HIV infection is rapidly becoming a major health
problem in Indian children(1-3). Between 20%-50% of HIV infected
patients develop oral lesions which suggest HIV disease progression.
Parotid gland enlarge-ment occurs in approximately 0.8% of adults and
4-47% of children with HIV infection(4). The present report deals with
a HIV positive child who had recurrent parotitis and also reviews the
significance of parotid gland enlargement in the disease progression.
A female child presented with four attacks of
parotid swellings from 18 to 27 months of age. Montoux test was
borderline positive (8 mm ´ 8 mm)
but chest X-ray showed right sided miliary shadows. Both
parents and the child were HIV seropositive by ELISA done twice with
two different kits. The parotitis resolved spontaneously in the first
attack but required clarithromycin and ciprofloxacin in subsequent
attacks. She was put on antitubercular treatment.
The most common oral lesion in HIV children is
candidiasis, others are parotid enlargement, herpes simplex and hairy
leuko-plakia(5). Little has been described about the prevalence and
prognostic significance of parotitis. Early detection of HIV related
oral lesions can be used to diagnose HIV infection and predict
prognosis of the diseases. Parotitis will be chronic and often
associated with lymphoid interstitial pneumonitis (LIP).
Histologically lymphocytic infiltration is seen which may be caused by
Epstein-Barr virus.
A study from San Francisco showed 72% had oral
candidasis and 47% parotid enlarge-ment. The median time from birth to
develop-ment of a lesion for oral candidiasis was of 2.4 yrs, while
the same was 4.6 yrs for parotid enlargement. The authors noted that
oral candidasis was associated with signficantly more rapid rate of
progression to death while parotid enlargement had a slower rate of
progression(5). Relative hazard of death for oral candidasis was 14.2,
for parotitis 0.38 and for herpes simplex 1.3 in the San Francisco
study(5).
Observers from the developing countries are of the
opinion that many children do not fulfill the standard WHO criteria
for screen-ing and diagnosis of Pediatric AIDS(2,6). In one of the
African study parotitis had 67% positive predictive value for
diagnosis compared to 47% for chronic diarrhea and 53% for oral
candidiasis(7). Hence, any child having chronic or recurrent parotitis
should be investigated for HIV. More studies from developing countries
with diverse geocultural and medical practices are needed to endorse
the above recommendation.
Parvat V. Havaldar,
Professor and Head,
Department of Pediatrics,
Karnataka Institute of Medical Sciences,
Hubli 580 002, India.
E-mail: [email protected]
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