{"id":2159,"date":"2024-11-12T13:29:02","date_gmt":"2024-11-12T13:29:02","guid":{"rendered":"https:\/\/live-champs-new.pantheonsite.io\/?post_type=resource&#038;p=2159"},"modified":"2025-11-13T18:45:22","modified_gmt":"2025-11-13T18:45:22","slug":"an-infant-with-severe-malnutrition-who-died-at-home-with-a-respiratory-infection-led-to-the-diagnosis-of-pneumonia-and-found-a-previously-unknown-hiv-infection","status":"publish","type":"resource","link":"https:\/\/champshealth.org\/resource\/an-infant-with-severe-malnutrition-who-died-at-home-with-a-respiratory-infection-led-to-the-diagnosis-of-pneumonia-and-found-a-previously-unknown-hiv-infection\/","title":{"rendered":"An infant with severe malnutrition who died at home with a respiratory infection led to the diagnosis of pneumonia and found a previously unknown HIV infection"},"content":{"rendered":"\n<div class=\"wp-block-cover alignfull is-light page-header-standard\"><img loading=\"lazy\" decoding=\"async\" width=\"1388\" height=\"1040\" class=\"wp-block-cover__image-background wp-image-2162\" alt=\"\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver.png\" data-object-fit=\"cover\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver.png 1388w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-1024x767.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-768x575.png 768w\" sizes=\"auto, (max-width: 1388px) 100vw, 1388px\" \/><span aria-hidden=\"true\" class=\"wp-block-cover__background has-background-dim-70 has-background-dim\" style=\"background-color:#b787b1\"><\/span><div class=\"wp-block-cover__inner-container is-layout-flow wp-block-cover-is-layout-flow\">\n<p class=\"has-text-align-center\">CHAMPS RESOURCES<\/p>\n\n\n\n<h2 class=\"wp-block-heading text-center\">CHAMPS Resources<\/h2>\n<\/div><\/div>\n\n\n<div class=\"publication-meta\"> \n\n<p class=\"publication-date\"> October 23, 2018 <\/p>\n\n<div class=\"publication-share\">\n\n<span class=\"share\">Share: <\/span> <ul> \n\n<li class=\"publication-share-facebook\"> <a href=\"\"> <i class=\"fa fa-facebook\"> <\/i> <\/a><\/li>\n<li class=\"publication-share-facebook\"> <a href=\"\"> <i class=\"fa-brands fa-x-twitter\"><\/i> <\/a><\/li>\n<li class=\"publication-share-instagran\"> <a href=\"\"> <i class=\"fa-brands fa-instagram\"><\/i> <\/a><\/li>\n\n<\/ul>\n <\/div>\n <\/div>\n\n <p class=\"publication-title\">An infant with severe malnutrition who died at home with a respiratory infection led to the diagnosis of pneumonia and found a previously unknown HIV infection <\/p>\n\n\n<div class=\"wp-block-group case-example-intro\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<div class=\"wp-block-group content-white\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"has-text-align-left w-65 margin-auto\">A&nbsp;<strong>6 month old baby girl died at home<\/strong>&nbsp;after a week of fever, trouble breathing and cold extremities. She had not been growing well for over three months. When she died, she weighed less than when she was born.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group pad-4 content-grey has-background\" style=\"background-color:#E6E6E6\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-columns w-65 margin-auto is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/IMG_5617-scaled-1-1024x683.jpg\" alt=\"\" class=\"wp-image-2168\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/IMG_5617-scaled-1-1024x683.jpg 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/IMG_5617-scaled-1-300x200.jpg 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/IMG_5617-scaled-1-768x512.jpg 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/IMG_5617-scaled-1-1536x1024.jpg 1536w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/IMG_5617-scaled-1-2048x1366.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<p>Over several months and even up to one week before she died,&nbsp;<strong>her family sought answers<\/strong>&nbsp;from different health facilities and a traditional healer, although the baby was never hospitalized.<br><strong>The family did not know what was wrong<\/strong>.<\/p>\n<\/div>\n<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group content-white case-uncovering-causes\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"has-text-align-left w-65 margin-auto\"><strong>Uncovering the cause<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p>After her death&nbsp;<strong>the baby\u2019s blood tested positive for human immunodeficiency virus (HIV)<\/strong>. Her mother had been tested for HIV five months prior to the baby\u2019s birth and was negative.&nbsp;<strong>She did not have testing again later<\/strong>&nbsp;during pregnancy when she must have acquired the infection. She was not on any medications that could have prevented her from passing HIV to her daughter.<br>By measuring the baby\u2019s weight after death, CHAMPS confirmed that&nbsp;<strong>she was severely malnourished<\/strong>, even though&nbsp;<strong>her parents reported&nbsp;<\/strong>in an interview&nbsp;with family members (called a verbal autopsy)&nbsp;<strong>that the baby was growing well<\/strong>. In addition, pathology examination showed that her liver was holding onto extra fat cells, a change called steatosis, which can be a sign of malnutrition.