Infections in children with human immunodeficiency virus/acquired immunodeficiency syndrome: An autopsy study of 30 cases in south Florida, 1990-1993

Thirty autopsies performed on infants and children with HIV infection and/or AIDS were reviewed for the presence and type of infection. Twenty-six (87%) demonstrated evidence of infection in addition to HIV at the time of postmortem examination. Pathogenic bacterial infections were the most frequently encountered, seen in 15 of the cases. Nine of the 15 (60%) were due to gram-negative rods, most commonly Pseudomonas aeruginosa. Infections with gram-negative organisms often involved multiple organ systems and were frequently undiagnosed both pre -and postmortem because of variability in culture results and difficulties in identification both clinically and in tissue sections. Discussion is presented of unusual staining characteristics and filamentous morphology found with these pathogens. Other pathogenic bacteria encountered were Klebsiella pneumoniae, Escherichia coli, Enterobacter sp., and Staphylococcus. Fungal infections due to Candida species were present in nine cases (31 %) but were invasive in only two of these. One instance of Aspergillus meningo-encephalitis was noted. Proven viral infections were present in five children (three cytomegalovirus, one herpes simplex, and one adenovirus). Pneumocystis carinii pneumonia was diagnosed in five of the patients (17%), and one instance of disseminated Mycobacterium avium-intracellulare was encountered..