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Letters to the Editor

Indian Pediatrics 2001; 38: 679-680  

Recurrent HIV Parotitis

 

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: pvhavaldar@usa.net

 References

1. Merchant RH, Shorff RC. HIV seroprevalence in disseminated tuberculosis and chronic diarrhea. Indian Pediatr 1998; 35: 883-887.

2. Daga SR, Verma B, Gosavi DV. HIV infec-tion in children: Indian experience. Indian Pediatr 1999; 36: 1250-1253.

3. Dhurat R, Mangalani M, Sharma R, Shah NK. Clinical spectrum of HIV Infection. Indian Pediatr 2000; 37: 831-836.

4. Patton LL, Vander Horst. Oral infections and mainfestations of HIV disease. Infect Dis Clin North Am 1999; 13: 879-900.

5. Katz MH, Mastruccl MT, Leggott PJ, Westenhouse, Greenspan J, Scott GB. Prog-nostic significance of oral lesions in children with perinatally acquired human immuno-deficiency virus infection. Am J Dis Child 1993; 147: 45-48.

6. Havaldar PV, Patil M. HIV seroprevalance by ELISA in high risk Indian children and their presentation. J Trop Pediatr 2001; 47: 119-120.

7. Lepage P, van de Pere P, Dabis F, Commeages De Orbinski J, Hitima DG, et al. Evaluation and simplification of the World Health Organization clinical case definition for Pediatric AIDS. AIDS 1989; 3: 221-225.

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