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Respiratory diseases are common in children in sub-Saharan Africa. They are usually treated empirically and there is little information about the pathology of fatal diseases. A study in Zambia (Chifumbe Chintu and colleagues.
) has illustrated the range of pathology.
At the university hospital in Lusaka between 15 September 1997 and 15 June 2000 a total of 1603 children aged between 1 month an 16 years died from respiratory illnesses. Of those parents approached for permission for a restricted (chest only) autopsy 75% refused. Two hundred and sixty-four autopsies were performed. Multiple lung pathology was common; a total of 357 main diagnoses were made in the 264 children. They included acute pyogenic pneumonia (44%), Pneumocystis carinii pneumonia (22%), tuberculosis (20%), cytomegalovirus infection (16%) (mostly mild but three cases of severe necrotising CMV pneumonia), interstitial pneumonitis (11%), shock lung (10%), pulmonary oedema (7%), and lymphocytic interstitial pneumonia (4%). Seven children had measles.
One hundred and eighty of the 264 children were HIV-positive. P carinii pneumonia, CMV, shock lung, and lymphocytic interstitial pneumonitis were more common in the HIV-positive group although acute pyogenic pneumonia was the most common finding in both groups. Of the 58 cases of P carinii pneumonia 52 were HIV positive and 45 of those were infants, 39 under 6 months. All six HIV-negative cases were under 6 months. Tuberculosis occurred at all ages and in both HIV-positive and HIV-negative children.
Many children die of preventable or treatable disease and better tests for pathogens are needed. WHO guidelines do not mention the management of HIV-positive children specifically and these authors call for that omission to be corrected.