This case study describes a 9-month-old Thai boy with HIV who presented with shortness of breath and cough. His symptoms did not improve with initial treatment. Physical examination found tachypnea and lung rhonchi and crepitations. He was diagnosed with HIV and respiratory adenopathy disease. The document then provides overview of common signs, symptoms, opportunistic infections, organ manifestations, and classification system seen in pediatric HIV/AIDS. Pneumocystis pneumonia is the most common opportunistic infection in children under 6 months of age.

1. Case study
• เด็กชายจุลจักร ปิ่นแก้ว
• อายุ 9 เดือน
• ภูมิลำาเนา อำาเภอเมือง จังหวัดสุราษฎร์ธานี

2. Admit ครั้งที่ 1 วันที่ 25 ก.ค. 2548
• CC : หายใจหอบเหนื่อย
• PI : 3 วันก่อนมาโรงพยาบาล มีไข้ ไอ มีนำ้ามูก
กินยาแล้วอาการไม่ดีขึ้น เมื่อวานมีหายใจหอบ
เหนื่อย จึงมาโรงพยาบาล
• PH : know case HIV (vertical infection)
HIV PCR positive
RAD

3. • PE : BT 38.0, PR 120, RR 36
• Weight : 9 kgs
• GA : active, not pale, no jaundice, dyspnea,
intercostal retraction
• HEENT : mild injected pharynx and tonsils, tonsil
1+
• Lungs : rhonchi, coarse crepitation
• Abd. : soft
• Heart : no murmur
• Dx : HIV with RAD

4. • CXR : patchy infiltration entired right lung

5. Case study
• เด็กชายจุลจักร ปิ่นแก้ว
• อายุ 1 ปี 6 เดือน
• ภูมิลำาเนา อำาเภอเมือง จังหวัดสุราษฎร์ธานี

6. Admit ครั้งที่ 2 วันที่ 11 เม.ย. 2549
• CC : ไข้และหอบเหนื่อย 5 วัน ก่อนมาโรง
พยาบาล
• PI : 5 วันก่อนมาโรงพยาบาล มีไข้ตลอด ไอมี
เสมหะ มีนำ้ามูกใส มีหายใจหอบเหนื่อย จึงมาพบ
หมอที่รพ.สุราษฎร์ธานี ได้รับยาไปกิน แต่
อาการไม่ทุเลา วันนี้เหนื่อยมากขึ้น ซึมลง จึงมา
โรงพยาบาล
• PH : เป็นลูกคนที่ 2/2
นำ้าหนักแรกคลอด 2950 gms
เคยนอนโรงพยาบาลด้วยอาการหอบ

7. • PE : BT 38.0, PR 120, RR 34
• GA : A Thai male child, dyspnea, tachypnea, not pale
• HEENT : mild injected pharynx, mucous rhinorrhea
• Heart : normal S1S2, no murmur
• Lungs : equal breath sound, generalized fine crepitation
• Abd. : soft, not tender, no distension, no
hepatosplenomegaly
• Skin : no rash
• Dx : Pneumonia

9. Signs and Symptoms

10. • Infants, physical examination at birth is normal
• Initial symptoms may be subtle
• Symptoms found more commonly in children than adults
• hepatosplenomegaly
• failure to thrive
• recurrent diarrhea
• interstitial pneumonia
• oral thrush
• Symptoms found more commonly in children than adults
• recurrent bacterial infections
• chronic parotid swelling
• lymphocytic interstitial pneumonitis
• early onset of progressive neurologic deterioration

11. HIV classification system
• categorize the stage of pediatric disease
• clinical status
• degree of immunologic impairment

12. Opportunistic infections

13. Pneumocystis carinii (jiroveci)
pneumonia (PCP)
• acute onset of fever
• tachypnea
• dyspnea
• marked hypoxemia
• Chest x-ray findings most commonly consist of
interstitial infiltrates or diffuse alveolar disease
, which rapidly progresses.