<\/p>\n\n\n\n<p>The HIV infection and malnutrition likely worked together to&nbsp;<strong>weaken the baby\u2019s immune system<\/strong>&nbsp;and make her likely to get sick from other infections, even though she was up to date on all of her recommended shots.<\/p>\n\n\n\n<p>CHAMPS testing showed that the baby\u2019s pneumonia was caused by a serious bacterial infection,&nbsp;<strong><em>Streptococcus pneumoniae<\/em><\/strong>, along with two viruses,&nbsp;<strong>cytomegalovirus&nbsp;<\/strong>and&nbsp;<strong>respiratory syncytial virus<\/strong>. Evidence of all of these pathogens were found in the baby\u2019s lung tissue.<\/p>\n\n\n\n<p>CHAMPS laboratory and pathology findings provided robust evidence that<strong>&nbsp;multiple respiratory infections led to death<\/strong>&nbsp;for this baby with underlying malnutrition and previously undiagnosed HIV.<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"391\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/Quote-Case-2-1024x391.png\" alt=\"\" class=\"wp-image-2166\" title=\"Quote Case 2\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/Quote-Case-2-1024x391.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/Quote-Case-2-300x115.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/Quote-Case-2-768x293.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/Quote-Case-2-1536x587.png 1536w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/Quote-Case-2.png 1911w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n<h2 class=\"wp-block-heading\">Pathology images<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n<\/div><\/div>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"767\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-Streptococcus-species-Lung-1024x767.png\" alt=\"\" class=\"wp-image-2165\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-Streptococcus-species-Lung-1024x767.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-Streptococcus-species-Lung-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-Streptococcus-species-Lung-768x575.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-Streptococcus-species-Lung.png 1388w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\"><strong>Abundant Streptococcus spp. bacteria seen by immunohistochemistry in the lung<\/strong><\/figcaption><\/figure><\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"767\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-HE-5X-liver-1024x767.png\" alt=\"\" class=\"wp-image-2160\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-5X-liver-1024x767.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-5X-liver-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-5X-liver-768x575.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-5X-liver.png 1388w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\"><strong>Low magnification of liver with steatosis from malnutrition<\/strong><\/figcaption><\/figure><\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"767\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40x-Lung-1024x767.png\" alt=\"\" class=\"wp-image-2163\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40x-Lung-1024x767.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40x-Lung-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40x-Lung-768x575.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40x-Lung.png 1388w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\"><strong>CMV infected&nbsp;cell&nbsp;in the lung with intranuclear eosinophilic viral&nbsp;inclusions<\/strong><\/figcaption><\/figure><\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"767\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-1024x767.png\" alt=\"\" class=\"wp-image-2162\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-1024x767.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver-768x575.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-40X-liver.png 1388w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\"><strong>Fat droplets (clear spaces) within hepatocytes due to steatosis from malnutrition<\/strong><\/figcaption><\/figure><\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"768\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-HE-10x-Lung-CMV-inclusions-arrow-1024x768.png\" alt=\"\" class=\"wp-image-2161\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-10x-Lung-CMV-inclusions-arrow-1024x768.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-10x-Lung-CMV-inclusions-arrow-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-10x-Lung-CMV-inclusions-arrow-768x576.