520Helicobacter pylori infection in parents and their children

Background Helicobacter pylori (H.pylori) may be commonly transmitted among family members, especially from parents to their children. Therefore, we investigated the prevalence of H.pylori infection in parents and their children. Method The subjects (n = 607) were selected from participants of the Japan Multi-Institutional Collaborative Cohort Study in Okazaki, Japan, which was conducted from November 2018 to March 2019, and their families. Of the 607 subjects, 126 subjects (32 men=fathers, 94 women=mothers) participated in this study with at least one of their children (126 children in total). We defined ‘H.pylori infection+’ as 1) H.pylori antibody titer≥3U/mL or 2) pepsinogen I ≤ 70ng/mL with the ratio of pepsinogen I/II≤3.0 or 3) past eradication of H.pylori or 4) past history of gastric cancer. The prevalence of ‘H.pylori infection+’ was compared with between mothers and fathers who has infected children. Finally, the 94 mothers were divided into two groups according to their birth-year (1936-1963 and 1964-1973), and we compared the prevalence of ‘H.pylori infection+’ in mothers and their children by group. Result The prevalence of ‘H.pylori infection+’ in mothers and fathers was 44 (46.8%) and 9 (28.1%), respectively. 13 (29.5%) of the 44 infected mothers had at least one infected child, but the infected fathers did not have infected children. The prevalence of ‘H.pylori infection+’ in 50 mothers born in 1936-1963 was 28 (56.0%), and 9 (32.1%) of the 28 infected mothers had at least one infected child. The prevalence of ‘H.pylori infection+’ in 44 mothers born in 1964-1973 was 16 (36.4%), and 4 (25.0%) of the 16 infected mothers had at least one infected child. Conclusion In family members, H.pylori may be transmitted mainly from mothers, rather than from fathers, to their children. Key messages Among Japanese, the prevalence of H.pylori infection will decrease with decline of the infection in women.

Disclosure of human immunodeficiency virus status to children: Pattern followed by parents and caregivers

Background: Disclosure of human immunodeficiency virus (HIV) status may be perceived as simply the process of revealing a person’s HIV status, whether positive or negative. Despite the emerging evidence of the benefits of disclosure, who, when and what to disclose to a HIV-infected child remains a challenge.Aim: This article reports on the patterns of HIV status disclosure to the infected children by their parents and caregivers.Setting: The study was conducted in the outpatient clinic of one referral hospital offering comprehensive HIV care in the Lubombo region, eSwatini.Methods: A qualitative descriptive design was followed. Data were collected through semi-structured individual interviews with a purposive sample of 13 parents and caregivers whose children were on antiretroviral treatment and collecting treatment from the specific outpatient clinic. Audio recorded data were transcribed verbatim, thematic content analysis was done and used to organise and present the findings.Results: Four themes that emerged in relation to the topic of patterns of disclosure were disclosure of HIV status as a process rather than an event, a proposed person to disclose the HIV status to the child, the appropriate age to disclose HIV status to a child and type and amount of information to give in relation to the HIV status. The proposed person to disclose the HIV status to the infected child was the parent or caregiver involved as the primary carer of the child. There was no agreeable appropriate age to disclose HIV status to an infected child and the type and amount of information to disclose varied with the individuals depending on what prompted disclosure.Conclusion: Human immunodeficiency virus disclosure to children demands parents’ and caregivers’ participation and their knowledge of child development.

The initial intravenous treatment of a human immunodeficiency virus-infected child with complicated abdominal tuberculosis

Introduction: There is very limited published experience with intravenous (IV) antituberculosis (anti-TB) and antiretroviral therapy (ART) especially in children. We have described a human immunodeficiency virus (HIV)-infected child with complicated abdominal tuberculosis who was initially treated with IV anti-TB and a partially IV ART regimen before transitioning to oral therapy.Patient presentation: A 3-year-old boy presented with hypovolaemic shock with a 3-day history of inability to pass stools, abdominal distension and bile-stained vomiting. Abdominal ultrasound and X-ray showed small-bowel obstruction. Human immunodeficiency virus antibody testing was positive, and Cluster of Differentiation (CD)4+ lymphocyte count was 56 cells/mL (15%). Xpert Mycobacterium tuberculosis (MTB)/Rifampicin (RIF) Ultra and TB culture on induced sputum detected MTB complex sensitive to rifampicin and isoniazid.Management and outcome: Following laparotomy and closure of bowel perforations, the child was commenced on IV rifampicin, moxifloxacin and amikacin. Amikacin was stopped after 3 days because of nephrotoxicity, and meropenem and IV linezolid were added. After 20 days, ART comprising IV zidovudine, oral lamivudine solution, oral lopinavir/ritonavir solution and additional oral ritonavir solution for super boosting was commenced. By day 40, the patient was well established on oral feeds and was switched to standard oral anti-TB medications. Sputum examined 1 month after starting the treatment was found culture-negative for MTB. After 4 months of treatment, the HIV viral load was 100 copies/mL. He completed a total of 12 months of anti-TB treatment.Conclusion: Despite limited experience and few available IV formulations of standard anti-TB and ARV medications, initial IV therapy may be beneficial for patients in whom oral medication is not an option.

The report of cardiomyopathy and mid aortic syndrome in a HIV infected child

Cardiomyopathy is a serious complication of Human Immunodeficiency virus (HIV) infection. Direct effects of HIV, cardiac autoimmunity, opportunistic infections (OIs), nutritional deficiencies (selenium) and severe immunesuppression have been implemented for HIV related cardiomyopathy (HIVAC) ; Elevated anti-alpha myosin antibodies in HIV infection cause cardiac autoimmunity, selenium deficiency leads to cardiomyopathy, myosite invasion and cytokine release cause myocarditis whereas zidovudine triggers reversible and dose dependent myocyte toxicity.