Pediatric lymphocytic interstitial pneumonia

　　1. Etiology

　　The etiology of lymphocytic interstitial pneumonia is unknown, and preterm birth and low immune function are often considered as triggers. The etiology includes several hypotheses:

　　1, HIV infection

　　HIV infection causes lymphoproliferation.

　　2, HIV associated with EBV infection

　　Both have a synergistic effect.

　　3, immune and genetic factors

　　It is related to HLA-DRs, and the relative risk of developing lymphocytic interstitial pneumonia in individuals with HLA-DRs phenotype is as high as 70.1%. It can also be accompanied by many immune-mediated diseases, such as autoimmune hemolytic anemia, chronic active hepatitis, juvenile rheumatoid arthritis, thyroiditis, systemic lupus erythematosus, myasthenia gravis, and Sjögren's syndrome, among others.

　　Second, pathogenesis

　　There are various hypotheses, one being that HIV itself causes lymphoproliferation; another is that HIV is accompanied by EBV infection, which has a synergistic effect with HIV. LIP is different from common interstitial pneumonia and desquamative interstitial pneumonia, and does not belong to interstitial pneumonia but is a pulmonary lymphocytic proliferative disease. It not only occurs in HIV infection but can also be seen in primary immunodeficiency and autoimmune diseases, including Sjögren's syndrome, chronic active hepatitis, myasthenia gravis, and aplastic anemia; immunodeficiency diseases include bone marrow transplant patients. Reports have shown that up to 30%-50% of children with HIV infection may develop LIP. Some believe that LIP can be familial, as antigen activation of T lymphocytes, such as CD4+ cells producing cytokines IL-2, can cause the proliferation of effector cells (CD8+). Reports have shown that 8 out of 10 LIP children had EBV found in lung biopsy specimens; there are also other reports. CD8 lymphocytosis includes parotid swelling, sicca syndrome, and LIP. Moreover, black patients are associated with HLA-DR5, and the relative risk rate for this syndrome in HLA-DR5 phenotype carriers is 70.1%.

　　It can develop into pulmonary fibrosis accompanied by respiratory insufficiency, and eventually lead to respiratory and circulatory failure. Due to hypoxia and carbon dioxide retention, multiple organ damage can occur, including the central nervous system, cardiovascular, respiratory, and digestive systems. Therefore, in respiratory failure, in addition to the symptoms of the primary disease, the main manifestations are the damage to various organs caused by hypoxia and carbon dioxide retention.

　　The onset age is about 1 year old (5-81 months), and the average survival time of children with HIV infection who have LIP as the primary symptom is 72 months. The onset is gradual, with non-specific symptoms, commonly including cough, dyspnea, and weight loss. Less common symptoms include fever, weakness, chest pain, and hemoptysis. Physical examination may show generalized lymphadenopathy, enlargement of salivary glands, rapid heart rate, increased respiratory rate, cyanosis, clubbing, normal auscultation or wheezing or inspiratory end rales. X-ray films may show increased pulmonary markings or reticular shadows, feather-like infiltrative shadows at the lung base, visible nodular shadows, and normal mediastinal lymph nodes. In the late stage, the development of pulmonary interstitial fibrosis presents as honeycomb lung. CT examination can show small nodular shadows and opacities. Pulmonary function tests show reduced lung volume, restrictive ventilatory dysfunction, decreased lung compliance, and abnormal diffusion function, the latter being a relatively sensitive indicator of disease progression.

　　Prevention methods are the same as AIDS, and prevent HIV infection

　　1. Management of the infectious source

　　High-risk groups should regularly test for HIV antibodies. Health and medical departments should report cases of infection in a timely manner, and relevant knowledge of HIV should be popularized among infected individuals to prevent transmission to others. The blood, body fluids, and secretions of infected individuals should be disinfected.

　　2. Interrupt the transmission route

　　Avoid unsafe sexual behavior, prohibit promiscuity, and eliminate prostitution. Strictly screen blood donors, strictly inspect blood products, and promote the use of disposable syringes. Prohibit the injection of drugs, especially the use of shared needles for injecting drugs. Do not share toothbrushes or razors. Do not go to unregular hospitals for examination and treatment.

