Diagnosis standard of the World Health Organization and American Centers for Disease Control and Prevention
1. HIV infection without laboratory demonstration
If it is not possible to conduct laboratory examination or only an unconfirmed experimental result can be obtained, the appearance of any one of the following diseases without other reasons of immune deficiency indicates the presence of AIDS in the patient, provided the disease is established by a confirmative diagnosis.
Monilia infection in the oesophagus, trachea, bronchus and lungs.
Crytococcosis in the lungs
Cryptosporidiosis accompanied by Persistent diarrhea over a month.
Cytomegalovirus infection sustained over a month in any organ except liver, spleen or lymph nodes.
Herpes simplex virus infection and mucous membrane skin ulcer over a month.
Mycobacterium avium complex located in any part except lungs, skin, neck lymph node ha hilar lymph node
Pneumocystis carinii pneumonis,
Progressive multi-focal leukoencephalopathy
Brain Toxoplasmosis over a month.
2.Diagnosis standard of HIV infection with laboratory demonstrati
Any one of the above-mentioned and the following disease can be diagnosed as AIDS with laboratory demonstration of HIV infection.
Bacterial infection inclusive of sapraemia, pneumonia or meningitis recurred for several times.
Sporozoosis accompanied by diarrhea sustained over a month.
Cerebral lymphoma at any age.
Non-Hodgkin¡¯s lymphoma of B cells
Diseases caused by lung monkey tubercle bacillus.
HIV consuming syndrome.
Recurrent sapraemia caused by non- salmonella typhi
3.Special cases to be excluded for children
Primary immunodeficiency diseases: neutrophilic granulocyte decrease,? neutrophil, neutrophil leukocyte dysfunction, IgA immune globulin deficiency or congenital thymic dysgenesis, far-advanced combined immunodeficiency disease, ataxia ataxia telangiectasis and immunodeficiency accompanied by thrombocytopenia and eczema.
Secondary immunodeficiency diseases: diseases related to immunosupression and lymph reticulocyte tumor. 3.1Fever
Fever itself ifs not a disease but a systematic reaction of the organism to a disease. However fever is of danger and may cause eclampsia and make patient feel discomfort of the whole body, headache, inappetency and intolerance of cold.
3.1.1Causes of fever
Opportunistic infections related to AIDS.
Epidemic diseases, such as malaria and measles.
Fever caused by HIV infection itself.
Fever is consumable to the body and measures should be taken in time to reduce the temperature of the body. For the children suffered from high temperature or fever for a long time, symptomatic managements are needed.
Keep the air circulating in the room, take off unnecessary clothing and the bedclothes should not be too thick.
Supplement energy and water to avoid excessive loss of water due to high temperature and let the patient take more fruits.
Physical cooling: cold compressing the forehead, large blood vessels with cold water or ice bag, or brush with 30-50% alcohol.
Medicinal cooling: taking medicines, such as acetosal and metalid, also traditional Chinese medicines, such as folium isatidis, radix isatidis and herba taraxact, and decreasing dosage for valetudinarians to avoid collapse.
3.1.3Consult a physician under the following situations
Fever heat with body temperature exceeding 39¡æ.
Sustained fever heat not able to be cooled with general method.
Fever heat complicated with cough and loss of body weight.
Fever heat accompanied by titanic throat, headache, fidget, twitch and unconsciousness.
Icteric sclera and severe diarrhea.
Fever heat not removed after taking anti-malaria medicines in malaria epidemic area.
AIDS Children often suffer diarrhea with watery stool at least 3 times a day, and sometimes accompanied by acute bellyache and emesis. Don¡¯t regard normal stool several times a day as diarrhea. Diarrhea sustained within 2 weeks is call acute diarrhea and that sustained more that 2 weeks is called persistent diarrhea. Diarrhea, if not treated in time, may develop into serious dehydration and malnutrition and finally cause death.
3.2.1 Common causes of diarrhea
Enteritis caused by unclean food and drinks
Opportunistic and morbigenous virus infections related to AIDS.
Side effect of some medicines.
Under normal conditions, the body¡¯s input and output of water are in balance, but when suffering from diarrhea, the output will be larger than the input, causing an imbalance and finally leading to dehydration.
High ambient temperature and complicated fever are more liable to bring about dehydration.
Long term diarrhea may cause and worsen malnutrition because ¢Ù loss of nutrient through stool; ¢Úin-taking not enough due to gastrointestinal dysfunction
3.2.2 Prevention of diarrhea
Drinking clean and boiled water.
Taking clean and sanitary food, which should be watered and boiled in the course of processing, especially meat.
Surplus food should be stored carefully, and through heated before taking again.
Washing hands before dinner and after shit or piss, particularly after looking after children to shit and piss. 3.2.3 Precautions in family nurse of diarrhea patients
Encouraging patients to drink much water
At the beginning of diarrhea, should encourage the patient take much water, fruit juice and porridge to avoid dehydration. For the children less than 2 years old, 50-100ml of drinks should be given after shit, and the children over 2 years, 120-200ml.
