ABSTRACT
Introduction. Severe pneumonia in infants who are HIV-infected is a common problem in many parts of the developing world; especially sub-Saharan Africa. What has been missing from previous studies of severe pneumonia in HIV-infected infants; however; is a description of the host inflammatory response and cytokine/chemokine profile that accompanies this disease. Objective. To describe the cytokine profiles associated with severe hypoxic pneumonia in HIV-infected infants Methods. In a cohort of HIV-infected children diagnosed clinically with severe hypoxic pneumonia; paired serum and sputum cytokines were tested. A control group of HIV-infected children with bronchiectasis contributed matching controls.Results. A total of 100 infants (mean age 2.8 months) with a clinical diagnosis of severe hypoxic pneumonia were included in this study. IP-10 was markedly elevated in both sputum (mean 560.77pg/ml) and serum (mean 9091.14pg/ml); while IP-10 was elevated in serum (mean 39.55 pg/ml); with both these cytokines being significantly higher than in stable children with HIV-related bronchiectasis. Conclusion. This study of HIV-infected infants with severe hypoxic pneumonia suggests that IL-10 and IP-10 are associated with more severe lung disease. However; further investigation of this association is required
Subject(s)
Cytokines , HIV Infections , Infant , PneumoniaABSTRACT
"Objectives. To determine the efficacy and safety of adjunctive corticosteroid therapy in clinical PCP pneumonia (Pneumocystis jiroveci pneumonia) in infants exposed to HIV infection. Design. Double blind randomised placebo-controlled trial. Methods: Infants with a clinical diagnosis of PCP; based on an ""atypical"" pneumonia with: 1) hypoxia out of proportion to the clinical findings on auscultation; 2) CRP less than 10 IU; 3) LDH above 500 IU; 4) compatible CXR findings and 5) positive HIV ELISA test were included in the study. Patients were randomised to receive either prednisone or placebo. The protocol provided for the addition of prednisone to the treatment at 48 hours if there was clinical deterioration or an independent indication for steroid therapy. Other treatment was carried out in accordance with established guidelines. in room air. Results. One hundred patients were included; 47 in the prednisone and 53 in the placebo group. Patients in the prednisone group had a 43 better chance of survival than the placebo group (HR 0.57; 95CI 0.30-1.07; p=0.08). No significant differences could be demonstrated between groups in respect of other parameters of recovery. Conclusions. In HIV exposed infants with clinical PCP pneumonia; adjunctive corticosteroid treatment does not appear to add benefit regarding time to recovery or oxygen independency; but early administration may improve survival. A large multi-centred trial is needed to confirm these findings.The primary study endpoint was in hospital survival. Secondary outcome was time from admission to the first day of mean oxygen saturation above 90"
Subject(s)
Adrenal Cortex Hormones/therapeutic use , HIV Infections , Infant , Pneumocystis carinii , PneumoniaABSTRACT
Acute diarrhoea is due to intestinal infection. The patient ingests the pathogen which has contaminated water; food; drink; toys or anything that can be placed in the mouth. An inadequate and unsafe water supply; and poor application and practice of hygiene leads to faecal contamination. The most important complication is dehydration; with a poor correlation between the clinical features and actual dehydration. The management of the dehydrated patient depends on a careful assessment of the state of the circulation and the need for resuscitation. In most instances; oral rehydration is appropriate and fully effective if the solution is offered in small quantities at a time. Normally nourished infants do not require modi fication of their feeds beyond adapting the quantity offered as tolerated; but if diarrhoea persists; there is a risk of intestinal mucosal damage with malabsorption and nutritional consequences