Serotipos y resistencia antimicrobiana de Streptococcus pneumoniae en población pediátrica china: una revisión de alcance

Esta revisión tuvo como propósito explorar la distribución de serotipos y la resistencia antimicrobiana de Streptococcus pneumoniae en la población pediátrica de China a partir de literatura publicada en los últimos seis años. Se realizó una revisión de alcance a partir de PubMed y dos bases de datos de China: CNKI y WanFang Data. Del total de 196 artículos extraídos, se seleccionaron 14 estudios para esta revisión. Hay 13 artículos que analizan la distribución de serotipos de Streptococcus pneumoniae; los serotipos más frecuentemente registrados son: 19F, 19A, 23F, 14 y 6B. Hay 11 artículos que analizan la resistencia antimicrobiana de Streptococcus pneumoniae, la prevalencia de no susceptibles a la penicilina se encuentra en el rango de 0 % a 95,7 %. Los aislados son muy resistentes a eritromicina, clindamicina, tetraciclina y trimetoprima-sulfametoxazol; son resistentes a penicilina en meningitis neumocócica pero son sensibles a penicilina en otras enfermedades neumocócicas, además, son muy sensibles a levofloxacina, vancomicina y Linezolid. Se concluye que la vacuna antineumocócica conjugada 13 tiene alta cobertura en los serotipos de Streptococcus pneumoniae en los niños de China continental, por eso se recomienda su inclusión en el programa de vacunación infantil; al mismo tiempo, se debe tener en cuenta la aparición de la sustitución de serotipos. Por eso, se deben incluir más pacientes pediátricos o niños en las investigaciones, especialmente los menores de cinco años. Es necesaria una vigilancia de alta calidad a largo plazo sobre la distribución de serotipos y resistencia antimicrobiana de Streptococcus pneumoniae para el desarrollo de la prevención de enfermedades neumocócicas.

This review aimed to explore the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in the Chinese pediatric population based on literature published in the last six years. A scoping review was performed using PubMed and two Chinese databases: CNKI and WanFang Data. Of the total of 196 articles extracted, 14 studies were selected for this review. There are 13 articles that analyze the distribution of Streptococcus pneumoniae serotypes, the most frequently registered serotypes are: 19F, 19A, 23F, 14 and 6B. There are 11 articles that analyze the antimicrobial resistance of Streptococcus pneumoniae, the prevalence of non-susceptible to penicillin is in the range of 0% to 95.7%. Isolates are highly resistant to erythromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole; they are resistant to penicillin in pneumococcal meningitis but are sensitive to penicillin in other pneumococcal diseases, in addition, they are very sensitive to levofloxacin, vancomycin and Linezolid. It is concluded that the pneumococcal conjugate vaccine 13 has high coverage in Streptococcus pneumoniae serotypes in children from mainland China, therefore its inclusion in the childhood vaccination program is recommended; at the same time, the occurrence of serotype substitution should be taken into account. Therefore, more pediatric patients or children should be included in research, especially those under five years of age. Long-term, high-quality surveillance of the serotype distribution and antimicrobial resistance of Streptococcus pneumoniae is necessary for the development of pneumococcal disease prevention.

Comportamiento de las neumonías graves en el Hospital Pediátrico Borrás-Marfán. 2015-2019 / Behavior of severe pneumonia at Borrás-Marfán pediatric hospital. 2015-2019

