ABSTRACT
Objective:To study the macrolides resistance of Mycoplasma pneumoniae(MP) in Suzhou area, and try to explore the relationship between drug resistance and refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods:From a series of hospitalized children who were diagnosed as Mycoplasma pneumoniae pneumonia (MPP) from October 2013 to September 2014 in Suzhou area, 48 children were treated with Azithromycin (10 mg/kg, once a day, intravenous drip for 5-7 days), and the clinical symptoms and chest imaging were still progressing so they were clinically diagnosed as RMPP, and 34 children who were successfully treated with macrolides antibiotics (MA) were clinically diagnosed as general MPP (GMPP). MP DNA was extracted from the airway secretion of children in the two groups, and the point mutations of 2063 and 2064 of 23S rRNA were sequenced, and according to the MP 23S rRNA sequencing results, the children were divided into macrolides antibiotic resistant MP group (MRMP) and macrolides antibiotic sensitive MP group (MSMP). The clinical characteristics of the two groups were compared. Results:In the MRMP group, the incidence of RMPP was 62.2% (46/74 cases), while in MSMP group, the incidence of RMPP was 25.0% (2/8 cases). The point mutation of MP 23S rRNA had no significant effect on the occurrence of RMPP ( χ2=2.719, P=0.099). Compared with MRMP group, MSMP group presented shorter fever time and less glucocorticoid use.No significant differences between the two groups were found in chest imaging examination, as well as some laboratory results, including the total number and classification of white blood cell (WBC), C-reactive protein (CRP), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB). Conclusions:The fever duration of MPP lasted more than 1 week, suggesting the possibility of macrolides resistance of MP, but macrolides resistance did not aggravate the occurrence of RMPP.It is unreliable to judge the MRMP by chest imaging features and laboratory results.
ABSTRACT
Objective:The epidemiological characteristics and drug susceptibility changes of Pseudomonas aeruginosa(PA) infection in the respiratory tract of children in suzhou were analyzed in order to provide guidance and suggestions for the rational use of antibiotics in this region. Methods:Bacterial culture results of nasopharyngeal secretions from 21 176 children admitted to the Department of Respiratory, Children′s Hospital Affiliated to Soochow University for respiratory tract infections from January 2008 to December 2017 were collected.According to age, season, underlying disease conditions and the presence of intensive care units (ICU) during the hospitalization, these children were divided into different groups.The epidemic characteristics of PA infection were monitored, and changes in PA drug sensitivity were dynamically observed.Results:Among 21 176 nasopharyngeal secretions from children with respiratory tract infection, 191 cultures were detected with PA, and showing a positive detection rate of 0.90% (191/21 176 cases). The annual detection rate was different.The highest detection rate was 2.24% (50/2 234 cases) in 2009 and the lowest was 0.41% (9/2 207 cases) in 2014.The detection rate of PA in children with in >6 months to 1-year-old group was the highest (1.52%, 53/3 497 cases), and the lowest was 0.57%(11/1 934 cases) in the >5-year-old group.The detection rates of PA in spring, summer, autumn, and winter were 1.11% (60/5 420 cases), 1.21% (61/5 046 cases), 0.81% (46/5 670 cases), and 0.48% (24/5 040 cases), respectively.The difference of PA detection rates between summer (the highest rate) and the winter (the lowest rate) was statistically significant ( χ2=18.611, P<0.001). Among the 21 176 children, 18.89% (4 000/21 176 cases) had basic diseases, and the PA detection rate in such kind of patients was 1.28% (51/4 000 cases), which was higher than that in patients without basic diseases (0.82%, 140/17 176 cases). The PA detection rate in the ICU group was 4.41% (15/340 cases), which was significantly higher than that in the general group (0.84%, 176/20 836 cases) ( χ2=7.678, 47.623, all P<0.05). There were no strains susceptible to Ampicillin, Ampicillin/Sulbactam and compound Sulfamethoxazole, and no strains susceptible to Ceftriaxone from 2010 to 2017.The susceptibility rate to Imipenem was low from 2012 to 2015, and the lowest was only 66.7% in 2014.The sensitivity rate to Aztreonam fluctuated significantly from year to year.Strains were all highly sensitive to Piperacillin, Piperacillin Tazobactam, Ciprofloxacin, Levofloxacin, Gentamicin, and Tobramycin. Conclusions:PA infection is prone to occur in young children with basic diseases and relatively severe illness.Summer is a high-incidence season.PA is generally highly resistant to commonly used antibiotics.
