AEGiS-11IAC: Clinical and pathologic analysis of 29 autopsies of pediatric AIDS patients.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Clinical and pathologic analysis of 29 autopsies of pediatric AIDS patients.

Int Conf AIDS 1996 Jul 7-12; 11:450 (abstract no. Pub.B.1076)
Queiroz W, Della Negra M, Yu CL, Veiga AP, Araujo MF; Inst. Infectologia Emilio Ribas, Sao Paulo, Brazil. Fax: +55-11-280.3954.

OBJECTIVES: To correlate the necropsy findings with clinical features and pre-morten diagnosis and therapy among Pediatric AIDS Patients.

METHODS: From January 1987 to December 1995 29 necropsy studies were performed with pediatric AIDS patients (CDC criteria) and were analyzed along with the clinical and therapeutic data prior to death. The necropsies were complete and included hematoxylin-eosin smears and others, when needed. Age at death varied from 2 to 118 months (mean=21.3 mo.); 26 were infected by vertical transmission and 2 by blood transfusion.

RESULTS: Cytomegalovirus (CMV) disease was identified in 10 cases (34.5%) and the lungs were compromised in 7 of these patients. Seventy per cent of the cases of CMV disease were detected in multiple organs. None of these cases had the diagnosis prior to death. Pneumocystis carinii Pneumonia (PCP) was identified in 7 cases (24.1%) and 4 patients were receiving specific therapy before death. In the 3 remaining cases the pre-morten diagnosis was bacterial sepsis. Cryptosporidial infection was found in 3 cases; all presented with chronic diarrheal illness and two of them had this diagnosis previously and were receiving Spiramycin. Tuberculosis (Tb) was found in one necropsy study, associated to CMV disease. This patient did not have Tb diagnosed prior to death and curiously other 5 patients who had this diagnosis did not present any sign of the disease at the necropsy studies. One case showed lymphoma in central nervous system, heart and lungs. This child died at age 18 mo. and presented diarrheal illness as the unique clinical manifestation. Candidiasis was diagnosed in 2 cases, being cause of pneumonia in one case who had the clinical diagnosis of Tb prior to death. In 8 cases, neither the clinical nor the hystopathologic findings were enough to determine a specific disease related to death (Interstitial pneumonitis, Bronchopneumonia and septic embolization of the lungs).

DISCUSSION: CMV disease was the most frequent finding associated to death. The clinical diagnosis prior to death is very difficult because most of the times the disease occur in advanced stages of HIV disease and in association with other opportunistic infections. Therapeutic failure occurred in 57.1% of the cases of PCP, probably due to the degree of immunodeficiency of the patients, and the lack of diagnosis pre-morten occurred in younger infants, in which the clinical features may look alike bacterial sepsis. Despite the high incidence of Tb in our country, proper therapy showed to be efficient in these cases. Lungs are compromised in 100% of the diseases that precede death. We believe that a clinical, laboratorial and pathologic studies of this organ could bring high benefits to this population.

Keywords: AEGIS, Autopsy, Acquired Immunodeficiency Syndrome, Pneumonia, Pneumocystis carinii, HIV Infections, Tuberculosis, Cytomegalovirus Infections, Death, Candidiasis, Opportunistic Infections, Cause of Death, CD4 Lymphocyte Count, Child, Human, Infant, pathology, diagnosis, ICA11

960707
PubB1076