Introducción: Las neumonías constituyen un grave problema de salud al ser causa frecuente de morbilidad y mortalidad infantil en el mundo. Objetivo: Describir el comportamiento de las neumonías graves en un grupo de pacientes ingresados en la Unidad de Terapia Intensiva Pediátrica (UTIP) del Hospital Pediátrico Docente Borrás-Marfán. Material y Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo, en 223 pacientes que ingresaron en el servicio de terapia intensiva mencionado, entre agosto de 2015 y diciembre de 2019, con diagnóstico de neumonía grave. Se caracterizó la muestra según variables demográficas, complicaciones, procederes invasivos realizados, aislamiento microbiológico, antibióticos utilizados y estadía en el servicio. Para el análisis de los resultados se empleó la estadística descriptiva. Resultados: El grupo de edades más representativo fue el de 1-4 años, con un ligero predominio de varones. Las complicaciones más frecuentes fueron el derrame pleural, el neumatocele y el neumotórax. Requirieron toracocentesis el 40,81 por ciento de los casos y pleurotomía el 33,18 por ciento. El principal germen aislado fue el Streptococcus Pneumoniae y la mayoría de los pacientes necesitaron dos antibióticos para el tratamiento. Conclusiones: En el período estudiado, la principal complicación de la neumonía fue el derrame pleural y se realizó toracocentesis y pleurotomía en aproximadamente la mitad de los casos con buenos resultados. El uso de dos antibióticos en la mayoría de los pacientes según los protocolos establecidos resultó efectivo(AU)

Introduction: Pneumonia is a serious health problem because it is a frequent cause of infant morbidity and mortality worldwide. Objective: To describe the behavior of severe pneumonia in a group of patients admitted to the Pediatric Intensive Care Unit (PICU) of Borrás-Marfán Pediatric Hospital. Material and Methods: An observational, descriptive and retrospective study was conducted in 223 patients with the diagnosis of severe pneumonia admitted to the aforementioned intensive care service from August 2015 to December 2019. The sample was characterized according to demographic variables, complications, invasive procedures performed, microbiological isolation, type of antibiotics used, and the number of days spent in the hospital. Descriptive statistics was used for the analysis of results. Results: The most representative age group was 1-4 years, with a slight predominance of males. The most frequent complications were pleural effusion, pneumatocele and pneumothorax. In this group, 40.81 percentof the cases required thoracentesis and 33.18 percent underwent pleurotomy. The main isolated germ was the Streptococcus Pneumoniae and most of the patients needed treatment with two antibiotics. Conclusions: During the period studied, the principal complication of pneumonia was the pleural effusion. Approximately half of the cases underwent thoracentesis and pleurotomy and good results were achieved. The use of two antibiotics according to established protocols were effective, too(AU)

New progress in diagnosis， prevention and epidemiology of Streptococcal pneumonia in Children / 上海预防医学

Streptococcus pneumoniae （Pneumococcus） is a kind of Gram-positive diplococcus with capsule， which is the main cause of morbidity and mortality of lower respiratory tract infection in the world. The death toll caused by Streptococcus pneumoniae is higher than that caused by Haemophilus influenzae type B， influenza virus and respiratory syncytial virus combined. In recent years， the infection rate and hospitalization rate of pneumococcal pneumonia have decreased with the vaccination of 7-valent pneumococcal conjugate vaccine （PCV 7） and 13-valent pneumococcal conjugate vaccine （PCV13）. This article will briefly review the new progress in hospitalization rate，diagnosis and treatment of pneumococcal pneumonia in children at home and abroad in the past decade.

Value Addition on Trend of Pneumonia Disease in India- The Current Update

Pneumonia continues to be the leading infectious cause of death among children under the age of five worldwide. Diagnosis of this disease is primarily dependent on physical examination, clinical history,and radiographic studies. Microbiological studies of the lower respiratory tract secretions have proven to be futile, however, sputum gram staining and culturing methods often aid in the diagnosis and management of these infections. Aspiration pneumonia often occurs in a community setting and primarily involves anaerobes like Staphylococcus aureus or gram-negative rods such as Klebsiella pneumonia, and other Enterobacteriaceae and Pseudomonas species. The total number of cases taken in the study of acute pneumonia was22 (15 male subjects and 7 female subjects). Biochemical tests were conducted for identifying different organisms present in the samples collected from patients suffering from acute pneumonia.Distribution of bacteria in the case of acute pneumonia was as follows: Staphylococcus aureus was recorded to be the highest (36.36%) followed by Streptococcus pneumonia (18.18%) and Klebsiella pneumonia (18.18%), Pseudomonas pneumonia (13.63%), Haemophilus influenza(9.09%) and lastly Chlamydia pneumonia(4.45%). A maximum number of laboratories proven acute pneumonia cases (36.36%) belonged to 61-70 years. The distribution of cases was marginally more in urban areas (63.63%). By occupation largest group (36.36%) was of others in case of acute pneumonia were as farmers, housewivesand others were the largest groups (22.73%) each. The microbial etiology derived from the present study found that Klebsiella pneumoniawas an independent risk factor for mortality in severe community-acquired pneumonia. Moreover, two important findings were drawn from this study. K. pneumoniawas identified as the causative pathogen in 22% of cases, second to S. pneumonia

