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Streptococcus pneumoniae bacteremia in children infected with HIV: presentation, course, and outcome
P S Dayan1, J M Chamberlain, S M Arpadi
1Children's National Medical Center, Washington, DC, USA.
Insights
Pneumococcal bacteremia in children with human immunodeficiency virus (HIV) can be serious, but occult cases often resolve well with antibiotics. Empiric antibiotic treatment helps reduce persistent bacteremia risks in these vulnerable children.
Area of Science:
- Pediatric Infectious Diseases
- Immunocompromised Host Research
- Bacteremia and Sepsis Studies
Background:
- Children with human immunodeficiency virus (HIV) are at increased risk for invasive bacterial infections.
- Pneumococcal bacteremia, caused by Streptococcus pneumoniae, poses a significant threat to immunocompromised children.
- Understanding the specific clinical course and outcomes in HIV-infected children is crucial for effective management.
Purpose of the Study:
- To investigate the clinical presentation, disease progression, and outcomes of pneumococcal bacteremia in pediatric HIV patients.
- To identify factors influencing the course and severity of pneumococcal bacteremia in this population.
- To evaluate the effectiveness of antibiotic treatment for pneumococcal bacteremia in HIV-infected children.
Main Methods:
- Retrospective analysis of HIV-infected children under 18 with Streptococcus pneumoniae bacteremia across four tertiary care hospitals.
- Evaluation of outcomes including persistent bacteremia, development of focal infections, and mortality.
- Comparison of outcomes based on treatment (antibiotics vs. no antibiotics) and clinical presentation (occult vs. overt disease).
Main Results:
- Fifty-four first episodes of pneumococcal bacteremia were analyzed in 59 HIV-infected children; 26/54 were occult.
- White blood cell (WBC) counts were not sensitive indicators for diagnosing pneumococcal bacteremia.
- Patients with occult bacteremia discharged on empiric antibiotics showed a reduced risk of persistent bacteremia compared to untreated patients.
Conclusions:
- Elevated WBC counts are unreliable for diagnosing pneumococcal bacteremia in HIV-infected children.
- Empiric antibiotic administration is beneficial in reducing the risk of persistent bacteremia.
- HIV-infected children with occult pneumococcal bacteremia generally have favorable outcomes with appropriate antibiotic therapy, and afebrile, well-appearing patients may be treated as outpatients.
Objective:
To examine the presentation, course, and outcome of pneumococcal bacteremia in children infected with human immunodeficiency virus (HIV).
Methods:
A retrospective series of HIV-infected children less than 18 years of age with Streptococcus pneumoniae bacteremia from four urban, tertiary care hospitals was evaluated. The main outcome measures included persistent bacteremia, the development of a focal infection, and death.
Results:
Seventy-two episodes of pneumococcal bacteremia were identified in 59 patients. Fifty-four first episodes were included; 26/54 were occult. Mean temperature was 39.8 degrees C. In patients with bacteremia, white blood cells (WBCs) > or = 15,000 and > or = 10,000 had sensitivities of 40% and 75%, respectively. At the time of bacteremia, age >3 years old was associated with a lower mean WBC count compared with episodes occurring in patients <3 years old (11.2 vs 16.1, P < 0.05). Patients with occult bacteremia who were discharged with antibiotics (12 i.m., 7 p.o.) were less likely than patients without antibiotic treatment to have persistent bacteremia at a return visit within 72 hours (0/19 vs 2/5, P < 0.05). No patient with occult bacteremia died, progressed to clinical meningitis, or had other sequelae. Two of fifty-four patients died as a result of their first episode of invasive pneumococcal disease. Both patients who died had meningitis and appeared ill on initial presentation.
Conclusions:
Neither a WBC count > or = 15,000 nor > or = 10,000 is a sensitive indicator of pneumococcal bacteremia in HIV-infected children. Empiric antibiotics are useful to decrease the risk of persistent bacteremia. Children infected with HIV who have occult pneumococcal bacteremia appear to do well with appropriate antibiotics. Patients who are afebrile and well appearing on reevaluation may be safely treated as outpatients.
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