Shapiro N L, Novelli V
Pediatric Otolaryngology, Division of Head and Neck Surgery, UCLA School of Medicine, Los Angeles, California 90095-1624, USA.
Int J Pediatr Otorhinolaryngol. 1998 Sep 15;45(1):69-75. doi: 10.1016/s0165-5876(98)00089-5.
Human immunodeficiency virus (HIV) infection continues to be a vexing problem in the pediatric population. Otitis media, a common entity in immunocompetent as well as immunocompromised children, is prevalent in pediatric patients with HIV infection. Recurrent infections and complications secondary to otitis media are also common in this population. The purpose of this review was to evaluate the records of a large group of children with HIV infection undergoing treatment for otitis media at a tertiary care center. Incidence of infections, severity of infections, and pathogens responsible were the key points of data collection in relation to each patient's HIV clinical and immunologic classification. We reviewed 72 patients with vertically-acquired HIV infection undergoing treatment at the Hospital for Sick Children, Great Ormond Street, London. All patients were born to HIV infected mothers of sub-Saharan African origin. A total of 32 (44.4%) of these children presented to our institution with one or more episodes of otitis media, six of whom suffered systemic complications secondary to middle ear pathology. Middle ear culture data, when available from actively draining ears, was similar to those of immunocompetent children in the general population. The most common complications were systemic bacteremia and recalcitrant infections requiring intravenous antibiotic therapy. Severity of immunosuppression was associated with higher incidence and severity of otitis media. Otitis media in an HIV infected child must be treated aggressively at its outset in an attempt to minimize possible complications. Administration of prophylactic antibiotics to these children may reduce the frequency of acute and chronic infections. Improvement in immunologic status using antiretrovirals or protease inhibitors is a primary goal in diminishing the severity of otitis media as well as other infections in these children.
人类免疫缺陷病毒（HIV）感染在儿科人群中仍然是一个棘手的问题。中耳炎在免疫功能正常以及免疫功能低下的儿童中都很常见，在感染HIV的儿科患者中也很普遍。中耳炎继发的反复感染和并发症在这一人群中也很常见。本综述的目的是评估在一家三级医疗中心接受中耳炎治疗的一大群HIV感染儿童的记录。感染发生率、感染严重程度以及致病病原体是与每位患者的HIV临床和免疫分类相关的数据收集要点。我们回顾了在伦敦大奥蒙德街儿童医院接受治疗的72例垂直感染HIV的患者。所有患者均出生于撒哈拉以南非洲裔感染HIV的母亲。其中共有32名（44.4%）儿童因一次或多次中耳炎发作前来我院就诊，其中6名儿童因中耳病变继发全身性并发症。从中耳有积液的耳朵获取的中耳培养数据与普通人群中免疫功能正常的儿童相似。最常见的并发症是全身性菌血症和需要静脉用抗生素治疗的顽固性感染。免疫抑制的严重程度与中耳炎的较高发病率和严重程度相关。对于感染HIV的儿童，中耳炎必须在发病初期积极治疗，以尽量减少可能的并发症。对这些儿童使用预防性抗生素可能会降低急性和慢性感染的发生率。使用抗逆转录病毒药物或蛋白酶抑制剂改善免疫状态是减轻这些儿童中耳炎以及其他感染严重程度的主要目标。
