neonatal acquired immunodeficiency syndrome
Introduction
Introduction to neonatal acquired immunodeficiency syndrome Human immunodeficiency virus (AIDS), also known as acquired immunodeficiency syndrome (AIDS), is a serious infectious disease caused by human immunodeficiency virus (HIV), which mainly causes damage to CD4 lymphocytes in the body, resulting in damage. Defects in systemic immune function, secondary to various opportunistic infections and tumors leading to death. basic knowledge Sickness ratio: 0.0001% Susceptible population: newborn Mode of infection: vertical infection of mother and baby Complications: interstitial pneumonia
Cause
Causes of neonatal acquired immunodeficiency syndrome
Iatrogenic infection (15%):
(1) Blood transfusion and blood product infection: Ammann et al (1983) reported that 1 case of newborns who received repeated blood transfusions and blood products within a few days after birth showed AIDS symptoms at 6 months after birth, without CMV, HDV and EBV infection. The evidence, after investigation by the blood donors, found that one of them had AIDS 7 months after the blood supply, speculating that the blood donor was a carrier of the pathogen, and that the blood product input or blood transfusion can spread AIDS.
(2) Syringe and needle infection: Newborns, babies can also be infected by multiple injections, such as syringes and needles.
Maternal-infant vertical infection (15%):
The onset of neonatal AIDS is closely related to the concept of pregnancy, as a significant proportion of infant AIDS is obtained through mother-to-infant vertical transmission. Newborns are mainly from mothers, and mothers of AIDS have three routes: intrauterine transmission, intrapartum transmission, and postpartum transmission. Most mother-to-child transmission is mostly intrauterine transmission, mainly through placenta and amniotic fluid infection. Scientists have isolated HIV from human cord blood and amniotic fluid, indicating that the infection of the fetus is transmitted vertically by the mother.
Maternal-infant level infection (15%):
Newborns can be infected after birth by the mother's milk infected with AIDS pathogens.
Prevention
Neonatal acquired immunodeficiency syndrome prevention
1. Prevent HIV-infected women of childbearing age: It mainly prevents HIV infection in women of childbearing age. For pregnant women who are HIV-positive, strict follow-up should be prohibited after birth or after birth.
2. Strict screening of blood transfusion personnel: high-risk (adult) subjects cannot be blood donors.
3. Strictly prevent iatrogenic infections: Medical personnel should pay attention to the pollution and spread of syringes and needles; blood products such as gamma globulin and anti-hemophilia globulin should not be abused.
4. HIV vaccine: The production of HIV vaccines is a fundamental approach to genetically engineered HIV vaccines.
Complication
Neonatal acquired immunodeficiency syndrome complications Complications of interstitial pneumonia
When HIV invades the human body, it destroys the immune function of the human body, and can cause various incurable infections and tumors, such as opportunistic infections, lymphatic interstitial pneumonia, repeated invasive bacterial infections, encephalopathy, wasting syndrome, malignant diseases such as tumors.
Symptom
Neonatal Acquired Immune Deficiency Syndrome Symptoms Common Symptoms Atrophic Lymph Nodes, Herpes, Hepatosplenomegaly, Rhubarb, Diarrhea
Because the immune system is still immature, the newborn is rarely exposed to foreign antigens, and the number of immune memory cells is small. The immune system damage is more serious than that of adults after HIV infection. The incubation period is short, the symptoms appear early, the disease progresses rapidly, and lymphocyte-like interstitial cells occur. Pneumonia and secondary bacterial infections are more common. Children born from mother-to-child transmission can develop clinical signs as early as a few months after birth. The incubation period ranges from several months to several years.
1. General clinical manifestations: persistent fever, weight loss, low birth weight, weight loss after birth, jaundice does not retreat, hepatosplenomegaly, multiple parts of superficial lymphadenopathy.
2. Bacterial infection: Severe repeated bacterial infections such as sepsis, pneumonia, diarrhea, urinary tract infections, skin infections, and central nervous system infections are among the important causes of infant death.
3. Opportunistic infection: persistent or recurrent thrush.
4. Tumor: Kaposi sarcoma seen in adult patients is rare in children.
The acute phase of HIV infection is often asymptomatic or mild, and is easily overlooked. Therefore, it is necessary to rely on serological tests. Serum anti-HIV antibodies can be detected by ELISA. If positive, Western blot is used to detect HIV antigen to confirm the diagnosis. Can diagnose HIV infection.
Examine
Examination of neonatal acquired immunodeficiency syndrome
1. Immunological examination: CD4 cells in peripheral blood of patients are significantly decreased, early CD4 can be >500/l, late <200/l until it drops to 0, CD8 cells do not change significantly, so the proportion of CD4 / CD8 is gradually reduced or inverted, normal The proportion of children was 2.0, and serum immunoglobulin IgG, IgM, and IgA were often elevated.
2. Serological examination: HIV antigen (core antigen p24) can be detected within 1 to 4 weeks after HIV infection, and then gradually disappear until the AIDS stage reproduces positive. Core anti-antigen can be measured 3 to 12 weeks after HIV infection. Gp41 antibody, anti-gp41 IgG can last a lifetime, because small infant antibodies within 15 months may reflect antibodies from mothers, so neonatal should be confirmed by HIV culture or PCR.
3. Virological examination: In vitro lymphocyte culture followed by Northern blotting to measure HIV-RNA in lymphocytes or serum to detect HIV antigenic proteins by Western blot or to directly detect HIV-DNA by PCR.
4. X-ray examination, B-ultrasound examination, CT examination, etc., combined with clinical syndrome performance, can be found in Pneumocystis carinii pneumonia, tumor and other manifestations.
Diagnosis
Diagnosis and identification of neonatal acquired immunodeficiency syndrome
Diagnostic criteria
The US Centers for Disease Control believes that children with an immunodeficiency that cannot be explained by other causes, in addition to HIV antibody positive, can be diagnosed as AIDS with the following symptoms:
1. Pneumocystis pneumonia.
2. Toxoplasmic encephalitis or diffuse infection.
3. Chronic cryptosporidiosis enteritis, more than 1 month.
4. Chronic skin mucosal herpes simplex, more than 1 month.
5. Cytomegalovirus infection occurs in organs other than liver or lymph nodes.
6. Progressive multifocal leukoencephalopathy.
7. Candida esophagitis.
8. Cryptococcal meningitis or disseminated infection.
9. Intracellular Mycobacterium avium infection.
10. Kaposi's sarcoma (under 60 years old).
11. Primary cerebral lymphoma.
12. Diffuse bacterial infections (not just lung or lymphatic infections).
Differential diagnosis
Establishing a diagnosis has certain difficulties and should be differentiated from immunodeficiency caused by congenital immunodeficiency disease and other causes.
1. Congenital infections and congenital immune defects
Neonatal AIDS is not easily differentiated from certain congenital infections and congenital immune defects.
2. Does not manifest as an opportunistic infection
Neonatal AIDS often does not manifest as opportunistic infection, but children with PLHLIP confirmed by lung biopsy can be diagnosed with AIDS as long as their HIV and HIV antibodies are positive, and children without lung biopsy are classified as AIDS-RC. .
