Prevalence of fat redistribution and metabolic disorders in human immunodeficiency virus-infected children.

UNLABELLED: In this study we assessed the prevalence of fat redistribution and metabolic disorders in a population of HIV-infected children on antiretroviral treatment. To make associations with epidemiological parameters, clinical-immune status, viral load and highly active antiretroviral therapy (HAART), we performed a cross-sectional study in HIV-infected children. Epidemiological parameters (age, sex, family history), clinical and immune status, viral load, and duration of antiretroviral treatment (ART) and HAART, including protease inhibitors, were recorded. Presence of clinical signs of fat redistribution and lipid, glucose and lactic acid levels were evaluated. A total of 56 HIV-infected children, including 30 boys (54%), aged between 21 months and 18 years (mean 9.5 years) were studied. In all, 49 patients (87.5%) were receiving ART (mean duration 4 years) and 43 (77%) were receiving HAART (mean duration 3.6 years). Fat redistribution or lipodystrophy was present in 14 patients (25%); seven had lipohypertrophy (12.5%), two lipoatrophy (3.5%) and five a mixed pattern (8.9%). Fat redistribution was higher in children older than 11 years (50%). Of the lipodystrophic patients, 71.4% presented hypertriglyceridaemia (> 130 mg/dl) and 57% hypercholesterolaemia (> 180 mg/dl). We found significant associations between lipodystrophy and age, ART and HAART duration and hypertriglyceridaemia ( P < 0.001, 0.002, 0.016 and < 0.001, respectively), but no significant association with sex, family history, clinical or immune status and viral load. CONCLUSION: The prevalence of lipodystrophy was 25% (95% confidence interval 14.8-34.6) with lipohypertrophy being the commonest pattern. Clinical fat redistribution was significantly associated with older age, duration of antiretroviral treatment and highly active antiretroviral therapy and hypertriglyceridaemia.

Twenty years of pulmonary tuberculosis in children: what has changed?

OBJECTIVES: To compare the frequency, clinical and radiologic manifestations and source of infection of pulmonary tuberculosis in children treated in our hospital during two decades (1978 through 1987 and 1988 through 1997) and to evaluate the influence of the emergence of HIV infection (since 1985) and the effect of the discontinuation of Calmette-Guérin bacillus (BCG) vaccination (since 1987) on childhood tuberculosis. METHODS: We reviewed 324 children diagnosed with pulmonary tuberculosis in our hospital during the 20 years (1978 through 1997). The data from 2 decades, 1978 through 1987 and 1988 through 1997, were compared. BCG vaccination in Spain was discontinued in 1987, and HIV infection emerged significantly as a public health problem. RESULTS: An increase in the number of children with single hilar adenopathy was observed (32.2% in 1978 through 1987 vs. 43.4%, in 1988 through 1997, P < 0.05) in comparison with those with parenchymal involvement or a mixed pattern (62.4% in 1978 through 1987 vs. 45.7% in 1988 to 1997). Frequency in extrapulmonary manifestations in both periods was similar, with a nonsignificant trend toward a lower rate of tuberculous meningitis in the latter decade (10.4 vs. 5.6%, P = 0.07). We were able to identify an adult source case for 67.1% of the children (100 of 149) in the first decade vs.58.3% (102 of 175) in the second (P = NS); 10.8% of adult contacts but only 2.3% of children (all of them in the second period) were HIV-positive. CONCLUSIONS: Discontinuation of BCG vaccination and emergence of HIV infection have had little influence on childhood tuberculosis in our area.

Infección otomastoidea por Fusobacterium necrophorum en niños: presentación de dos casos / Mastoidal infection due to fusobacterium necrophorum in children. Report of two cases

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