Clinical spectrum of pneumonia in children aged 1 month to 18 years by serum polymerase chain reaction, in a tertiary care centre in Bengaluru, Karnataka, India

Background: Pneumonia accounts for 15% all deaths in children under 5 years of age, being the single largest infectious cause of deaths in children worldwide according to WHO. Establishing the exact etiological factor is a difficult task, as there are no definite clinical, radiological markers to differentiate between causative organisms. Hence by detecting the genetic material of causative organism by serum PCR (polymerase chain reaction) and correlating it with the clinical and radiological features can help in appropriate use with antibiotics.Methods: It is a observational study conducted in department of paediatrics KIMS hospital Bangalore, India which included inpatients admitted with clinical and radiological features of pneumonia over a study period from February 2018-April2019 .In this study we excluded immunocompromised children . After obtaining informed written consent, detailed history and clinical examination was done. Investigations including complete hemogram, CXR were done. Under sterile precautions, blood samples for serum PCR and blood culture and sensitivity were obtained. Serum PCR was done for a panel of 33 respiratory pathogens.Results: Etiological agents were identified in 63% of cases. Streptococcus pneumoniae was the most common causartive agent being detected in 50.6% of the cases. Staphylococcus aureus has been detected to be the second common organism 16%.Conclusions: In our study Pneumococci was identified in 50.6% of cases. Multiplex serum PCR could be a useful rapid diagnostic tool to identify the etiological agents. Introduction of pneumococcal vaccine worldwide in government immunization schedule, nationwide will help to reduce the disease burden caused by Streptococcus pneumoniae.

Antibiotic regimens utilization in treating community acquired pneumonia of a government practice setting: a prospective observational study in medical inpatients

Background: Pneumonia is a lower respiratory tract infection characterized by inflammation of lung tissue accompanied by infiltration of alveoli and bronchioles. Most common type is community acquired pneumonia (CAP). Initial therapy is usually empirical that is designed to treat various pathogens. In CAP cases, antibiotic therapy should begin at the earliest. The objectives of the study include to identify most common causative micro-organisms, to assess risk of developing CAP in patients having co-morbidities, to identify most commonly prescribed antibiotic regimen.Methods: A prospective observational study was conducted for period of 6 months at RIMS, Kadapa. 120 patients were recruited based on inclusion criteria. Treatment was given according to Infectious Diseases Society of America and American Thoracic Society guidelines.Results: In a total of 120 patients, 77 were males and 43 were females. 69 patients belong to 46-55 & above age groups. 84 patients had social habits and 36 patients are without social habits. Patients with single lobe infiltrations are 105 and patients with multiple lobe infiltrations are 15. In our study, streptococcus pneumoniae and pseudomonas aeruginosa were the most common isolated organisms. Monotherapy was given for 7 patients, dual therapy for 97 patients and triple therapy for 16 patients. 33 patients received ceftriaxone (CEF) and augmentin (AUG), 29 patients received CEF and azithromycin (AZI), 7 patients received levofloxacin (LEV), 25 patients received CEF and LEV, 10 patients received CEF and ciprofloxacin (CIP) and 16 patients received CEF, AUG and AZI. 100 patients had less than 8 days of hospital stay.Conclusions: Research study concluded that ? lactum antibiotics were the most commonly prescribed class. CEF and AUG was highly recommended drug regimen.

