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Acquired immunodeficiency with disseminated cryptococcosis.

M J Pippard, A Dalgleish, P Gibson

    Archives of Disease in Childhood
    |March 1, 1986
    PubMed
    Summary

    A young boy with severe wasting and cryptococcal infection showed symptoms consistent with Acquired Immunodeficiency Syndrome (AIDS). Treatment with high-dose antifungal medications led to resolution of the disseminated infection.

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    Area of Science:

    • Pediatrics
    • Infectious Diseases
    • Immunology

    Background:

    • Human T-lymphotropic virus III (HTLV-III) infection, now known as Human Immunodeficiency Virus (HIV), can lead to Acquired Immunodeficiency Syndrome (AIDS).
    • Disseminated fungal infections, such as cryptococcosis, are serious opportunistic infections in individuals with compromised immune systems.
    • Pediatric cases of HIV/AIDS present unique challenges in diagnosis and management.

    Observation:

    • A 9-year-old boy presented with severe wasting, a significant indicator of malnutrition and underlying illness.
    • The patient exhibited a disseminated cryptococcal infection, suggesting a severely weakened immune system.
    • Clinical and laboratory data strongly indicated Acquired Immunodeficiency Syndrome (AIDS).

    Findings:

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  • The disseminated cryptococcal infection was successfully treated with high doses of both intrathecal (within the spinal canal) and parenteral (administered via injection or infusion) antifungal agents.
  • Despite extensive investigation, the only identified potential risk factor for HTLV-III infection was neonatal blood transfusions, highlighting a possible vertical or early transfusion-related transmission route.

    • Implications:

    • This case underscores the importance of considering HIV/AIDS in children presenting with opportunistic infections and severe wasting, even without typical risk factors.
    • Aggressive antifungal therapy can be effective in managing disseminated cryptococcosis in pediatric AIDS patients.
    • The case emphasizes the need for vigilance regarding transfusion-transmitted HIV in neonates and the potential for atypical transmission routes.