Paying attention to nutrition
The limitation of diets of patients may cause or worsen malnutrition instead of relieving diarrhea, and the fluid drank can not meet the requirements of organism for food. The patient should have many nutritious and digestible meals, such as corn, legume, meat, fish, mild products, eggs and fruit, but little food at each time to avoid loss of body weight and hunger. After stopping of diarrhea, the meals can be increased for two weeks. This is helpful to recover the body weight lost during diarrhea.
Foods unsuitable for patients include food containing rough fiber and not easy to digest such vegetable skin, corn with particles, food and drinks with high content of sugar.
Identifying and treating in time of dehydration
Relatives and nursing staff should be able to identify the phenomena of dehydration, such as thirst, uropenia, fidget, drowsiness and poor elasticity of skin. If phenomena of dehydration appear, the patient should be given water and oral fluid replacement or sent to hospital.
Patients with diarrhea should be carefully nursed, and should see the doctor when the following signs have appeared: fidget, thirst, fever, unable to take food, diarrhea accompanied with emesis and not turning better, stool with blood and appearance of dehydration signs.
3.3 Nurse of mouth and throat
The pain in the mouth of AIDS patients is often accompanied with spot-shaped pathological changes on the surface of the tongue, which may fall upon the esophagus, leading to dysphagia and disturbing diet. Besides, pathological changes such as bubbles and ulcer in the mouth also may happen.
3.3.1 Pathological changes commonly seen in the mouth and throat
Mouth herpes simplex.
3.3.2Family nurse of mouth diseases
Not taking rough and hard food.
Taking insipid food.
Drinking water and soup with a sucker to avoid stipulating ulcer face.
Taking some cold drinks, cold food or ice water to numb the mouth and relieve the pain.
For the treatment of thrush, saline, rinsing fluid and citric acid, such as gentianviolet to rinse out the mouth 3-4 times a day, because citric acid can restrain the growth of fungi.
Chough and dyspnea
AIDS patients are often accompanied with serious diseases in respiratory system, including cold, tracheitis, bronchitis, tuberculosis, pneumocystis carinii pneumonis and interstitial lymph pneumonia.
3.4.1 The following measures can be taken to relieve the symptoms if complicated with diseases in the respiratory system:
Patting slightly the chest and back to facilitate the air flow in the lungs, especially for babies.
Keeping ventilation in the bed room to ensure the air fresh.
When dyspnea appears, the pillow or the head of bed may be lifted to keep the patient in a semireclining position, so as to improve the patient¡¯s respiratory situation. If suffered from diseases in the respiratory system with mucous membrane in the nose often full of blood that may influence eating or breast feeding, the secretion should dried or removed.
If lung infection is complicated with cough, the patient should drink much water to supplement the fluid needed by the organism and that lost due to fast respiration to keep the secretion in the lungs not dry and easy to be coughed out. Breathing quickly and breathing hard are very dangerous and should be treated as soon as possible.
3.4.2 Seeking help from the doctor when the following situations appear:
Cough that lasted over 3 weeks and accompanied with dyspnea.
Respiration with mouth opened or bronchial wheezing can be heard or dypsnea has influenced diet.
3.5 Nausea and emesis
Nausea and emesis are common symptoms of AIDS and can be caused by many factors. When serious symptoms appear, the following measures should be taken:
Prohibition against drinking and eating for 1-2 hours.
Drinking gradually some warm water, weak tea, and other clean fluid or clean ice water.
Gradually increasing some food, starting from insipid diets when nausea and emesis are relieved.
Keeping oral hygiene.
Keeping fresh the air in the room to make patient feel comfort and not stimulated by special smell of lampblack and drugs.
Seeking help from the doctor when the following situations appear:
Emesis appears repeatedly, unable to swallow, or possible to dehydrate.
Regular emesis sustained for 24 hours and accompanied with bellyache.
Emesis accompanied with high fever.
Fierce emesis, especially the vomitus being in dark color or having the smell of stool.
3.6Nutritious problem Children with AIDS may lose their body weight even if having high quality meals. This is because:
The nutrition is not sufficiently absorbed and used.
Diets are restrained by pains caused by complicating diseases in the mouth and oesophagus, such as oral candidiasis and ulcer.
Nausea and emesis
The foods familiar to people can be divided into 3 categories:
Foods that is rich in proteins, iron and calcium and beneficial to the growth and recovery, such as bean, peanut egg, meat and milk.
Foods that can provide energy, such as potato, sweet potato, wheat, rice, kaoliang, maize, animal fat and vegetable oil.
Foods that is rich in vitamin and helps the organism to improve anti-disease capacity, including fruits and vegetables, especially dark green vegetables.
It is important to correctly process and store foods, keep them clean and fresh, so as not causing diseases after eating.
The people who are suffering from difficulty to eat and unable to maintain normal growth and body weight should pay attention to:
Have many meals but little food at each and defined time.
Don¡¯t take uncooked food, which is not easy to be digested and likely to infect diseases.
Patients suffered from diarrhea for a long time should take soft and soupy food, avoiding food with stipulation, such as hot pepper.
Drink much water and understand the clinical manifestations of dehydration.