ABSTRACT
Objective To study the epidemiological and clinical features of viral pathogen of acute respiratory tract infection(ARTI)in children in Suzhou. To provide the evidence-based medicine for early warning,diagnosis and treatment of respiratory tract infection in children. Methods The study population comprised of all the children ranging from 28 days to 15 years old with ARTI admitted to Department of Respiration,the Childrenˊs Hospital Affiliated to Soo-chow University,between January 2006 and December 2015. The study cases were divided into 4 age groups based on ages(28 days to <1 year old,1- <3 years old,3- <5 years old and ≥5 years old). The nasopharyngeal aspirates and medical history were obtained by qualified medical personnel. Seven kinds of common respiratory virus were detec-ted by using the direct immunofluorescence. Mycoplasma pneumonia(MP),chlamydia pneumonia(CP)and human bo-cavirus(hBoV)were detected by adopting fluorescence quantitative PCR. Human rhinovirus(HRV)and human metap-neumovirus(hMPV)were detected by means of reverse transcriptionpolymerase chain reaction( RT -PCR). Sputum was cultured for bacteria. Results In 21 624 cases,17 618 cases were detected,and the positive detection rate of virus was 30. 74%(5 416 cases). The highest detection rate of virus was 44. 25%(881/1 991 cases)in 2011 in the 10 years. There were 3 317 cases of single virus pathogen infection,accounting for 18. 83%. Among them,respiratory syn-cytial virus(RSV)was the first with 9. 42%(1 660/17 618 cases),followed by HRV(5. 17%,278/5 372 cases), hBoV(3. 12%,351/11 263 cases),Pinf 3(2. 17%,383/17 618 cases),and the lowest rate was Pinf 2 with 0. 05%(8/17 618 cases). There were 2 099 cases of overlap infection,accounting for 11. 91%. The virus combined with bacte-rial infection accounted for 7. 86%(1 384/17 618 cases),which had the most positive cases. With the increase of age, the single virus pathogen infection rate gradually dropped. The highest detection rate was 22. 82%(1 976/8 656 cases) in the group between 28 days and <1 year old,and the lowest detection rate was 7. 81%(159/2 035 cases)of children over 5 years of age. The virus positive rate of the four seasons was 18. 28%(833/4 556 cases),13. 86%(625/4 508 cases),5. 91%(684/4 298 cases),27. 68%(1 178/4 256 cases),respectively,and detection rate in winter was the highest,and the least in summer. In the single virus infection,bronchiolitis had the highest percentage(36. 32%,25/69 cases),and the least rate was 5. 83%(63/1 080 cases)of lobar pneumonia. Conclusions Monitored for 10 years of the virus respiratory infection in Suzhou area,RSV,HRV and hBoV turned out to play an important role in respiratory tract infection in children. The children less than 3 years old are the most susceptible to virus infection. The epidemic season of each virus is different and characteristic.
ABSTRACT
Objective To analyze the infection composition and drug resistance to Gram-negative (G-) bacilli in children's respiratory tract in Suzhou,in order to provide evidence for rational use of antibiotics clinically.Methods G-bacilli culture samples were collected from 21 561 cases of nasopharyngeal secretions from patients with respiratory tract infection admitted at the Department of Respiratory,Children's Hospital of Soochow University from January 2007 to December 2016,including 21 246 cases in general wards,and 315 patients who were transferred to the respiratory department after treatment in the Intensive Care Unit(ICU),and the children were divided into the general ward group and the ICU group,and the pathogens were compared and the changes in bacterial susceptibility were dynamically observed between the 2 groups.Results The primary G-bacteria for respiratory infection was Haemophilus influenzae,followed by Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii.The detection rates of Klebsiella pneumoniae and Pseudomonas aeruginosa in the ICU group were 16.8% (21/125 strains) and 14.4% (18/125 strains),respectively,which were significantly higher than those in the general ward group [10.0% (208/2 071 strains),9.2% (190/2 071 strains)].The detection rates of G-bacteria in the ICU group were 33.7% (106/315 cases),which were significantly higher than those in the general ward group [9.4% (1 997/21 246 cases)],and the difference was statistically significant (x2 =210.325,P < 0.001).The rare G-bacillus such as Stenotrophomonas maltophilia,Acinetobacter junii and Burkholderia onion were higher in the ICU group [17.6% (22/125 strains)] than that in the general ward group [6.4% (132/2 071 strains)].The rate that of G bacteria with two or more mixed infection in ICU group [17.0% (18/106 cases)] was significantly higher than in the general ward group [3.4% (68/1 997 cases)],and the difference was statistically sigmficant(x2 =47.3,P <0.05).For the mixed infection,the ICU group was mainly composed of Klebsiella pneumoniae mixed with Pseudomonas aeruginosa or Escherichia coli,while the general ward group was composed of Haemophilus influenzae mixed with Pseudomonas aeruginosa or Escherichia coli.The sensitivity of Haemophilus infiuenzae to Ampicillin,Sultamicillin,Cefuroxime,Cefaclor and Azithromycin decreased,and the sensitivity to Chloramphenicol,Tetracycline and Trimethoprim + Sulfamethoxazole increased year by year,and there were statistically significant differences in different years (all P < 0.05).The sensitivity to Escherichia coli to Ceftazidime decreased year by year,and the sensitivity to Ampicillin and Levofloxacin increased year by year,and there were statistically significant differences in different years (all P < 0.05).The sensitivity to Klebsiella pneumoniae to Cefoperazone/Sulbactam and imipenem decreased,and the sensitivity to Ciprofloxacin and Levofloxacin increased,and there were statistically significant differences in different years (all P < 0.05).The sensitivity to Pseudomonas aeruginosa,Cefoperazone/Sulbactam and Ceftriaxone decreased year by year,and the sensitivity to Levofloxacin increased,and there were statistically significant differences in different years (all P < 0.05).The detection rate of carbapenem-resistant strains of Klebsiella pneumoniae and Pseudomonas aeruginosa showed an increasing trend,and there were statistically significant differences in different years (all P < 0.05).Conclusions The primary G-bacteria for respiratory infections is Haemophilus influenzae,G-bacilli especially,the mixed infection of G-bacilli,is more likely to cause severe and critical respiratory infections.The resistance rate of G-bacteria infection in children's respiratory tract to commonly used antibiotics is generally on the rise.
