The prevalence of abnormal chest radiography findings among HIV infected children

Abstract

Background Human Immunodeficiency virus infected children are highly susceptible to opportunistic infections of the respiratory system which are the most common cause of morbidity and mortality. The chest radiograph is the most frequently requested examination. Its applications include screening, diagnosis and monitoring response to medication of respiratory illnesses. Objective: To determine the prevalence of abnormal chest radiograph findings among HIV infected children. Setting: Kenyatta National Hospital and Mbagathi District Hospital general paediatrics wards and Comprehensive Care Clinic. Design: A hospital based cross-sectional study. Study Justification: The prevalence of abnormal chest radiograph findings of HIV infected children in our setting has not been documented. This study provides baseline data that can be used to develop future diagnostic algorithms. Participants: HIV infected children age 1 month to 15 years admitted in KNH or MDH general paediatric ward or on follow-up at the CCC outpatient clinic. Study Procedure: HIV infected children who met the inclusion criteria including informed consent from their guardian(s) were recruited. A structured questionnaire was used to collect data on patient demographics, clinical symptoms and chest radiograph findings through guardian/parent interviewing and chest radiograph assessment. The chest radiographs were interpreted by two independent qualified radiologists. xi Sampling procedure: Consecutive and convenient sampling. Study Duration: Four months (November 2014 and February 2015). Results: A total of 123 HIV infected children were studied. Normal chest radiographs were found in 54/123 (43.9%) while 69/123 (56.1%) had abnormal chest radiographic findings. Pulmonary opacities were identified in the majority of patients with abnormal chest radiographs (66.7%) while 28% showed lymphadenopathy. In the pulmonary opacities, “other infiltrate‟‟ (60.9%) was found to be more common than consolidation (39.1%). Pleural effusions were not common while cavitary lesions and pneumothorax were not identified. There was no significant association between the radiographic findings and the children‟s age and sex. The most common symptom was cough (86%), of which 22% was productive of sputum. A significant number of children had features of respiratory distress (48.8%) as well as weight loss (32%) and night sweats (23%). The findings of this study correlated well with similar studies in Africa. Conclusion: HIV infected children, especially those below the age of 5 years, are highly susceptible to chest infections. This was seen in the high incidence of cough and severe respiratory distress as well as the significant number of abnormal chest radiograph findings. The chest radiograph has been shown to be a useful study in detection of pulmonary disease in symptomatic children with HIV and the radiologist can assist in narrowing the differential diagnosis. The high prevalence of „other infiltrate‟ in this study may indicate that the causative pathogen may not respond to standard antibiotic regimes; however more clinical studies to confirm this is required. xii Recommendation: Due to the non-specific nature of abnormal chest radiograph findings in children with HIV, correlation with the level of immune suppression as well as the clinical and laboratory findings is vital. The addition of baseline chest radiographs to our local protocols may enable early diagnosis of chest infections especially pulmonary tuberculosis as well as establish whether abnormal chest radiograph findings in symptomatic children are new lesion. Study Limitations: The chest radiograph findings were not compared to laboratory findings and level of immune suppression due to budgetary constraints