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Pediatric HIV infection in its second decade--the changing pattern of lung involvement. Clinical, plain film, and
W E Berdon1, R B Mellins, S J Abramson
1Department of Radiology, Babies Hospital, Columbia-Presbyterian Medical Center, New York, New York.
Insights
Pediatric HIV infection patterns are changing, with vertical transmission leading to infant infections. Chronic lung conditions like lymphocytic interstitial pneumonitis (LIP) and Mycobacterium infections are increasingly observed in children.
Area of Science:
- Pediatric Infectious Diseases
- Radiology
- Pulmonology
Background:
- Pediatric HIV infection patterns have evolved.
- Vertical transmission remains a significant route of infant HIV infection.
- Early-life catastrophic illnesses have decreased, but chronic pulmonary conditions persist.
Purpose of the Study:
- To illustrate the changing patterns of pediatric HIV infection.
- To highlight evolving chronic pulmonary manifestations in children with HIV.
- To document the emergence of Mycobacterium infections and unusual masses.
Main Methods:
- Review of plain films and computed tomographic (CT) scans.
- Analysis of clinical presentation and diagnostic findings.
- Correlation of imaging findings with infectious agents and disease progression.
Main Results:
- Vertical transmission accounts for approximately one-third of infant HIV infections.
- Diffuse lymphocytic infiltrative syndromes, including lymphocytic interstitial pneumonitis (LIP), continue to be a major cause of chronic lung disease.
- LIP can progress to cystic lung disease and bronchiectasis.
- Increasing prevalence of Mycobacterium infections is noted.
- Apparent smooth muscle tumors (leiomyosarcomas) may represent pseudotumors associated with Mycobacterium avium intracellulare infection.
Conclusions:
- The radiographic and CT findings in pediatric HIV infection demonstrate evolving patterns.
- Chronic pulmonary complications, such as LIP and its sequelae, are significant.
- Co-infections with Mycobacterium species are increasingly prevalent and can mimic other pathologies.
- Radiologists and clinicians should be aware of these changing patterns in pediatric HIV management.
Abstract:
The changing pattern of pediatric HIV infection is illustrated in this article with plain films and computed tomographic scans. Today, vertical transmission from infected mothers results in HIV infection of exposed infants in about one third of pregnancies. Although the high mortality with catastrophic illnesses such as Pneumocystis carinii pneumonia seen in early life appears to be decreasing, chronic illness with pulmonary involvement due to diffuse lymphocytic infiltrative syndromes continues. Lymphocytic interstitial pneumonitis (LIP) has evolved in some patients to cystic lung disease and bronchiectasis. There are increasing numbers of patients infected with Mycobacterium. Masses seemingly of smooth muscle origin, thought to be leiomyosarcoma are appearing; they may be pseudotumors related to concomitant Mycobacterium avium intracellulare infection.