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Endoscopy findings in HIV-infected children from sub-Saharan Africa
M L Cooke1, E A Goddard, R A Brown
1School of Child and Adolescent Health, University of Cape Town, Red Cross Children's Hospital, Cape Town, South Africa. lcooke@sun.ac.za
Insights
Upper GI endoscopy in HIV-infected children revealed diverse gastrointestinal diseases, guiding clinical management. This study highlights endoscopy
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- HIV/AIDS Research
Background:
- Persistent gastrointestinal symptoms in HIV-infected children in sub-Saharan Africa are poorly understood.
- Limited data exists on the specific causes of these symptoms in this vulnerable population.
Purpose of the Study:
- To document the clinical, radiological, and endoscopic findings in HIV-infected children with upper gastrointestinal symptoms.
- To identify pathogens and assess the clinical relevance of upper GI endoscopy in managing these children.
Main Methods:
- Retrospective review of clinical, radiological, and endoscopic data from HIV-infected children undergoing upper GI endoscopy.
- Documentation of presenting symptoms, endoscopic findings, and histological results.
- Pathogen identification through microbiological and histological analysis.
Main Results:
- Twenty-six children (median age 1 year) with advanced HIV disease (WHO Stage 4) underwent endoscopy.
- Common symptoms included persistent vomiting, dysphagia, and gastrointestinal bleeding.
- Pathogens identified in 10 children: cytomegalovirus (7), Candida (2), and Helicobacter pylori (1).
- Endoscopic findings influenced clinical management in 81% of cases.
Conclusions:
- Upper GI endoscopy is valuable in diagnosing a wide range of conditions in HIV-infected children with gastrointestinal issues.
- Endoscopic findings provide clinically relevant information crucial for patient management.
Background:
The causes of persistent gastro-intestinal symptoms in HIV-infected children from sub-Saharan Africa remain poorly documented.
Methods:
The clinical, radiological and endoscopic findings of all HIV-infected children who underwent upper GI endoscopy at Red Cross Children's Hospital, Cape Town, South Africa, from February 2003 to October 2005 were documented.
Results:
Twenty-six HIV-infected children underwent endoscopy; median age 1 year (range: 0.17-10.9 years). The majority had advanced HIV disease; 18 (69%) were WHO Stage 4; median CD4 10.7% (range: 1-39.8%). Presenting symptoms included persistent vomiting (18), dysphagia (4) and GIT bleed (6). Observational and histological findings showed poor correlation. Pathogens were identified in 10 children: cytomegalovirus infection in seven (two with cryptosporidium co-infection), Candida in two, Helicobacter pylori in one. Age and CD4 count were not associated with the pathogens. Endoscopy findings influenced clinical management in 21 (81%) cases.
Conclusion:
Upper-GI endoscopy identified a diverse spectrum of disease and provided information that would be clinically relevant to most HIV-infected children with upper gastro-intestinal symptoms.
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