一例母亲检测阴性的儿童通过母婴传播感染艾滋病的调查

Investigation of a pediatric AIDS case of mother-to-child transmission whose mother tested negative

目的了解亲生母亲艾滋病检测阴性的患儿S某感染艾滋病的途径。方法对S某父母亲进行详细的流行病学调查,并采集血液进行艾滋病的检测,对S某出生医院接生医护人员现场调查并查看病历,并对S某可能感染来源的Z某及其子的艾滋病感染情况进行核查。结果 S某艾滋病确诊阳性,其父母亲筛查阴性排除感染;S某在出生后使用负压吸引器吸取羊水和分泌物时,可能造成口腔及咽部的粘膜破损,出生后又呕吐羊水数次,呕吐物中的胃酸可能烧灼口腔、咽部和食道,加重破损的程度,而在出生后20 h左右就给其喂养了Z某的母乳3~5 min;Z某是S某母亲的一名感染了艾滋病的毒友,于2011年10月确诊感染艾滋病,Z某在S某出生时并不知道自己感染了艾滋病;Z某儿子也因母婴传播感染艾滋病且比S某早出生3个月,因此判断Z某在给S某哺乳时已经感染艾滋病,并且当时可能已经发病,其母乳的HIV病毒载量可能较高。结论 S某感染艾滋病的最可能途径是经Z某单次母乳喂养导致的艾滋病母婴传播。

Objective To investigate the route of transmission of a pediatric AIDS case S whose natural mother tested negative. Methods At first, the detailed epidemiological investigation for S＇s parents was conducted, and their bloods were collect for HIV testing. Then the doctors and nurses who delivered S were investigated and the medical records of the S＇s born hospital were checked. In addition, HIV-antibody for Z who might be the infection source to S and Z＇s son was tested.Results S was tested HIV positive and his parents were negative. S＇s amniotic fluid and secretion was sucked by a vacuum extractor when he was born and this operation was likely to producing mucosal trauma of his oral cavity and pharynx. S vomited amniotic fluid on several occasions after he was born, the gastric acid from vomit caused cauterization to his oral cavity,pharynx and esophagus probably. Then his mucosal trauma was aggravated seriously. Z breastfed S for 3-5 minutes when he was born 20 hours. Z was a confirmed AIDS case who was a drug abuser with S＇s mother. She was confirmed of AIDS in October 2011, but Z did not know her test result when she breastfed S. In fact, Z＇s son was a confirmed HIV case because of mother-to-child transmission and he was born three months earlier than S. So Z had been infected with HIV when she breastfed S, and Z might suffer from full-blown AIDS with a high viral load in her breast milk. Conclusion The most probably infection route of S is a single breastfeeding of Z.