ABSTRACT
Objective@#To analyze the infection composition and drug resistance to Gram-negative (G-) bacilli in children′s respiratory tract in Suzhou, in order to provide evidence for rational use of antibiotics clinically.@*Methods@#G- bacilli culture samples were collected from 21 561 cases of nasopharyngeal secretions from patients with respiratory tract infection admitted at the Department of Respiratory, Children′s Hospital of Soochow University from January 2007 to December 2016, including 21 246 cases in general wards, and 315 patients who were transferred to the respiratory department after treatment in the Intensive Care Unit(ICU), and the children were divided into the general ward group and the ICU group, and the pathogens were compared and the changes in bacterial susceptibility were dynamically observed between the 2 groups.@*Results@#The primary G-bacteria for respiratory infection was Haemophilus influenzae, followed by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii.The detection rates of Klebsiella pneumoniae and Pseudomonas aeruginosa in the ICU group were 16.8% (21/125 strains)and 14.4%(18/125 strains), respectively, which were significantly higher than those in the general ward group [10.0%(208/2 071 strains), 9.2%(190/2 071 strains)]. The detection rates of G-bacteria in the ICU group were 33.7%(106/315 cases), which were significantly higher than those in the general ward group [9.4%(1 997/21 246 cases)], and the difference was statistically significant(χ2=210.325, P<0.001). The rare G-bacillus such as Stenotrophomonas maltophilia, Acinetobacter junii and Burkholderia onion were higher in the ICU group [17.6%(22/125 strains)] than that in the general ward group [6.4% (132/2 071 strains)]. The rate that of G-bacteria with two or more mixed infection in ICU group [17.0% (18/106 cases)] was significantly higher than in the general ward group [3.4%(68/1 997 cases)], and the difference was statistically significant(χ2=47.3, P<0.05). For the mixed infection, the ICU group was mainly composed of Klebsiella pneumoniae mixed with Pseudomonas aeruginosa or Escherichia coli, while the general ward group was composed of Haemophilus influenzae mixed with Pseudomonas aeruginosa or Escherichia coli.The sensitivity of Haemophilus influenzae to Ampicillin, Sultamicillin, Cefuroxime, Cefaclor and Azithromycin decreased, and the sensitivity to Chloramphenicol, Tetracycline and Trimethoprim+ Sulfamethoxazole increased year by year, and there were statistically significant differences in different years (all P<0.05). The sensiti-vity to Escherichia coli to Ceftazidime decreased year by year, and the sensitivity to Ampicillin and Levofloxacin increased year by year, and there were statistically significant differences in different years (all P<0.05). The sensitivity to Klebsiella pneumoniae to Cefoperazone/Sulbactam and imipenem decreased, and the sensitivity to Ciprofloxacin and Levofloxacin increased, and there were statistically significant differences in different years (all P<0.05). The sensitivity to Pseudomonas aeruginosa, Cefoperazone/Sulbactam and Ceftriaxone decreased year by year, and the sensitivity to Levofloxacin increased, and there were statistically significant differences in different years (all P<0.05). The detection rate of carbapenem-resistant strains of Klebsiella pneumoniae and Pseudomonas aeruginosa showed an increasing trend, and there were statistically significant differences in different years (all P<0.05).@*Conclusions@#The primary G-bacteria for respiratory infections is Haemophilus influenzae, G-bacilli especially, the mixed infection of G-bacilli, is more likely to cause severe and critical respiratory infections.The resistance rate of G-bacteria infection in children′s respiratory tract to commonly used antibiotics is generally on the rise.
ABSTRACT
Objective@#To investigate the safety and efficacy of haploidentical hematopoietic stem cell transplantation with different intensity conditioning regimen in the treatment of childhood aplastic anemia (AA) .@*Methods@#Thirty-seven AA patients who underwent haploidentical transplantation in BaYi Children's Hospital Affiliated to PLA Army General Hospital from January 2013 to January 2017 were enrolled. According to the dosage of conditioning regimen, 34 patients excluding 3 other conditioning regimens were divided into high-dosage group (regimen 2, 22 cases) and low-dosage group (regimen 3, 12 cases). The data of Engraftment, graft-vs-host disease (GVHD), hematopoietic reconstitution, relapse, infection, overall survival (OS) were analyzed. The comparison between the two groups was tested by χ2 test.@*Results@#A total of 35 of 37 patients achieved primary engraftment; 2 cases died of regimen-related toxicity and severe infection before the infusing of the grafts. The activation rate of CMV and EBV was 60% (21/35) . Post-transplant lymphocyte disease (PTLD) of lung occurred in one case. The cumulative incidences of acute GVHD grade Ⅰ-Ⅳ and chronic GVHD were 29% (10/35) and 34% (12/35) respectively and the incidence of extensive chronic GVHD was 6% (2/35) . The median follow-up time was 18.8 (2.9-44.1) months, the OS was 92% (34/37) .All survived patients were no longer dependent on blood transfusion and none of them had recurrence. Comparing the rates of overall survival(86%(19/22) vs.100%(12/12)) and rates of chronic GVHD(40%(8/20) vs. 17%(2/12)) in regimen 2 and regimen 3 group, there were no significant difference (χ2=1.742, 1.841, all P>0.05) . Significant difference was found at the incidence of Ⅰ-Ⅳ acute GVHD (10% (2/20) vs. 50% (6/12) ,χ2=6.200, P=0.013).@*Conclusions@#Haploidentical hematopoietic stem cell transplantation is effective and safe. It is suitable for patients who are not eligible for matched donor transplantation. Application of reduced dose preconditioning in haploid transplantation is worth exploring.
