Outcome of human immunodeficiency virus–exposed and –infected children admitted to a pediatric intensive care unit for respiratory failure

dc.contributor.authorKitchin, Omolemo P.
dc.contributor.authorMasekela, Refiloe
dc.contributor.authorBecker, Piet J.
dc.contributor.authorMoodley, Teshni
dc.contributor.authorRisenga, Samuel Malamulele
dc.contributor.authorGreen, Robin J.
dc.date.accessioned2013-06-26T06:19:27Z
dc.date.available2013-12-31T00:20:05Z
dc.date.issued2012
dc.description.abstractObjective: Acute severe pneumonia with respiratory failure in human immunodeficiency virus-infected and -exposed infants carries a high mortality. Pneumocystis jiroveci is one cause, but other organisms have been suggested to play a role. Our objective is to describe the coinfections and treatment strategies in a cohort of human immunodeficiency virus-infected and -exposed infants with respiratory failure and acute respiratory distress syndrome, in an attempt to improve survival. Design: Prospective intervention study. Setting: Steve Biko Academic Hospital, Pretoria, South Africa. Patients: Human immunodeficiency virus–exposed infants with respiratory failure and acute respiratory distress syndrome were recruited into the study. Interventions: All infants were treated with routine therapy for Pneumocystis jiroveci and bacterial coinfection. However, in addition, all infants received ganciclovir from admission until the cytomegalovirus viral load result was demonstrated to be <log 4. Measurements: Routine investigations included human immunodeficiency virus polymerase chain reaction, cytomegalovirus viral load, blood culture, C-reactive protein, and white cell count. Tracheal aspirates for Pneumocystis jiroveci detection, bacterial culture, tuberculosis culture, and viral identification were performed. Main Results: Sixty-three patients met the recruitment criteria. The mortality rate was 30%. Pneumocystis jiroveci was positive in 33% of infants, while 38% had cytomegalovirus viral load ≥log 4. Only 7.9% of infants had a positive tuberculosis culture. Nineteen deaths occurred, 13 of which had a cytomegalovirus viral load ≥log 4. Bacterial coinfection and CD4 count were not predictors of mortality. Conclusions: A case fatality rate of 30% is achievable if severe pneumonia with respiratory failure and acute respiratory distress syndrome is managed with a combination of antibiotics and ventilation strategies. Cytomegalovirus infection appears to be associated with an increased risk of death in this syndrome. This may, however, be a marker of as yet undefined pathology.en_US
dc.description.librarianhb2013en_US
dc.description.urihttp://www.pccmjournal.orgen_US
dc.identifier.citationKitchin, OP, Masekela, R, Becker, P, Moodley, T, Risenga, SM & Green, RJ 2012, 'Outcome of human immunodeficiency virus–exposed and –infected children admitted to a pediatric intensive care unit for respiratory failure', Pediatric Critical Care Medicine, vol. 13, no. 5, pp. 516-519.en_US
dc.identifier.issn1529-7535 (print)
dc.identifier.issn1947-3893 (online)
dc.identifier.other10.1097/PCC.0b013e31824ea143
dc.identifier.urihttp://hdl.handle.net/2263/21709
dc.language.isoenen_US
dc.publisherLippincott, Williams & Wilkinsen_US
dc.rights© 2013 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. This is a non-final version of an article published in final form in Pediatric Critical Care Medicine, vol. 13, no. 5, pp. 516-519, 2012. DOI : 10.1097/PCC.0b013e31824ea143.en_US
dc.subjectPneumocystis syndromeen_US
dc.subjectCytomegalovirusen_US
dc.subjectHuman immunodeficiency virus (HIV)en_US
dc.subjectMortalityen_US
dc.subjectGancicloviren_US
dc.titleOutcome of human immunodeficiency virus–exposed and –infected children admitted to a pediatric intensive care unit for respiratory failureen_US
dc.typePostprint Articleen_US

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