HIV in Children

DIARRHEA

Dr. Ira Shah
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Last Updated : 1st September 2012

Microsporidia


Microspora are obligate spore forming protozoa that cause moderate to severe diarrhea with weight loss. They are transmitted by feco-oral route due to contamination of food or water. Diagnosis is established by examination of concentrated stool or duodenal aspirate with modified trichrome stain.

Treatment


Immune restoration after HAART frequently results in clearance of microsporidia. No consistently effective therapy exists for microsporidia. Agents used:
  • Albendazole :- 7.5 mg/kg/dose BD (max dose : 400 mg BD)

  • Nitazoxanide
    • 1-3 years: 100 mg by mouth twice daily x 3 days
    • 4-11 years: 200 mg by mouth twice daily x 3 days
  • Fumagillin: It is an antibiotic derived from the fungus Aspergillus fumigatus. (Dose = 20 mg/dose three times daily for 2 weeks). Adverse effects include dose related bone marrow toxicity. Fumagillin is not available in India.

Prophylaxis


  • Advocate proper hand washing
  • No chemoprophylaxis is known to prevent microsporidiosis.

Isospora Belli & Cyclospora
These organisms are rare causes of chronic diarrhea in HIV infected children. Diagnosis is established by characteristic oocytes on microscopic examination of the stool with modified acid fast stain.

Treatment for Isospora
  • TMP/SMX - 20 mg/kg/day of TMP in 4 divided doses for 10 days and then twice a day for 3 days.
  • Pyrimethamine with folinic acid can be used in patients allergic to sulfonamide.

Treatment of Cyclospora
  • TMP/SMX - 10 mg/kg/day of TMP in 2 divided doses for 7 days.

Prophylaxis
  • Advocate proper hand washing
  • Drinking water should be boiled and filtered
  • TMP/SMX used as prophylaxis for PCP also protects against Isospora and cyclospora.
  • Secondary prophylaxis with TMP/SMX [150 mg/m2/day of TMP] is recommended to prevent relapse.

Treatment and Diagnosis of Amoebiasis, Giardiasis, bacterial and viral infections is the same as that of an HIV uninfected child. No chemoprophylaxis is advocated.



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.