WHO clinical staging of HIV/AIDS for children with confirmed HIV infection

Clinical stage 1
  • AsymptomaticPersistent
  • generalized lymphadenopathy
Clinical stage 2
  • Unexplained persistent hepatosplenomegaty
  • Papular pruritic eruptionsFungal nail infection
  • Angular cheilitisLineal gingival erythema
  • Extensive wart virus infection
  • Extensive molluscum contagiosum
  • Recurrent oral ulcerations
  • Unexplained persistent parotid enlargement Herpes zoster
  • Unexplained persistent parotid enlargement Herpes zoster
  • Recurrent or chronic upper respiratory tract infectionsotitis media,
  • oton'hoea, sinusitis or tonsillitis
Clinical stage 3
  • Unexplained moderate malnutrition or wasting not adequately responding to standard therapy
  • Unexplained persistent diarrhoea (14 days or more)
  • Unexplained persistent fever (above 37.5°C intermittent or constant,for longer than one month)
  • Persistent oral candidiasis (after first 6-8 weeks of life)
  • Oral hairy leukoplakia
  • Acute necrotizing ulcerative gingivitis or periodontitisLymph node tuberculosis
  • Pulmonary tuberculosis
  • Severe recurrent bacterial pneumonia
  • Symptomatic lymphoid interstitial pneumonitisChronic HIV-associated lung disease including brochiectasis
  • Unexplained anaemia (9 per litre) and or chronic thrombocytopaenia (9per litre)
Clinical stage 4
  • Unexplained' severe wasting or severe mainutnuon not responding to standard therapy
  • Pneumocystis pneumonia
  • Recurrent severe bacterial chest infections (such as empyema, pyomyosrtts, bone or ioint infection or meningitis but excluding pneumonia)
  • Chronic herpes simplex infection (orolanial or cutaneous of more than one month'sDuration or visceral at any site)
  • Oesophageal candidiasis (or candidiasis of trachea, bronchi or lungs)
  • Extrapulmonary tuberculosisKaposi sarcoma (in adult)
  • Cylomegalovirus infection: retintlis or cytomegalovirus infection affecting another organ, with onset at age older than one monthCentral nervous system toxoplasmosis (after one month of lite)
  • Extrapulmonary cryptococcosis (including meningitis)HIV encephalopathyDisseminated endemic mycosis (coccidiomycosis or histoplasmosis)
  • Disseminated non-tuberculous rnycobacterial infection
  • Chronic cryptosporidiosis (with diarrhoe)
  • Chronic isosporiasisCerebral or B-cell non-Hodgkin lymphoma
  • Progressive multifocal leukoencephalopathy
  • Depression is most common psychological feature
  • Symptomatic HIV-associated nephropathy or HIV-associated cardiomyopathy
DISEASES ASSOCIATED WITH AIDS:
  • Necrotizing Granuloma
  • Granulomatous inflammation is a specialized form of chronic inflammation, which begins with the uptake of foreign antigens by macrophages. These cells process and present the antigen to helper T lymphocytes, which in turn activate macrophages by interferon-γ secretion.
  • Granulomas may be due to infectious and noninfectious causes.
  • Usually, infectious granulomas are necrotizing and non-infectious granulomas are non-necrotizing, but there are many exceptions to this rule.
  • Among the infectious causes, mycobacterial infections are of the utmost importance, especially in patients with AIDS.
  • By definition caseating necrosis is pathognomonic of mycobacterial infection.
  • Lung biopsy shows multiple nodular lesions consisting of large epithelioid cells surrounded by lymphocytes and fibroblasts. There is an area of necrosis in the center of some nodules.
  • Numerous acid-fast bacilli are demonstrated by Ziehl-Neelsen staining within the cytoplasm of epithelioid cells.
Progressive Multifocal Leukoencephalopathy

  • Rapidly progressive demyelinating disorder in which the JC virus (a papovavirus) infects oligodendroglial cells in the brain. The eosinophilic inclusions represent accumulations of JC virus. PML occurs in about 1% of AIDS patients, and is the AIDS-defining illness in half of the patients who develop the condition.
  • There is no effective treatment for this disorder.
  • Shows hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration.
  • MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter.
  • An electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres
  • Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions.
Exam Question

  • HIV in children, characteristic finding is Recurrent chest infection
  • Feature of HIV infection in childhood Failure to thrive is universal, Lymphadenopathy, P. Carinii pneumonia, M.C. AIDS defining illness in children, Dermatological
  • complication, Recurrent and chronic bacterial infections (first sign), Candidiasis, Otitis, Sinusitis, Pneumonia, Lymphoid interstitial pneumonia, Hepatosplenomegaly,Cardiomyopathy, Anemia / Thrombocytopenia / Neutropenia Hepatitis
  • Acquired immunodeficiency syndrome (AIDS) is the MOST likely condition that predisposed the patient to necrotizing granuloma developing as a result of infection by acid-fast bacilli (most likely mycobacteria).
  • Progressive multifocal leukoencephalopathy develops hemiparesis, ataxia, homonymous hemianopia, and cognitive deterioration with MRI of the brain demonstrates widespread areas of abnormal T2 signal in the white matter and electroencephalogram is remarkable for diffuse slowing over both cerebral hemispheres where Brain biopsy reveals demyelination with abnormal giant oligodendrocytes, some of which contain eosinophilic inclusions.
  • Depression is the most common psychological features of AIDS
  • Teratogenic effects are rare with HIV infections
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