Related Experiment Videos
Finger clubbing in children with human immunodeficiency virus infection
1Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa. heather@rmh.uct.ac.za
Insights
Finger clubbing is significantly more common in HIV-infected children with pneumonia. This finding can help identify children with undiagnosed HIV in high-prevalence areas.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Finger clubbing is a known clinical sign, but its association with pediatric HIV and pneumonia requires further investigation.
- Understanding the clinical, laboratory, and radiological features associated with finger clubbing in HIV-infected children is crucial for diagnosis and management.
Purpose of the Study:
- To determine the frequency of finger clubbing in HIV-infected children hospitalized with acute pneumonia.
- To describe the clinical, laboratory, and radiological characteristics associated with finger clubbing in this population.
- To assess the association between finger clubbing and in-hospital mortality in pediatric pneumonia cases.
Main Methods:
- A comparative study was conducted on 150 HIV-infected children and 99 HIV-negative control patients hospitalized for acute pneumonia.
- Clinical data, laboratory results (including lymphocyte counts and LDH), and radiological findings (specifically Lymphoid Interstitial Pneumonitis - LIP) were collected and analyzed.
- Statistical analysis was performed to compare the prevalence of clubbing and associated features between HIV-infected and HIV-negative groups, as well as outcomes.
Main Results:
- Finger clubbing was observed in 20% of HIV-infected children versus 1% of HIV-negative controls (p < 0.001).
- Clubbing was associated with lower heart and respiratory rates, enlarged parotid glands, altered lymphocyte profiles (lower CD4+ T-cells, CD4:CD8 ratio), and higher serum protein/gammaglobulin levels.
- Radiological findings of LIP were more common in children with clubbing, and these children had a significantly lower in-hospital mortality rate (6.7% vs 24.2%, p = 0.035).
Conclusions:
- Finger clubbing is a prevalent sign in HIV-infected children with pneumonia and is linked to specific clinical and laboratory findings, including LIP.
- The presence of finger clubbing in children with respiratory illness in high HIV prevalence areas should prompt suspicion for HIV infection.
- Despite associations with LIP, finger clubbing in this context may indicate a less severe disease course or better response to treatment, correlating with lower mortality.
Abstract:
We investigated the frequency of finger clubbing in 150 HIV-infected children consecutively hospitalized for acute pneumonia in South Africa and described associated clinical, laboratory and radiological features. Clubbing occurred in 30 of 150 (20%) HIV-infected children compared with one of 99 (1%) HIV-negative control patients, p < 0.001. Clubbing was associated with lower presenting heart and respiratory rates and enlarged parotid glands. Total and CD4 + lymphocytes, CD4:CD8 ratio and LDH were lower in children with clubbing, but serum protein and gammaglobulin were higher. No differences in the prevalence or type of microbial pathogens were found between the two groups. Clubbing was associated with a radiological diagnosis of LIP. Children with clubbing had a lower in-hospital mortality rate than those without clubbing (6.7% vs 24.2%, p = 0.035). In geographical areas with high HIV seroprevalence rates, the presence of clubbing in a child hospitalized for respiratory disease should raise the suspicion of HIV infection.