Investigation on colonization status of Streptococcus pneumoniae and Haemophilus influenzae in healthy infants in Wuhan / 公共卫生与预防医学

Objective To understand the colonization status of Streptococcus pneumoniae and Haemophilus influenzae in nasopharynx of healthy infants in Wuhan. Methods Six vaccination clinics were randomly selected, and the nasopharyngeal specimens of healthy infants were collected and cultured for Streptococcus pneumoniae and Haemophilus influenza. Results The carrying rate of Streptococcus pneumoniae and Haemophilus influenzae in 998 healthy infants was 18.84% and 17.54%, respectively. The carrying rate of Streptococcus pneumoniae and Haemophilus influenzae within 6 months of age was 15.79% and 14.39%, and the carrying rate of Streptococcus pneumoniae and Haemophilus influenzae at 7-12 months old was 22.90% and 21.73%, respectively. The difference was statistically significant (Sp: χ2=5.60 P=0.02; Hi：χ2=8.98　P=0.00); The carrying rate of Streptococcus pneumoniae in urban and suburban areas was 18.08% and 19.78%, respectively, and the Haemophilus influenzae carrying rate was 17.18% and 17.98%, respectively. The differences were not statistically significant (Sp：χ2=0.47　P=0.50; Hi：χ2=0.11　P=0.74). The correlation coefficient (r value) of the age of the month and the carrying rate of sp and hi was 0.98 and 0.96, respectively. Conclusion The age of healthy infants in Wuhan was highly linearly and positively correlated with the carrying rate of Streptococcus pneumoniae and Haemophilus influenza.

Enfermedad neumocócica invasiva en menores de cinco años en Cienfuegos (2009-2015) / Invasive pneumococcal disease in children younger than five years in Cienfuegos (2009-2015)

RESUMEN Fundamento: Desde hace más de una década, la dirección política del país, el sistema de salud y la industria biotecnológica, han otorgado máxima prioridad al proyecto cubano de desarrollo de un candidato vacunal conjugado heptavalente contra los neumococos. El Hospital Pediátrico de Cienfuegos es uno de los centros centinelas para la introducción de dicha vacuna. Objetivo: describir las características clínicas, epidemiológicas y de laboratorio en los pacientes diagnosticados con enfermedad neumocócica invasiva. Métodos: estudio descriptivo, con los pacientes menores de cinco años egresados con diagnóstico de enfermedad neumocócica invasiva. Se analizó edad, sexo, forma de presentación, días previos al ingreso con síntomas, localización del lugar donde se realizó el aislamiento, hospitalización en unidad de cuidados intensivos, mes de ingreso y serotipo aislado. Resultados: predominaron los menores de sexo masculino (60 %). La forma de presentación predominante fue la neumonía, con el 77,7 % de los casos y 66 aislamientos por hemocultivos. El mayor número de casos se concentró en los meses de invierno, y la mayoría de los aislamientos se reportaron en los serotipos 14, 19A y 19F. Un total de 62 pacientes estuvieron ingresado en la Unidad de Cuidados Intensivos. Conclusión: la enfermedad neumocócica invasiva presenta elevada incidencia en menores de cinco años, y es la neumonía la forma de presentación más frecuente con predominio del Serotipo 14.

ABSTRACT Foundation: For more than a decade, the political leadership of the country, the health system and the biotechnology industry have given top priority to the Cuban development project of a heptavalent conjugate vaccine candidate against pneumococci. The Pediatric Hospital of Cienfuegos is one of the sentinel centers for the introduction of this vaccine. Objective: to describe the clinical, epidemiological and laboratory characteristics in patients diagnosed with invasive pneumococcal disease. Methods: a descriptive study with patients younger than five years with a diagnosis of invasive pneumococcal disease. The variables analyzed were: Age, sex, form of presentation, days prior admission with symptoms, location of isolation, hospitalization in intensive care unit, month of admission and isolated serotype. Results: male infants predominated (60%). The predominant presentation was pneumonia, with 77.7% of the cases and 66 isolations by blood cultures. The largest number of cases was concentrated in the winter months, and most of the isolations were reported in serotypes 14, 19A and 19F. A total of 62 patients were admitted to the Intensive Care Unit. Conclusion: invasive pneumococcal disease has a high incidence in children younger than five years, and pneumonia is the most frequent presentation with predominance of Serotype 14.

