 2.1 million children living with HIV are in sub-Saharan Africa due to high maternal infection rates and PMTCT inefficiency.
- Predictors of rapid disease progression in infants include high maternal viral load, early infant infection, and low CD4 counts.
This document provides information on the care of children with HIV/AIDS. It discusses what HIV is, how it is transmitted, the stages of infection, diagnosis, treatment including antiretroviral therapy, prevention of mother-to-child transmission, and the nursing care of children with HIV/AIDS. The nursing care involves supporting the emotional needs of the child and family, maintaining nutrition, treating infections early, ensuring immunization when appropriate, and providing a good quality of life.
This document provides an overview of pediatric tuberculosis. It discusses that M. tuberculosis is the main causative agent and can spread through airborne droplets. Children under 5 years old are most vulnerable. The presentation of TB in children varies and can include pulmonary or extrapulmonary disease. Diagnosis involves clinical features, tuberculin skin testing, radiology, and microbiological methods like smear microscopy and culture. Treatment consists of a standard 6 month drug regimen. Monitoring includes checking for clinical response and side effects. BCG vaccination is recommended for infants.
1. HIV attacks T-cells in the immune system, leading to AIDS in advanced stages. Children progress more rapidly than adults, with half of untreated children dying within 2 years.
2. In India, around 2.4 million people live with HIV, with 25,000 new infections annually in children, most occurring during pregnancy or birth. Approximately 5,000 infected children progress to AIDS each year.
3. HIV is diagnosed through PCR testing in children under 18 months or antibody testing along with clinical symptoms in older children. Management includes cotrimoxazole prophylaxis, antiretroviral therapy, treatment of opportunistic infections, adequate nutrition and immunization.
The document discusses HIV/AIDS, including how it is transmitted, testing strategies, stages of infection, treatment, and monitoring of treatment. Some key points:
- HIV is a retrovirus that infects immune cells and destroys their function. If untreated, it can develop into AIDS within 10-15 years.
- HIV is transmitted through unprotected sex, contaminated blood transfusions, sharing needles, and from mother to child during pregnancy, birth, or breastfeeding.
- Testing strategies include consent, confidentiality, counseling, ensuring correct results, and linking those infected to care and treatment. Testing methods include rapid tests and laboratory tests.
- Treatment involves antiretroviral therapy (ART). When
HIV 1 and 2 belong to the Lentivirus genus and Retroviridae family. They contain two copies of single-stranded RNA and encode viral core, enzyme, and envelope proteins. Vertical transmission from mother to child is the primary route of infection in children, which can occur prenatally, during delivery, or through breastfeeding. Combination antiretroviral therapy is the standard treatment and involves two nucleoside reverse transcriptase inhibitors plus a non-nucleoside reverse transcriptase inhibitor or protease inhibitor.
These slides contain detailed description of HIV in children including : Introduction, Definition, HIV structure, Incidence, Impact of HIV on infant and child survival, Mode of transmission - Vertical transmission and horizontal transmission, Pathophysiology, Clinical features, Laboratory investigations, Management, Prevention, Nursing management, Nursing diagnosis.
This document discusses HIV/AIDS in children. It provides epidemiological data showing that in 2020, 300,000 children were newly infected with HIV. The three main modes of HIV transmission to children are vertical (mother-to-child), through blood, and sexually. HIV progresses more rapidly in children than adults due to their immature immune systems. Treatment involves antiretroviral drugs and monitoring to support adherence. Vaccines are generally recommended for HIV-infected children, though some live vaccines may not be safe depending on immune status.
Akanksha chandra pediatric nursing care of HIV/AIDS infected patientAKANKSHA CHANDRA
This document provides information on nursing care for HIV/AIDS children. It begins with an introduction to HIV/AIDS in children, defining it as a spectrum of conditions caused by HIV infection. It then discusses topics like immunity, immunoglobulins, the history and epidemiology of HIV, how it is transmitted including vertically from mother to child, pathogenesis, clinical manifestations in children at different stages, complications, diagnostic evaluation, antiretroviral therapy, cotrimoxazole prophylaxis, nutrition, and immunization of HIV positive children.
