Cervical adenocarcinoma and oral contraceptives

Although H influenzae may be found in the sputum of children with cystic fibrosis, we were surprised that Staphylococcus aureus was not also isolated. Furthermore, C albicans is an unusual finding in children's sputum unless they have been receiving long term antibiotic treatment. Diarrhoea and failure to thrive are common presenting features in children with symptomatic HIV infection.2 In our child the diarrhoea was not malabsorptive and did not respond to pancreatic replacement treatment. Organisms which may be suspected in this situation are protozoans such as cryptosporidium, microsporidia, and Isospora belli. A search should also be made for atypical mycobacteria, cytomegalovirus, and herpes simplex virus, any of which may cause a malabsorptive picture. Our patient had no evidence ofany of these organisms or any evidence of neoplasia. With the incidence ofcystic fibrosis in the community of 1 in 2000 it would not be surprising that a child with clear evidence of cystic fibrosis responding to standard treatment should be found to be HIV positive (personal communication, Dr J Mok, consultant paediatrician, City Hospital, Edinburgh). Although initially HIV positive this child has since become HIV negative, therefore suggesting clearing of maternal HIV antibody. Measuring immunoreactive trypsin is not helpful as a diagnostic aid beyond the neonatal period, and gene probe analysis would not have been useful as there was no family history ofcystic fibrosis. We think that there is little doubt that our patient had not got cystic fibrosis. We therefore suggest that children presenting with symptoms suggestive of cystic fibrosis but with atypical features such as unexpected bacteriological results, failure to respond to treatment, or hyperglobulinaemia should have both their sweat test result validated by a fludrocortisone suppression test and their HIV state checked. If the HIV test result is positive it will, as in our family, allow rationalisation of treatment and counselling for the family.