15. Pneumocystis carinii (jiroveci)
pneumonia (PCP)
• most common opportunistic infection in the
pediatric population
• peak incidence of PCP occurs at age 3–6 mo
• highest mortality rate in children <1 yr of age

16. Atypical mycobacterial infection
• Mycobacterium avium-intracellulare complex
(MAC)
• fever, malaise, weight loss, and night sweats
• diarrhea, abdominal pain, and rarely intestinal
perforation or jaundice (due to biliary tract
obstruction by lymphadenopathy) may also be
present

17. Oral candidiasis
• most common fungal infection seen in
HIV-infected children
• anorexia, dysphagia, vomiting, and fever

19. Viral infections
• especially with the herpesvirus group
• HSV causes recurrent gingivostomatitis

20. Respiratory viruses
• respiratory syncytial virus (RSV) and
adenovirus
• prolonged symptoms and persistent viral
shedding

21. Central Nervous System
• incidence of CNS involvement in
perinatally infected children is 50–90%
in developing countries
• loss or plateau of developmental
milestones
• cognitive deterioration
• impaired brain growth resulting in acquired
microcephaly
• symmetric motor dysfunction

22. Central Nervous System
• Encephalopathy
• initial manifestation of the disease or may present
much later when severe immune suppression
occurs
• cerebral atrophy
• increased ventricular size
• basal ganglia calcifications

23. Central Nervous System
• CNS lymphoma may present with a new onset
of focal neurologic findings, headache, seizures,
and mental status changes
• CNS toxoplasmosis is exceedingly rare in
young infants, but may occur in HIV-infected ado
lescents

24. Respiratory Tract
• Otitis media and sinusitis are very
common
• Common groups
• S. pneumoniae, H. influenzae, Moraxella
catarrhalis

25. Respiratory Tract
• LIP
• common chronic lower respiratory tract abnormality
• chronic process with nodular lymphoid hyperplasia in the
bronchial and bronchiolar epithelium
• tachypnea, cough, and mild to moderate hypoxemia with
normal auscultatory findings or minimal rales
• Progressive disease may be accompanied by digital clubbing
and symptomatic hypoxemia
• pneumonia
• S. pneumoniae is the most common bacterial pathogen
• P. aeruginosa

26. Cardiovascular System
• dilated cardiomyopathy
• left ventricular hypertrophy
• congestive heart failure
• Hemodynamic instability
• Gallop rhythm with tachypnea
• hepatosplenomegaly

27. Gastrointestinal and Hepatobiliary
Tract
• erythematous or pseudomembranous
candidiasis
• periodontal disease
• salivary gland disease
• Bacteria
• Salmonella, Campylobacter, MAC
• protozoa
• Giardia, Cryptosporidium, Isospora, microsporidia
• fungi
• Salmonella, Campylobacter, MAC

28. Gastrointestinal and Hepatobiliary
Tract
• most common symptoms of gastrointestinal
disease are chronic or recurrent diarrhea with
malabsorption, abdominal pain, dysphagia, and
failure to thrive
• Chronic liver inflammation
• Cryptosporidial cholecystitis is associated with
abdominal pain, jaundice, and elevated gamma
GT
• portal hypertension and liver failure
• Pancreatitis

29. Skin Manifestations
• Seborrheic dermatitis or eczema
• Recurrent or chronic episodes of HSV,
herpes zoster, molluscum contagiosum,
flat warts, anogenital warts, and candidal
infections are common
• Allergic drug eruptions are also common

31. Hematologic and Malignant
Diseases
• Anemia occurs in 20–70% of HIV-infected
children, more commonly in children with AIDS
• Leukopenia occurs in almost ⅓ of untreated
HIV-infected children
• Non-Hodgkin lymphoma, primary CNS
lymphoma, and leiomyosarcoma are the most
commonly reported neoplasms among HIV-
infected children
• Kaposi sarcoma