ABSTRACT
Objective To analyze the clinical characteristics and laboratory indexes of pneumonia complicated with pertussis syndrome in Suzhou area in order to provide the basis for rational treatment.Methods Children who had been hospitalized at Department of Respiratory,Children's Hospital of Soochow University during January 2012 to October 2016 were enrotled and diagnosed as pneumonia complicated with pertussis syndrome.A total of 236 cases were enrolled.Multiple pathogen detection and clinical information were collected in all patients.The subjects were divided into 28 days-< 3 months group,3-< 6 months old group,6-< 12 months old group and ≥ 12 months old group.The clinical data of children in each age group were retrospectively analyzed.Results Pneumonia complicated with pertussis syndrome was easy to occur within 6 months of infants,with the highest incidence in the 3-< 6 months group,there was a significant difference among the different age groups (x2 =231.870,P < 0.05) [28 d-< 3 months group:5.3% (102/1 910 cases),3-<6 months group:5.7% (76/1 341 cases),6-< 12 months group:2.0% (36/1 762 cases),≥12 months group:0.4% (22/5 304 cases)].The patients could become sick all the year round,with the highest incidence in summer[2.6% (72/2 740 cases)in spring,3.7% (96/2 611 cases)in summer,2.1% (56/2 749 cases) in autumn,and 0.48% (12/2 487 cases)in winter],and there were significant differences among the different seasons (x2 =62.380,P <0.001).Clinical symptoms were paroxysmal spasmodic cough,33.0% (78/236 cases) of the performance with wheezing,mainly in the older than 3 months group.The incidence of fever was positively correlated with age(x2 =12.938,P < 0.05).Peripheral white blood cell count and lymphocyte percentage increased,and the 3-< 6 months old group increased markedly.White blood cell count as high as (19.01 ± 11.99) × 109/L,the highest percentage of lymphocytes was up to 0.80,platelets were significantly increased in more than 80% of children.The incidence of C-reactive protein (CRP) was negatively correlated with age,28 days-< 3 months group more prone to have high CRP.Pulmonary inflammatory pathology showed multiple pulmonary involvement by chest radiography,and it was more likely to occur in 28 d-< 3 months group.Viruses,bacteria and mycoplasma pneumoniae (MP) could cause pneumonia associated with pertussis syndrome,and mixed infection occurred in 56 cases.The top three pathogens were rhinovirus,MP and Streptococcus pneumoniae,and mixed infection was more prone to occur in 28 d-< 3 months group.Conclusion Pneumonia complicated with pertussis syndrome is easy to occur within 6 months of infants,with the highest incidence in summer.Viruses,bacteria and MP all could cause pneumonia associated with pertussis syndrome,and mixed infection could occur in some cases.The top three pathogens are rhinovirus,MP and Streptococcus pneumoniae.
ABSTRACT
Objective To analyze the epidemiological characteristics of Streptococcus pneumonia (SP) in children with respiratory tract infection in Suzhou area,and the correlation between the air pollutants and the epidemiological characteristics of SP.Methods The real-time air quality test data of Suzhou in Jiangsu province was recorded from January 2012 to December 2014,and sputum specimens of 6 653 cases of hospitalized children with respiratory tract diseases in the same period were collected.The SP detection content and the correlation between SP and the concentration level of PM2.5,PM 10,nitrogen dioxide (NO2),sulfur dioxide (SO2),carbon monoxide (CO),ozone (O3) in Suzhou were analyzed.Results The SP detection rate was 9.94% in 6 653 children.The SP detection rates were respoctively 7.69% (183/2 381 cases),10.87% (235/2 161 cases),11.51% (243/2 111 cases) between 2012 and 2014.The SP detection rates of children at the age of ≤ 1 year old,> 1-3 years old,> 3-< 7 years old and ≥ 7 years old more respectively were 7.11% (227/3 192 cases),13.48% (244/1 810 cases),13.76% (168/1 221 cases),5.12% (22/430 cases).The SP detection rate of children at the age of > 1-3 years old and >3-<7 years old was higher than that of ≤ 1 years old and ≥7 years old,and the difference was significant (x2 =84.980,P < 0.001).The SP detection rates in spring,summer,antumn and winter respectively were 9.79% (173/1 768 cases),7.66% (130/ 1 697 cases),11.76% (187/1 590 cases),10.70% (171/1 598 cases).The SP detection rate of children in summer was the lowest (x2 =4.897,15.839,9.165,all P < 0.05).The concentrations of PM2.5,PM 10,SO2,NO2,CO and O3 were in a state of fluctuation during the survey period.The SP detection rate had positive correlation with the concentration of PM2.5,PM10,SO2,NO2,CO and O3 (r =0.650,0.586,0.680,0.467,all P < 0.005),and there was no obvious correlation between the SP detection rate and the concentration of CO,O3 (all P > 0.05).Conclusions SP is one of the important pathogens of respiratory tract infection in children in Suzhou area,and the detection rate in infants and preschoolers is higher but the detection rate in summer is lower.The SP detection rate is closely correlated with the concentration of PM2.5,PM10,SO2,NO2.
ABSTRACT
Objective@#To analyze the epidemiological characteristics of influenza virus type A (FluA) in children with respiratory tract infection, and to provide scientific basis for clinical diagnosis and treatment.@*Methods@#Sputum specimens of 35 529 cases of hospitalized children with respiratory tract diseases from January 2006 to December 2015 in Suzhou were collected. FluA was detected by direct immunofluorescence and the FluA detection result was analyzed. Groups were compared with chi-square test.@*Results@#The FluA infection rate was 1.60% in 35 529 children. The FluA infection rate of boys was 1.58%, and the rate of girls was 1.63%. There was no obvious statistically significant difference in sex (χ2=0.139, P=0.709). The FluA infection rates of children at the age of less than 1 year, less than 3 years, less than 7 years and older than 7 years respectively were 1.12%, 2.49%, 1.78%, and 1.24%; there was significant differences among these result (χ2=75.401, P=0.000). The FluA infection rates in spring, summer, autumn and winter respectively were 0.88%, 1.44%, 1.32%, 2.70%. The rates in four seasons had significant difference (χ2=105.432, P=0.000). The FluA infection rate was the highest in winter and the lowest in spring. The FluA infection rate was 6.55% in the autumn of 2008, which was the highest in the recent ten years.@*Conclusions@#FluA is one of the important pathogens of respiratory tract infection in children in Suzhou area. The infection rate of infant is higher and the epidemic peak is in winter. The FluA infection has obvious epidemic season and year. The FluA infection rates in Suzhou area are 0.64%-3.49%, and there was no outbreak in the recent ten years.
