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[AIDS in childhood]
F Bellini1, A Plebani, P Barbaccia
1Servizio di Radiologia, Università di Milano.
Insights
Pediatric HIV infection can lead to respiratory and neurological complications. Imaging studies reveal characteristic changes in infants, aiding in diagnosis and management of these opportunistic infections.
Area of Science:
- Pediatric Infectious Diseases
- Diagnostic Imaging
- Neonatal Care
Background:
- Vertical transmission of Human Immunodeficiency Virus (HIV) in infants necessitates early diagnosis and monitoring.
- Antibody levels in infants decrease over time, requiring clear criteria for infection status beyond 18 months.
- Understanding the clinical and imaging manifestations of HIV in infants is crucial for timely intervention.
Purpose of the Study:
- To analyze the clinical and diagnostic imaging findings in a cohort of 209 Human Immunodeficiency Virus (HIV)-positive infants.
- To assess the evolution of changes detected through chest X-rays, brain, and abdomen ultrasounds (US).
- To correlate imaging findings with clinical and laboratory data for improved diagnostic accuracy.
Main Methods:
- Follow-up of 209 babies born to HIV-positive mothers.
- Clinical and laboratory assessments.
- Diagnostic imaging including chest films, brain and abdomen US, and CT scans.
Main Results:
- Infants are susceptible to bacterial, viral, and protozoal infections, frequently affecting the respiratory system with conditions like dilatative cardiomyopathy.
- Radiological patterns for bacterial infections show opacities with blurred, irregular, and confluent features.
- Viral and protozoal infections present with linear fan-like opacities, small shadow areas, or enlarged hila; some cases show lung hyperexpansion without opacities.
- Brain and abdomen US revealed no significant changes in newborns, but later US and CT showed hydrocephalic, atrophic, and hemorrhagic changes.
- Common lung infections include Pneumocystis and Cytomegalovirus, presenting as diffuse, blurred, or cotton-like opacities.
- Chronic interstitial lymphocyte pneumonia was observed with punctiform images.
- Tuberculosis was rare, with only one case of active primary complex.
- Candida infections and uncommon hepatopancreatic/lymph node changes were noted.
Conclusions:
- Early life HIV infection in infants predisposes them to severe bacterial and opportunistic infections, particularly affecting the respiratory system.
- Diagnostic imaging, including chest X-rays and US, plays a vital role in identifying characteristic changes and monitoring disease progression in HIV-infected infants.
- Neurological complications such as hydrocephalus and brain atrophy can develop in HIV-infected infants, detectable through imaging.
Abstract:
HIV infection in infants is transmitted through the placenta. Antibodies reduce and annul in nearly 18 months: HIV + subjects older than 18 months are considered as infected and divided into two classes--i.e., P1: infected and P2: AIDS. The most interesting clinical and diagnostic imaging findings are reported relative to 209 babies who were born HIV + and followed-up with clinical and laboratory tests plus chest films, brain and abdomen US to assess the presence of changes and their evolution features. The following conclusions have been drawn: 1) in their early life, HIV + subjects are especially liable to the action of bacteria, viruses and protozoa: their respiratory system is easily affected with acute, recurring and/or chronic inflammations which are frequently associated with heart enlargement from dilatative cardiomyopathy. Bacterial inflammations are characterized by single or multiple opacities, with blurred and irregular patterns, which are frequently confluent in areas of inhomogeneous opacity. The diagnosis of virus and protozoa infections is more difficult because of their radiologic patterns--i.e., linear fan-like opacities, small shadow areas, enlarged hila. In some cases radiology demonstrates only or mostly lung hyperexpansion, with no opaque images, which however does not exclude the presence of severe and diffuse bronchioloalveolar and interstitial compromission with high-grade pulmonary insufficiency. The common association of cytomegalovirus and Pneumocystis carinii infections with slow-evolution changes and frequent recurrences appears on radiologic images as diffuse and blurred shadows and irregular cotton-like opacities. 2) Brain and abdomen US scans in the newborn show no particular changes, while in the following months both US and CT demonstrate hydrocephalic, atrophic and hemorrhagic changes. 3) In both early and late infancy, lung infections are mostly caused by pneumocystis and cytomegalovirus. Chronic interstitial lymphocyte pneumonia is a peculiar finding with punctiform images in the bases of lung and spreading craniocaudally with similar features to miliary tuberculosis. Different than in the adult, in our series of 209 infants no tubercular abnormalities were observed: in one patient only an active primary complex was demonstrated with broncholavage. Candida infections were observed in 3 patients in their late infancy. Hepatopancreatic and lymph node changes suggesting probably evolving inflammation were uncommon in our series; this condition must be followed-up and checked over time.