Candida perforation of the intestine in an HIV exposed but uninfected infant

Abstract

BACKGROUND. Oral and nappy Candida infections are common in neonates and infants, but candidaemia and its consequences are more often seen in children with risk factors for immunosuppression. This case presentation illustrates that exposure to HIV, without infection, should be considered one of those risk factors. OBJECTIVES. To determine whether HIV-exposed, but uninfected, children have immune dysfunction that could alter their disease profile, and to elucidate the interactions of the gastrointestinal tract (GIT) with Candida infections. METHODS. Keywords/key phrases searched on databases were: candidiasis; GIT and Candida; HIV-exposed infants; immunity and HIVexposed neonates. RESULTS. Several detailed original studies confirm an impaired immunological response in neonates and infants born to HIV-infected mothers. Impairment extends to children born to mothers on antiretroviral medication. The duration of immune dysfunction is unclear, but it appears to persist for several years. Homeostasis of the GIT is essential in order to prevent the translocation of Candida into the bloodstream. GIT immunity plays a critical role in the clearance of fungi. The HI virus interferes negatively with this ability. CONCLUSION. If HIV-exposed but uninfected children have a degree of immunodeficiency, then the risk of opportunistic infections is higher than in HIV-unexposed uninfected children. The clinician should bear this in mind when these patients present, in order to decrease the morbidity and mortality associated with delayed diagnosis and treatment of candidaemia.