RESUMEN
BACKGROUND: Vertical transmission from mother to infant is the most common mode of transmission of HIV infection in children. Data on pediatric HIV in the Middle East and Gulf region are scarce. We describe the spectrum, characteristics and outcome of HIV infection in Saudi children. METHODS: We collected descriptive data on HIV-infected or exposed children seen at the King Faisal Hospital and Research Centre (KFSH&RC) between 1986 and 2003. RESULTS: Sixty-three children had proven HIV infection. The source of infection was perinatal transmission in 63.5% of cases and contaminated blood or blood products transfusion in 34.5%. Median age at diagnosis was 6 years. In 42 patients for whom complete records were available, 90% were delivered by spontaneous vaginal delivery and 10% by cesarean delivery. Ninety-three percent of infected infants were breastfed throughout infancy. The complete medical records were available for 66% of children; for the remainder, part of the records could not be retrieved. Thirteen percent had an AIDS-defining opportunistic infection, with disseminated cytomegalovirus (CMV) infection being the most common (37.5%). All cases received antiretroviral therapy starting in 1997. Of those who received highly active antiretroviral therapy, 79% were compliant with treatment and had a sustained virologic response below the detectable level. Seventy-five percent of those diagnosed before 1995 died compared with 7.7% diagnosed later. CONCLUSION: Effective preventive measures, such as antiretroviral prophylaxis, cesarean delivery, and abstention from breastfeeding are not being applied. This could be largely due to lack of knowledge among patients and healthcare providers. Physicians must recognize the signs and symptoms of HIV infection, and have a high index of suspicion so that infected children are diagnosed early and referred to a specialized center for treatment and follow-up.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Infecciones Oportunistas/epidemiología , Terapia Antirretroviral Altamente Activa , Transfusión Sanguínea , Lactancia Materna/epidemiología , Cesárea , Niño , Preescolar , Femenino , Infecciones por VIH/prevención & control , Humanos , Masculino , Educación del Paciente como Asunto , Arabia Saudita/epidemiologíaAsunto(s)
Bacteriemia/diagnóstico , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Recien Nacido Prematuro , Reacción en Cadena de la Polimerasa/métodos , Bacteriemia/microbiología , Diagnóstico Diferencial , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Recién Nacido , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Clinical characteristics of HIV-1 infection in people inhabiting Western, Sub-Saharan African, and South-East Asian countries are well recognized. However, very little information is available with regard to HIV-1 infection and treatment outcome in MENA countries including the Gulf Cooperation Council (GCC) states. METHODS: Clinical, demographic and epidemiologic characteristics of 602 HIV-1 infected patients followed in the adult Infectious Diseases Clinic of King Faisal Specialist Hospital and Research Centre, in Riyadh, Kingdom of Saudi Arabia a tertiary referral center were longitudinally collected from 1989 to 2010. RESULTS: Of the 602 HIV-1 infected patients in this observation period, 70% were male. The major mode of HIV-1 transmission was heterosexual contact (55%). At diagnosis, opportunistic infections were found in 49% of patients, most commonly being pneumocysitis. AIDS associated neoplasia was also noted in 6% of patients. A hundred and forty-seven patients (24%) died from the cohort by the end of the observation period. The mortality rate peaked in 1992 at 90 deaths per 1000 person-year, whereas the mortality rate gradually decreased to <1% from 1993-2010. In 2010, 71% of the patients were receiving highly active retroviral therapy. CONCLUSIONS: These data describe the clinical characteristic of HIV-1-infected patients at a major tertiary referral hospital in KSA over a 20-year period. Initiation of antiretroviral therapy resulted in a significant reduction in both morbidity and mortality. Future studies are needed in the design and implementation of targeted treatment and prevention strategies for HIV-1 infection in KSA.
RESUMEN
Legionnaires disease continues to be underreported in the Middle East--a reflection of underdiagnosis, both clinically and by laboratory investigations. We draw the attention to this unusual cause of occasionally fatal, yet severe, pneumonia by reporting an immunocompromised infant who succumbed to Legionella pneumophila pneumonia. The urinary test for Legionella antigen was positive, and this was then confirmed by a bronchoalveolar fluid culture. Moreover we have reviewed the incidence, pathophysiology, association with immunodeficiency, diagnostic tools, and treatment in this case report.
