Bowel obstruction in an infant with AIDS

DISCUSSION Mortality among children in South Africa with vertically acquired HIV infection is high in the first year of life, 4 with 83% of children in one cohort from Durban dying before 10 months of age. 4 This is in stark contrast with the 10% mortality rate by the age of 1 year reported by the European Collaborative Study. 5 Malnutrition and perinatal coinfection such as tuberculosis, syphilis, and cytomegalovirus is associated with rapidly progressive HIV-1 and early death. 2, 6 Gastrointestinal (GI) illness is the second most common presenting complaint in children with HIV infection (after respiratory illness) and diarrhoea, poor nutritional status, and failure to thrive are extremely common. 4, 7 The most frequent GI symptom is gastroenteritis, 3 but odynophagia and dysphagia due to oesophagitis in the presence of Candida albicans, cytomegalovirus (CMV), or herpes simplex virus 1 is common. 7 Overall, GI morbidity is mainly related to infection; although diarrhoea may be due to the more typical organisms such as Salmonella, Shigella, and Campylobacter, the commonest causes of AIDS related enteritis are the protozoa Cryptosporidium and Isospora belli. 7 CMV can cause severe infection of the small bowel in AIDS patients, leading to mucosal ulceration, enterocolitis, severe haemorrhage, obstruction, or perforation. 8, 9 These complications represent the commonest gastrointestinal surgical manifestations of AIDS in infancy. 7 Severe, multifocal CMV enterocolitis has been reported as the cause of small bowel obstruction (SBO) in an infant with AIDS.