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The clinical data of patients with chlamydia psitsiti pneumonia confirmed by metagenomic next-generation sequencing (mNGS) who were admitted to the Huizhou Municipal Central Hospital from January 2020 to November 2021 were retrospectively analyzed. Among 21 patients, the serum creatine kinase (CK) was elevated in 10 cases, and 5 cases was complicated with rhabdomyolysis (RM). The symptoms of patients with Chlamydia psittaci pneumonia-induced RM were severe, including high fever, dyspnoea, headache and myalgia; 2 case were complicated by acute kidney injury (AKI) and neurological symptoms. Laboratory testing showed a marked increase in CK, myoglobin (Mb), high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and D-dimer levels in all 5 patients. The chest CT revealed large areas of pulmonary consolidation, ground-glass opacity in 1 case and a small amount of pleural effusion in 2 cases. One patient died from multiple organ failure, and the other 4 patients were discharged with considerable improvement. Patients with psittacosis pneumonia are prone to developing rhabdomyolysis, early detection and early treatment can effectively improve the prognosis of patients.
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Bluetongue virus (BTV) causes Bluetongue (BT) of ruminants vectored by culicoides midges. It is also a classic model for studying the release mechanism of non-enveloped virus. This review begins with the infection and assembly of BTV, then summarizes the advances of different ways of releasing BTV. This includes BTV-induced autophagy and the release as extracellular vesicles via multivesicular bodies, BTV-induced apoptosis and the lytic release, as well as different pathways of release through budding via plasma membrane. The regulatory mechanisms of NS3 which is a key non-structural protein during the release of BTV are also discussed, providing a basis for further understanding the molecular mechanisms underpinning the infection, proliferation and release of BTV.
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Animals , Bluetongue , Bluetongue virus , Ceratopogonidae , Sheep , Viral Nonstructural ProteinsABSTRACT
Objective:To analyze the clinical characteristics of Chlamydia psittaci pneumonia and to investigate the correlation between serum inflammatory biomarkers and severity of the disease. Methods:Sixteen patients with Chlamydia psittaci pneumonia admitted to the Huizhou Municipal Central Hospital from January 2020 to July 2021 were selected as the study subjects, including 10 severe cases and 6 mild cases. Clinical data were collected and analyzed, such as baseline characteristics, clinical symptoms, laboratory inspection and chest imaging manifestations. Results:① Thirteen Chlamydia psittaci pneumonia were associated with a definite bird or poultry contact history. Common symptoms included high fever, chill, cough, fatigue, and anorexia (16 cases), dyspnoea (12 cases), and other systemic symptoms. ② Laboratory test results showed normal white blood cell count (WBC, 10 cases), decreased lymphocyte count (LYM, 13 cases), increased high sensitive C-reactive protein (hs-CRP, 16 cases), D-dimer (15 cases), lactate dehydrogenase (LDH, 13 cases), aspartate aminotransferase (AST, 16 cases) and alanine aminotransferase (ALT, 12 cases) levels, however, the albumin (Alb, 15 cases) lever was decreased. The numbers of CD3 + T cells and CD4 + T cells decreased in 10 patients. ③ The levels of D-dimer, interleukins (IL-2, IL-6, IL-10) in severe Chlamydia psittaci pneumonia were significantly higher than those in mild Chlamydia psittaci pneumonia [D-dimer (μg/L): 10 257±4 203 vs. 1 085±642, IL-2 (ng/L): 1.1 (0.8, 1.7) vs. 0.3 (0.1, 0.7), IL-6 (ng/L): 315 (182, 505) vs. 75 (18, 131), IL-10 (ng/L): 7.0±4.1 vs. 2.3±0.7], but the LYM was lower (×10 9/L: 0.4±0.1 vs. 1.1±0.4), with significant differences (all P < 0.05). ④ Chest imaging manifestations were exudative lesions and large consolidation of lungs. Large consolidation of both lungs can occur in some critically ill patients. Conclusions:Chlamydia psittaci pneumonia is mainly associated with a bird or poultry contact history. The clinical manifestations usually present high fever, dyspnea, normal or slightly increased leucocytes, and lung consolidation. The levels of LYM, D-dimer, IL-2, IL-6 and IL-10 in serum are expected to predict the severity of the Chlamydia psittaci pneumonia.
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Toll-like receptor 3 (TLR3) is a member of the TLR family, mediating the transcriptional induction of type I interferons (IFNs), proinflammatory cytokines, and chemokines, thereby collectively establishing an antiviral host response. Studies have shown that unlike other TLR family members, TLR3 is the only RNA sensor that is utterly dependent on the Toll-interleukin-1 receptor (TIR)-domain-containing adaptor-inducing IFN-β (TRIF). However, the details of how the TLR3-TRIF signaling pathway works in an antiviral response and how it is regulated are unclear. In this review, we focus on recent advances in understanding the antiviral mechanism of the TRIF pathway and describe the essential characteristics of TLR3 and its antiviral effects. Advancing our understanding of TLR3 may contribute to disease diagnosis and could foster the development of novel treatments for viral diseases.
