Pediatric emergency medicine trisk 2344 2344
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TABLE 94.25
CLINICAL MANIFESTATIONS AND DIAGNOSIS OF ACUTE HIV
INFECTION
Symptoms
Signs
Laboratory findings
Fever
Pharyngitis
Pyrexia
Generalized lymphadenopathy
Rash
Maculopapular rash
HIV PCR
ELISA, Western blot
often initially
negative, convert to
positive by 2–4 mo
Leukopenia
Myalgias
Headache
Nausea, vomiting
Diarrhea
Mucocutaneous ulcerations
Hepatomegaly
Splenomegaly
Neurologic symptoms: aseptic
meningitis,
meningoencephalitis,
neuropathy, radiculopathy,
facial nerve palsy, Guillain–
Barré syndrome, psychosis
Thrombocytopenia
HIV, human immunodeficiency virus; PCR, polymerase chain reaction; ELISA, enzyme-linked
immunosorbent assay.
HIV-positive patients with fever who appear ill should be treated like other illappearing, febrile children because they are likely to be infected with the same
types of organisms that infect immunocompetent children. An LP is indicated for
those with meningismus, change in mental status, or an underlying abnormal
mental status makes assessment difficult; the clinician should consider obtaining
a CT of the brain prior to LP to evaluate for a mass-occupying lesion. If a child
is believed to be so unstable that LP is not safe, it can be delayed. In either case,
the child should be started on parenteral broad-spectrum antimicrobials.
Ceftriaxone (100 mg/kg/day divided every 12 hours) is an appropriate choice
because it covers the organisms that most commonly cause sepsis in children. In
areas with high rates of pneumococcal penicillin resistance, addition of
vancomycin should be considered. In young children, because of the possibility
of PCP presenting with fever and ill appearance, TMP-SMZ (5 mg/kg/dose of
