TB Presenting as Recurrent Pneumonia in a HIV-Infected Infant in Central Viet Nam

Abstract

Abstract:We report on a six-month-old infant admitted to our intensive care unit (ICU) with recurrent severe pneumonia. The mother was infected with human immunodeficiency virus (HIV)-infected, but initially failed to disclose this to doctors. Neither did she report the grandmother of the child's chronic coughing, likely due to tuberculosis (TB). The infant was diagnosed with X-pert MTB/RIF ® confirmed TB and tested positive for HIV infection. Once a correct diagnosis was established, the child demonstrated good recovery with appropriate TB and antiretroviral treatment (ART). The case demonstrates the importance of including TB in the differential diagnosis for young children not responding to first-line pneumonia treatment, especially in TB endemic areas. Taking a meticulous TB and HIV exposure history, with careful consideration of potential social stigma, is essential. It also demonstrates how the inaccessibility of HIV results and the absence of a continuous patient record may jeopardize patient care.Keywords: tuberculosis; Mycobacterium tuberculosis; infant; HIV; opportunistic infection Case ReportWe admitted a six-month-old girl to the Da Nang Hospital for Women and Children, a provincial referral hospital in central Viet Nam, with a diagnosis of recurrent severe pneumonia. She was discharged from the same hospital two days earlier, but developed a fever with associated heavy breathing at home. On admission, she weighed 5.5 kg and her vital signs were temperature 39 • C, breathing rate 80/min, heart rate 135 beats/min and peripheral oxygen saturation (SpO 2 ) 88% in air; 95% with high flow nasal oxygen.On examination, she was alert, but malnourished with visible chest indrawing. On physical examination she had extensive white plaques in her mouth, suggestive of oral thrush, and hepatosplenomegaly. On auscultation she had symmetric air entry with normal vesicular breathing and no abnormal breath sounds. She was admitted to the intensive care unit (ICU) for intravenous (IV) antibiotics (ceftazidime and gentamycin) and oxygen supplementation. Initial laboratory investigations revealed an abnormal full blood count (hemoglobin: 8.7 g/dL; white blood cells: 10.5 ×

Chest X-Ray in Human Immunodeficiency Virus (Hiv) Infected-Pediatrics: A Case Series Review

“…Figure 3. AP radiograph on admission to ICU (case 3) (Nguyen et al, 2018) Figure 4. PA chest radiograph shows reticulonodular changes (case 3) (Wei, Tsai, and Wu, 2016) Case 3…”

“…Figure 5. AP radiograph 10 days before the patient is admitted to the ICU (case 4) (Nguyen et al, 2018) Figure 6. Chest radiograph AP shows left-sided pneumothorax (case 4) (Wei, Tsai, and Wu, 2016) Case 4…”

“…Chest x-ray examination according to the article written by Wei, Tsai, and Wu, (2016) was performed with PA and AP projections, or PA projection only (Oninla et al, 2016). Meanwhile, Jouego, et al (2018), Nguyen et al (2018), and Shrestha, Basnet, and Kanskar (2013) stated that the AP projection was performed for that examination. The selection of projections in the article is following Lampignano and Kendrick (2018) who stated that a pediatric chest x-ray was performed with anteroposterior (AP), posteroanterior (PA), and lateral projections.…”

“…Pediatric radiography is an examination that requires careful handling. Pediatric chest x-ray examination can be performed with anteroposterior (AP), posteroanterior (PA), and lateral projections (Lampignano and Kendrick, 2018); (Wei, Tsai, and Wu, 2016); (Oninla et al, 2016); (Jouego et al, 2018); Nguyen et al (2018); (Shrestha et al, 2013).…”

“…In terms of pediatrics with HIV, a chest x-ray examination can be used to see the typical figure of TB (Oninla et al, 2016;Jouego et al, 2018;Nguyen et al, 2018), visualize its typical features of pneumonia (Nguyen et al, 2018;Wei, Tsai, and Wu, 2016), and also its bronchiectasis characteristic (Shrestha, Basnet, and Kanskar, 2013). Based on the previous findings, the authors are interested in studying more deeply chest x-ray projections, their role in pediatrics with clinical HIV infection, and the characteristics of each HIV OIs.…”