　　3. Protect susceptible populations

　　Promote pre-marital and pre-pregnancy physical examinations. For pregnant women with HIV positive, maternal and child prevention should be carried out. This includes obstetric intervention (termination of pregnancy, cesarean section) + antiviral drugs + artificial feeding. Medical personnel should strictly follow medical operation procedures to avoid occupational exposure. In case of occupational exposure, the wound should be pressed towards the heart as soon as possible to try to挤出 the blood from the injured area, and then the wound should be washed with soap and running water; when the eyes or other mucous membranes are contaminated, they should be repeatedly flushed with a large amount of normal saline; the wound should be disinfected locally with 75% alcohol or 0.5% iodophor, and bandaging should be avoided as much as possible. Then, immediately consult a professional doctor in the infectious disease department for risk assessment and decide whether to carry out prophylactic treatment. If medication is needed, it should be administered as soon as possible within the shortest time after occupational exposure (as soon as possible within 2 hours), and it is best not to exceed 24 hours, but even if it exceeds 24 hours, it is still recommended to implement prophylactic treatment. Counseling and monitoring after occupational exposure are also required.

　　1. The peripheral blood picture shows an increase in lymphocytes and eosinophils.

　　2. The bone marrow examination shows an increase in lymphocytes, plasma cells, and eosinophils.

　　3. Blood biochemistry examination shows increased immunoglobulins, mainly IgM; a few cases may be accompanied by hypogammaglobulinemia.

　　4. Blood gas analysis shows hypoxemia.

　　5. No pathogens are found in the alveolar bronchial lavage fluid. Lung biopsy can make an definite diagnosis, and in recent years, it is considered that fiberoptic bronchoscopy and bronchoalveolar lavage can also make a definite diagnosis.

　　6. Chest X-ray shows increased pulmonary纹理 and网点状 shadows, with the lung base showing obvious feather-like patterns, and in the late stage, it shows interstitial fibrosis, presenting as honeycomb lung shadows.

　　6. Lung function shows restrictive ventilation impairment, decreased lung compliance, and decreased diffusion function.

　　Pediatric lymphocytic interstitial pneumonia is a relatively serious disease in pediatrics. Children generally need to pay attention to diet in addition to active treatment to accelerate recovery. What should children with lymphocytic interstitial pneumonia eat? Let's let pediatric pneumonia experts recommend some foods that are beneficial to the recovery of children.
　　1. Houttuynia cordata and Rhizoma Polygoni multiflori Decoction: Take 30 grams of Houttuynia cordata, 30 grams of Rhizoma Polygoni multiflori, and 12 grams of jujube. Boil the above ingredients in water for 30 minutes and drink the decoction. It has the effect of clearing heat and resolving phlegm.
　　2. Sugar-apricot pear: Take one pear, 10 grams of almond, and 12 grams of rock sugar. Peel and core the pear, add almond and rock sugar, and steam for 20 minutes before eating. It has the effect of clearing heat and promoting lung function.
　　3. Ginseng and Jujube Porridge: Take 12 grams of Codonopsis, 15 grams of jujube, and 50 grams of glutinous rice. Boil the above ingredients into porridge for consumption. It has the effect of invigorating the Qi and tonifying the spleen.
　　4. Duck Gizzard and Yam Porridge: Take one duck gizzard, 15 grams of yam, 15 grams of芡实, and 50 grams of glutinous rice. Clean and chop the duck gizzard, then add yam,芡实, and glutinous rice to water and boil into porridge for consumption. It has the effect of invigorating the spleen and consolidating the interior.
　　5. Goji and Polygonatum Porridge: Take 15 grams of goji, 20 grams of Polygonatum, 50 grams of glutinous rice, and a little sugar. Boil the above ingredients into porridge for consumption. It has the effect of invigorating the Qi and tonifying the kidney.

　　1. Treatment

　　There is currently no specific treatment method. Adrenal cortical hormones and human blood gamma globulin therapy are effective, and for those who do not respond well to hormones, cyclophosphamide, azathioprine, and other immunosuppressants can be used. For those with respiratory difficulty, bronchodilators and oxygen therapy can be used, and infections should be actively controlled. There are also reports that Zidorudine has good effects.

　　2. Prognosis

　　LIP is a chronic, progressive, interstitial pneumonia, often accompanied by AIDS, with a poor prognosis. The duration of the disease depends on the speed of its development, with most patients dying of respiratory failure, and only a few patients have their condition stabilized or long-term relief after treatment.