Antibacterial Activity of Locally Prepared Herbal Cough Extracts against Klebsiella pneumoniae and Streptococcus pneumoniae

Aim: Cough due to Klebsiella pneumoniae andStreptococcus pneumoniae is currently managed by conventional antibiotics and herbal extracts in Uganda. However, much as these herbal extracts are extensively used, their antibacterial activity is not known. This study aimed at determining the antibacterial activity of the selected locally prepared herbal cough extracts against two bacterial strains i.e. Klebsiella pneumoniae (ATCC 700603), and Streptococcus pneumoniae (ATCC 49619). Methods: The herbal cough extracts were screened for antibacterial activity using Agar-well diffusion method for determining zone of inhibition, macro broth dilution method for Minimum Inhibitory Concentration (MIC) determination and Streak plate method for Minimum Bactericidal Concentration (MBC). Results:In vitro evaluation of antibacterial activity of the 5 brands of herbal cough extracts against K. pneumoniae and S. pneumoniae revealed that all extracts possessed significant antimicrobial effects against all microorganisms tested (p < 0.05). However, MM04 (35.6±0.0) mm and MM03 (33.6±1.5) mm had maximum zones of inhibition as compared to other herbal extracts against K. pneumoniae and S. pneumoniae respectively. Average MIC results for extracts against K. pneumoniae indicated that MM01 had the highest MIC (2.5000 mg/ml) while MM03 had the least MIC (0.0625 mg/ml). Average MIC results for extracts against S. pneumoniae showed MM01 had the highest MIC (2.0000 mg/ml) while MM03 3 had the least MIC (0.0438 mg/ml). Average MBC results for extracts against K. pneumoniae indicated that MM01 had the highest MBC (4.000 mg/ml) while MM03 had the least MBC (0.030 mg/ml). Average MBC results for extracts against S. pneumoniae showed MM01 had the highest MBC (4.000 mg/ml) while MM03 had the least MBC (0.033 mg/ml). Conclusion: The results obtained in present study were revealed that locally prepared herbal extracts had significant antibacterial activity. Hence they can be used as promising alternatives of antibiotics used against Respiratory Tract Infections due to K. pneumoniae and S. pneumoniae.

Meningitis bacteriana de presentación atípica en paciente adulta mayor: reporte de caso / Atypical presentation for bacterial meningitis in an elderly woman: report of a case

La meningitis es un proceso inflamatorio de las leptomeninges cuyas manifestaciones clínicas son inespecíficas en los extremos de la vida. Presentamos el caso de una paciente mujer de 70 años de edad, que ingresó a emergencia con un tiempo de enfermedad de 14 horas y un cuadro de cefalea, vómitos y trastorno del sensorio, hemiparesia derecha en mal estado general; se diagnosticó inicialmente un accidente cerebro vascular. La tomografía cerebral no mostró evidencia de lesiones isquémicas o hemorrágicas. La paciente empeoró y cursó con fiebre, por lo que se realizó una punción lumbar y se inició tratamiento antibiótico empírico. El cuadro empeoró y la paciente falleció a las 36 horas del ingreso. Tanto el cultivo del líquido cefalorraquideo como el hemocultivo fueron positivos para Streptococcus pneumoniae. Discutimos el diagnóstico, presentación atípica, tratamiento y la necesidad del reconocimiento oportuno de esta patología.

Meningitis is an inflammatory process affecting leptomeninges, whose clinical manifestations are nonspecific both in the very young and the elderly. We present the case of a 70-year-old female patient who was admitted to emergency with 14-hour time of illness who presented with headache, vomiting, conscience impairment, and right hemiparesis. The patient was in a poor general condition, and the initial diagnosis was stroke. The brain CT scan showed no evidence of ischemic or hemorrhagic lesions. The patient worsened and developed fever, so a lumbar puncture was performed and empirical antibiotic treatment was started. Her condition got worse, and she died 36 hours after admission. Both the cerebrospinal fluid culture and the blood culture were positive for Streptococcus pneumoniae. We discuss the diagnosis, the atypical presentation, treatment and the need for the timely recognition of this condition.

