Lichenstein R, King J C, Farley J J, Su P, Nair P, Vink P E
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA.
Pediatr Infect Dis J. 1998 May;17(5):381-5. doi: 10.1097/00006454-199805000-00007.
Risk factors for bacteremia in febrile HIV-infected children are unknown.
To describe the frequency of bacteremia in febrile HIV-infected infants and young children in ambulatory settings and its association with clinical and laboratory factors.
In a birth cohort of 42 HIV-infected children, all febrile outpatient encounters at < or = 36 months of age were reviewed for HIV disease severity, presence of a central venous catheter (CVC) and the usage of antibiotics and/or intravenous immunoglobulin (IVIG). Blood culture results, highest temperature and white blood cell count (WBC) were noted.
There was a mean of 1.8 febrile visits (210 visits/116.5 subject years) per child year of observation. Rapid HIV-disease progressors (n=14) were 4 times more likely to have a febrile visit than 28 non-rapid HIV disease progressors (P < 0.01). Blood cultures and WBCs were obtained for 87 and 89% of the febrile visits, respectively. Eleven of the 27 positive blood cultures grew Streptococcus pneumoniae and 16 grew CVC related organisms. The only pathogen identified (n=9) in 104 febrile visits in children without a CVC was S. pneumoniae, which was often (7 of 9) associated with mild illnesses. In children without a CVC temperature > or = 39 degrees C was significantly associated with S. pneumoniae bacteremia (P < 0.05). In 79 febrile visits by subjects with a CVC, temperature > or = 39 degrees C and WBC > or = 15000 cells/mm3 were frequently observed in the 16 bacteremic compared with the 63 nonbacteremic episodes (P < or = 0.05). There was a trend toward fewer S. pneumoniae bacteremias (3 of 11) in febrile subjects who were receiving antibiotics or IVIG.
HIV-infected children younger than 36 months of age have a high incidence of S. pneumoniae and CVC-related bacteremias. Temperature > or = 39 degrees C, WBC > or = 15000 cells/mm3 and the presence of a CVC should be considered in the management of febrile HIV-infected children.
发热的HIV感染儿童发生菌血症的危险因素尚不清楚。
描述门诊环境中发热的HIV感染婴幼儿菌血症的发生率及其与临床和实验室因素的关系。
在一个有42名HIV感染儿童的出生队列中，回顾了所有年龄小于或等于36个月的发热门诊病例，以了解HIV疾病的严重程度、中心静脉导管（CVC）的存在情况以及抗生素和/或静脉注射免疫球蛋白（IVIG）的使用情况。记录血培养结果、最高体温和白细胞计数（WBC）。
每个儿童观察年平均有1.8次发热就诊（210次就诊/116.5个观察对象年）。快速进展型HIV疾病患儿（n = 14）发热就诊的可能性是非快速进展型HIV疾病患儿（28例）的4倍（P < 0.01）。分别对87%和89%的发热就诊病例进行了血培养和白细胞计数检查。27份阳性血培养中有11份培养出肺炎链球菌，16份培养出与中心静脉导管相关的微生物。在没有中心静脉导管的儿童的104次发热就诊中，唯一鉴定出的病原体（n = 9）是肺炎链球菌，其常（9例中的7例）与轻症疾病相关。在没有中心静脉导管的儿童中体温≥39℃与肺炎链球菌菌血症显著相关（P < 0.05）。在有中心静脉导管的患儿的79次发热就诊中，16例菌血症患儿的体温≥39℃和白细胞计数≥15000个/mm³的情况比63例非菌血症病例更常见（P≤0.05）。接受抗生素或静脉注射免疫球蛋白的发热患儿中肺炎链球菌菌血症有减少的趋势（11例中的3例）。
36个月以下的HIV感染儿童肺炎链球菌和与中心静脉导管相关的菌血症发生率较高。在处理发热的HIV感染儿童时，应考虑体温≥39℃、白细胞计数≥15000个/mm³以及中心静脉导管的存在情况。
