title: Lung infiltrates in antiretroviral-naive HIV-infected children with chronic lung disease: value of non-bronchoscopic bronchoalveolar lavage in the detection of Candida albicans.
abstract: OBJECTIVE
  To describe the etiology of lung infiltrates in HIV-infected antiretroviral-naive children with chronic persistent/recurrent lung disease in whom routine cultures were negative and were non-responders to World Health Organization standard antimicrobial therapy.
  
  
  METHODS
  Non-bronchoscopic bronchoalveolar lavage (NBBAL) was performed on these non-responders.
  
  
  RESULTS
  Fifty children were enrolled. Single isolates on NBBAL were seen in 28 cases, dual pathogens in 5 cases and no growth in 14 cases. Haemophilus influenzae (n = 12), Candida albicans (n = 5) and Mycobacterium spp. other than tuberculosis (n = 4) were the commonest pathogens seen. Eight cases with no growth had segmental or lobar collapse: in five cases, NBBAL was therapeutic and in two cases, a diagnosis of lymphoma was made on open lung biopsy. Thirty-two of the 38 cases (84%) had favorable outcomes on follow-up.
  
  
  CONCLUSIONS
  Haemophilus influenzae, C. albicans and Mycobacterium spp. other than tuberculosis are important pathogens in children with HIV and HIV-associated chronic lung disease.
authors.affiliation: Department of Paediatrics and Child Health, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Radhika
authors.initials: R
authors.lastname: Singh
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Thula
authors.forename: Prakash M
authors.initials: PM
authors.lastname: Jeena
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D018893:Bronchoalveolar Lavage / Q000009:adverse effects / Q000379:methods*; D002176:Candida albicans / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008171:Lung Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology; D008297:Male; D017678:Sex Distribution; D013019:South Africa