A 45-year-old woman presented with fatigue, weakness, and appetite loss. Laboratory tests found elevated liver enzymes, bilirubin, and HCV RNA. A liver biopsy showed severe inflammation and fibrosis. She was diagnosed with hepatitis C based on her history of blood transfusion and laboratory results. Treatment with antiviral therapy is recommended to prevent further liver damage from the hepatitis C infection.
This document discusses HIV/AIDS, including transmission, testing, treatment, and comprehensive care approaches. It provides details on:
- How HIV enters the body, common routes of transmission, and viral load in different body fluids.
- The stages of HIV infection and testing methods, including the window period and antibody response.
- Treatment options like HAART and the importance of early diagnosis and treatment.
- Components of comprehensive care including medical, psychological, and socioeconomic support, with an emphasis on prevention and respect for human rights.
Congenital syphilis is an infection transmitted from mother to fetus during pregnancy. It can occur at any stage of maternal infection. Without treatment, it can cause complications like stillbirth, neonatal death, and long term effects on bones, teeth, eyes and brain. Diagnosis involves serologic testing of both mother and infant. Treatment is with penicillin to prevent transmission and complications in the newborn. Careful follow up is needed to monitor treatment response and detect any late manifestations.
The document provides information about HIV/AIDS, including:
- HIV is a virus that causes AIDS by infecting helper T cells. There is no cure for HIV/AIDS.
- AIDS is the late stage of HIV infection where the immune system is severely damaged and people are vulnerable to opportunistic infections.
- HIV is transmitted through bodily fluids and can be contracted through unprotected sex, needle sharing, or from mother to child during birth or breastfeeding.
- The stages of HIV infection progress from initial infection, to asymptomatic infection where the virus is dormant, to symptomatic infection where AIDS develops without treatment.
Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection within the first month of life. It is a leading cause of neonatal mortality, responsible for about 52% of neonatal deaths. The presentation and risk factors differ based on whether the onset of sepsis is early (within 72 hours of life) or late (after 72 hours of life). Management involves screening protocols to determine the need for antibiotics and treatment, which typically involves empiric broad-spectrum antibiotics that may need to be adjusted based on culture and sensitivity results. Close monitoring is important as the condition can deteriorate rapidly.
This document discusses HIV in pediatrics. It describes the two types of HIV, HIV-1 being most common worldwide. It outlines the WHO clinical staging of HIV in adolescents and children from Stage 1 (asymptomatic) to Stage 4 (severe manifestations). It discusses diagnosis of HIV infection in infants and children, including early infant diagnosis using viral RNA or antigen detection. It covers ART goals, considerations before initiation, groups and classes of drugs used, monitoring after initiation and management of treatment failure in children living with HIV. Key counseling issues for child clients and their parents/caregivers are also summarized.
This document provides an overview of neonatal immunology and the epidemiology, clinical presentation, diagnosis, and treatment of common neonatal infections. It discusses how the neonatal immune system is immature and ineffective, putting neonates at high risk for infection. The most common bacterial infections are sepsis, meningitis, and pneumonia, often caused by Group B Streptococcus, E. coli, and other organisms. Signs of early onset sepsis can be nonspecific but include respiratory distress, hypothermia/fever, and poor feeding. Diagnosis involves blood, urine and CSF cultures along with blood tests. Empiric antibiotics such as ampicillin and gentamicin are typically started. Late onset infections from healthcare-associated sources are also
Human Immunodeficiency Virus (HIV) is a retrovirus that infects host cells and uses their DNA to make its own viral DNA. It has a long incubation period between exposure and symptoms. HIV consists of RNA surrounded by a lipid envelope and infects immune cells like T-lymphocytes. It is transmitted through sexual contact, blood exposure, mother-to-child transmission, and shared needles. While there is no cure for HIV, antiretroviral drug therapy can control the virus and prolong the lives of infected individuals.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
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তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
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Answers about how you can do more with Walmart!"
