Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.

A 2-year-old, previously healthy boy presents to the clinic with a history of 24 hours of fussiness, decreased appetite, and several short-lived episodes of acute abdominal pain. During the past 8 hours he has had several red, "bloody" stools. There is no vomiting.Physical examination reveals an alert child whose vital signs are normal. His abdomen is soft and nondistended. A palpable "mass" extends through the right upper and lower quadrants. Rectal examination does not reveal any fissures or tears. Auscultation reveals diminished bowel sounds. His remaining physical findings are within normal limits. After examination, the patient passes a redcolored stool (Fig. 1). Laboratory examination shows normal complete blood count and serum electrolyte concentrations. Stool guaiac testing is positive. Additional testing reveals the diagnosis. Case 2 PresentationA 2-year-old healthy girl presents with the complaint of a single large, red, "bloody" stool. She has had no vomiting, diarrhea, abdominal pain, fussiness, fever, or other systemic complaints. She has no history of constipation. Her mother brings the stool for examination (Fig. 2).Physical examination reveals an alert, playful child whose vital signs are normal. Findings on abdominal examination are unremarkable, and the rectal examination does not reveal any fissures or tears. The remainder of her physical examination is normal. Stool guaiac testing is negative. Additional history reveals the diagnosis. Case 3 PresentationA 5-month-old boy who has a recent history of acute otitis media presents with three episodes of red, "bloody" stools in the past 48 hours. The child is otherwise well and has no vomiting, diarrhea, fever, or abdominal pain. His appetite is good, and he drinks 8 oz of formula every 3 to 4 hours. He has no prior history of constipation or formula intolerance. Currently, he is taking oral cefdinir for the otitis media. His mother brings a stool sample for examination (Fig. 3).

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Concerns over infraglottic and bronchial infections have been a source of anxiety and lost sleep for many children, parents, and physicians. The annual incidence of lower respiratory tract infections in children younger than 6 years old exceeds 5 million in the United States. Despite the frequency of these infections, the often common and nonspecific clinical symptomatology, variable severity, and changing epidemiology over time all have contributed to our understanding and misunderstanding of these disorders.