HIV in Children

DIARRHEA

Dr. Ira Shah
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Last Updated : 1st September 2012
Chronic diarrhea is a major problem in HIV infected children. Organisms responsible for diarrhea include :-

Protozoa Isospora belli, Cryptosporidium parvum, Microsporidia, Entemoeba histolytica, Giardia lamblia
Bacteria Salmonella, Campylobacter, Shigella, Clostridium difficile and MAC
Viruses CMV, Adenovirus, HIV, HSV and Rotavirus
Fungi Histoplasma

Chronic diarrhea lasts for > 14 days and is associated with weight loss. Treatment consists of correction of dehydration and nutritional rehabilitation (as per IMCI) as well as treatment of specific organism causing the diarrhea.

Cryptosporidium


Cryptosporidium protozoa invade the gut mucosa causing profuse non bloody watery diarrhea leading to dehydration and malnutrition. Three common species infecting humans are C. hominis, C. parvum, and C. meleagridis. It is transmitted by ingestion of oocysts excreted in the feces of infected humans and animals. The parasite tends to affect the jejunum and terminal ileum (7). Cryptosporidium can migrate into the bile duct and result in inflammation of the biliary epithelium, cholecystitis and cholangitis.

Diagnosis :

Microscopic examination of stool sample with modified acid fast stain for detection of acid-fast positive oocysts. Immunoflorescence and ELISA of stool are more sensitive and specific. At least 3 stool samples should be submitted for oocyst evaluation as oocyst excretion can be intermittent.

Treatment :

Immune restoration after HAART frequently results in clearance of Cryptosporidium. No consistently effective therapy exists for cryptosporidiosis in HIV infected children. Agents that can be tried are:
  • Nitazoxanide
    • In children 1-3 years : 100 mg by mouth twice daily for 3 days
    • In children 4-11 years : 200 mg by mouth twice daily for 3 days
  • Pararomycin : 25-35 mg/kg/day in 3-4 divided doses (period unknown)
  • Azithromycin : 10 mg/kg on Day 1 & then 5 mg/kg PO OD for 2-10 days

Prophylaxis


  • Advocate proper hand washing
  • Drinking water should be boiled and filtered. (Filters capable of removing particles 1 um in diameter)
  • Rifabutin or Clarithromycin when taken as prophylaxis against MAC has been found to protect against cryptosporidiosis (38, 39). However, studies are not extensive to recommended these drugs as chemoprophylaxis for cryptosporidiosis.


DIARRHEA
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.
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