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
2. A 14 year old girl brought with c/o
P/C: cough – 2 weeks
fever – 2weeks
white patches in the mouth – 2 weeks
HOPI:
Cough :
insidious onset
productive - yellow colored sputum,
blood stained +
more in recumbent posture
Fever : intermittent high grade
no chills or rigors
Oral lesions : white in color
not associated with pain
gradually increasing in nature
3. PAST HISTORY :
Scaly skin lesions over both legs : 3 years
Recurrent respiratory infections : 1 ½ years.
Similar oral lesions : 1 year.
Loose mucoid stools , on & off : 1 year
P/H/O febrile seizures was on regular AED`S till 3 years
of age.
4. BIRTH HISTORY : uneventful
DIET HISTORY :Loss of appetite - 1 year
IMMUNISATION HISTORY : Immunised .
FAMILY HISTORY :
5. O/E : Afebrile, cachexic, Wt: 35 kg Grade III PEM
Pallor + Ht : 142cm GradeII stunting
Generalised lymphadenopathy +
Grade III clubbing +
Oral thrush
Dystrophic nail changes,
Hypopigmented macules over forehead
Scaly plaques over both legs
S/E: CVS : s1 s2 normal, No murmur
RS : B/L coarse crepitations,
bronchial breathing right infrascapular region
P/A : soft, no hepatosplenomegaly
CNS: No focal neurological deficits
11. DISCUSSION
HIV MODES OF TRASMISSION :
Unprotected sex with an infected person
Blood – to- blood contact
Pregnancy
Childbirth
Breast feeding by HIV positive mothers
12. Babies can acquire HIV infection during:
Gestation
Labor & delivery
Breastfeeding
13. CLINICAL STAGING OF HIV INFECTION
WHO CLASSIFICATION :
Stage 1
Asymptomatic
Persistent generalized lymphadenopathy
15. Stage 3
Unexplained moderate malnutrition not adequately
responding to standard therapy
Unexplained persistent diarrhoea (14 days or more )
Unexplained persistent fever (> 37.5oC intermittent or
constant, > one month)
Persistent oral candidiasis (after first 6-8 weeks of life)
Oral hairy leukoplakia
Pulmonary TB
Severe recurrent bacterial pneumonia
Symptomatic lymphoid interstitial pneumonitis
Chronic HIV-associated lung disease including
bronchiectasis
Unexplained anemia (<8g/dl )
Neutropenia (<0.5X 109/L3) or
Chronic thrombocytopenia (<50 x 109/L3)
16. Stage 4
Unexplained severe wasting, stunting or severe malnutrition
not responding to standard therapy
Pneumocystis pneumonia
Recurrent severe bacterial infections (e.g.
empyema, pyomyositis, bone or joint infection, meningitis, but
excluding pneumonia)
Chronic herpes simplex infection; (orolabial or cutaneous of
more than one month’s duration or visceral at any site)
Extrapulmonary TB
Kaposi sarcoma
Oesophageal candidiasis (or candidiasis of trachea, bronchi or
lungs)
Central nervous system toxoplasmosis (after one month of life)
17. Contd..
HIV encephalopathy
Cytomegalovirus infection: meningitis)
Disseminated endemic mycosis (extrapulmonary
histoplasmosis renitis or CMV infection affecting another
organ, with onset at age over 1 month.
