HIV, Hand foot and mouth, Septicaemia Flashcards
What is HIV?
A virus which affects CD4 T lymphocytes.
Who gets HIV?
• Most affected children are in Sub-Saharan Africa
• Main route of transmission in children is mother-to-child transmission which can
occur:
o Intrauterine: during pregnancy
o Intrapartum: at delivery
o Postpartum: through breastfeeding
• Uncommon routes of infection in children: infected blood products, contaminated
needles, sexual abuse
What is the pathophysiology of HIV?
HIV is a retrovirus that destroys CD4 T cells and is the aetiological agent of acquired
immunodeficiency syndrome (AIDS)
• HIV is divided into two types – both cause AIDS
o HIV1: responsible for global epidemic
o HIV2: less pathogenic and restricted mostly to West Africa
• AIDs is a constellation of opportunistic and other infections, conditions or
malignancies – occurs as a result of increasing immune depletion over time
What are the clinical features of HIV?
AIDS by age 1y Lymphadenopathy Parotid enlargement HIV associated infections Growth problems Encephalopathy Hepatosplenomegaly thrombocytopaenia
What investigations do you do for HIV?
Children > 18 months: detect antibodies against the virus
Children < 18 months who are born to infected mothers will have transplacental
maternal IgG HIV antibodies, so a positive antibody test at this point will confirm
HIV exposure but not infection
o The most sensitive test in this age group is HIV RNA PCR
o ALL babies born to HIV-infected mothers should be tested, irrespective of
whether they are symptomatic or not
o Two negative HIV DNA PCRs within first 3 months of life, at least 2 weeks
after completion of postnatal antiretroviral therapy, indicate infant is not
infected – although this is confirmed by the loss of maternal HIV antibodies
from infant circulation after 18 months age
What is the management of HIV?
infants should start ART shortly after diagnosis because they
are at higher risk of disease progression
PCP prophylaxis with co-trimoxazole is given to infants who are HIV infected
Immunisations except BCG (inffluenza, HepA/B and VZV)
MDT
Regular FU incl. wt and development
How do you reduce vertical transmission?
o Mothers with a high viral load are more likely to transmit HIV to their infant
o Avoidance of breastfeeding also reduces transmission
o In high-income countries, perinatal transmission of HIV is < 1% due to:
▪ Use of effective ART during pregnancy and intrapartum to achieve an
undetectable maternal viral load at delivery
▪ Post-exposure prophylaxis given to infant
▪ Avoidance of breastfeeding
▪ Active management of labour/delivery to avoid prolonged rupture of
the membranes and unnecessary instrumentation
▪ Pre-labour caesarean section if the mother’s viral load is detectable
close to the due date
What is Hand, Foot and Mouth disease?
Hand-foot-and-mouth disease is a highly contagious childhood viral infection caused by the coxsackievirus.
What is the aetiology of HFM disease?
The most common viruses implicated are a group of enteroviruses known as the coxsackieviruses. Coxsackievirus A16 (CV-A16) infection is the most common cause, but A4 through to A7, A9, and A10 infections also occur.
What is the epidemiology of HFM disease?
The infection usually occurs as a sporadic event, but outbreaks do occur worldwide. Coxsackievirus infection is extremely contagious. It affects males and females equally and is most common in children <10 years of age.
What would you find in the history and exam of a child with HFM disease?
Low grade fever
Oral vesicles and ulcers
Rash/ vesicles on hands and feet
sore mouth, LO appetite, sore throat
What investigations would you do for HFM disease?
FBC
Viral culture if necessary- clinical diagnosis sufficient
What is the management of HFM disease?
Analgesia and antipyretics
What is septicaemia?
Septicaemia is when bacteria enter the bloodstream, and cause blood poisoning which triggers sepsis.
What are the symptoms of septicaemia in a child?
Fever/ hypothermia Tachypnoea Tachycardia Hypotension Focal pathology related symptoms
