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ORIGINAL RESEARCH
Year : 2015  |  Volume : 4  |  Issue : 2  |  Page : 78-87

HR-CT chest findings and their correlation with CD4 cell counts in HIV infected children presenting with digital clubbing, chronic cough and crackles in chest


1 Department of Pediatrics, Jawaharlal Nehru Institute of Medical Sciences (JNIMS) Imphal, Manipur, India
2 Department of Obstetrics & Gynaecology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS) Imphal, Manipur, India
3 Department of Radiodiagnosis, Jawaharlal Nehru Institute of Medical Sciences (JNIMS) Imphal, Manipur, India
4 Radiodiagnosis, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India
5 Community Medicine, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India

Correspondence Address:
H Apabi
Department of Pediatrics, Jawaharlal Nehru Institute of Medical Sciences (JNIMS) Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


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Objectives: To study the High Resolution-Computed Tomography (HR-CT) chest findings and correlation with CD4 cell counts among HIV infected children presenting with digital clubbing, chronic cough and crackles in chest. Setting: Department of Pediatrics, Jawaharlal Nehru Institute of Medical sciences (JNIMS), Imphal, Manipur, India. Participants: 300 HIV positive children of both sexes in the age group of 18 months to 15 years with or without antiretroviral therapy (ART) were studied over a period of four years. Methods: The children presenting with digital clubbing, chronic cough and crackles in chest were selected from the 300 HIV infected children after thorough clinical examinations. The retrospective analysis of all the CD4 cell counts, before and during ART of the selected patients was done. All the selected children were referred for chest X-Ray, HR-CT chest and sputum for fungal element staining and culture. Results: 8(2.66%) children out of the 300 HIV infected children were presenting with digital clubbing, chronic cough and extensive crackles in chest. A definitive microbiological diagnosis of fungal infections was made from the sputum fungal element staining and cultures in 7 (87.5%) patients out of the selected 8 patients, which included Aspergillus fumigatus in 3, Cryptococcus neoformans in 2 and Candida albicans in 2 patients. The mean of lowest CD4 cell counts, before and during ART up to the time of examination of the selected 8 children was 137.87 cells/μL (± 76.53). The means of lowest CD4 cell counts of 3 cases of pulmonary aspergillosis, 2 cases of pulmonary cryptococcosis and 2 cases of pulmonary candidiasis were 93.6 cells/μL (±5.03), 114 cells/μL(±14.14) and 137 cells/μL(±24.04) respectively. The HR-CT chest images of all the above selected 8 children were showing with findings suggestive of fungal lung infections. The suggestive findings were extensive ground glass opacity (GGO), multiple nodules with halo sign, cystic and traction bronchiectasis, peribronchial cuffing and capsulated cavitary lesion with suggestive of fungal ball and air crescent. Conclusion: Digital clubbing, chronic cough and extensive crackles in chest were the strong clinical findings suggestive of invasive fungal lung infections among the HIV infected children. The patients with this high index of suspicion for fungal chest infections may be considered for the HRCT chest. HRCT chest findings of pulmonary fungal infection were diverse but some characteristic HRCT chest findings were highly suggestive of pulmonary fungal infections in immuno-compromised patients. HIV positive children with fungal infections of lung were significantly associated with low CD4 cell counts below 200cells/μl .This may be due to either delay in starting ART or getting resistance to ART during treatment, especially with poor adherence to ART. Regular pre ART CD4 cell counts every 6 months, early initiation of ART as per the ART guide line, strict adherence to ART and early diagnosis of treatment failure of ART will be one of the best options for prevention of fungal chest infections.


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