Extrapulmonary cryptococcosis
(including, coccidiomycosis)
cryptosporidiosis
Chronic isosporiasis
Disseminated non-tuberculous mycobacteria infection
Cerebral or B cell non-Hodgkin lymphoma
Progressive multifocal leukoencephalopathy
Symptomatic HIV-associated nephropathy or HIV-
associated cardiomyopathy
18. Classification of HIV associated
immunodeficiency - CD 4 COUNTS
Classification of ≤ 11 12 -35 36 -59 ≥5 years
hiv assoc. (%)months months(%) months (cells/mm3)
immunodeficiency (%)
Not significant >35 >30 >25 >500
Mild 30 - 35 25 - 30 20 - 25 350 - 499
Advanced 25 - 29 20 - 24 15 - 19 200 - 349
Severe <25 <20 <15 <200 or <15%
19. HIV is difficult to diagnose in infants
Routine HIV antibody tests cannot be used
Specialised virological tests are necessary
Clinical diagnosis requires clinical and close follow up
of infant
20. Common diagnostic tests
Antibody tests:
HIV rapid test
ELISA
Western blot
These tests detect antibodies that are produced during
immune response to HIV.
False negative tests may occur when infected individuals do
not produce detectable antibodies, such as during
early acute phase of infection (window period)
Very late stages of infection ( immune suppression)
21. All infants born to HIV+ mothers will test HIV
antibody positive in the first several months of life
Maternal HIV antibody (IgG) is transferred across the
placenta during pregnancy
A positive HIV antibody test in infants <18 months of
age will not distinguish whether or not the infant is
HIV-infected; rather it shows that:
Mother is HIV-infected
Infant is at risk for HIV infection (exposed to HIV)
If the child is not infected the HIV antibody fades
during first 6 - 18 months of life
Most uninfected infants test negative by 12 months of age
All uninfected infants test negative by 18 months of age
22. Virological tests:
Specialized virologic tests must be used
HIV DNA PCR
HIV RNA PCR
p24 Antigen
Viral Culture
Two positive virologic tests = HIV infection
One positive virologic test = Presumed HIV infection
23. HIV DNA PCR
HIV DNA PCR is a special laboratory test that detects
pieces of the viral gene that are incorporated in the human
blood cell
By comparison, HIV Antibody testing detects the antibody
that the body makes in response to the HIV virus
Sensitivity of HIV DNA PCR increases with time during the
first month of life
The infant may have HIV infection but there may not be
enough virus in the blood to detect it at birth. It becomes
easier to find/detect as the infant gets a little older
24. MANAGEMENT OF<6 MONTHS OLD INFANTS BORN TO
HIV POSITIVE MOTHER
ADVISORY 1:
Start cotrimoxazole if not already started.
Asses and encourage breast feeding if replacement feeding
not started.
Collect and send dried blood spot sample(DBS) of babies
b/w 6wk to 6 months for DNA PCR
25. HIV DNA DETECTED
collect and send whole blood for DNA PCR
HIV DNA DETECTED IF NOT DETECTED
HIV INFECTED
Repeat with another sample
ADVISORY 2
Continue cotrimoxazole IF DNA DETECTED
Manage OI if any
Start ARV as per protocol
Continue breast feeeding
Avoid mixed feeding
26. If DNA DETECTED WITH INITIAL DBS SAMPLE BUT
NOT WITH 2 REPEAT WHOLE BLOOD SAMPLES:
ADVISORY 3:
Infant probably not infected but at risk.
Repeat DNA PCR by DBS test at 6mon , or 6wk at last
breast feeding or child develops symptoms of HIV
infection.
Continue cotrimoxazole until definitely negative.
Discourage weaning too early - use local guidelines
and AFASS criteria met before weaning .
