Gesner M, Desiderio D, Kim M, Kaul A, Lawrence R, Chandwani S, Pollack H, Rigaud M, Krasinski K, Borkowsky W
Division of Infectious Disease and Immunology, New York University Medical Center, NY.
Pediatr Infect Dis J. 1994 Aug;13(8):697-703. doi: 10.1097/00006454-199408000-00004.
The purpose of this study was to characterize systemic Streptococcus pneumoniae disease in human immunodeficiency virus type 1 (HIV-1)-infected children. All cases of bacteremia and meningitis caused by S. pneumoniae among children less than 18 years old were collected by review of the Microbiology Laboratory records at the Bellevue Hospital Center during the period August 1, 1978, through July 31, 1993. There were 31 bouts of systemic S. pneumoniae disease in 19 of 235 HIV-1-infected children cared for by the Pediatric Infectious Disease staff and 116 bouts in 113 children not known to be HIV-1-infected. Four of the 19 HIV-1-infected children had multiple episodes of S. pneumoniae bacteremia as compared with 3 of 113 in the general population (P = 0.008). The frequency of serotypes and distribution of infections by season of the year did not differ between the 2 groups. The median ages at the time of the S. pneumoniae infection were 1.8 and 1.1 years for the HIV-1-infected children and the general population of children, respectively, when those children with multiple episodes were included for their initial episode only (P = 0.06). In the HIV-1-infected patients, 10 episodes were associated with pneumonia, 5 with pneumonia and otitis media, 5 with otitis media only, 1 with pneumonia and meningitis, 1 with meningitis only and 1 with periorbital cellulitis; 5 had no apparent focus of infection. One episode of pneumonia was complicated by lung abscess and there were 2 deaths. Most HIV-1-infected patients recovered without significant sequelae, and the clinical course of their systemic infections did not appear to be markedly different than that of healthy children.
本研究的目的是描述1型人类免疫缺陷病毒（HIV-1）感染儿童的全身性肺炎链球菌疾病。通过查阅1978年8月1日至1993年7月31日期间贝尔维尤医院中心微生物实验室记录，收集了所有18岁以下儿童由肺炎链球菌引起的菌血症和脑膜炎病例。在接受儿科传染病科医护人员治疗的235名HIV-1感染儿童中，有19名发生了31次全身性肺炎链球菌疾病发作；在113名未知是否感染HIV-1的儿童中，有116次发作。19名HIV-1感染儿童中有4名出现多次肺炎链球菌菌血症发作，而普通人群中113名儿童中有3名出现多次发作（P = 0.008）。两组之间的血清型频率和按年份季节划分的感染分布没有差异。仅将多次发作儿童的首次发作纳入计算时，HIV-1感染儿童和普通儿童人群发生肺炎链球菌感染时的中位年龄分别为1.8岁和1.1岁（P = 0.06）。在HIV-1感染患者中，10次发作与肺炎相关，5次与肺炎和中耳炎相关，5次仅与中耳炎相关，1次与肺炎和脑膜炎相关，1次仅与脑膜炎相关，1次与眶周蜂窝织炎相关；5例无明显感染灶。1例肺炎并发肺脓肿，有2例死亡。大多数HIV-1感染患者康复后无明显后遗症，其全身性感染的临床病程似乎与健康儿童没有明显差异。
