Initiation of antiretroviral treatment with dual nucleoside reverse transcriptase inhibitors in human immunodeficiency virus-infected infants with less advanced disease in a resource-limited setting: a multi-center study in Thailand 1998-2000.

OBJECTIVES: To evaluate the feasibility, duration of efficacy, and outcome of therapy with dual nucleoside reverse transcriptase inhibitors (NTRI) initiated in HIV-infected infants with mild to moderate disease. MATERIAL AND METHOD: During 1998-2000, a multi-center prospective open-labeled operational study was conducted. Antiretroviral naôve HIV-infected infants were enrolled in seven hospitals to receive either zidovudine (AZT) plus lamivudine (3TC) or AZT plus didanosine (ddI). Infants who were in CDC stage "C3" were excluded from the study. RESULTS: Of the 88 infants, the mean age of treatment initiation was 6.8 months, and the mean initial CD4 was 1538 cells/mm3 (21.4%). The z-scores for weight and height increased after 4-8 months of treatment, and by the 24th month, were +0.89 and +0.69 higher than at enrollment. The CD4% peak increased at 8 months of treatment, by a mean increment of 4.19%, but decreased to the level of 1.08% above baseline by the 24th month of treatment. Three (3.4%) infants died, 11 (12%) had disease progression, 7 (8%) was prematurely discontinued from the study protocol due to poor compliance, and 37 (42%) were lost to follow-up. At the end of 24 months, all remaining 30 children were in stable condition with a chance of clinical and immunological stability of 34% and 68% by intention-to-treat and on-treatment analysis, respectively. CONCLUSION: Clinical and immunological benefit from dual NRTI was limited. Treatment of HIV-infected infant with mild to moderate disease in a resource-limited setting may have limited feasibility due to the high drop-out rate.

Subacute infective endocarditis caused by Corynebacterium diphtheriae: a case report.

The authors report an 11-year-old boy with septicemia and subacute infective endocarditis due to toxigenic-Corynebacterium diphtheriae. The patient had underlying congenital heart disease and incomplete immunization. He presented with fever, epistaxis and congestive heart failure. He received high-dose penicillin therapy and diphtheria antitoxin with clinical improvement. While he was receiving a high dose of penicillin for 1 month he developed a generalized tonic clonic seizure. A computerized tomogram revealed intracerebral and ventricular hemorrhage. Craniotomy with blood clot removal and ventriculostomy drainage were done. He died 2 days later from brain death and cardiovascular failure.

Congenital tuberculosis.

This is a retrospective study of congenital tuberculosis in Queen Sirikit National Institute of Child Health from 1979 to 1998. There were 9 patients with a mean birth weight of 2,500 grams (range 1,800-3,300). The onset of symptoms and age of diagnosis ranged from 7 to 42 (mean, 21) days and 14 to 75 (mean, 54) days after birth, respectively. The presenting signs and symptoms were fever (100%), poor feeding (100%), irritability (100%), failure to gain weight (100%), hepatomegaly (100%), splenomegaly (77.8%), cough (88.9%), respiratory distress (66.7%) and abdominal distension (77.8%). The tuberculin skin test reaction with > or = 10 mm induration was found in 2 of 8 patients. Their abnormal chest radiographs revealed bronchopneumonia 66.7 per cent, miliary pattern 33.3 per cent and multiple cystic lesion 11.1 per cent. The bacteriological study from gastric aspirate content for acid-fast bacilli (AFB) staining and culture were positive in 62.5 and 71.4 per cent respectively. Fatality rate was 33.3 per cent with no sequele found in the survivors. Congenital tuberculosis is a rare entity and difficult to give an early diagnosis. There should be a high index of suspicion for tuberculosis in those who had pneumonia and were unresponsive to aggressive antibiotics or had unexplained etiology.

Rapid diagnosis of cytomegalovirus in Thai pediatric AIDS patients.

Blood samples were collected from 100 pediatric AIDS patients for the detection of CMV in pp65-bearing leukocytes (PBLs) by immunoperoxidase staining (IP) and PCR. IgM antibody assay was performed to determine the correlation of antigen and antibody. IP and PCR can be used as methods for the early detection of CMV (prior to the presence of IgM antibody). The sensitivity and specificity of IP were 73% and 97% respectively. IP is superior to PCR in several ways: it is very easy to perform, less time consuming, less expensive, and does not require expensive instruments.