ABSTRACT
Objective To analyze the correlation between response to hepatitis B virus (HBV) vaccine and cellular immunity and clinical characteristics in children with respiratory infection.Methods Nine hundred and sixty children in Department of Respiratory in Children's Hospital of of Soochow University,who were over 7 months old and had full course of HBV vaccination between January and December 2015 were enrolled in this study.Peripheral blood (1-2 mL) was collected,and antigen-antibody of HBV was detected by using enzyme-linked immunosorbent assay and PCR included HBV surface antigen,hepatitis B antibody,HBV e antigen,HBV e antibody,HBV core antibody,and HBV nucleic acid.According to the results,these children were divided into 4 groups:non response group,low response group,normal response group and high response group according to their responses to HBV vaccine.Cellular immunity was detected by using flow cytometry and patients' clinical data was collected.Results There was no statistical differences of CD3 + CD4 +,which were (3.43 ± 0.28) %,(3.42 ± 0.30) %,(3.43 ± 0.36) % and (3.52 ± 0.29) %,among the four groups (F =0.520,P =0.669).CD3 + CD8 + in non response group was (3.18 ±0.28)%,which was significantly higher than that in low response group,normal response group and high response group [(3.08 ± 0.36)%,(3.05 ±0.34)%,(2.93 ±0.30)%],the differences were significant (all P<0.05);CD4/CD8 in non response group (0.26 ± 0.43) were significantly lower than that in normal response group (0.40 ± 0.50),the differences were significant (P =0.001).There was no significant difference of CD3 +,CD3 + CD8 + and CD4/CD8 among low response group,normal response group and high response group (all P > 0.05).CD3-CD19 + and CD19 + CD23 + level were lowest in non response group [(3.00 ± 0.57) %,(2.25 ± 0.67) %] and highest in high response group [(3.33 ± 0.45) %,(2.57 ± 0.38) %],the differences were significant (all P < 0.05).Among the 4 groups,children in normal response group had the shortest average hospitalization days [(1.88 ±-0.31) d],which was significantly shorter than that in non response group,low response group and high response group [(1.96 ± 0.39) d,(1.95 ± 0.38) d,(1.96 ±0.15) d],the differences were significant (all P <0.05),there was no significantly difference of average hospitalization days among other 3 groups (all P > 0.05).Proportion of severe pneumonia was significantly higher in non response group [6.1% (22/363cases)] and high response group [13.3% (2/15 cases)] compared to those in normal response group [2.6% (7/274cases)],the differences were statistically significant (x2 =4.417,P =0.036;x2 =5.476,P =0.019).The total white blood cell number was lowest in non response group (F =4.695,P =0.003).Platelet number was increased with higher degree of response to HBV (F =6.598,P < 0.001).Conclusions Cellular immunity is lower in respiratory infection children with non response or low response to HBV vaccine.After they have respiratory infection,children with non response to HBV vaccine may have a longer course of disease and worse condition.
ABSTRACT
Objective To study the characteristics of etiology of lobar pneumonia in hospitalized children.Methods Medical history and sputum specimens were collected from 1 179 hospitalized children with lobar pneumonia from January 2006 to December 2015.Multiple pathogenic joint detection combined with the history data were used for analysis.Seven kinds of common respiratory virus were detected by direct immunofluorescence.Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP) and human Bocavirus (hBoV) were detected by fluorescence quantitative polymerase chain reaction (PCR).Human Rhinovirus (HRV) and human Metapneumovirus (hMPV) were detected by reverse transcription PCR.Aspirates were cultured for bacteria.MP specific antibody IgG and IgM were tested by enzyme-linked immunosorbent assay (ELISA).Positive rates of each group were compared by χ2 test or Fisher exact test.Results Total etiology detection rate of lobar pneumonia in hospitalized children was 83.9% (989/1 179).The etiology detection rate of MP, virus, bacteria and streptococcus pneumoniae (SP) were 74.0%, 14.2%, 18.3% and 12.2%, respectively.The virus detection rate in 1-3 years old group was the highest, and that in ≥6 years old group was lower than other group (χ2=70.095, P0.05).The MP detection rate was above 70% in every season.The detection rates of SP and hBoV were basically the same in every season.The detection rate of HI was higher in spring, Pinf 3 and SA were higher in summer, HRV was higher in autumn, and respiratory syncytial virus (RSV) and moraxella catarrhalis (MC) were higher in winter.Conclusions Lobar pneumonia occurs more common in elder children.MP is the major pathogen of lobar pneumonia, and SP is the second.The MP detection rate increases with age.The pathogen detection rate varies with age, but the effect of seasonal factor is not obvious on pathogen detection in lobar pneumonia.
