HIV in Children

RESPIRATORY DISTRESS IN AN HIV INFECTED CHILD(COMMUNITY MANAGEMENT)

Dr. Ira Shah
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Last Updated : 1st September 2012

Causes of Respiratory Disease in HIV infected children


  • PCP
  • Bacterial pneumonia – Streptococcus pneumoniae,Hemophilus influenzae,Staphylococcus aureus,Pseudomonas aeruginosa,Mycoplasma pneumoniae,Chlamydia pneumoniae.
  • Mycobacteria (Tuberculosis and Avium Complex)
  • Viral pneumonia – Cytomegalovirus,Measles,
    Adenovirus,Parainfluenzae,Influenza, Respiratory syncitial virus,Varicella,Herpes simplex
  • Fungal infections – Aspergillosis,Histoplasmosis,Candida,Nocardia.
  • Lymphocytic Interstitial Pneumonia
  • Congestive Cardiac failure
  • Malignancy: Lymphomas.

Community management


Severe pneumonia
  • Chest indrawing
  • Stridor in a calm child
  • Unable to take any feed
  • Lethargic or unconscious
  • Infants less than 2 months with respiratory rate of > 60 breaths/min

Treatment
  • Give first dose of Ceftriaxone IM
  • Give first dose of TMP/SMX treatment
  • Give oxygen
  • If stridor, give nebulised adrenaline
  • Keep child warm and refer urgently.

Moderate pneumonia


  • Fast breathing – [in a child from 2 months to 12 months > 50 breaths/min. 12 months – 5 years > 40 breaths/min]
  • Give oral amoxycillin for 5 days
  • Relieve the cough
  • If cough more than 14 days, rule out TB, asthma or PCP
  • Give TMP/SMX treatment for 5 days
  • Mother to bring back child in 2 days
  • If condition worsens, she should come back immediately and early referral to the hospital.


RESPIRATORY DISTRESS IN AN HIV INFECTED CHILD(COMMUNITY MANAGEMENT)
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.