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Objective:To analyze the clinical features and follow-up results of children with acute exogenous lipoid pneumonia (ELP), and to investigate the diagnosis strategy, treatment and risk factors of ELP.Methods:The clinical features, imaging manifestations, results of bronchoalveolar lavage fluid (BALF), treatment methods and prognosis of 41 ELP inpatients in Guangzhou Women and Children′s Medical Center, Guangzhou Medical University from May 2013 to May 2018, were summarized and analyzed, and the related literature was reviewed.Results:(1) Among 41 patients, 29 cases were male and 12 cases were female.The age of onset ranged from 4 to 53 months.Most of them (35/41 cases, 85.4%) were less than 3 years old, and the majority were aged 1 to 2 years (23/41 cases, 56.1%). (2) The grease taken by children by accident included perfume oil (11 cases), white electric oil (7 cases), electric mosquito oil (5 cases), lubricating oil (5 cases), paraffin oil (4 cases), gasoline/diesel oil (3 cases), kerosene (2 cases), cod-liver oil (2 cases), sewing machine oil (1 case), and unclear oil (1 case). (3) The main clinical manifestations were cough (26/41 cases, 63.4%), shortness of breath (23/41 cases, 56.1%), fever (17/41 cases, 41.5%), cyanosis with hypoxemia (15/41 cases, 36.6%), wheezing (9/41 cases, 22.1%), respiratory distress (9/41 cases, 22.1%), pulmonary hemorrhage (6/41 cases, 14.7%), feeding difficulties and transient vomiting (4/41 cases, 9.8%). Some cases showed no symptoms (3/41 cases, 7.3%). (4) Chest X-ray mainly showed bilateral pulmonary exudative changes or pulmonary consolidation.The most common sign of high-resolution computerized tomography (HRCT) was local or extensive exudation, often accompanied by pulmonary consolidation (18/41 cases, 43.9%). The most common affected sites were bilateral lower lobes (8/41 cases, 19.5%), followed by right lower lobes (3/41 cases, 7.3%), right middle lobes (2/41 cases, 4.8%) and left lower lobes (2/41 cases, 4.8%). Other signs included alveolar changes, hyperventilation, ground glass changes, and nodule formation.(5) Seven children needed mechanical ventilation due to respiratory failure, and all patients underwent bronchoalveolar lavage (BAL). All patients recovered without death, with (11.67±4.90) days of hospitalization, and the hospitalization time of ELP patients with adenovirus infection was (19.25±5.93) days.Nine of them were lost to follow-up (8 cases were mild and 1 case was severe). The symptoms of the remaining children disappeared within 1 week to 1 month.The lung images of 21 cases returned to normal within 1 month after discharge, 7 cases returned to normal within 3 months after discharge, and 4 cases returned to normal after 6 months.Conclusion:The clinical manifestations and lung imaging of children with acute ELP have no specificity.Pulmonary imaging of severe patients shows multiple lobes involved, and consolidation and vacuolar changes may occur.Most patients have a favorable prognosis.Co-infection, especially adenovirus infection, may be a risk factor for acute ELP in children.BAL can play a role in both diagnosis and treatment, and its combination with local/systemic glucocorticoid therapy is effective for severe acute ELP.
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Objective@#To evaluate the efficacy and safety of oseltamivir in the treatment of suspected influenza in children.@*Method@#A multicenter, randomized and open-label trial was conducted among 229 individuals with suspected influenza which were collected from the clinic of 5 hospitals in Guangdong province (Guangzhou Women and Children′s Medical Center, Shenzhen Baoan District Maternity and Child Care Service Center, the Second Affiliated Hospital of Shantou University Medical College, Dongguan Maternity and Child Care Service Centre, Yuexiu District Children′s Hospital of Guangzhou) from April to July 2015. They were randomized either to oseltamivir group (oseltamivir 30-75 mg, twice daily for 5 days) or control group who were given symptom relief medicines for 5 days.@*Result@#No significant difference was found between two groups in influenza symptoms of the patients before the treatment(P>0.05). Altogether 229 individuals (114 in oseltamivir group, 115 in control group) were analyzed for efficacy, in which 73 individuals (42 oseltamivir, 31 control), 31.9%, were identified as influenza-infected through laboratory test. No significant difference was found between the two groups in the duration of fever although shortened. In the 229 individuals , the cumulative alleviation proportion between oseltamivir and control group was not significantly different (P>0.05): the median duration of illness was 69.9 hours (95% CI 65.3-91.5) in oseltamivir group and 75.4 hours (95%CI 63.9-91. 7) in control group; the median duration of fever was 40.4 hours (95%CI 31.5-53.4) in oseltamivir group and 44.0 hours (95%CI 33.2-50.0) in control group. In the 73 individuals, the cumulative alleviation proportion between oseltamivir and control group was significantly different (P<0.05). The median duration of illness was 61.2 hours (95%CI 48.0-121. 0) in oseltamivir group, being significantly shorter than that of 116.0 hours (95%CI 91.5-175.0) in control group. But it was not significantly different that the median duration of fever was 32.8 hours (95%CI 24.0-47.0 ) in oseltamivir group and 55.8 hours (95%CI 43.6-78.3 ) in control group (P>0.05). And the median duration of fever in 60 individuals (38 oseltamivir, 22 control) was significantly different between two groups(P<0.05), who had finished a course of taking oseltamivir in the 73 individuals, 34.8 hours (95%CI 24.0-48.5 ) in oseltamivir group being significantly shorter than that of 53.3 hours (95%CI 43.6-104.0 ) in control group. There was certain difference in side effects rate between the two groups (oseltamivir 10%, control 2%, P<0.05). The main side-effects were gastrointestinal symptoms (stomachache, diarrhea, poor appetite, vomiting).@*Conclusion@#The duration of illness and fever in suspected influenza patients treated with oseltamivir was shorter than those in the patients treated with no oseltamivir, the difference was not statistically significant, when 31.9% was confirmed with positive result of virus test in suspected influenza in children. But in these patients with positive result of virus test, the duration of illness was significantly shortened with treatment with oseltamivir as compared with no treatment with oseltamivir, and it would be better if full oseltamivir course was completed for reducing the duration of fever. Oseltamivir treatment was safe with mild side effects.