ABSTRACT
Objective To analyze the clinical features of infants infected by respiratory syncytial virus (RSV) or human rhinovirus (HRV) in lower respiratory tract in Suzhou area based on the month age and the month of the year.Methods From January 2013 to December 2015,2 206 nasopharyngeal aspirates specimens were collected from the infants with lower respiratory tract infection.Direct immunofluorescence assay was performed to test RSV.Reverse transcription-polymerase chain reaction(RT-PCR) method was used to test HRV.The medical history was collected and pulmonary function tests were performed in some infants who were infected with RSV and HRV.Results In 2 206 cases,total RSV positive rate was 19.90% (439/2 206 cases) and simple RSV infection positive was detected in 399 cases.Total HRV positive rate was 14.14% (312/2 206 cases),in which simple HRV infection positive was detected in 250 cases and the detection rate of RSV was significantly higher than that of HRV(x2 =25.88,P <0.05).The incidence rate of wheezing in simple RSV infection was 68.17% (272/399 cases),which was significantly higher than that of simple HRV infection (42.80%,107/250 cases) (x2 =11.174,P < 0.05).RSV infection was frequent from November to February of the next year in which the detection rate in December was highest with the proportion of 50.00% (99/198 cases) while the rate in June was only 0.57% (1/175 cases).The detection rate of HRV was 22.86% (40/175 cases),20.47% (35/171 cases) and 20.33% (25/123 cases) in June,July and September respectively.The detection rate of HRV was lower during December to February of the next year.In January,the detection rate was only 4.68% (11/235 cases),which was the lowest in the whole year.The detection rates of RSV were 33.33% (4/12 cases),25.21% (118/468 cases),23.46% (84/358 cases) and 23.81% (60/252 cases) in the age group of 28 d-1 month,> 1-2 month,> 2-3 month and > 3-4 months respectively.Up to the age of 4 months old,the detection rate decreased gradually,and with the increase of age and the detection rate in > 7-8 month group was only 10.96% (16/146 cases).The detection rate of HRV was 0 (0/12)and 9.40% (44/468 cases) in the age group of 28 d1 month,> 1-2 month,respectively.After 2 months age old,the detection rate fluctuation ranged from 13.22% to 16.67%.The incidence rate of severe RSV infection was 12.30% (54/439 cases) and the incidence rate of severe HRV infection was 5.13% (16/312 cases).Increased respiratory rate was more common in patients with severe RSV infection while severe HRV infection in infants were accompanied by multiple lobar involvement.After RSV infection,the incidence rate of pulmonary function damage was 89.03% (276/310 cases).After HRV infection,89.27% (183/205 cases)of the infants suffered from pulmonary function damage.Both RSV and HRV infection might cause pulmonary function damage.Conclusions RSV and HRV are the major pathogens in infants of Suzhou areas.The incidence of RSV-induced wheezing is significantly higher than that of HRV.RSV is detected positive mainly in winter and early spring and the infants within 4-month old are susceptible population.HRV is detected positive mainly in June,July and September and the infants older than 2 months are susceptible population.The incidence of severe RSV infection is significantly higher than that of HRV.Severe RSV infection may cause increased respiratory rate and severe HRV infection mainly cause multiple lobar involvement.RSV and HRV infection may cause pulmonary function damage.
ABSTRACT
Objective To explore the influence of coinfection with other pathogens on human metapneumovirus (hMPV) infection in children.Methods A total of 11 299 children admitted to the Department of Respiratory Disease,Children's Hospital of Soochow University between June 2010 and May 2015 were enrolled in this study.Sputum specimens were collected and multiple pathogenic joint detection was done,including peripheral blood,and blood routine,C reactive protein (CRP),hepatic function and cellular immunity.Patients' clinical data were collected.Results Among 11 299 hospitalized children,hMPV was positive found in 222 children (1.96%).One hundred and fourteen children (51.4%) had hMPV simple infection and 108 cases of them (48.6%) were coinfected with other pathogens.The hMPV coinfected with bacteria (63 cases,28.4%)was most common.The average age of multiple coinfected children was older than that of simple hMPV infection in children [(2.43 ± 2.47) years old vs.(1.27 ± 1.30) years old],and the difference was significant (Z =-2.360,P < 0.05).Fever seemed to be more common in children coinfected with bacteria or multiple coinfection (63.5% and 70.0%) compared with those with simple hMPV infection (43.0%),and the differences were significant (x2 =6.827,4.986,all P < 0.05).There was no significant difference in other clinical features among 5 groups (all P > 0.05).Multiple coinfection children had a higher percentage of neutrophils (0.50 ± 0.18) than that in simple hMPV infection children (0.37 ± 0.19),children coinfected with bacteria (0.39 ±0.19) or other virus (0.35 ±0.19),and the differences were significant (all P <0.05).CRP was elevated in 30.2% (19/63 cases) of children coinfected with bacteria,which was significantly higher than that of simple hPMV infection children (16.7 %,19/114 cases),and the difference was significant (x2 =4.381,P < 0.05).CD3 + CD4 + was significantly lower in multiple coinfection children (0.31 ± 0.07),but there were no significant difference compared with other groups (all P > 0.05).CD19 + CD23 + was significantly higher in children coinfected with other virus com pared with that of simple hMPV infection group,hMPV coinfected with bacteria,hMPV coinfected with Mycoplasma pneumonia and multiple coinfect group (0.37 ± 0.10 vs.0.30 ± 0.09,0.30 ± 0.08,0.29 ± 0.07,0.29 ± 0.09),and the differences were significant (all P < 0.05).Conclusions It is suggested that hMPV seems easily coinfected with other pathogens,especially with bacteria.It should be on high alert that bacteria coinfection is accompanied with high percentage of neutrophils and high level of CRP.Coinfection does not significantly exacerbate the clinical symptoms of hMPV infection,but may exacerbate the cellular immune disorders to a certain extent.
