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Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency
D D Vernon1, B H Holzman, P Lewis
1Department of Pediatrics, University of Miami.
Insights
Acute respiratory failure in children with acquired immunodeficiency syndrome (AIDS) is often caused by Pneumocystis pneumonia or cytomegalovirus. Bacterial superinfections, particularly Pseudomonas, significantly increase mortality in these pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases in immunocompromised children
- Respiratory medicine
Background:
- Acute respiratory failure (ARF) presents a significant mortality risk for children with acquired immunodeficiency syndrome (AIDS).
- Understanding the specific causes of ARF is crucial for improving outcomes in this vulnerable pediatric population.
Purpose of the Study:
- To investigate the etiological factors contributing to acute respiratory failure in children diagnosed with AIDS or AIDS-related complex (ARC).
- To analyze the outcomes and survival rates of these children following intensive care unit admission for ARF.
Main Methods:
- A retrospective review of medical records for 31 children with AIDS or ARC admitted to a pediatric intensive care unit (PICU) over a 46-month period.
- Analysis of the primary and secondary causes of acute respiratory failure, including infectious agents and superinfections.
Main Results:
- Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) pneumonia were leading causes of ARF, followed by bacterial pneumonias and sepsis.
- A high incidence of bacterial and Candida superinfections (11/19 patients) was observed in those with PCP or CMV pneumonia.
- Pseudomonas aeruginosa and Klebsiella pneumoniae were identified as common bacterial pathogens responsible for superinfections.
Conclusions:
- Bacterial infections, especially Gram-negative organisms like Pseudomonas, are critical contributors to respiratory failure in pediatric AIDS patients, alongside PCP and CMV.
- The overall survival rate was low (16% at PICU discharge), with a grim prognosis, highlighting the need for targeted interventions and careful consideration of medical support limits.
Abstract:
Acute respiratory failure has a high mortality in patients with acquired immunodeficiency syndrome (AIDS). This study was undertaken to determine the etiology of acute respiratory failure and the outcome of children with AIDS and AIDS-related complex. Records of 31 children with AIDS or AIDS-related complex admitted to the pediatric intensive care unit for acute respiratory failure throughout a 46-month period were reviewed. Acute respiratory failure was due to Pneumocystis carinii pneumonia in 13, cytomegalovirus pneumonia in six, bacterial pneumonia in five, severe bacterial sepsis in four, Candida pneumonia in two, and a giant cell pneumonia in one patient. In addition, 11/19 patients with acute respiratory failure due to P carinii pneumonia or cytomegalovirus had superinfections with bacteria or Candida. Of the total of 19 primary and secondary bacterial infections, Pseudomonas aeruginosa was responsible in ten and Klebsiella pneumoniae in three children. Five children (16%) survived until pediatric intensive care unit discharge; three died within 6 months. The causes of acute respiratory failure were not significantly different in survivor and nonsurvivor groups. It is concluded that, in addition to P carinii pneumonia and cytomegalovirus pneumonia, bacterial infections (especially due to Pseudomonas and other Gram-negative organisms) are important causes of respiratory failure. The high mortality and grim ultimate prognosis seen may have implications for pediatricians attempting to identify the proper limits of medical intervention for this group of patients.