Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country

Main Article Content

H Peens-Hough
P Goussard
D Rhode
L van Wyk
J Janson

Abstract





Background. Bronchiectasis (BE) in children living with HIV (CLWH) remains a significant cause of morbidity and mortality, especially in tuberculosis (TB)-endemic low- and middle-income countries. Treatment modalities for BE in CLWH currently focus mainly on prevention of infections and management of symptoms, while surgical management is indicated for a select group. In contrast, surgical management in non-cystic fibrosis BE is well established.


Objectives. To describe the indications for and complications of surgical resection for BE in CLWH, and to identify variables influencing outcome.


Methods. A retrospective medical records review was conducted of all CLWH aged ≤14 years who underwent surgical resection for BE at Tygerberg Hospital, Cape Town, South Africa, between 1 January 2007 and 30 September 2014. The variables collected included immune status, antiretroviral treatment (ART), previous treatment for TB, operative and postoperative complications, and postoperative symptom relief.


Results. Twelve CLWH on ART with symptomatic BE underwent surgical resection. The mean age was 7 years and the mean CD4 count 970 cells/μL. Indications for surgery included recurrent infections, chronic cough and persistent lobar collapse. The most common procedures were left lower lobe lobectomy (42%), left pneumonectomy (17%) and right bilobectomy (17%). Complications were limited to persistent pneumothorax after surgery in one child. There were no deaths. Ten children (83%) showed significant improvement of symptoms at follow-up.


Conclusion. Surgical resection for BE in CLWH can be performed safely with a low complication rate, resulting in significant improvement of symptoms postoperatively.





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How to Cite
1.
Peens-Hough H, Goussard P, Rhode D, van Wyk L, Janson J. Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country. Afr J Thoracic Crit Care Med [Internet]. 2024 Oct. 14 [cited 2024 Dec. 10];30(3):e1128. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/1128
Section
Original Research: Articles

How to Cite

1.
Peens-Hough H, Goussard P, Rhode D, van Wyk L, Janson J. Surgery for bronchiectasis in children living with HIV: A case series from a low- to middle-income country. Afr J Thoracic Crit Care Med [Internet]. 2024 Oct. 14 [cited 2024 Dec. 10];30(3):e1128. Available from: https://samajournals.co.za/index.php/ajtccm/article/view/1128

References

1. Sheikh S, Madiraju K, Steiner P, Rao M. Bronchiectasis in pediatric AIDS. Chest 1997;112(5):1202-1207. https://doi.org/10.1378/chest.112.5.1202

2. Stafler P, Carr SB. Non-cystic fibrosis bronchiectasis: Its diagnosis and management. Arch Dis Child Educ Pract Ed 2010;95(3):73-82. https://doi.org/10.1136/adc.2007.130054

3. Statistics South Africa. P0302 Mid-year population estimates 2017. Statistical release

P0302. Pretoria: Stats SA, 2017. https://www.statssa.gov.za/publications/P0302/P0 3022017.pdf (accessed January 2024).4. Poolman M, van der Walt N, Luwaca B. Annual progress report 2015/16: Western Cape Provincial AIDS Council. https://sanac.org.za//wp-content/uploads/2018/08/ Western-Cape.pdf (accessed January 2024).

5. World Health Organization. Global tuberculosis report 2020. 15 October 2020. https://www.who.int/publications/i/item/9789240013131 (accessed January 2024).

6. Zar HJ. Pneumonia in HIV-infected and HIV-uninfected children in developing

countries: Epidemiology, clinical features, and management. Curr Opin Pulm Med

2004;10(3):176-182. https://doi.org/10.1097/00063198-200405000-00006

7. Zar HJ. Chronic lung disease in human immunodeficiency virus (HIV) infected

children. Pediatr Pulmonol 2008;43(1):1-10. https://doi.org/10.1002/ppul.20676

8. Berman DM, Mafut D, Djokic B, Scott G, Mitchell C. Risk factors for the development of bronchiectasis in HIV-infected children. Pediatr Pulmonol 2007t;42(10):871-875.

https://doi.org/10.1002/ppul.20668

9. Ferrand RA, Luethy R, Bwakura F, Mujuru H, Miller RF, Corbett EL. HIV infection presenting in older children and adolescents: A case series from Harare, Zimbabwe. Clin Infect Dis 2007;44(6):874-878. https://doi.org/10.1086/511873

10. Masekela R, Anderson R, Moodley T, et al. HIV-related bronchiectasis in children: An emerging spectre in high tuberculosis burden areas. Int J Tuberc Lung Dis 2012;16(1):114-119. https://doi.org/10.5588/ijtld.11.0244

11. Ferrand RA, Desai SR, Hopkins C, et al. Chronic lung disease in adolescents with delayed diagnosis of vertically acquired HIV infection. Clin Infect Dis 2012;55(1):145- 152. https://doi.org/10.1093/cid/cis271

12. Mwalukomo T, Rylance SJ, Webb EL, et al. Clinical characteristics and lung function in older children vertically infected with human immunodeficiency virus in Malawi. J Pediatric Infect Dis Soc 2016;5(2):161-169. https://doi.org/10.1093/jpids/piv045

