Knowledge and practice of prechewing/prewarming food by HIV-infected women

HIV Transmission Through Premastication

Premastication is a potential route of transmission of HIV from caregiver to child. We report the case of a 13-month-old Alaska Native child from rural Alaska who presented with failure to thrive, recurrent pneumonias, severe dental decay, and dysphagia. The mother was HIV-uninfected. Respiratory failure prompted transfer to a children's hospital outside of Alaska where the child received a diagnosis of HIV infection. A grandparent who had been acting as primary caregiver was discovered to be HIV-infected with detectable viral load resulting from intermittent nonadherence to her medication regimen. This grandparent reported feeding the child premasticated food. Sequencing of the hypervariable C2V5 region of the HIV envelope gene in both patients demonstrated less than 0.05% variation, consistent with transmission from grandparent to child. Health care providers should be aware that transmission of HIV can occur via premastication, educate parents and caregivers regarding this risk, and rigorously pursue HIV testing when indicated even in children with HIV-uninfected mothers.

Unusual erythematous plaque with white scales, a case of acquired syphilis in a child and literature review

BACKGROUND

Syphilis in children is uncommon with the mode of infection for this rare condition likely being congenital or acquired. While most acquired cases of syphilis in children result from sexual abuse, children can also be infected with syphilis through kissing, breastfeeding, sharing of daily necessities or pre-chewed food. Here, we report a case of acquired secondary syphilis in a child due to consumption of pre-chewed-food and provide a review of the literature on the characteristics of acquired syphilis in preschool children.

CASE PRESENTATION

A 3-year-old girl presented with erythematous plaques and scales on her head, neck, and thighs as well as flat red papules with a moist, well circumscribed surface covered with a grayish-white film. The grandmother who cared for the girl was in the habit of pre-chewing food before giving it to the girl. The child and grandmother tested positive for RPR. The girl, who was not sexually abused, was diagnosed with acquired secondary syphilis, resulting from the transmission of pre-chewed food from her grandmother.

CONCLUSIONS

Our case report and literature review reveal that close contact among family members can result in the transmission of syphilis. We recommend that pre-chewing food should be discouraged by caregivers when caring for their children to avoid disease transmission.

Syphilis in an Infant Acquired by Mouth-to-Mouth Transfer of Prechewed Food

A 2-year-old infant boy presented with a large ulcerative lesion on his tongue. The grandmother who cared for the boy was in the habit of chewing food before giving it to the boy and had active syphilis. The infant was diagnosed with acquired early syphilis, which had been transmitted by prechewed food from his grandmother. Prechewing food is a custom in most parts of China. Prechewing an infant's food could be an avenue of disease transmission, although this is not fully recognized. No studies have been conducted to evaluate prechewed food as a disease transmission route.

Premasticating food for weaning African infants: a possible vehicle for transmission of HIV

BACKGROUND

Although premastication of food for weaning infants might have nutritional benefit, it is also associated with transmission of pathogens. We investigated premastication practices in Cape Town, South Africa, in lower socioeconomic status caregivers of infants below 2 years of age.

METHODS

A previously reported questionnaire was adapted for South African conditions. A convenience sample of infant caregivers was captured at public maternal/pediatric and HIV outpatient clinics and home visits.

RESULTS

We interviewed 154 caregivers, 92% of whom were the biological mothers (median age: 29). Of these, 70% were black, and 29% were colored. There were 106 (69%) caregivers who practiced premastication. The median age of infants who received premasticated food was 6 (interquartile range: 4-6) months. Forty-six (43%) infants were teething, and 44 (42%) had oral mucosal lesions while receiving premasticated food. Fifty-five (52%) caregivers reported an oral condition, mostly bleeding gums, mouth sores, and thrush, and 41 (39%) caregivers reported blood in the food. Premasticating caregivers had a significantly lower educational level than those caregivers who did not engage in this practice. Premastication practices were cultural (40%), habit (20%), and on mother's advice (75%). Reasons for premastication were to pretaste (68%), encourage eating (61%), estimate food temperature (85%), and homogenize food (60%).

CONCLUSIONS

Counselors and caregivers should be aware of the adverse effects of premastication. Education should include advice to avoid premastication and to seek health advice for oral conditions in the caregiver and child. More studies are needed to better define the extent and risks of premastication, including its possible role in increasing HIV-1 transmission.