AIMS:To establish the prevalence and clinical correlates of HIV among children with acute lower respiratory tract infection.

METHODS:Children admitted to a rural Zambian hospital were studied over an eight month period. The diagnosis of acute lower respiratory tract infection was made clinically, according to World Health Organisation (WHO) criteria. Clinicians, who were unaware of the children's HIV status, prescribed antibiotic and supportive treatment according to WHO guidelines. HIV status was established using the polymerase chain reaction (Amplicor HIV1, Roche) applied to dried blood spots.

RESULTS:Acute lower respiratory tract infection was diagnosed in 132 children (median age 8 months, range 1 month to 4 years). The WHO criteria for severe or very severe pneumonia were met by 96/132 patients (73%) and 21 patients (16%) died. HIV dried blood spot PCR was positive in 14 cases (11%), of whom four fulfilled the WHO clinical case definition for paediatric AIDS and five died. The group as a whole were malnourished, but the HIV positive children were more severely malnourished (mean z score for weight = -3.01) than the HIV negative children (mean z score = -1.73, p < 0.001). The relative risk of death was 2.6 in the HIV positive group but this was not significant (p = 0.079).

CONCLUSIONS:An important minority of children with acute lower respiratory tract infection in rural Zambia will be infected with HIV. However, most HIV positive children presenting with respiratory infection will survive given simple antibiotic and supportive treatment.

译文

AIMS :确定急性下呼吸道感染儿童中HIV的患病率和临床相关性。

方法:收治于赞比亚农村医院的儿童在八个月的时间里学习。根据世界卫生组织(WHO)的标准,临床上对急性下呼吸道感染进行了诊断。不了解儿童艾滋病毒感染状况的临床医生根据世界卫生组织的指南开了抗生素和支持治疗的处方。使用聚合酶链反应(Amplicor HIV1,Roche)应用于干血斑来确定HIV状况。

结果:在132名儿童(中位年龄为8岁)中诊断出急性下呼吸道感染个月,范围为1个月至4年)。 96/132例患者(73%)符合WHO的严重或极重度肺炎标准,死亡21例(16%)。 HIV干血斑PCR阳性14例(11%),其中4例符合WHO对儿科AIDS临床病例的定义,5例死亡。整个组营养不良,但与阴性的HIV阳性儿童相比,与阴性的HIV阳性儿童相比,其营养不良严重(体重z平均值= -3.01)(z平均值= -1.73,p <0.001)。 HIV阳性组的相对死亡风险是2.6,但这并不显着(p = 0.079)。

结论:在中国,急性下呼吸道感染的少数儿童非常重要。赞比亚农村地区将感染艾滋病毒。但是,大多数出现呼吸道感染的HIV阳性儿童只要接受简单的抗生素和支持治疗就可以存活。

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