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Diagnostic flexible bronchoscopy in human immunodeficiency virus (HIV)-positive children
N Sculerati1, M M Ambrosino, A J Avni-Singer
1Department of Otolaryngology, New York University Medical Center, New York.
Insights
Flexible bronchoscopy aided in diagnosing respiratory infections in children with human immunodeficiency virus (HIV). This procedure identified causes like Pneumocystis pneumonia (PCP) and cytomegalovirus (CMV) in pediatric HIV patients.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Medical Diagnostics
Background:
- Children with human immunodeficiency virus (HIV) are susceptible to opportunistic infections affecting the respiratory system.
- Diagnostic challenges in pediatric HIV patients necessitate effective bronchoscopic evaluation.
- Flexible bronchoscopy is a key tool for investigating respiratory symptoms in immunocompromised children.
Purpose of the Study:
- To evaluate the diagnostic utility of flexible bronchoscopy in children with laboratory-confirmed HIV infection presenting with respiratory symptoms.
- To identify common etiologies of pneumonia in this pediatric cohort.
- To discuss optimal techniques for maximizing diagnostic yield during bronchoscopy.
Main Methods:
- Flexible bronchoscopy with bronchoalveolar lavage or washings was performed on 12 HIV-positive children.
- Patients ranged from 3.5 months to 10 years 5 months, presenting with respiratory distress or lobar collapse.
- Samples were analyzed to determine the cause of pulmonary pathology.
Main Results:
- Bronchoscopy successfully diagnosed the etiology of pneumonia in 7 out of 12 children.
- Identified pathogens included Pneumocystis carinii pneumonia (PCP), Streptococcus viridans, and cytomegalovirus (CMV).
- Mechanical obstruction was also identified as a cause of respiratory issues; the procedure was non-diagnostic in 5 cases.
Conclusions:
- Flexible bronchoscopy is a valuable diagnostic tool for identifying pulmonary infections and other causes of respiratory compromise in children with HIV.
- The study highlights the importance of bronchoscopy in the management of respiratory illness in pediatric HIV.
- Further refinement of bronchoscopic techniques can improve diagnostic accuracy in this vulnerable population.
Abstract:
Twelve children with laboratory evidence of human immunodeficiency virus (HIV) infection underwent diagnostic flexible bronchoscopy with washings or bronchoalveolar lavage at Bellevue Hospital Center from October 1987 to April 1989. The patients included 7 boys and 5 girls ranging from age 3.5 months to 10 years 5 months. Indications for bronchoscopy included respiratory distress with or without focal changes on chest radiograph in 11 patients, and persistent but asymptomatic right middle lobe collapse in one child. The etiology of pneumonia was diagnosed in 7 children and included Pneumocystis carinii, (PCP) (17%), Streptococcus viridans (17%), mechanical obstruction (17%) and cytomegalovirus (CMV) (8%). Bronchoscopy was non-diagnostic in 5 cases. Techniques for maximal yield of information using flexible bronchoscopy in HIV-positive children are discussed.