6months is often good time to discuss possibility of
weaning
27. IF DBS SAMPLE AT 6 WKS HIV DNA NOT DETECTED
If child develops signs or symptoms of infection
at <6mon age repeat DNA PCR by DBS
If asymptomatic repeat DNA PCR at 6months
HIV DNA DETECTED HIV DNA NOT DETECTED
Follow advisory 1
Confirm by rpt DNA PCR by BREAST FED NOT FED
whole blood IN 6wk IN 6Wk
BEFORE TEST before
FOLLOW ADVISORY3
HIV DNA DETECTED HIV NOT DETECTED NOT INFECTED
INFANT INFECTED WITH STOP
HIV COTRIMOXAZOLE
FOLLOW ADVISORY2 AVOID BREASTFEEDING
28. HIV EXPOSED CHILD > 18MONTHS OF AGE
Child > 18 months of
age* HIV Antibody
NEGATIVE
Rapid HIV Antibody
Test
Breast feeding child
Non-breast feeding child remains at risk of infection
UNINFECTED
HIV Antibody
POSITIVE
Repeat HIV Rapid Antibody
HIV-INFECTED
>6-12 weeks after weaning
HIV Antibody POSITIVE (after 6months of EBF)
HIV-INFECTED
Refer for HIV care
& HIV Antibody
Refer for HIV NEGATIVE
treatment
care & UNINFECTED
treatment
29. HIV DIAGNOSIS IN CHILDREN <18 MONTHS WITH
DNA -PCR
Delivery
HIV + PREGNANT HIV exposed infant
Symptomatic HIV-
WOMEN (breastfed and non-
exposed
breastfed
infant <18 months
6 – 8 weeks age age (not previously
1st HIV DNA 1st HIV DNA PCR
+
PCR
_ diagnosed
Repeat HIV NEGATIVE
DNA PCR PCR test
To confirm
Breastfed Not breast fed
+
REPORT _ 2nd PCR after 6–8 2nd PCR at 6 months
HIV Positive weeks of stopping to confirm status
breast-feeding
+
Repeat test and
+ _ _ Repeat test
refer for REPORT & refer for
follow-up HIV negative follow -up
30. What if the Initial DNA PCR is Negative
but the child is ILL?
If the HIV DNA result is negative, but the child
develops HIV symptoms
Oral thrush
Pneumonia
Poor growth
Developmental delay
Chronic diarrhea
Repeat HIV DNA PCR testing
31. Post exposure prophylaxis
Health care personnel are at risk of blood borne infection
Percutaneous injury( needle stick, sharps)
Contact - mucous membrane of eye & mouth of an infected person
-non intact skin or blood
-potentially infected body fluids .
What is infectious and what is not ?
Infectious :
blood
semen
vaginal secretions,
peritoneal
pericardial,
amniotic fluid
contaminated with visible blood can lead to infection.
Non infectious:
sweat
saliva
urine
feces
unless these contain blood .
32. First Aid in management of exposure
Immediately wash the wound and surrounding skin
with soap and water.
Don’ts
Don’t squeeze the wound to bleed
Don’t put pricked finger in mouth
Don’t use bleach or antiseptic or alcohol
33. Establish eligibility for PEP
Risk of transmission proportional to amount of HIV
transmitted.
A baseline rapid HIV test of exposed and source
person must be done before PEP.
Informed consent must be obtained.
A designated person or trained doctor must asses the
risk of transmission following an AEB. Assessment
must be quick to start treatment without delay ideally
within 2 hrs but certainly within 72 hrs after
exposure.
34. Assessing risk of transmission:
Mild
Moderate
Severe
Counsel for PEP
Psychological support
Document exposure
35. Deciding on PEP regimen
Exposure Status of source
HIV+ and HIV + and HIV status unknown
asymptomatic clinically
symptomatic
Mild Consider 2 Start 2 drug PEP Usually no pep or consider 2
drug PEP drug PEP
Moderate Start 2 drug Start 3drug PEP -DO -
Severe Start 3 drug Start 3drug PEP -DO-
36. Drug regimen for PEP
There are 2 types of regimens:
Basic regimen : 2 drug combination
Zidovudine(AZT)+ Lamivudine (3TC)
or
Stavudine(d4T) + Lamivudine
Expanded regimen: 3 drug combination
above either combo’s of 2 drugs with protease inhibitors
( Lopinavir or Indinavir or Nelfinavir)_
37. MANAGEMENT OF CHILDREN WITH HIV
INFECTION
Attention to growth, nutrition and immunization of
child.
Treatment and prevention of opportunistic infections.
Antiretroviral therapy.
38. Prophylactic therapy
Cotrimoxazole prophylactic therapy:
For prevention of pneumocystis jiroveci , toxoplasma , malaria
and other bacterial infections.
