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Pathologic pulmonary findings in children with the acquired immunodeficiency syndrome: a study of ten cases
Insights
Pediatric acquired immunodeficiency syndrome (AIDS) can cause severe lung disease, including opportunistic infections and interstitial pneumonitis. Open lung biopsy is crucial for diagnosing and treating these pulmonary conditions in children with AIDS.
Area of Science:
- Pediatric Pathology
- Immunology
- Infectious Diseases
Background:
- Children with acquired immunodeficiency syndrome (AIDS) present with significant pulmonary complications.
- Pulmonary lesions in pediatric AIDS are diverse and can include opportunistic infections and interstitial lung diseases.
- The origin of immune deficiency in these children is likely not congenital.
Purpose of the Study:
- To investigate the spectrum of pulmonary lesions in children with AIDS.
- To explore the pathogenesis of these lung conditions in the context of immune deficiency.
- To highlight the diagnostic utility of open lung biopsy in pediatric AIDS.
Main Methods:
- Histopathological examination of lung and lymphoreticular tissues from ten children with AIDS.
- Clinical, epidemiological, and immunological data review.
- Autopsy and open biopsy specimen analysis.
Main Results:
- Common pulmonary lesions included diffuse alveolar damage (DAD), Pneumocystis carinii and/or cytomegalovirus pneumonitis, lymphoid interstitial pneumonitis (LIP), and desquamative interstitial pneumonitis (DIP).
- DAD pathogenesis involved mechanical ventilation, oxygen therapy, and opportunistic infections.
- LIP and DIP, not previously described in adult AIDS, were potentially linked to immunologic abnormalities.
Conclusions:
- Pulmonary disease in pediatric AIDS is complex, involving opportunistic infections and unique interstitial lung diseases.
- Immune deficiency in these children is likely acquired, not congenital.
- Open lung biopsy is essential for diagnosing and managing pulmonary disease in children with AIDS.
Abstract:
Lung tissue and tissue from the lymphoreticular system obtained at open biopsy and/or autopsy were studied in ten children with the acquired immunodeficiency syndrome (AIDS). One or both parents of nine of the children had AIDS or risk factors for AIDS. The remaining child had hemophilia. The following pulmonary lesions were seen: 1) diffuse alveolar damage (DAD), 2) Pneumocystis carinii and/or cytomegalovirus pneumonitis, 3) lymphoid interstitial pneumonitis (LIP), and 4) desquamative interstitial pneumonitis (DIP). Combinations of such factors as mechanical ventilation, oxygen therapy, and opportunistic infection played a role in the pathogenesis of DAD. Opportunistic infections were related to the defective cell-mediated immunity in these children. The clinical, epidemiologic, immunologic, and pathologic features of the thymuses of these patients indicate that the immune deficiency was unlikely to have been of congenital origin. The immunologic abnormalities may also have been related to the pathogenesis of LIP and DIP. Neither LIP nor DIP has been described in adults with AIDS. Open lung biopsy is of practical importance in the diagnosis and treatment of pulmonary disease in children with AIDS.