Neurologic Manifestations of Pediatric Acquired Immunodeficiency Syndrome: Clinical Features and Therapeutic Approaches

Mintz, Mark; Epstein, Leon G.

doi:10.1055/s-2008-1041157

Cited by 26 publications

(13 citation statements)

References 2 publications

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“…25,28 Peripheral neuropathies, however, are rarely seen in HIV-infected children. 29,30 Although polyradiculopathy has not been previously associated with the attenuated virus, our patient's clinical presentation, EMG, and laboratory evidence for dissemination of the vaccine strain of varicella (bronchioalveolar lavage and lung biopsy) implicates it as the causative agent. The onset of the child's weakness corresponded to the onset of the rash and the most affected limb was the site of the vaccination suggesting possible lumbar root involvement.…”

Section: Discussionmentioning

confidence: 58%

Disseminated Vaccine Strain Varicella as the Acquired Immunodeficiency Syndrome-Defining Illness in a Previously Undiagnosed Child

et al. 2001

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ABSTRACT. The Food and Drug Administration licensed a live-virus varicella vaccine (Varivax In March 1995, the Food and Drug Administration approved a live-attenuated varicella vaccine for use in healthy individuals 12 months of age and older. The vaccine has been shown to be safe and effective in healthy children and adults, 1,2 as well as in children with leukemia. [3][4][5] The American Academy of Pediatrics does not recommend routine screening of children for human immunodeficiency virus (HIV) infection before vaccination. In addition, routine administration of varicella vaccine is not recommended for all HIV-infected children. 6 Significant morbidity and mortality is caused by varicella-zoster virus (VZV) in immunocompromised individuals, including those infected with HIV. 7-9 Postexposure varicella-zoster immune globulin prophylaxis decreases the likelihood and severity of varicella in high-risk individuals, but the breakthrough rate can be as high as 26%. 4,5 Exposures to varicella are often not recognized, further limiting the utility of postexposure prophylaxis. Immunization, on the other hand, has the potential of establishing permanent immunity. After primary infection in HIV-infected adults, the risk of reactivation remains low well into the progression of acquired immunodeficiency syndrome. These individuals are at risk of developing zoster, but have a relatively low risk of dissemination. 8 This suggests that the immunization of HIV-infected children could prevent primary (wild-type) infection, thereby eliminating viral entry into dorsal root ganglia 3 and subsequent reactivation.Immunization of immunocompromised patients has been limited to children with leukemia and solid tumors following strict guidelines to limit the potential for serious adverse events. 5 Routine immunization of all healthy children carries the potential risk that unrecognized immunocompromised children could be inadvertently vaccinated. Reported here is a 16-month-old, previously undiagnosed, HIV-infected boy who developed dissemination of the vaccine strain of varicella zoster virus after routine immunization. CASE REPORTA previously healthy 16-month-old boy who was admitted to the University of Michigan Mott Children's Hospital with a 5-day history of increasing respiratory distress, fever (101°F), cough, emesis, and lower extremity weakness. In addition, he had a 1-month history of a progressive erythematous papular rash, which began in the groin and upper right thigh progressing to involve the trunk, axilla, and right knee and foot. The rash was associated with a low-grade fever and the patient had recently been refusing to walk for several days. On admission, he had a pulse of 173 beats/min, and a respiratory rate of 24 breaths/min. Weight (9 kg), height (74 cm), and head circumference (45 cm) were all below the fifth percentile. Physical examination was remarkable for oral thrush, diffuse rhonchi, and scattered wheezes, and a confluent macular rash over the trunk and arms. There was also an erythematous zosteriform patc...

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Section: Discussionmentioning

confidence: 58%

Disseminated Vaccine Strain Varicella as the Acquired Immunodeficiency Syndrome-Defining Illness in a Previously Undiagnosed Child

et al. 2001

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“…A well-defined triad of clinical features is seen: impaired brain growth, loss of developmental milestones with cognitive deterioration and symmetrical motor deficits [6, 8, 49]. …”

Section: Types Of Cns Involvement In Hiv Infectionmentioning

confidence: 99%

“…Seizures are notably infrequent, probably because HIV is mainly a white matter disease [6, 8]. Older children and adolescents may show learning difficulties and behavioral changes [49]. …”

Section: Types Of Cns Involvement In Hiv Infectionmentioning

confidence: 99%

Central Nervous System Abnormalities in Pediatric Human Immunodeficiency Virus Infection

Gavin¹,

Yogev²

1999

Pediatr Neurosurg

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“…The most common neurologic findings of pediatric HIV infection include progressive encephalopathy; nonprogressive developmental delay; and motor dysfunction as evidenced by corticospinal tract signs (1,2,8). Progressive encephalopathy has been noted in approximately half to two-thirds of symptomatic infants and young children with HIV (8,9).…”

Section: Epidemiology Of Pediatric Cns Hiv Diseasementioning

confidence: 99%

“…Among older infected children and adolescents, findings are more subtle. They may include short-term memory loss, hand tremors, slowing in fine motor skills, attentional difficulties, apathy, depression and emotional lability (10).…”

Section: Epidemiology Of Pediatric Cns Hiv Diseasementioning

confidence: 99%

Pediatric HIV infection: Neurologic and neuropsychologic findings

Fowler¹

1994

Acta Paediatrica

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Neurologic Manifestations of Pediatric Acquired Immunodeficiency Syndrome: Clinical Features and Therapeutic Approaches

Cited by 26 publications

References 2 publications

Disseminated Vaccine Strain Varicella as the Acquired Immunodeficiency Syndrome-Defining Illness in a Previously Undiagnosed Child

Disseminated Vaccine Strain Varicella as the Acquired Immunodeficiency Syndrome-Defining Illness in a Previously Undiagnosed Child

Central Nervous System Abnormalities in Pediatric Human Immunodeficiency Virus Infection

Pediatric HIV infection: Neurologic and neuropsychologic findings

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