When to start?
1 – 5 yrs : WHO clinical stage 2,3 or 4
regardless CD4 counts.
If CD4 count <25% irrespective of
stage.
>5 yrs : WHO stage 2,3, or 4 if CD4 counts not available
WHO stage 3 or 4 irrespective of CD4 counts.
CD4 count <350 cells/mm3 irrespective of stage.
39. Dose : 5mg/kg/day
Duration : To be continued till 5 years of age.
After 5 yrs, consider stopping, if
CD4 count >350 cells/mm3 on 2
occasions at least 3 months apart.
40. ISONIAZID PROPHYLACTIC THERAPY (IPT)
Screening for TB strongly recommended for all
Children living with HIV OR AIDS(CLHA)
> 1 YR : 6 Months IPT who have no contact
with a TB case and are unlikely to have
active symptoms.
<1 YR : IPT recommended for only those who
have contact with TB case and who
are unlikely to have active TB.
Dose : 10 mg/kg/day.
41. ANTIRETROVIRAL THERAPY
ART decreases mortality in CLHA.
However ART is not a cure for infection.
Pre ART workup:
CLINICAL:
Weight, height, head circumference, and other measures
of growth.
Nutritional status, assessment of dietary intake
Developmental assessment.
Concomitant medical conditions.
WHO clinical staging.
Details of drugs child receiving including CPT
42. LABORATORY:
Hemoglobin , complete blood counts.
Biochemical tests: LFT, RFT, Blood glucose, serum
electrolytes, serum lipids, amylase, lipase levels.
Pregnancy test in adolescent girls.
CD4 counts and percentage.
Viral load if available.
43. PRE ART COUNSELING
Identification of primary care giver who understands
implications of ART.
Identify secondary care giver in absence of primary
care giver.
Adequate counseling of care giver regarding dose
,duration, timing and side effects of drug is mandatory
before initiating ART.
44. Time of initiation of ART
All infected children <24 months of age.
All children < 18 months of age with presumptive
clinical diagnosis of HIV.
In 24 – 59 months of age:
WHO stage 3 and 4
CD4 < 25% or CD4 count <750
cells/mm3
For >60 months age:
WHO clinical stage 3 or 4 disease.
CD4 count < 350 mm3
45. When to start ART in children, guided by CD4
< 11 month infants : if CD4 < 1500 cells/mm3
(< 25%)
12–35 months : if CD4 < 750 cells/mm3
(<20%)
36–59 months : if CD4 <350 cells/mm3
(15%)
> 5 years old : follow adult guidelines ie
start ART if < 350 cells/mm3
especially if symptomatic.
Initiate ART before CD4 drops below 200 cells/mm
48. CURRENT ART REGIMENS FOR USE
IN CHILDREN
Standard first line regimen :
2NRTI + 1 NNRTI
commonly used NRTI are AZT, d4T, 3TC, ABC.
commonly used NNRTI are EFV, NVP.
49. Choice of first line ART
CHILDREN NOT EXPOSED TO NNRTI:
AZT+ 3TC+ NVP
CHILDREN EXPOSED INFANT OR MATERNAL
NVP OR OTHER NNRTI`S USED FOR
MATERNAL TREATMENT:
AZT+3TC+LPV
IF EXPOSURE TO ARV IS UNKNOWN:
2NRTI+ 1NNRTI.
50. FOLLOW –UP
Followed up once every month for initial 6 months
Evaluation at every visit should include evaluation for
efficacy of treatment which include clinical
improvement and weight gain.
Monitoring for adverse drug reactions.
51. Role of the Parent/caregiver
Parent needs to understand:
That infant diagnosis is an ongoing process
The importance of early testing, frequent
monitoring, and adherence to care
Often the first to notice signs and symptoms.
Often has multiple complex roles and needs, including
self-care, caretaker role for other family
members, feelings about transmission of HIV to the
infant.
Parent needs understanding and support.
51