Detection of viral pathogens and allergens in infants and young children at high risk of asthma during a wheezing episode / 中国当代儿科杂志

OBJECTIVE@#To investigate the viral etiology and allergen distribution in infants and young children at high risk of asthma during a wheezing episode.@*METHODS@#A total of 135 infants and young children at high risk of asthma were enrolled who were admitted due to asthmatic bronchitis or asthmatic bronchopneumonia between April 2016 and August 2017. Fluorescent probe PCR was used to measure influenza A (Flu A), respiratory syncytium virus (RSV), adenovirus (ADV), parainfluenza virus (PinF), human rhinovirus (HRV), human partial lung virus (hMPV) and human bocavirus (HBoV) in nasopharyngeal aspirates. ImmunoCAP was used to measure inhaled allergens, food allergens, and total IgE concentration.@*RESULTS@#Among the 135 patients, the overall virus detection rate of nasopharyngeal aspirates was 49.6%, and HRV had the highest detection rate of 25.2%, followed by HBoV (9.6%), RSV (8.1%), PinF (5.9%), Flu-A (3.7%), ADV (1.5%) and hMPV (0.7%). The 1-3 years group had a significantly higher detection rate of HRV than the <1 year group (P<0.05). The positive rate of allergen screening was 59.3%, with 44% for inhaled allergens and 89% for food allergens. Among the inhaled allergens, dust mites had the highest positive rate of 77%, followed by mould (37%), pollen (26%) and animal dander (9%). Among the food allergens, egg white had a positive rate of 73% and milk had a positive rate of 68%. The <1 year group had a significantly higher positive rate of inhaled allergens than the 1-3 years group (P<0.05). The 1-3 years age group had a significantly higher level of T-IgE than the <1 year group (P<0.05). The positive virus group had a significantly higher positive rate of inhaled allergens than the non-virus group (P<0.05). The children with the second wheezing episode had significantly higher positive rates of inhaled allergens and food allergens and level of T-IgE than those with the first wheezing episode (P<0.05). The children with the second wheezing episode also had significantly higher positive rates of dust mites and mould than those with the first wheezing episode (P<0.05).@*CONCLUSIONS@#Early HRV infection and inhaled allergen sensitization are closely associated with the development of wheezing in infants and young children at high risk of asthma.

Study of etiology and clinical characteristics of pertussis-like syndrome in children / 中国实用儿科杂志

OBJECTIVE: To investigate the etiology and clinical characteristics of pertussis-like syndrome. METHODS: Thenasopharyngeal secretionscollectedfrompatientswithpertussis-likesymptominChildren's Hospital Affiliated to Soochow University from February 2016 to December 2017 were detected for pertussis DNA using PCR assays and other microbiological assessment. RESULTS: A total of 197 children were enrolled in the study,of whom 119(60.4%)patients were positive for Bordetella pertussis,and 37 cases(37.8%)were positive for other pathogens,including 14 cases(37.8%)of rhinovirus,14 cases(37.8%)of Mycoplasma pneumoniae,4 cases(10.8%)of human bocavirus,3 cases(8.1%)of parainfluenza virus and1 case(2.7%)of respiratory syncytial virus,and 1 case(2.7%)of Haemophilus influenzae. There were no significant differences in mean age,paroxysmal cough,inspiratory whoop,posttussive vomiting,paroxysmal cyanosis,or pulmonary signs between pertussis group and pertussis-like syndrome group(P>0.05). The proportion of male in pertussis group(57.1% vs. 35.3%),white blood cell counts[(18.83±11.54)×10~9/L vs.(12.46±6.01)×10~9/L)],lymphocyte counts[(10.62±8.48)×10~9/L vs.(6.54±5.13)×10~9/L)]were significantly higher than those in pertussis-like syndrome group(P<0.05). CONCLUSION: Rhinovirus and Mycoplasma pneumoniae are the main pathogens of pertussis-like syndrome. Leukocyte and lymphocyte counts can be used as an index to differentiate pertussis from pertussis-like syndrome.

Clinical study on the efficacy and safety of terbutaline sulfate for injection in the treatment of children with wheezing disease / 中国实用儿科杂志

OBJECTIVE: To investigate the efficacy and safety of nebulized inhalation of terbutaline sulfate for injection in the treatment of children with wheezing disease. METHODS: From December 2016 to April 2018,440 cases of lower respiratory tract infection with cough and wheezing were hospitalized for treatment in the Department of Respiratory Medicine of Children's Hospital of Soochow University,Chengdu Women's & Children's Central Hospital and Dalian Children's Hospital of Dalian Medical University. The children were selected and randomly divided into terbutaline sulfate for injection group(Group A),terbutaline sulphate solution for nebulization group(Group B)and control group(Group C). The efficacy and adverse reactions of the three groups were compared. RESULTS: The scores of wheezing symptoms in group A and group B decreased more significantly than those in group C(P<0.05). Group A and group B had a certain influence on heart rate,and the heart rate at 30 minutes and 60 minutes after nebulization was higher than that of group C. In addition to the effect on heart rate,no other adverse reactions were found in group A and group C;one patient in the group B developed arm tremor and disappeared after stopping the drug. CONCLUSION: Inhalation of terbutaline sulfate for injection in the treatment of children with wheezing disease can shorten the treatment time and effectively improve the clinical treatment effect. The clinical efficacy is comparable to that of terbutaline sulphate solution for nebulization,and it is safe and worthy of clinical application.

