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Epidemiology
Epidemiology
In 2013, 240,000 children younger than 15
years of age were newly infected with HIV
bringing the total number of children worldwide
living with HIV or acquired immune deficiency
syndrome (AIDS) to 3.2 million or approximately
9 percent of all people living with AIDS
It is estimated that 343,460 adults are in need of AntiRetroviral Therapy (ART).
Definition of HIV
HIV infection is a condition caused by
Human Immunodeficiency Virus (HIV).
This condition gradually destroys the
immune system, which makes it hard for the
body to fight infections.
It causes acquired immunodeficiency virus
(ADIS).
Difference between
HIV-1 & HIV-2:
HIV-2 is lower transmissibility.
HIV-2 develops more slowly.
MTCT )Mother to child transmission) is
relatively rare with HIV-2.
HIV-2 is found primarily in West Africa.
HIV-1 is more common worldwide.
V
I
H
f
o
s
e
g
Sta
With its
symptoms
Stage 1:
Primary HIV Infection
The first stage is called acute infection.
It is often accompanied by a short flu-like illness
It typically happens within 2 to 6 weeks after
exposure or becoming infected.
During this stage there is a large amount of HIV in
the peripheral blood and the immune system begins to
respond to the virus by producing HIV antibodies.
This process is known as (seroconversion).
Fatigue
Fever
vomiting
Sore throat
Diarrhea that
lasts for more
than a week
Stage 2:
Clinically Asymptomatic Stage
Stage 3:
Symptomatic HIV Infection
AIDS (acquired immune deficiency
syndrome) is the advanced stage of HIV
infection. When the CD4 T-cell number drops
below 200, people are diagnosed with AIDS.
Diagno
sis
Cont ..
Western blot.
This test is more difficult than the ELISA to
perform.
Polymerase chain reaction (PCR).
This test finds either the RNA of the HIV virus
or the HIV DNA in white blood cells infected
with the virus.
CD4 cells are a type of white blood cell that's specifically targeted
and destroyed by HIV.
Viral load:
Babys investigation of
HIV after birth
Most HIV tests look for antibodies to HIV, not the
virus itself. But these tests arent very useful for babies
born to HIV-positive mothers.
WHY ?
Thats because the mothers HIV antibodies get into the
babys blood during pregnancy. If the mother is HIVpositive, the regular HIV test will show that the baby is
HIV-positive, even when that isnt true.
Treatment
Treatment
Anti-retroviral medicines work by stopping the HIV from
making copies of itself .
To strengthen the immune system.
The amount of virus in your body (viral load) is
decreased.
Allows your body to make more CD4 T cells.
Commonly three different types of medicines are taken
together. This is called combination therapy. And that helps
to prevent the virus from becoming resistant to the
medicines. These medicines are usually taken for life.
Preventi
on
CASE REPORT
Name
: MA
Age : 6 years 6 month
Sex : Female
MR : 00.62.36.60
Date of Admission : 14th November2014
Chief Complaint: Diarrhea
History:
Since approximately 3 weeks ago, having diarrhea non-stop , 3
times in 1 day with volume aqua bottle size.
Children complain of cough (+), appetite decreased (+) and fever
(+), the child looks weak (+), chills (-), seizures (-). In addition to
fever patients do not experience red eyes (-), cough (-), cold (-),
nausea (+), vomiting (+), weight loss (+) 5kg within 3 months
Urinary pain (-), red or murky urin (-), back pain (-), slightly
urin (-), liquid form defecation (-), hard defecation (-), black
defecation (-).
Patient was referred to the emergency room laboratories
Adam Malik Hospital, Medan. In the ER RS.H.Adam Malik,
Medan
History of previous illness : Patients were referrals from
the general hospital of Kabanjahe by pediatrics specialist
doctor with diagnosis of malnutrition and TB Primer.
History of drugs : Ceforaxime, Paracetamol and OAT
Pregnant History
: She is third child, age of
the mother when pregnant patients is 27 years old,
maternal history of fever (-), diabetes (-), hypertension
(-), taking birth control pills (-), drinking herbs (-) and
drugs (-), and Father of child is diagnosed as TB patient
and undergoing OAT medicine.
Birth History
: Spontaneous; aterm;
attended by midwives; crying (+); history of blue (-);
BW2500 gram; BL 46 cm.
Immunization History
: BCG, Hepatitis B, DPT,
Polio Vaccines were complete
PRESENS STATUS
Consciousness: Alert
Body temperature: 38,6 oC
HR : 96 bpm
RR : 24 x/i
Blood pressure : 100/60 mmHg
Body Weight : 12kg
Body Length : 102cm
Anemic (+) Icteric (-) Cyanosis (-) Edema (-)
Dyspnea (-).
