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Streptococcus pneumoniae in human immunodeficiency virus type 1-infected children
1Division of Infectious Disease and Immunology, New York University Medical Center, NY.
Insights
Children with human immunodeficiency virus type 1 (HIV-1) infection experienced Streptococcus pneumoniae infections, including bacteremia and meningitis. While HIV-1 infected children had more recurrent S. pneumoniae bacteremia, their overall clinical course was similar to healthy children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Immunology
Background:
- Systemic Streptococcus pneumoniae infections pose a significant health risk, particularly in immunocompromised populations.
- Human immunodeficiency virus type 1 (HIV-1) infection can impair immune function, potentially increasing susceptibility to bacterial infections.
Purpose of the Study:
- To characterize the incidence, clinical presentation, and outcomes of systemic Streptococcus pneumoniae disease in children with HIV-1 infection.
- To compare the characteristics of S. pneumoniae infections in HIV-1 infected children versus a general pediatric population.
Main Methods:
- Retrospective review of Microbiology Laboratory records at Bellevue Hospital Center from August 1, 1978, to July 31, 1993.
- Inclusion criteria: children under 18 years old with bacteremia or meningitis caused by S. pneumoniae.
- Comparison between HIV-1 infected children and children without known HIV-1 infection.
Main Results:
- 19 HIV-1 infected children experienced 31 episodes of systemic S. pneumoniae disease, compared to 113 children with 116 episodes in the general population.
- HIV-1 infected children had a significantly higher rate of multiple S. pneumoniae bacteremia episodes (P = 0.008).
- Clinical presentation and seasonal distribution of infections were similar between groups; most HIV-1 infected patients recovered without significant sequelae.
Conclusions:
- Children with HIV-1 infection are at increased risk for recurrent Streptococcus pneumoniae bacteremia.
- Despite increased recurrence, the clinical course and outcomes of systemic S. pneumoniae infections in HIV-1 infected children are comparable to those in the general pediatric population.
- This highlights the importance of continued surveillance and management of pneumococcal disease in pediatric HIV-1 cohorts.
Abstract:
The purpose of this study was to characterize systemic Streptococcus pneumoniae disease in human immunodeficiency virus type 1 (HIV-1)-infected children. All cases of bacteremia and meningitis caused by S. pneumoniae among children less than 18 years old were collected by review of the Microbiology Laboratory records at the Bellevue Hospital Center during the period August 1, 1978, through July 31, 1993. There were 31 bouts of systemic S. pneumoniae disease in 19 of 235 HIV-1-infected children cared for by the Pediatric Infectious Disease staff and 116 bouts in 113 children not known to be HIV-1-infected. Four of the 19 HIV-1-infected children had multiple episodes of S. pneumoniae bacteremia as compared with 3 of 113 in the general population (P = 0.008). The frequency of serotypes and distribution of infections by season of the year did not differ between the 2 groups. The median ages at the time of the S. pneumoniae infection were 1.8 and 1.1 years for the HIV-1-infected children and the general population of children, respectively, when those children with multiple episodes were included for their initial episode only (P = 0.06). In the HIV-1-infected patients, 10 episodes were associated with pneumonia, 5 with pneumonia and otitis media, 5 with otitis media only, 1 with pneumonia and meningitis, 1 with meningitis only and 1 with periorbital cellulitis; 5 had no apparent focus of infection. One episode of pneumonia was complicated by lung abscess and there were 2 deaths. Most HIV-1-infected patients recovered without significant sequelae, and the clinical course of their systemic infections did not appear to be markedly different than that of healthy children.