Subject(s)
Bronchopneumonia/complications , HIV Infections/complications , HIV-1 , Lymphatic Diseases/complications , Sarcoma, Kaposi/complications , Child, Preschool , HIV Infections/diagnosis , Herpesvirus 8, Human/isolation & purification , Humans , Male , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/virologyABSTRACT
This study examined the EBV status and the morphology in parotid glands of a large cohort of HIV-positive pediatric patients. Nineteen children with vertically acquired HIV infection, ranging in age from three months to seven years and two months, were analyzed. Seventeen patients were assessed for serological evidence of EBV infection; nine showed evidence of past infection, one each re-activation and current infection and six did not have serological evidence of EBV. Immunohistochemistry and in situ hybridization for EBER 1 and 2 were performed on formalin-fixed, paraffin-embedded tissue. Fourteen of the 19 cases were classified as severe or established myoepithelial sialadenitis (MESA) and five were regarded as having mild MESA. The majority of intraepithelial lymphocytes were of B-cell lineage, while the pericystic infiltrate contained CD8-positive T-lymphocytes. p24 immunohistochemistry for HIV showed positive follicular dendritic cells, lymphoid cells and macrophages. Ten of 14 cases were positive for EBER 1 and 2. These included cases that were serologically negative for EBV. This study confirms that the morphology and immunophenotype of pediatric HIV-associated parotid lesions are similar to those seen in adults. Ten of 14 cases with evidence of EBV within the lymphoid infiltrate showed the same morphology and immunophenotype as cases in which EBV was not detected either by serology or by in situ hybridization. These findings indicate that EBV is not uniformly found in either the tissue or serum of these patients, and may not have a pathogenetic role in HIV-associated lymphoepithelial lesions in the pediatric age group.
Subject(s)
HIV Seropositivity/virology , Herpesvirus 4, Human/isolation & purification , Parotid Gland/virology , Parotitis/virology , Child , Child, Preschool , Female , HIV Seropositivity/metabolism , HIV Seropositivity/pathology , Humans , Immunoenzyme Techniques , In Situ Hybridization , Infant , Male , Parotid Gland/metabolism , Parotid Gland/pathology , Parotitis/metabolism , Parotitis/pathology , RNA, Viral/metabolism , Sialadenitis/metabolism , Sialadenitis/pathology , Sialadenitis/virologyABSTRACT
A retrospective review of 10 children with biopsy proved mucosa-associated lymphoid tissue lymphoma of the parotid glands demonstrated multifocal hypoechoic intraparotid nodules and cysts with punctate calcification on sonography. This was confirmed on computed tomographic examination. All children were seropositive for human immunodeficiency virus and had depressed CD4 counts. Mucosa-associated lymphoid tissue lymphoma should be considered in the diagnosis of bilateral parotid swelling in children with acquired immunodeficiency disease-related complex.
Subject(s)
Lymphoma, AIDS-Related/diagnosis , Lymphoma, B-Cell, Marginal Zone/diagnosis , Parotid Neoplasms/diagnosis , Child , Child, Preschool , Humans , Infant , Lymphoma, AIDS-Related/diagnostic imaging , Lymphoma, B-Cell, Marginal Zone/diagnostic imaging , Parotid Neoplasms/diagnostic imaging , Retrospective Studies , UltrasonographyABSTRACT
The objective of this study was to investigate household clustering of hepatitis B virus (HBV) infection in South Africa in order to understand intra-household patterns of virus transmission that would provide information on potential risk factors of HBV infection. Subjects were the household contacts of 28 hepatitis B surface antigen (HBsAg) positive children (index-carrier), 22 hepatitis B surface antibody positive children (index-past-infection) and 35 children with no serological evidence of HBV infection (index-negative). Evidence of HBV infection (at least one positive HBV marker) was present in 73.7%, 48.7% and 38.2% and HBsAg was present in 19.9%, 8.7% and 2.9% of household contacts of index-carrier (N = 186), index-past-infection (N = 150) and index-negative (N = 207) children respectively. The clustering of HBV infection and HBsAg was present in all subgroups of household contacts regardless of the degree of relatedness to the index child. As age increased, the cumulative prevalence of HBV infection increased while the likelihood of being HBsAg positive decreased. Regardless of age, males were more likely (p less than 0.01) than females to be HBsAg positive. We conclude that HBV infection clusters in households; that there is an increased susceptibility, which is probably not genetically mediated, of becoming an HBV carrier in certain households and that males are at greater risk of being HBV carriers. Intra-household horizontal person-to-person transmission, the precise mechanisms of which are not known, is important in South African blacks.
Subject(s)
Hepatitis B/transmission , Adolescent , Adult , Age Factors , Child , Family Health , Female , Hepatitis B/diagnosis , Hepatitis B/epidemiology , Hepatitis B Surface Antigens/analysis , Humans , Male , Risk Factors , Sex Factors , South Africa/epidemiology , Space-Time ClusteringABSTRACT
A community-based study in northern Natal/KwaZulu, South Africa, assessed the prevalence of hepatitis B virus (HBV) infection in rural Black adults. The prevalence of HBV carriers was 4.4 percent in women (N = 342) and 7.1 percent in men (N = 99). At least one marker of HBV infection was present in 81 percent of women and 86 percent of men. The relative risk (RR) of HBV marker positivity in women due to scarification, adjusted for the presence of pierced ears, was 1.37 (95% CI = 0.9, 2.1). Risk factors such as scarification and pierced earlobes need to be further investigated to assess their role in the transmission of the HBV.
Subject(s)
Black or African American , Hepatitis B/epidemiology , Rural Health , Adolescent , Adult , Aged , Aged, 80 and over , Black People , Cicatrix , Female , Hepatitis B/blood , Hepatitis B/transmission , Hepatitis B Antibodies/immunology , Hepatitis B Surface Antigens/immunology , Humans , Male , Middle Aged , Risk Factors , Sex Factors , South AfricaABSTRACT
The sera of statistically selected urban (805), rural (238) and institutionalized (127) black children were tested for markers of hepatitis B virus (HBV) infection. The age-standardized (6-14 years) prevalence rates of HBs antigenaemia for comparison between urban, rural and institutionalized children were 10%, 18.5% and 25.1% and the HBV exposure rates were 31.4%, 62.1% and 72.0% respectively. In the newborn to six years age group the prevalence rates of HBsAg and HBV exposure were 2.5% and 7.1% for urban children and 53.1% and 70.3% for institutionalized children. Peak prevalences of HBsAg occurred in the 6-8 year age group and were 14.4% and 22.6% in urban and rural children respectively. Hepatitis Be Antigen (HBeAg) was detected in 46.5% and antibodies to hepatitis Be antigen (HBeAb) in 10.0% of all HBsAg positive children. Multiple mechanisms involving horizontal rather than vertical transmission appeared to be important in urban children, with HBV exposure in females being significantly associated with ear-piercing (p less than 0.001) and scarification (p less than 0.05). In addition, HBsAg was detected in 25 of 29 pools of bloodfed mosquitoes caught at the children's institution and was negative in all four pools of unfed mosquitoes, suggesting that these arthropods may also be one factor in the horizontal spread of HBV infection. Familial clustering of HBV infection was suggested by a significantly higher (p less than 0.01) prevalence of HBsAg amongst family contacts of HBsAg positive urban children (17.7%) than in the control groups of family contacts of HBsAb positive children (8%) and children who were negative for all HBV markers (2.4%). The significance and implications of these findings are discussed.
