| People, especially children with HIV cases also suffer | | | | and hilus. LIP is currently a diagnosis of exclusion. |
| from respiratory infections and as well, central | | | | In addition to PCP and LIP, other routine and |
| nervous system disorders. How can this come about | | | | opportunistic infections must be considered in an HIV- |
| and how drastic are these two manifestations? | | | | infected child with respiratory distress. Bacterial |
| Respiratory Infections | | | | pathogens are frequent. Another common pathogen |
| Pulmonary infection is a common and serious | | | | is respiratory syncytial virus (RSV) an extremely |
| manifestation of HIV infection. The most commonly | | | | common viral infection in young infants and children, |
| diagnosed infection is Pneumocystis Carini Pneumonia | | | | which can cuase giant cell pneumonia in the |
| (PCP), which can present acutely with respiratory | | | | compromised host. Cytomegalo-virus can be cultured |
| distress or with a history of progressive cough and | | | | from the lung in these patients, although it is not |
| respiratory symptoms over days to weeks. Clinically, | | | | always clear that it is the primary pathogen. Other |
| it may be difficult to distinguish PCP from more | | | | opportunistic pulmonary infections are also in the |
| typical causes of childhood pneumonia. The chest | | | | differential diagnosis, including atypical mycobacteria |
| X-ray typically shows a diffuse intersititial pneumonitis, | | | | and fungi. |
| although almost every pattern of infiltrate has been | | | | Central nervous system Disorders |
| seen with PCP. | | | | CNS disorders are prominent part of the clinical |
| A second common pneumonitis is lymphoid intersitital | | | | spectrum of HIV infections in children. |
| pneumonitis (LIP); the cause is unknown. Children with | | | | Encephalopathy, either static or progressive, if often |
| LIP often have a longstanding history of pulmonary | | | | noted. Manifestations often include acquired |
| symptoms, particularly cough. They are usually not | | | | microcephaly, progressive motor dysfunction, loss of |
| febrile or acutely dyspneic, and rarely have significant | | | | developmental milestones, ataxia, and extra-pyramidal |
| auscultatory findings. A concomitant infection can | | | | rigidity. Isolated seizures are unusual but may occur |
| cause a child with pre-existing LIP to present acutely. | | | | with a concomitant febrile illness. Focal neurologic |
| LIP is most often seen in children with other | | | | signs are uncommon in pediatric AIDS and should |
| Lympho-proliferative manifestations of HIV such as | | | | suggest possible CNS lymphoma. Opportunistic |
| lymphadenopathy and parotitis: these patients may | | | | infections, particularly cryptococcal meningitis, may be |
| have signs of chronic pulmonary disease such as | | | | present in the child with CNS symptoms. However, in |
| clubbing. The chest X-ray shows a diffuse interstitial | | | | most series of children dying with HIV |
| infiltrate similar to that seen with PCP, but in some | | | | encephalopathy, opportunistic infection of the CNS is |
| longstanding cases there may be a diffuse nodular | | | | rare, and msot signs and symptoms are secondary |
| pattern with widening of the superior mediastinum | | | | to HIV infection of the nervous system. |