ABSTRACT
Objective To investigate the therapeutic effects of anti-B7-H3 blocking monoclonal antibody(McAb) in a murine model of neutrophilic asthma. Methods Twenty-four female BALB/c mice were randomly divided into four groups: PBS control group (group A), neutrophilic asthma group (group B),anti-B7-H3 McAb group (group C) and IgG isotype control group (group D). Those in group A were sensitized by injection of PBS and challenged with PBS through inhalation,while the other mice were sensi-tized by injection of ovalbumin (OVA) plus airway instillation of lipopolysaccharide(LPS),and then chal-lenged with OVA. Moreover,mice in group C and group D were respectively injected with anti-B7-H3 McAb and IgG isotype control in the induction period. Each mouse′s performance was observed. Samples of bron-choalveolar lavage fluid (BALF) and lung tissues were collected. Total and differential cell counts in BALF were determined by using microscope. Levels of cytokines including IFN-γ,IL-4,IL-6,IL-17,tumor nec-rosis factor-α (TNF-α) and granulocyte colony stimulating factor (G-CSF) in BALF were measured by ELISA. Lung sections were stained with hematoxylin and eosin (HE) and periodic acid-Schiff (PAS) to identify tissue inflammation and mucus production,respectively. Immunohistochemistry was used to measure the expression of B7-H3 in frozen mouse lung sections. Results Mice in group B and group D showed asth-matic symptoms such as breathlessness,dysphoria and incontinence after nebulization,while these symptoms in group C were alleviated due to anti-B7-H3 McAb treatment. No abnormalities were observed in group A. Compared with group A,the other three groups showed increased total cell count in BALF and higher per-centages of neutrophil and eosinophil(P<0.05). These three indicators in group C were lower than those in group B and group D (P<0.05). With regard to lung infiltration by Th1,Th2 and Th17 cells,the levels of IFN-γ,IL-4,IL-6,IL-17,TNF-α and G-CSF in BALF were increased in group B,group C and group D as compared with those in group A. Compared with group C,group B and group D showed higher levels of IL-6, TNF-α,IL-17 and G-CSF(P<0.05),but lower level of IL-4(P<0.05). No statistical difference in the level of IFN-γ was observed among group B, group C and group D. Histological staining of lung sections showed that no obvious inflammatory cells and mucus secretion was observed in group A. Massive infiltration of inflammatory cells and neutrophils and mucus hypersecretion were detected in group B and group D. Treatment with anti-B7-H3 McAb inhibited the accumulation of neutrophils and mucus hypersecretion in lung tissues of group C. Compared with group A, levels of B7-H3-positive cells were significantly increased in group B and group D. Anti-B7-H3-treated mice showed reduced levels of B7-H3-positive cells in lung tissues as compared with those in group B and group D(P<0.05). Conclusion Treatment with anti-B7-H3 bloc-king McAb in an early stage can relieve the asthmatic syndrome, reduce airway inflammatory cells, inhibit mucus production and down-regulate Th17 cell-related cytokine secretion,which helps to alleviate airway and systematic inflammation in mice with NA,and partially inhibit the development of NA.
ABSTRACT
The aim of the present research was to investigate and analyze the hunting intentions of medical students for rural grassroots in Gansu and to provide a reference for decision-making on rural health human resource . A questionnaire is the research tool which was used to investigate the views of the senior students from six medical schools , and we studied their employment willingness to rural healthcare institutions .Chi-square test and non-condi-tional logistic regression analyses were used for data analysis .A sample of 600 medical graduates was involved in this investigation.The results of this study show that more than a half (55.6%) of the students would like to work in ru-ral, but only 13.8%of which were “very willing” to work at the rural healthcare institutions .According to the out-comes of this investigation , the number of junior college students who would like to work at the grassroots was 2.3 times the number of the undergraduate students .Medical students whose monthly salary expectations were not high ,with the household registration in rural areas , and having a better understanding of the policy of rural grass-roots em-ployment were more likely to work at the rural healthcare institutions .Based on the findings of this investigation , it can be concluded that the grassroots medical career intention of medical students is not only influenced by its own fac -tors, such as education and household registration , but also the policy of the government , school employment guid-ance and social atmosphere play an important role .The above-mentioned factors should be considered by decision-making and management departments of public healthcare .The departments should introduce a reasonable recruit-ment policy and strengthen the construction of grass-roots medical technology , equipment , and infrastructure , im-prove the grass-roots of employment environment and career development opportunities and strengthen the medical students'employment guidance work to make medical students more willing to work at rural healthcare institutions .
ABSTRACT
Objective To explore the non-bacteria pathogens of acute laryngitis in children. Methods The clinical data and sputum sample were collected from 325 patients hospitalized due to acute laryngitis in consecutive 10 years from January 2006 to December 2015 . The multiple non-bacteria pathogens were detected and analyzed with clinical data. Seven types of respiratory viruses were detected by direct immunolfuorescence. Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP), and Boca virus (HBoV) were detected by lfuorescence quantitative PCR. The rhinovirus (HRV) and human metapneumovirus (hMPV) were detected by RT-PCR. Venous blood was collected within 24 h after hospitalization and 7-10 d after treatment. The MP antibody of IgG and IgM were detected by ELISA. Results The detection rate of non-bacteria pathogens was 46 . 2%in 325 children with acute laryngitis ( 150/325 ), including 76 cases ( 23 . 4%) of virus and 99 cases ( 30 . 5%) of MP. Virus detection rate in 1-3 year old children was obviously higher than in 0-1 year old children and over 3 years old children (χ2?=?9 . 527 , P=?0 . 009 ). With the increase of age, the detection rate of MP increased gradually (χ2?=?10 . 132 , P=?0 . 006 ). The detection rates of RSV and hBoV were higher in under 3-year-old children. The detection rates of virus in winter and spring were signiifcantly higher than those in summer and autumn (χ2?=?5.064, P=?0.024). The detection rates of MP in winter, spring, summer, and autumn was 13.1%, 25 . 0%, 38 . 2%, and 44 . 9%respectively, and the MP detection rates were increased gradually over seasons (χ2?=?4 . 438 , P=?0 . 035 ). The detection rate of RSV was higher in winter, and hBoV was higher in summer. Conclusion Acute laryngitis mainly occurred in children under 3-years-old children, and the detected non-bacteria pathogens were different among different ages and seasons. Virus was the major pathogens in young children, while MP was more common in older children.
ABSTRACT
Objective To explore the level of expression, clinical signiifcance of sB 7-H 3 in the bronchoalveolar lavage lfuid (BALF) of refractory Mycoplasma pneumoniae (MP) pneumonia (RMPP) in children and the relationship between sB7-H3 and various cytokines. Methods The BALF of forty-three hospitalized children with RMPP (RMPP group) were collected for the diagnosis and treatment. Thirteen cases were lavaged only once and the other thirty cases had collected the BALF twice. The BALF of iffteen hospitalized children with bronchial foreign body were collected as control group. The expression levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF were detected by enzyme-linked immunosorbent assay. The expression levels of sB 7-H 3 , IL-1β, IL-2 and IL-36 in the BALF at the acute phase were compared with control group and the group after treatment. Analyzed the correlation between the level of sB 7-H 3 and IL-1β, IL-2 , IL-36 in the BALF of RMPP children at acute stage. Results The levels of sB 7-H 3 , IL-1β and IL-36 in the BALF of the ifrst lavage group were higher than those of single lavage group and control group (all P0 . 05 ). The levels of sB 7-H 3 had positive correlation with the levels of IL-1β, IL-2 and IL-36 (all P<0 . 001 ). Conclusions sB 7-H 3 may control the secretion of IL-1β, IL-2 and IL-36 , and participate in immune response and lung injury after MP infection, which may lead to occurrence and development of RMPP.