LOCALIZED STATUS
Head
Eye: Isochoric pupil (3mm/3mm), light reflex (+/+), inferior palpebra conjunctiva pale
(-/-), icteric sclera (-/-).
Nose and Ear were within normal limit
Mouth: Lips mucosa pale (-).
Neck
TVJ R-2 cmH2O, Lymph node enlargement (-)
Thorax
Symmetrical fusiformis, Chest retraction(-), HR : 96 bpm, reguler, murmur (-), RR: 22
x/i, regular, rales (-/-).
Abdomen
Rapid turgor. Normoperistaltic. Liver was palpable with 2cm, spleen and renal
unpalpable
Extremities
Pulse 96 bpm, regular, adequate pressure and volume, warm acral, CRT < 3, Blood
Pressure 90/60 mmHg
Urogenital
Female , within normal limit.
Working Diagnosis:
Suspected TB milier, suspected HIV and Malnutrition
Management:
Diet F 75 130cc/2hr/with Mineral Mix 2,6cc
Rifampisin 1150mg
INH 1100mg
Pirazinamid 1150mg
Prednisolon 115mg
Vitamin A 1200mg
Asam Folat 150mg
Multivitamin without Fe 11 cth
Follow up
Diarrhea (+)
Head
Neck
Thorax
enlargement (-).
Symmetrical fusiformis, Chest retraction
(-), HR : 96 bpm, reguler, murmur (-), RR:
22 x/i, regular, rales (-/-).
Abdomen
Extremities
Genital
Diet F 75 130cc/2hr/with
Mineral Mix 2,6cc
Rifampisin 1150mg
INH 1100mg
Pirazinamid 1150mg
Prednisolon 115mg
Vitamin A 1200mg
Asam Folat 150mg
Multivitamin without Fe 11
cth
Diagnostic Planning :
Consul division of
respiratory and
pulmonulogy
Consul division of nutrition
and metabolic disease
Consul division of social
pediatric
Consul division of allergy
and immunology
November 15th
2014
S
Head
Neck
Thorax
enlargement (-).
Symmetrical fusiformis, Chest retraction
(-), HR : 96 bpm, reguler, murmur (-), RR:
Abdomen
Extremities
unpalpable.
Pulse 96 bpm, regular, adequate pressure
Genital
Susp. TB milier +
susp. HIV and
Malnutrition
Diet F 75
130cc/2hr/with
Mineral Mix 2,6cc
Rifampisin 1150mg
INH 1100mg
Pirazinamid
1150mg
Prednisolon 115mg
Vitamin A 1200mg
Asam Folat 150mg
Multivitamin without
Fe 11 cth
Diagnostic
Planning:
Consul division of
nutrition and
metabolic disease
November 16th
2014
S
Head
Neck
Thorax
enlargement (-).
Symmetrical fusiformis, Chest retraction
(-), HR : 96 bpm, reguler, murmur (-), RR:
Abdomen
Extremities
unpalpable.
Pulse 96 bpm, regular, adequate pressure
Genital
Susp. TB milier +
susp. HIV and
Malnutrition
Diet F 75
130cc/2hr/with
Mineral Mix 2,6cc
Cotrimoxazole
1240mg
Rifampisin 1150mg
INH 1100mg
Pirazinamid 1150mg
Prednisolon 115mg
Vitamin A 1200mg
Asam Folat 150mg
Multivitamin without
Fe 11 cth
November 17th
2014
S
Head
Neck
Thorax
enlargement (-).
Symmetrical fusiformis, Chest retraction
(-), HR : 96 bpm, reguler, murmur (-), RR:
Abdomen
Extremities
Genital
Susp. TB milier +
Susp. HIV and
Malnutrition
Diet F 75
130cc/2hr/with
Mineral Mix 2,6cc
Cotrimoxazole
1240mg
Rifampisin 1150mg
INH 1100mg
Pirazinamid 1150mg
Prednisolon 115mg
Vitamin A 1200mg
Asam Folat 150mg
Nystatin 41 cc
Multivitamin without
Fe 11 cth
November 18th
2014 November
24th 2014
S
Head
Neck
Thorax
enlargement (-).
Symmetrical fusiformis, Chest retraction
(-), HR : 96 bpm, reguler, murmur (-), RR:
22 x/i, regular, rales (-/-).
Abdomen
Extremities
Susp. TB milier +
Susp. HIV and
Malnutrition
November 25th
2014
November29th 2014
S
Head
Neck
Thorax
enlargement (-).
Symmetrical fusiformis, Chest retraction
(-), HR : 96 bpm, reguler, murmur (-), RR:
Abdomen
Extremities
unpalpable.
Pulse 96 bpm, regular, adequate pressure
Genital
Susp. TB milier +
Susp. HIV and
Malnutrition