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-HE-10x-Lung-CMV-inclusions-arrow.png 1388w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\"><strong>CMV infected cells (arrows)&nbsp;in the lung with intranuclear eosinophilic viral inclusions<\/strong><\/figcaption><\/figure><\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"767\" src=\"https:\/\/live-champs-new.pantheonsite.io\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-CMV-Lung-1024x767.png\" alt=\"\" class=\"wp-image-2164\" srcset=\"https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-CMV-Lung-1024x767.png 1024w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-CMV-Lung-300x225.png 300w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-CMV-Lung-768x575.png 768w, https:\/\/champshealth.org\/wp-content\/uploads\/2024\/11\/2017-3322-IHC-40X-CMV-Lung.png 1388w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><figcaption class=\"wp-element-caption\"><strong>CMV inclusions staining by immunohistochemistry in the lung<\/strong><\/figcaption><\/figure><\/div>\n\n\n<h2 class=\"wp-block-heading\">Family follow up<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p>The CHAMPS team provided results to the family and ensured that&nbsp;<strong>the mother was tested and treated for HIV<\/strong>. She will be able to take medicines to&nbsp;<strong>stay healthy<\/strong>&nbsp;and&nbsp;<strong>prevent her from transmitting HIV<\/strong>&nbsp;during any future pregnancies.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Public Health Implications<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p>This baby\u2019s parents sought care several times during her life. Each of these visits to the health system was a missed opportunity for routine testing for HIV, intervention for malnutrition, or hospital care that may have led to earlier identification of her HIV- measures that could have saved her life. Local teams can work with their health care system to identify barriers to care, to strengthen capacity for identifying and treating malnourished infants and children.<br><a href=\"http:\/\/www.who.int\/hiv\/pub\/guidelines\/arv2013\/clinical\/testingintro\/en\/index5.html\"><strong>Prevention of Maternal to Child Transmission (PMTCT) Programs<\/strong><\/a>&nbsp;exist to prevent mothers from passing HIV on to their babies. The&nbsp;<a href=\"http:\/\/www.who.int\/hiv\/pub\/guidelines\/arv2013\/clinical\/testingintro\/en\/index5.html\">World Health Organization recommends<\/a>&nbsp;that women who live in areas with a high prevalence of HIV and who do not have the virus when they are tested early in pregnancy are retested in the third trimester, during labor, or after delivery.&nbsp;Studies show that women have a high risk of becoming infected with HIV during pregnancy,&nbsp;and a mother who acquires a new HIV infection during pregnancy has a greatly increased risk of passing the infection to her baby, yet repeat testing is not always done. This CHAMPS case emphasizes why repeat testing is important and can save lives. Local partners can ensure that all mothers receive the recommended testing and treatment for HIV to eliminate perinatal transmission of HIV.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"has-text-align-center\"><strong>Interested in more CHAMPS updates?<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center\"><a href=\"https:\/\/ianphi.us1.list-manage.com\/subscribe?u=11ad46d81331e83cdf62a0d0a&amp;id=7fc15b483f\" target=\"_blank\" rel=\"noreferrer noopener\">Sign up for our mailing list!<\/a><\/p>\n\n\n\n<p class=\"has-text-align-center\">Email&nbsp;<a href=\"mailto:data@champshealth.org\">data@champshealth.org<\/a>&nbsp;for information about CHAMPS pathology slide images.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A&nbsp;6 month old baby girl died at home&nbsp;after a week of fever, trouble breathing and cold extremities. She had not been growing well for over three months. When she died, she weighed less than when she was born. Over several months and even up to one week before she died,&nbsp;her family sought answers&nbsp;from different health [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/champshealth.org\/resource\/an-infant-with-severe-malnutrition-who-died-at-home-with-a-respiratory-infection-led-to-the-diagnosis-of-pneumonia-and-found-a-previously-unknown-hiv-infection\/\">Read More&#8230;<span class=\"screen-reader-text\"> from An infant with severe malnutrition who died at home with a respiratory infection led to the diagnosis of pneumonia and found a previously unknown HIV infection<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":2162,"parent":0,"template":"","meta":{"_acf_changed":false,"footnotes":""},"tags":[],"resource_category":[9],"class_list":["post-2159","resource","type-resource","status-publish","has-post-thumbnail","hentry","resource_category-case-example"],"acf":[],"_links":{"self":[{"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/resource\/2159","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/resource"}],"about":[{"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/types\/resource"}],"author":[{"embeddable":true,"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/users\/3"}],"version-history":[{"count":6,"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/resource\/2159\/revisions"}],"predecessor-version":[{"id":4878,"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/resource\/2159\/revisions\/4878"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/media\/2162"}],"wp:attachment":[{"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/media?parent=2159"}],"wp:term":[{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/tags?post=2159"},{"taxonomy":"resource_category","embeddable":true,"href":"https:\/\/champshealth.org\/wp-json\/wp\/v2\/resource_category?post=2159"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}