15.7.2 HIV

Question 1

Which children are at highest risk from sepsis?

Answer 1

• very young (<6months)
• neonates (premature) -> highest risk

Other risks
- underlying medical condition (primary and secondary)
- unvaccinated (when sepsis is not prevented)
- socio economics (because of more exposure, delayed access to care)
- Urinary tract abnormalities
- large surgical procedures
- Device in pt

Question 2

Which bacteria most likely bacterial cause in paediatric sepsis?

Answer 2

- Staphylococcus aureus (gram+, in clusters)
- E. coli (rod, pink, gram-)
- C. Pneumonia (gram-, rod)
- Salmonella (gram-, rod)
- C. Bacterium
- S. Pneumonia (coccus, chains, blue)
- H. Influenza

Age and site of infection is very important to make diagnosis of which organism

Question 3

A 2 year old child presents with fever and refusing to walk for 2 days. You see that child is high temp and worried about arthritis in right hip

Answer 3

• infection is sepsis when other organ systems are involved
• Staph aureus (bone)
  If it was in soft tissue: other strep pyogenes
  Pneumonia: staph aureus + strep pneumonia + h influenza

how know if rest of body is infected?
- HR
- Resp rate (children have cold shock)
- BP

Biochemical responses
- high white cell count
- lactate goes up (impaired tissue oxygenation, anarobic respiration -> hypoxia, inability to carry o2, inability of o2 to get into cell, error in mitochondria)
- DIC (change in INR, dimers, fibrinidin, platelets)
- clotting
- hyperfusion
- increased inflam markerd

Question 4

Target cells for HIV

Answer 4

• Virus exposes mucosa (vaginal, rectal, tonsil)
• attaches to cells that have CD4 receptor (receptors are on dendritic cells), CXR4, CCR

Question 5

How does children get HIV?

Answer 5

Vertical
- In utero (transplacental bleeds)
- Birth canal (transplacental bleed, rupture of membranes, exposure to fluids that is swallowed by baby)
- Breastfeeding (baby swallowing fluid with virus)

Question 6

How does HIV cause decline in CD4 cells?

Answer 6

CD4 cells are being killed by other cells, they are also going through apoptosis
- chronic inflam state that HIV creates

• memory cells are very important, if this decline = ⬆️ risk for CD4 decline

Question 7

Breastfeeding and HIV

Answer 7

…

Question 8

Why do you need different diagnostic approaches in children?

Answer 8

• antibody, antigen test