Evaluation of clinical usefulness of pneumococcal urinary antigen test: single center experience

OBJECTIVE: A pneumococcal urinary antigen (PUA) test, which can be performed quickly and easily, is performed frequently in emergency rooms because of its high sensitivity and specificity. On the other hand, it is a relatively expensive test, and it is not known how it affects the clinicians' prescription of antibiotics. This study evaluated the clinical utility of the PUA test. METHODS: This study was conducted retrospectively on patients aged ≥18 years, who underwent a PUA test and were hospitalized with a diagnosis of pneumonia in an emergency room from January to December 2016. The patients were divided into a PUA test positive group and negative group, and the clinical characteristics and antibiotic regimen were compared. RESULTS: A total of 533 patients were enrolled, of which 54 were positive and 479 were negative. The antibiotic prescriptions were similar in the positive and negative groups. After the PUA test result, only two of the positive group used the antibiotics recommended by the Infectious Diseases Society of America and the American Thoracic Society for Streptococcus pneumoniae. Furthermore, there was an appropriate change in eight patients after the blood culture test, but the PUA test result was judged to be meaningful in only two patients. CONCLUSION: The results of the PUA test did not affect the clinician's antibiotic prescription significantly. A prescription standard for the PUA test is needed, and it should be performed after admission rather than in the emergency room.

Comparison of the virulence of Streptococcus pneumoniae in ICR mouse stocks of three different origins / 한국실험동물학회지

Streptococcus pneumoniae causes many people to suffer from pneumonia, septicemia, and other diseases worldwide. To identify the difference in susceptibility of and treatment efficacy against S. pneumoniae in three ICR mouse stocks (Korl: ICR, A:ICR, and B:ICR) with different origins, mice were infected with 2 × 106, 2×107, and 2×108 CFU of S. pneumoniae D39 intratracheally. The survival of mice was observed until three weeks after the infection. The three stocks of mice showed no significant survival rate difference at 2 × 106 and 2 × 107 CFU. However, the lung and spleen weight in the A:ICR stock was significantly different from that in the other two stocks, whereas the liver weight in B:ICR stock was significantly lower than that in the other two stocks. Interestingly, no significant CFU difference in the organs was observed between the ICR stocks. The level of interferon gamma inducible protein 10 in Korl:ICR was significantly lower than that in the other two stocks. The level of granulocyte colony stimulating factor in B:ICR was significantly lower than in the other two stocks. However, tumor-necrosis factor-alpha and interleukin-6 levels showed no significant difference between the ICR stocks. In the vancomycin efficacy test after the S. pneumoniae infection, both the single-dose and double-dose vancomycin-treated groups showed a significantly better survival rate than the control group. There was no significant survival difference between the three stocks. These data showed that Korl:ICR, A:ICR, and B:ICR have no susceptibility difference to the S. pneumoniae D39 serotype 2.

Clinical distribution and antibiotic resistance of Streptococcus pneumonia isolated from pediatric patients in Guangzhou / 国际检验医学杂志

Objective To explore the sample type and drug resistance characteristics of Streptococcus pneu-monia(Spn)isolated from pediatric patients in Guangzhou district,and their age distribution to offer instruc-tions for prevention and clinical treatment.Methods Spn isolates were cultured and identified according to the national standard procedure for clinical laboratory operation,followed by analysis of sample type and age dis-tribution of pediatric patients with positive isolates of Spn in Guangzhou Women and Children′s Medical Cen-ter from 2013 Jan 1st to 2015 Dec 31st,drug resistance status was determined by MIC test.Results Totally, 1 243 strains of Spn were isolated,which were mainly from pediatric patients under 1 year old(42.80%).Spn isolates were mainly isolated from respiratory tract(72.81%),ear secretions(15.37%),blood(5.63%),cere-brospinal fluid(3.06%)and hydrothorax(2.01%).For all Spn isolates,the resistance rate to erythromycin, tetracycline and sulfamethoxazole was especially high as 94.93%,85.76%,73.53% respectively,with relative high resistance to penicillin G(24.70%),amoxicillin(39.59%),ceftriaxone(24.05%),meropenem(22.85%) and cefotaxime(19.89%),low resistance to quinolone antibiotics(<10.00%),and no resistance to vancomycin and linezolid.Conclusion The major age group of children with Spn infection is infants under one year old in Guangzhou,clinicians should be serious about the high resistant rate of Spn to erythromycin,tetracycline and sulfamethoxazole,the significantly increased resistant rate to penicillin,amoxicillin and ceftriaxone.Clinicians should choose antibiotics rationally according to the characteristics of drug sensitivity for better treatment.

