STREPTOCOCCUS-PNEUMONIAE BACTEREMIA IN CHILDREN INFECTED WITH HIV - PRESENTATION, COURSE, AND OUTCOME

Objective: To examine the presentation, course, and outcome of pneumoc occal bacteremia in children infected with human immunodeficiency viru s (HIV). Methods: A retrospective series of HIV-infected children less than 18 years of age with Streptococcus pneumoniae bacteremia from fo ur urban, tertiary care hospitals was evaluated. The main outcome meas ures included persistent bacteremia, the development of a focal infect ion, and death. Results: Seventy-two episodes of pneumococcal bacterem ia were identified in 59 patients. Fifty-four first episodes were incl uded; 26/54 were occult, Mean temperature was 39.8 degrees C, In patie nts with bacteremia, white blood cells (WBCs) greater than or equal to 15,000 and greater than or equal to 10,000 had sensitivities of 40% a nd 75%, respectively. At the time of bacteremia, age >3 years old was associated with a lower mean WBC count compared with episodes occurrin g in patients <3 years old (11.2 vs 16.1, P < 0.05), Patients with occ ult bacteremia who were discharged with antibiotics (12 i.m., 7 p.o.) were less likely than patients without antibiotic treatment to have pe rsistent bacteremia at a return visit within 72 hours (0/19 vs 2/5, P < 0.05), No patient with occult bacteremia died, progressed to clinica l meningitis, or had other sequelae, Two of fifty-four patients died a s a result of their first episode of invasive pneumococcal disease, Bo th patients who died had meningitis and appeared ill on initial presen tation Conclusions: Neither a WBC count greater than or equal to 15,00 0 nor greater than or equal to 10,000 is a sensitive indicator of pneu mococcal bacteremia in HIV-infected children, Empiric antibiotics are useful to decrease the risk of persistent bacteremia. Children infecte d with HIV who have occult pneumococcal bacteremia appear to do well w ith appropriate antibiotics. Patients who are afebrile and well appear ing on reevaluation may be safely treated as outpatients.