ABSTRACT
An 70-year-old male come for swallowing pain 5 years, turning worse 10 months. Laryngoscopy showed a tumor with rough surface at the laryngeal surface of epiglottic. Outpatient pathology: poorly differentiated carcinoma of the larynx. CT: the root of epiglottic is slightly thickened. He accepted the partial laryngectomy, tracheotomy, bilateral functional neck dissection. Pathology: atypical carcinoid of larynx.
Subject(s)
Aged , Humans , Male , Carcinoid Tumor , Pathology , Epiglottis , Pathology , Laryngeal Neoplasms , Pathology , Laryngectomy , Laryngoscopy , Larynx , Pathology , Neck Dissection , TracheotomyABSTRACT
Objective To analyze the epidemiological characteristics of Mycoplasma pneumoniae (MP) infection in children with respiratory tract diseases ,and to provide scientific basis for clinical diagnosis and treatment and to formulate control measurements for the administrative department of public health .Methods Sputum specimens of 20 021 cases of hospitalized children with respiratory tract diseases from October 2005 to December 2014 in Suzhou were collected .MP DNA was detected by fluorescence quantitative polymerase chain reaction .At the same time ,venous blood was collected within 24 h after admission and 7-10 d of treatment .Specified MP antibodies IgG and IgM were tested by enzyme-linked immunosorbent assay to analyze the detection rate of MP . The positive rates between groups were compared using chi-square test or Fisher exact test .Measurement data were compared using Wilcoxon test .Results The MP infection rate was 36 .08% (7 224/20 021 cases) in 20 021 children .The MP infection rate of girls was 40 .81% (3 057/7 490) ,which was significantly higher than that of boys (33 .25% [4 167/12 531] ,χ2=116 .20 ,P<0 .01) .The MP infection rates of children at the age of less than six months ,6 months to 1 year old ,1-3 years old ,3-7 years old and older than 7 years old were 18 .35% ,29 .39% ,43 .93% ,54 .10% and 64 .48% ,respectively ,which increased with age (χ2 =1 949 .65 , P<0 .01) .The MP infection rates in spring ,summer ,autumn and winter were 31 .97% ,41 .57% , 40 .88% and 29 .90% , respectively . The MP infection rate of children in summer and autumn was significantly higher than that in spring and winter (χ2 =234 .61 , P<0 .01) .The MP infection rate was highest in the autumn of year 2008 (55 .07% ) and lowest in the spring of year 2010 (18 .48% ) for the decade .The MP infection rate showed fluctuations with different degrees in four seasons except in 2007 . In the past ten years ,the MP infection rate in Suzhou area was at a higher level in 2008 ,2009 ,2012 and 2013 ,which were 46 .03% ,46 .60% ,39 .28% and 47 .40% ,respectively .The MP infection rate was the lowest (25 .24% ) in 2011 in the decade ,and maintained around 30% in the rest years .Conclusions The MP infection rate in children with respiratory tract diseases is at a high level in Suzhou area .The MP infection rate of girls is higher than that of boys .MP infection could occur among all age groups ,and the MP infection rate increases with age .MP infection rate peaks in summer and autumn .MP infection has a small prevalence every two or three years ,which could sustain about two years .
ABSTRACT
Objective To study the pathogenic etiology between nasopharyngeal aspirates (NPA) and bronchoalveolar lavage lfuid (BALF) in children with lower respiratory infection. Methods Multiple pathogen in NPA and BALF from 210 cases with lower respiratory tract infection was detected. Seven common respiratory virus (respiratory syncytial virus, adenovirus, in-lfuenza virus A, inlfuenza virus B, parainlfuenza 1, parainlfuenza 2, parainlfuenza 3) were detected by direct immunolfuorescence assay. MP, CP and HBoV were detected by lfuorescence quantitative PCR.HRV and hMPV were detected by RT-PCR. Aspirates were cultured for bacteria. The results of pathogen detection in secretions of upper and lower respiratory tract were analyzed. Results Total positive detection rate of NPA and BALF in 210 cases was 91.9%(193/210), which is higher than that in NPA 75.2%(158/210) and that in BALF 85.2%(179/210). Bacteria detection rate in NPA was 13.3%(28/210), and 8.6%(18/210) in BALF, without signiifcant difference (P=0.118). Bacteria detection rate in NPA and BALF was of poor consistency (Kappa=0.262). Virus detection rate in NPA was 24.3%, which is higher than that in BALF15.2%. BALF-MP detection rate was 77.6%(163/210), signiifcantly higher than that in NPA 53.3%(112/210). There are 95.5%(107/112) cases with positive results in NPA-MP detec-tioncan also be detected in the BALF-MP. MP copies in BALF were signiifcantly higher than that in NPA (4.28×106 vs. 1.31×105), and its positive rate in NPA was still higher than that in BALF. MP detection rate in NPA in children with clinical course of longer than two weeks was much lower than those with clinical course of two weeks or less. Conclusions The pathogen detection of virus and MP in NPA can be used as a reference for lower respiratory tract infection. The joint detection of NPA and BALF can improve the detection power. The sensitivity of virus detection in NPA is higher than that in BALF. NPA pathogen detection of virus and MP is of great important evidence-based medicine in the diagnosis of lower respiratory infection. MP detection rate and its copies in BALF are signiifcantly higher than that in NPA. BALF detection is the supplement of pathogen diagnosis in severe or refractory lower respiratory infections.