Журнал «Здоровье ребенка» 4 (47) 2013

In the article published data that HIV-negative children born after HIV-positive mothers have a defective immune system. These children have weaker vaccine response to diphtheria and pertussis toxoids in DTP vaccine; they synthesize fewer antibodies of the IgG isotype and all of its subclasses, and IgA, but have increased production of IgM. Furthermore, their response differs by the unbalanced expansion of CD4 + T-cells, which is specific for the early stage of HIV infection. These children have a weaker form of immediate and delayed hypersensitivity type to toxoids. And what is the most important; it is lasts up to 10 years. Therefore, we can expect unpredictable responses in infectious diseases. Also, drugs used for prevention of vertical transmission have toxicity, suppressing a bone marrow function, such as granulocytopenia and anemia. The statements are confirmed by a clinical case.

The child was born on time after her mother’s 5^th pregnancy, 2^nd delivery by caesarean section. Apgar score was 8 points, weight at birth was 3350 g., and the height was 53 cm. The diagnosis was R - 75 (child born from HIV-positive mother). Recommendations upon leaving hospital were for the baby to stay with mother and to be fed by adapted milk formula – Lazanna, Zidavir 1.34 ml. Vaccination with BCG was not done.

Since 19^th weeks of pregnancy the child's mother started to receive HAART: zidovir + lamivir + aluviya, which she continued after birth.

At the age of 6 days, the child was examined by a doctor. Condition was satisfactory. At the age of 1 month the child was examined by PCR for the presence of HIV DNA in the blood - HIV proviral DNA was not detected.

At the age of 3 months old no clinical signs of HIV infection were detected and second PCR test for HIV proviral DNA was negative. A child considered healthy and released without medical supervision.

Child’s growth and development was ordinary but at the age of 5 months, 20 days, his mother turned to local clinic. The pediatrician diagnosed acute rhinitis and prescribed the course of antibiotic and symptomatic therapy. In 4 days, due to a rogression of the disease, the child was hospitalized to children's infectious diseases hospital. Complaints were a fever up to 37,5 ˚ C, cough, runny nose, drowsiness. At the time of admission his condition was characterized as moderately severe, temperature 36.8 ° C, pulse 137 in 1 minute, breathing rate 48 per min.

The skin color was pale with perioral cyanosis. The peripheral lymph nodes were small and painless. The oropharynx was moderately hyperemic. At auscultation in the lungs respiratory was hard, dry and coarse moist rales from both sides. The cardiac tones were rhythmic. The stomach was soft, no pain in the abdominal area reported.  The liver and the spleen were not palpable. The stool and urine output were normal.

The diagnosis: acute respiratory viral infection. Obstructive bronchitis without respiratory failure.

CBC: Hb – 128 g/l and RBC – 2,3х10¹², colour index 0,85, PLT -280 х10⁶ ,WBC 6,2х10⁹, ESR - 4mm/h, stabs  - 10%, segs – 29%, lymph – 57%, mn – 5%., ESR 4  mm/h

Rx: in the right clavicle area  a homogeneous shadow is determined, blurring of vascular pattern in the root zone, the shadow of the heart is expanded arch due to the left ventricle. Conclusion: interstitial edema of the lung tissue of right lung. Congenital heart defect?

Stool culture sample for intestinal group of bacteria: negative

On the 13th day of the disease signs of clinical death (asystole, apnea, areflexia) were registered.  The resuscitation: artificial ventilation, chest compressions, administration of epinephrine and atropine – did not give any effect. The biological death was registered at 7:32 am.

The child stayed in the hospital 8 days.

The final clinical diagnosis:

Main disease: 1.1. Acute community-acquired pneumonia of unknown etiology, severe course.

           1.2. Congenital heart disease, unspecified.

Complications: cardiovascular failure. Pulmonary edema. Brain edema.

Accompanying diagnosis: E-HIV-infection.

Postmortem diagnosis of ICD A 48.8, Z 20.6, R-89.7

The main disease: Sepsis: septicemia: serous meningitis, erosive enterocolitis, bilateral interstitial pneumonia, myelosis of the spleen (Culture test N 9, 10 K. pneumoniae).

In fact, we faced with a new pediatric problem: HIV-negative children born from HIV-positive mothers who require medical supervision and correction of immunity.