STREPTOCOCCUS-PNEUMONIAE IN HUMAN-IMMUNODEFICIENCY-VIRUS TYPE 1-INFECTED CHILDREN

The purpose of this study was to characterize systemic Streptococcus p neumoniae disease in human immunodeficiency virus type 1 (HIV-1)-infec ted children. All cases of bacteremia and meningitis caused by S. pneu moniae among children less than 18 years old were collected by review of the Microbiology Laboratory records at the Bellevue Hospital Center during the period August 1, 1978, through July 31, 1993. There were 3 1 bouts of systemic S. pneumoniae disease in 19 of 235 HIV-1-infected children cared for by the Pediatric Infectious Disease staff and 116 b outs in 113 children not known to be HIV-1-infected. Four of the 19 HI V-1-infected children had multiple episodes of S. pneumoniae bacteremi a as compared with 3 of 113 in the general population (P = 0.008). The frequency of serotypes and distribution of infections by season of th e year did not differ between the 2 groups. The median ages at the tim e of the S. pneumoniae infection were 1.8 and 1.1 years for the HIV-1- infected children and the general population of children, respectively , when those children with multiple episodes were included for their i nitial episode only (P = 0.06). In the HIV-1-infected patients, 10 epi sodes were associated with pneumonia, 5 with pneumonia and otitis medi a, 5 with otitis media only, 1 with pneumonia and meningitis, 1 with m eningitis only and 1 with periorbital cellulitis; 5 had no apparent fo cus of infection. One episode of pneumonia was complicated by lung abs cess and there were 2 deaths. Most HIV-1-infected patients recovered w ithout significant sequelae, and the clinical course of their systemic infections did not appear to be markedly different than that of healt hy children.