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Enteric pathogens associated with gastrointestinal dysfunction in children with HIV infection
A G Ramos-Soriano1, J M Saavedra, T C Wu
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287-4933, USA.
Insights
Gastrointestinal issues in children with HIV are common. Opportunistic infections like Pneumocystis carinii, CMV, and HSV can cause these problems, even with preventative measures.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Immunology
Background:
- Gastrointestinal (GI) manifestations are frequent in children with human immunodeficiency virus (HIV) infection, leading to diarrhea, malabsorption, and growth failure.
- The exact causes and mechanisms of GI dysfunction in pediatric HIV are not fully understood.
- Standard microbiological tests often fail to identify pathogens in these cases.
Purpose of the Study:
- To investigate the presence of opportunistic pathogens in the intestinal tissue of HIV-infected children experiencing GI dysfunction or growth failure.
- To compare findings in HIV-infected children with those in HIV-uninfected children.
Main Methods:
- Immunocytochemical analysis of intestinal biopsy samples from 19 HIV-infected children with GI symptoms.
- Testing for antigens of Pneumocystis carinii, cytomegalovirus (CMV), and herpes simplex virus (HSV) using immunohistochemistry.
- Comparison with intestinal tissue samples from 10 HIV-uninfected children with non-infectious GI conditions.
Main Results:
- Opportunistic pathogens were detected in intestinal tissues of 8 (42%) of 19 HIV-infected children.
- Pneumocystis carinii was the most common pathogen (5/8), even in children on prophylaxis and without active pulmonary infection.
- CMV antigens were found in 4 children, and HSV in 1 child. Two children had multiple infections.
- No targeted pathogens were found in HIV-uninfected control patients (P < 0.01).
Conclusions:
- Opportunistic pathogens, including P. carinii, CMV, and HSV, can cause GI dysfunction in HIV-infected children, often missed by standard stool analysis.
- Intestinal P. carinii infection can occur despite standard prophylaxis for pulmonary disease.
- These findings highlight the importance of investigating opportunistic infections in the GI tract of pediatric HIV patients.
Abstract:
Infants and young children with HIV infection commonly suffer from gastrointestinal manifestations of their disease. Many HIV infected children have evidence of persistent diarrhoea, malabsorption, malnutrition or growth failure. The aetiology and pathogenesis of gastrointestinal dysfunction in HIV infected children have not been well defined. We performed immunocytochemical analyses on intestinal tissue from 19 HIV-infected children with gastrointestinal dysfunction or growth failure. None of these 19 children had microbial pathogens identified in faecal samples using standard microbiological methods. Intestinal tissues were obtained from the children by biopsy and were examined for antigens from Pneumocystis carinii, cytomegalovirus (CMV) and herpes simplex virus (HSV) using the avidin-biotin-complex immunohistochemical technique and monoclonal or monospecific antibodies. We detected at least one of these pathogens in samples from eight (42%) of 19 HIV infected children. P. carinii was the most prevalent pathogen, found in five of the eight HIV infected children. All of the children with intestinal pneumocystis infection were receiving prophylaxis directed at the prevention of pulmonary disease with this organism and none of them were undergoing active pulmonary infection. We also identified CMV antigens in intestinal tissues from four children and HSV antigens in intestinal tissues from one child. Two children were infected with more than one pathogen. On the other hand, none of these pathogens were found in the tissues obtained from 10 HIV-uninfected patients who had intestinal tissues obtained for chronic non-infectious diarrheal and inflammatory diseases (P < 0.01, Fisher's exact test). Our findings indicate that some children with HIV infection and gastrointestinal dysfunction may be infected with opportunistic pathogens despite negative analyses employing standard microbiological methods. Our study also indicates that HIV infected children can undergo intestinal infection with P. carinii despite the administration of standard immunoprophylactic regimens directed at the prevention of infection with this organism.