Lawrence D. Frenkel

Transmission from one child to another of human immunodeficiency virus type 1 with a zidovudine-resistance mutation.

BACKGROUND AND METHODS. We describe a child who apparently acquired human immunodeficiency virus type 1 (HIV-1) infection in the home setting. The suspected source of infection was a child with the acquired immunodeficiency syndrome who had received zidovudine and whose virus contained a mutation associated with in vitro zidovudine resistance. The children were born to different HIV-1-infected mothers, but they lived in the same home between the ages of two and five years. Child 1 was infected perinatally; Child 2 was not and was repeatedly found to be seronegative. Child 2 was examined because of acute lymphadenopathy and had seroconverted to HIV-1 positivity. HIV-1 proviral DNA was amplified from peripheral-blood mononuclear cells and subjected to sequence analysis. Sequences from Child 2 were compared with those from Child 2s mother, Child 1, and local HIV-1-infected control children.

Qualitative and Quantitative Analysis of T Lymphocytes During Normal Human Pregnancy

PROBLEM: Human reproduction involves contact between cells which are allogeneic to one another, however the fetus not only survives but thrives.

More laboratory testing: greater cost but not necessarily better.

Background. The bacterial latex agglutination assay is ordered predominantly on the pediatric population, for rapid screening for bacterial surface antigens in cerebrospinal fluid (CSF) or urine specimens. The high cost of this assay and questions raised in the literature regarding its accuracy led to a retrospective review of the use of this assay at a medium‐sized midwest teaching hospital. The results of 6370 bacterial latex agglutination tests performed between May, 1995, and November, 1996, and charts of patients being tested were reviewed. Results. This study demonstrated a sensitivity and specificity of 28.6% and 86.7% for urine specimens and 70.0% and 99.4% for CSF specimens. A total of 11 pathogens were accurately detected (7 CSF and 4 urine). There were 13 false negatives and 59 false positives. None of the true positives had a discernible effect on either treatment or hospital course; however, several of the erroneous tests resulted in delayed or unnecessary treatment and workup of the involved patients. The annual billed cost of this test at this institution (fiscal years 1995 to 1997) averaged

Effect of the HIV-1 syncytium-inducing phenotype on disease stage in vertically-infected children

167 000 per annum. This does not include indirect costs associated with increased length of hospital stay, overutilization of antibiotics and excess laboratory tests ordered as a result of false positives. Conclusions. Bacterial antigen latex agglutination testing is neither sufficiently sensitive nor specific to be used as a screening test. Accurate results have no demonstrable clinical impact, whereas numerous inaccurate results are often generated at great cost. The continued use of the latex agglutination assay should be seriously questioned in an era when cost containment and clinical efficiency are becoming increasingly important.

Can parents do a throat culture

The syncytium‐inducing (SI) capability of HIV‐1 isolates from 48 HIV‐infected children was determined in order to examine the association of the SI phenotype with an AIDS diagnosis and/or with other clinical parameters in HIV‐infected children. In a retrospective cross‐sectional analysis, phenotypic data were linked to clinical and immunologic data from each patient. Multiple longitudinal samples were analyzed from 14 patients. Children with SI viruses were older than children with nonsyncytium‐inducing (NSI) strains. Twelve of 13 children less than 2 years old carried NSI viruses, seven of the 12 already had a diagnosis of AIDS. Two children under 2 years of age died within 1 month of NSI virus isolation. Although plasma p24 antigen levels tended to be higher in the NSI group, the difference appeared to reflect high p24 levels in children under 2 years old with AIDS. When children under 2 were omitted, differences in age, CD4+ cell counts, p24 antigenemia, and clinical parameters were not significant. The SI phenotype of HIV‐1 did not occur more frequently in children with an AIDS diagnosis. Four children remained stable with SI isolates over time periods of 16 to 31 months. Three childrens isolates converted from NSI to SI and 2 converted from SI to NSI. These data indicate that SI viruses do not play a significant role in progression to AIDS during the first 2 years of life. Furthermore, for children above the age of 2, the association between advanced disease stage and the SI phenotype in adults may not apply. J. Med. Virol. 55:56–63, 1998.

Pediatric human immunodeficiency virus infection and disease

Throat swabs for Group A beta-hemolytic Streptococcus were obtained from 98 patients, ages 4 to 17 years, both by their parents and by physician investigators. Compared with results obtained by physicians, there was a false negative rate of 32% (P < 0.001) for the parents. The discrepancy was greater in the youngest age group (38% false negative rate in the 4− to 8-year-olds) compared with older children (P < 0.001). The overall sensitivity and negative predictive value for the parent-obtained swabs were 68 and 45%, respectively. In the 4− to 8-year-old group, these values were 62 and 37%, respectively. Because there were no false positives the positive predictive value was 100%. We conclude that the false negative rate for untrained parents obtaining throat swabs is too high to warrant the implementation of home testing for Group A streptococci.

Cytomegalovirus Infection in Children with AIDS

Because almost all pediatric human immunodeficiency virus (HIV) infection is perinatally acquired, the geometric increase in acquired immunodeficiency syndrome cases in women is reflected in a corresponding increase in HIV infection in children. The pathogenesis of HIV infection in children often involves immune complex phenomenon with elevation of tumor necrosis factor and B-cell abnormalities. Most diagnostic assays (polymerase chain reaction, HIV culture, in vitro HIV-specific antibody production, and HIV-specific IgA) are sensitive in testing infants 6 months of age or older. Previous impressions that HIV infection in infants always progresses rapidly to death have been refuted. Infectious complications include primary bacteremia, acute pneumonia, and sinusitis. Opportunistic pathogens include Pneumocystis carinii, Candida, and Mycobacterium species, and cytomegalovirus. Although malignancies are not common in these children, B-cell malignancies have been reported. Central nervous involvement is much more common in children than in adults with HIV infection. Treatment options for HIV-infected children include intravenous immunoglobulin prophylaxis for P. carinii pneumonia, zidovudine, dideoxyinosine, and dideoxycytidine.