Factors affecting prognosis of bronchiolitis in children and management after hospitalization / 中国实用儿科杂志

Bronchiolitis is a common lower respiratory tract infection in infants. Its incidence is high in young children,which seriously affects children's health. A variety of factors can affect the prognosis of bronchiolitis. Giving preventive and therapeutic measures can affect its prognosis,and reduce the occurrence of wheezing in some children.

Comparison of clinical features and co-infection between pneumonia caused by influenza virus A and pneumonia caused by influenza virus B among children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To compare the clinical features and co-infection between pneumonia caused by influenza virus A (IVA) and pneumonia caused by influenza virus B (IVB) among children.</p><p><b>METHODS</b>A total of 165 children with pneumonia caused by influenza virus (IV) were included in the study. These subjects were divided into IVA(n=71) and IVB pneumonia groups (n=94) according to the subtypes of IV. The IVA pneumonia group was further divided into simple infection (n=14) and co-infection subgroups (n=57), and the IVB pneumonia group was also further divided into simple infection (n=27) and co-infection subgroups (n=67). Co-infection rate and pathogen spectrum were analysed in children with IV pneumonia.</p><p><b>RESULTS</b>The IVB pneumonia group had significantly increased mean age of onset and significantly prolonged mean duration of fever compared with the IVA pneumonia group (P<0.05). Co-infection rate among children with IV pneumonia was 75.2%, who were co-infected with bacteria (44.2%), Mycoplasma pneumoniae (MP, 21.8%) and other viruses (45.5%). Respiratory syncytial virus (RSV) was most common in children co-infected viruses (89% ). The rate of co-infection with RSV was significantly higher in the IVA pneumonia group than in the IVB pneumonia group. There were no significant differences in age, length of hospital stay, duration of fever, percentage of neutrophils, prealbumin, C-reactive protein, alanine aminotransferase, and creatine kinase-MB between the simple infection and co-infection subgroups of each group.</p><p><b>CONCLUSIONS</b>Children with IVB pneumonia have prolonged duration of fever and increased age of onset compared with those with IVA pneumonia. Co-infection rate is high among children with IV pneumonia, who may be co-infected with bacteria, viruses and MP. Co-infection with RSV is more common in children with IVA pneumonia. It is difficult to identify the presense of co-infection using clinical indices.</p>

Changes of exhaled nitric oxide and peripheral blood eosinophils in children with asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>This study examined the levels of exhaled nitric oxide (eNO) and peripheral blood eosinophils (EOS) as well as the correlation between the two markers in children with bronchial asthma (AS),AS complicated by allergic rhinitis (AS/AR) and chronic cough variant asthma (CVA), in order to explore the value of eNOS detection in children with AS.</p><p><b>METHODS</b>The eNO level was measured using light-emitting electrochemical photometry in 12 children with AS, 29 children with AS/AR and 10 children with CVA. Peripheral blood EOS was counted by blood cell counter (Coulter JT). Forced expiratory volume in one second (FEV1) was assessed by lung function measurement. Thirty children without atopic disease and acute respiratory infection as well as without a family history of atopic diseasea served as the control group.</p><p><b>RESULTS</b>The levels of eNO and blood EOS in the AS, the AS/AR and the CVA groups were significantly higher than those in the control group (p<0.01). The AS/AR group showed increased levels of eNO (50.3 + or - 6.7 ppb) and EOS (5.9 + or -4.2 x 109 ) compared with the AS (30.5 + or - 8.8 ppb and 4.2 + or - 3.2 x 109 respectively) and the CVA groups (26.0 + or - 3.2 ppb and 3.7 + or - 6.9 x 109 respectively) (p<0.05). There were no significant differences in eNO and EOS levels between the AS and the CVA groups. The eNO level was positively correlated with the EOS level (r=0.51, p<0.05), but not with FEV1 (r=0.144, p>0.05) in the AS group.</p><p><b>CONCLUSIONS</b>NO is highly expressed in children with symptoms of atopy and can reflect the levels of eosinophilic airway inflammation in children with AS.</p>

Etiology of pneumonia in hospitalized patients less than 3 years of age / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To understand the etiology of pneumonia in hospitalized patients less than 3 years of age.</p><p><b>METHODS</b>A total of 316 children with pneumonia admitted to the Children's Hospital of Suzhou University in Jiangsu Province from March, 2006 to January, 2007 were enrolled in this study. Sputum samples were obtained by deep nasotracheal aspiration technique for bacterial and viral cultures.</p><p><b>RESULTS</b>Of the 316 samples, specific microbial etiology was obtained in 192 cases (60.8%). Bacterial infection was found in 162 cases (51.3 %), viral infection in 19 cases (6.3%)and compound infection with virus and bacteria in 11 cases (3.5 %). Haemophilus influenzae was the most common agent (46 cases; 14.6%) in bacterial infection, followed by Streptococcus pneumoniae (32 cases; 10.1%). Respiratory syncycial virus (RSV) was the most common agent (12 cases; 4.0%) in viral infection, followed by adenovirus (11 cases; 3.6%).</p><p><b>CONCLUSIONS</b>Bacterial infection was a leading cause of pneumonia in children less than 3 years of age in Suzhou area. Haemophilus influenzae was the most common agent, followed by Streptococcus pneumoniae.</p>