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Children with unrecognized human immunodeficiency virus infection. An emergency department perspective
J A Fein1, L R Friedland, R Rutstein
1Section of Emergency Medicine, Children's Hospital of Philadelphia, University of Pennsylvania 19104.
Insights
Diagnosing human immunodeficiency virus (HIV) in children presenting to acute care settings requires recognizing subtle signs. This approach categorizes presentations to aid early detection in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Public Health
Background:
- Early diagnosis of human immunodeficiency virus (HIV) infection in children is crucial for effective management and improved outcomes.
- Acute care settings, including emergency departments, are often the first point of contact for undiagnosed pediatric cases.
- Subtle clinical manifestations in children can delay HIV diagnosis compared to adults.
Observation:
- Pediatric HIV presentations in acute care are diverse and may include recurrent bacterial infections, failure to thrive, and unexplained organomegaly.
- Adolescents with HIV may present with unique clinical or historical findings.
- Late presentation of perinatally acquired HIV requires specific diagnostic considerations in the acute care environment.
Findings:
- The study outlines five key categories for identifying pediatric HIV in acute care: recurrent bacterial infections, failure to thrive, organomegaly, adolescent-specific presentations, and late-onset perinatal HIV.
- Each category is illustrated with clinical case examples relevant to the acute care setting.
- Recognizing these distinct presentation patterns can significantly enhance early diagnosis.
Implications:
- Implementing this diagnostic framework can improve the timely identification of HIV in children within emergency departments and acute care clinics.
- Early diagnosis facilitates prompt initiation of antiretroviral therapy, leading to better long-term health outcomes for children with HIV.
- Healthcare providers in acute care settings can be better equipped to diagnose pediatric HIV by understanding these specific clinical presentations.
Objective:
To provide an approach toward the diagnosis of children with human immunodeficiency virus (HIV) infection in the acute care setting.
Design:
Patient reports and review of recent literature.
Setting:
Emergency departments or acute care clinics.
Selection Procedures:
Analysis of important recent clinical publications.
Interventions:
None.
Results And Conclusions:
The clinical and historical findings associated with pediatric HIV infection are occasionally subtle and differ from those findings in adults. In this article, we have divided the first presentation of HIV in the acute care setting into five categories: recurrent bacterial infections, failure to thrive, unexplained organomegaly, adolescents with HIV, and late presentation of perinatally acquired HIV. Each category is illustrated by a patient treated in the acute care setting. Recognition of these categories of presentation will hopefully assist acute care physicians in the early diagnosis of HIV infection.