Asunto(s)
Huésped Inmunocomprometido , Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/fisiopatología , Neumonía Bacteriana/fisiopatología , Antígenos Bacterianos/orina , Líquido del Lavado Bronquioalveolar/microbiología , Resultado Fatal , Femenino , Humanos , Lactante , Enfermedad de los Legionarios/diagnóstico , Enfermedad de los Legionarios/microbiología , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/microbiología , Arabia Saudita , Índice de Severidad de la EnfermedadAsunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Humanos , Esquemas de Inmunización , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/economía , Vacunas Neumococicas/inmunología , Arabia Saudita , Serotipificación , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/aislamiento & purificación , Vacunas ConjugadasRESUMEN
Interleukin-12 receptor ß1 (IL-12Rß1) deficiency is the most common form of Mendelian susceptibility to mycobacterial disease (MSMD). We undertook an international survey of 141 patients from 102 kindreds in 30 countries. Among 102 probands, the first infection occurred at a mean age of 2.4 years. In 78 patients, this infection was caused by Bacille Calmette-Guérin (BCG; n = 65), environmental mycobacteria (EM; also known as atypical or nontuberculous mycobacteria) (n = 9) or Mycobacterium tuberculosis (n = 4). Twenty-two of the remaining 24 probands initially presented with nontyphoidal, extraintestinal salmonellosis. Twenty of the 29 genetically affected sibs displayed clinical signs (69%); however 8 remained asymptomatic (27%). Nine nongenotyped sibs with symptoms died. Recurrent BCG infection was diagnosed in 15 cases, recurrent EM in 3 cases, recurrent salmonellosis in 22 patients. Ninety of the 132 symptomatic patients had infections with a single microorganism. Multiple infections were diagnosed in 40 cases, with combined mycobacteriosis and salmonellosis in 36 individuals. BCG disease strongly protected against subsequent EM disease (p = 0.00008). Various other infectious diseases occurred, albeit each rarely, yet candidiasis was reported in 33 of the patients (23%). Ninety-nine patients (70%) survived, with a mean age at last follow-up visit of 12.7 years ± 9.8 years (range, 0.5-46.4 yr). IL-12Rß1 deficiency is characterized by childhood-onset mycobacteriosis and salmonellosis, rare recurrences of mycobacterial disease, and more frequent recurrence of salmonellosis. The condition has higher clinical penetrance, broader susceptibility to infections, and less favorable outcome than previously thought.
Asunto(s)
Sudunidad beta 1 del Receptor de Interleucina-12/deficiencia , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Citocinas/sangre , Femenino , Genotipo , Humanos , Lactante , Recién Nacido , Sudunidad beta 1 del Receptor de Interleucina-12/genética , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Infecciones por Mycobacterium no Tuberculosas/genética , Mycobacterium bovis/aislamiento & purificación , Mycobacterium tuberculosis/aislamiento & purificación , Micobacterias no Tuberculosas/aislamiento & purificación , Análisis de SupervivenciaAsunto(s)
Fracturas Óseas/prevención & control , Directrices para la Planificación en Salud , Osteoporosis/diagnóstico , Osteoporosis/terapia , Anciano , Anciano de 80 o más Años , Densidad Ósea/efectos de los fármacos , Densidad Ósea/fisiología , Enfermedades Óseas Metabólicas/diagnóstico , Enfermedades Óseas Metabólicas/fisiopatología , Enfermedades Óseas Metabólicas/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/fisiopatología , Osteoporosis Posmenopáusica/diagnóstico , Osteoporosis Posmenopáusica/fisiopatología , Osteoporosis Posmenopáusica/terapia , Factores de Riesgo , Arabia SauditaAsunto(s)
Antirretrovirales/uso terapéutico , Quimioprevención/métodos , Transmisión de Enfermedad Infecciosa/prevención & control , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Profilaxis Posexposición/métodos , Reacción a la Transfusión , Anemia de Células Falciformes/terapia , Niño , ADN Viral/sangre , Femenino , VIH/aislamiento & purificación , Anticuerpos Anti-VIH/sangre , Antígenos VIH/sangre , Humanos , ARN Viral/sangreRESUMEN
Members of the Toll-like receptor (TLR) and interleukin-1 receptor (IL-1R) superfamily share an intracytoplasmic Toll-IL-1 receptor (TIR) domain, which mediates recruitment of the interleukin-1 receptor-associated kinase (IRAK) complex via TIR-containing adapter molecules. We describe three unrelated children with inherited IRAK-4 deficiency. Their blood and fibroblast cells did not activate nuclear factor kappaB and mitogen-activated protein kinase (MAPK) and failed to induce downstream cytokines in response to any of the known ligands of TIR-bearing receptors. The otherwise healthy children developed infections caused by pyogenic bacteria. These findings suggest that, in humans, the TIR-IRAK signaling pathway is crucial for protective immunity against specific bacteria but is redundant against most other microorganisms.