Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa.
BMC Pediatr. 2012 Jun 14;12:68. doi: 10.1186/1471-2431-12-68.
Swallowing disorders, well recognised in adults, contribute to HIV-infection morbidity. Little data however is available for HIV-infected children. The purpose of this study is to describe swallowing disorders in a group of HIV-infected children in Africa after the introduction of combined anti-retroviral therapy.
We describe 25 HIV-infected children referred for possible swallowing disorders. Clinical and videofluoroscopic assessment of swallowing (VFSS), HIV stage, and respiratory and neurological examination were recorded.
Median age was 8 months (range 2.8-92) and 15 (60%) were male. Fifteen (60%) were referred for recurrent respiratory complaints, 4 (16%) for poor growth, 4 (16%) for poor feeding and 2 (8%) patients for respiratory complaints and either poor growth or feeding. Twenty patients (80%) had clinical evidence of swallowing abnormalities: 11 (44%) in the oral phase, 4 (16%) in the pharyngeal phase, and 5 (25%) in both the oral and pharyngeal phases. Thirteen patients had a videofluoroscopic assessment of which 6 (46%) where abnormal. Abnormalities were detected in the oral phase in 2, in the pharyngeal phase in 3, and in the oral and pharyngeal phase in 1; all of these patients also had evidence of respiratory involvement. Abnormal swallowing occurred in 85% of children with central nervous system disease. CNS disease was due to HIV encephalopathy (8) and miscellaneous central nervous system diseases (5). Three of 4 (75%) patients with thrush had an abnormal oral phase on assessment. No abnormalities of the oesophagus were found.
This report highlights the importance of swallowing disorders in HIV infected children. Most patients have functional rather than structural or mucosal abnormalities. VFSS makes an important contribution to the diagnosis and management of these patients.
吞咽障碍在成人中得到广泛认识，是导致 HIV 感染患者发病和死亡的重要原因。然而，有关 HIV 感染儿童吞咽障碍的数据却很少。本研究的目的是描述在非洲引入联合抗逆转录病毒治疗后，一组 HIV 感染儿童的吞咽障碍。
我们描述了 25 例因可能存在吞咽障碍而就诊的 HIV 感染儿童。记录了临床和视频荧光吞咽检查（VFSS）、HIV 分期、呼吸和神经系统检查的结果。
中位年龄为 8 个月（范围 2.8-92 个月），15 例（60%）为男性。15 例（60%）因反复呼吸道感染、4 例（16%）因生长不良、4 例（16%）因喂养不良、2 例（8%）因呼吸道感染和生长不良或喂养不良而就诊。20 例（80%）患儿有吞咽异常的临床证据：11 例（44%）发生在口腔期，4 例（16%）发生在咽期，5 例（25%）发生在口腔和咽期。13 例行 VFSS 检查，其中 6 例（46%）异常。口腔期异常 2 例，咽期异常 3 例，口腔和咽期异常 1 例；所有这些患者均有呼吸受累的证据。中枢神经系统疾病患儿异常吞咽发生率为 85%。中枢神经系统疾病是由 HIV 脑病（8 例）和各种中枢神经系统疾病（5 例）引起的。4 例（75%）鹅口疮患儿中有 3 例在评估时口腔期异常。未发现食管异常。
本报告强调了吞咽障碍在 HIV 感染儿童中的重要性。大多数患者存在功能而非结构或黏膜异常。VFSS 对这些患者的诊断和治疗具有重要意义。