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Objective To validate the efficacy of Pediatric Early Warning Score (PEWS) in severity evaluation of respiratory inpatients.Methods Four hundred and thirteen children with respiratory disease were hospitalized in Pneumology Department of Guangzhou Women and Children's Medical Centre from October 2012 to October 2013,of which 36 cases required Intensive Care Unit (ICU) treatment while the rest 377 controls did not.According to the disease severity,cases and controls were further categorized into 3 groups:no-monitor-required group (n =302,controls),monitor-required group (n =75,controls),ICU group (n =36).PEWS was assessed at admission in controls and 12 hours before ICU transfer,respectively.PEWS were compared among all groups and receiver operator characteristic curve(ROC) was performed.Results The median [interquartile rang(IQR)] age in ICU group was 10 months(4-13 months),monitor-required group was 10 months (6-16 months),and no-monitor-required group was 14months(6-24 months),and the difference was significant (H =13.59,P ＜ 0.01).The median (IQR) of PEWS in ICU group was 6 scores (6-7 scores),monitor-required groups was 5 scores (4-5 scores),on-monitor-required group was 2 scores (1-2 scores),and the difference was significant (x2 =255.641,P ＜ 0.01).PEWS in monitor required group and ICU group was 3.5 score with area under ROC (AUC) as 0.898 (95％ CI:0.867-0.929,sensitivity0.907,specificity 0.893) and 4.5 with AUC as 0.978 (95％ CI:0.964-0.992,sensitivity 1.000,specificity 0.862),respectively.Conclusions PEWS can be indicative for severity classification in hospitalized respiratory pediatric patients,and can serve as a potentially excellent screening tool for prediction of ICU admission.
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Objective To observe the clinical effects and safety degree of treating children's cough variant asthma for mite allergy with Montelukast sodium combined with Flixotide. Methods Forty cases of infant patients with cough variant asthma for mite allergy in Guangzhou Women and Children's Medical Center from February 2012 to Octo-ber 2013 were taken as research subjects and randomly divided into treatment group and control group,each group 20 cases. The control group was treated with Flixotide aerosol;the treatment group took extra medicine Montelukast sodium chewable tablets. The treatment period covered half a year. After treatment both groups were observed for 3 months. During the treatment period the recovery process of clinical symptoms and adverse reaction of all the infant patients were observed and recorded. The data was analyzed with statistical software SPSS 17. 0. Results The duration of cough im-proved and solved in treatment group in the acute phase was(5. 82 ± 0. 90)d,much shorter than that of the control group[(6. 54 ± 1. 30)d],and the difference was of statistical significance(P ﹤ 0. 05). In the procedure,4 times of cough scores of treatment group[(3. 90 ± 0. 90)scores,(0. 90 ± 0. 30)scores,(0. 70 ± 0. 30)scores,(1. 90 ± 0. 70) scores]declined apparently more than those of control group[(4. 10 ± 0. 70)scores,(1. 20 ± 0. 40)scores,(1. 30 ± 0. 50)scores,(2. 40 ± 0. 80)scores];the difference was of statistical significance(all P ﹤ 0. 05);and the both were rebounded after 3 months without medicine. In terms of pulmonary function PD20,the patients in treatment group [(0. 46 ± 0. 08)mg vs(1. 76 ± 0. 07)mg]showed better improvement than those in control group[(0. 46 ± 0. 07) mg vs(1. 70 ± 0. 07)mg],and the difference was of statistical significance(P ﹤ 0. 05). Conclusions Treating chil-dren's cough variant asthma for mite allergy with Montelukast sodium combined with Flixotide is of good therapy effect in the acute phase and the control phase,worthy of further clinical application.