13. McHugh G, Rylance J, Mujuru H, et al. Chronic morbidity among older children and adolescents at diagnosis of HIV infection. J Acquir Immune Defic Syndr 2016;73(3):275-281. https://doi.org/10.1097/QAI.0000000000001073

14. Weber HC, Gie RP, Cotton MF. The challenge of chronic lung disease in HIV-infected children and adolescents. J Int AIDS Soc 2013;16(1):18633. https://doi.org/10.7448/ IAS.16.1.18633

15. Ötgün İ, Karnak İ, Tanyel F, Şenocak M, Büyükpamukçu N. Surgical treatment of bronchiectasis in children. J Pediatr Surg 2004;39(10):1532-1536. https://doi. org/10.1016/j.jpedsurg.2004.06.009

16. Andrade CF, Melo IA, Holand AR, Silva ÉF, Fischer GB, Felicetii JC. Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children. Pediatr Surg Int 2014;30(1):63-69. https://doi.org/10.1007/s00383-013-3420-7

17. Redding GJ. Bronchiectasis in children. Pediatr Clin North Am 2009;56(1):157-171.

https://doi.org/10.1016/j.pcl.2008.10.014

18. World Health Organization. Global tuberculosis report 2015, 20th ed. https://apps.

who.int/iris/handle/10665/191102 (accessed January 2024).

19. De Jongste JC, Shields MD. Cough 2: Chronic cough in children. Thorax

2003;58(11):998-1003. https://doi.org/10.1136/thorax.58.11.998

20. Cohen R, Just J, Koskas M, et al. Infections respiratoires récidivantes: Quels bilans, quels traitements? [Recurrent respiratory tract infections: How should we investigate and treat?]. Arch Pediatr 2005;12(2):183-190. https://doi.org/10.1016/j.

arcped.2004.11.013

21. World Health Organization. WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. 2007. https://apps.who.int/iris/handle/10665/43699 (accessed January 2024).

22. Attia EF, Weiss NS, Maleche Obimbo E, et al. Risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi. Pediatr Infect Dis J 2017;36(4):e93-e97. https://doi.org/10.1097/INF.0000000000001453

23. Verwey C, Gray DM, Dangor Z, et al. Bronchiectasis in African children: Challenges and barriers to care. Front Pediatr 2022;10:954608. https://doi.org/10.3389/fped.2022.954608 24. Masekela R, Vosloo S, Venter SN, de Beer WZ, Green RJ. The lung microbiome in children with HIV-bronchiectasis: A cross-sectional pilot study. BMC Pulm Med

2018;18(1):87. https://doi.org/10.1186/s12890-018-0632-6

25. Githinji L, Zar HJ. Respiratory complications in children and adolescents with human

immunodeficiency virus. Pediatr Clin North Am 2021;68(1):131-145. https//doi.

org/10.1016/j.pcl.2020.09.016

26. Theodoratou E, McAllister DA, Reed C, et al. Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: A meta-analysis and modelling study. Lancet Infect Dis 2014;14(12):1250-1258. https://doi.org/10.1016/ S1473-3099(14)70990-9

27. Fry SH, Barnabas SL, Cotton MF. Tuberculosis and HIV – an update on the ‘cursed duet’ in children. Front Pediatr 2019;7:159. https://doi.org/10.3389/fped.2019.00159 28. Desai SR, Nair A, Rylance J, et al. Human immunodeficiency virus-associated chronic

lung disease in children and adolescents in Zimbabwe: Chest radiographic and high- resolution computed tomographic findings. Clin Infect Dis 2018;66(2):274-281. https://doi.org/10.1093/cid/cix778

29. Du Plessis AM, Andronikou S, Machemedze T, et al. High-resolution computed tomography features of lung disease in perinatally HIV-infected adolescents on combined antiretroviral therapy. Pediatr Pulmonol 2019;54(11):1765-1773. https:// doi.org/10.1002/ppul.24450

30. Karpelowsky JS, Millar AJ, van der Graaf N, van Bogerijen G, Zar HJ. Comparison of in- hospital morbidity and mortality in HIV-infected and uninfected children after surgery. Pediatr Surg Int 2012;28(10):1007-1014. https://doi.org/10.1007/s00383-012-3163-x

31. Karpelowsky JS, Millar AJ, van der Graaf N, van Bogerijen G, Zar HJ. Outcome of HIV-exposed uninfected children undergoing surgery. BMC Pediatr 2011;11:69. https://doi.org/10.1186/1471-2431-11-69

32. Blyth DF, Buckels NJ, Sewsunker R, Soni MA. Pneumonectomy in children. Eur J Cardiothorac Surg 2002;22(4):587-594. https://doi.org/10.1016/s1010- 7940(02)00404-9

33. Lee H, Kim J. A study on the relapse rate of tuberculosis and related factors in Korea using nationwide tuberculosis notification data. Osong Public Health Res Perspect 2014;5(Suppl):S8-S17. https://doi.org/10.1016/j.phrp.2014.11.001

34. Molnar TF. Tuberculosis: Mother of thoracic surgery then and now, past and prospectives: A review. J Thorac Dis 2018;10(Suppl 22):S2628-S2642. https://doi. org/10.21037/jtd.2018.04.131

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