Recurrent fever, bulging fontanelle and elevated white blood cell / 中华实用儿科临床杂志

This patient presented with fever,seizure and bulging fontanelle when he was 6-month-old.According to the investigations,white blood cell (WBC),erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased significantly,and Streptococcus Pneumonia grew in both blood and cerebrospinal fluid (CSF).He responded to standard antibiotic treatment poorly even it lasted long enough.At the same time,the inflammation seemed to be over-activated,the WBC level was still elevated,high fever continued.Thus they thought of primary immunodeficiency and sent blood sample for gene panel testing (Sanger sequencing) but got negative result.At last,they added steroid together with anti-tuberculosis drug therapy,his temperature as well as the intracranial pressure became better ever since.At the age of 1 year and 1 month,he got another Streptococcus Pneumonia meningitis,while he was still on anti-tuberculosis drug therapy and tapering off steroid.At this time,he presented with coarse hair,hypohidrosis and delayed eruption of teeth,which strongly indicated Anhidrotic Ectodermal Dysplasia with Immunodeficiency (EDA-ID).NEMO is the most common gene responsible for EDA-ID and locates on X chromosome.It has a pseudogene named IKBKGP which locates downstream of NEMO.IKBKGP and NEMO share 3-10 exons with the homology of 99.8％,which makes it difficult to find out most real mutations within NEMO with Sanger sequencing.Then they performed PCR with the primer starting upstream of the shared exons.Finally,they found out the pathogenic mutation [c.505G ＞ C(p.A169P)] of NEMO,which has been reported.This finding led us to make the right diagnosis as well as the proper treatment and the prognosis for this patient.

Streptococcus pneumoniae Infection Increases Expression of von Willebrand Factor (vWF) in a Mouse Brain Endothelium Model

von Willebrand factor (vWF) is a large multimeric glycoprotein which is normally released by the brain endothelial cells and is therefore present as a circulating protein in the blood. The initial and mature structure of vWF is uncleaved; however, pneumococcal infection can cause the cleavage of the protein, thus forming several multimers at different sizes. The present study tested the hypothesis that Streptococcus pneumoniae infection of brain endothelial cells in culture induces the release of vWF at certain sizes time-dependently. Immortalized mouse brain endothelial cells (bEnd.3) were infected at specific hours with Streptococcus pneumoniae strains (serotype 19F). Immunofluorescence microscopy was performed and quantified accordingly. Cells were also extracted, and the proteins were separated into different sizes by western blot. The expression of vWF was then analysed and compared for a potential relationship between the strains and between the specific time of infection. The expression of vWF was elevated during infection. Even though multiple and non-specific events can also cause the cleavage of vWF, this study showed that the cleavage pattern of vWF is potentially dependent on the incubation time of infection.

The characteristics of lower respiratory tract infection by Streptococcuspneumonia in children under the age of 5 years and drug resistance study / 国际检验医学杂志

Objective To study the characteristics of lower respiratory tract infection by Streptococcus pneumonia in children aged from 0 to 5 years and drug resistance,so as to provide the rational basis for clinical treatment and epidemiology.Methods The medical data from 4 815 children aged 0 to 5 years with lower respiratory tract infection between September 2014 and September 2016 were retrospectively reviewed.Results Totally 343 strains of Streptococcus pneumonia were isolated from 4 815 sputum samples,with the isolation rate of 7.12％.Of the isolated streptococcus pneumonia strains,80.76％ were isolated from the children with pneumonia,9.33％ were isolated from the children with bronchitis,5.83％ were isolated from the children with capillary bronchitis,4.08％ were isolated from the children with bronchial asthma.There was no significant difference in the incidence of Streptococcus pneumonia infections between the genders of the children(P>0.05),but the incidence of Streptococcus pneumonia detection rates differed significantly in different seasons and children of different ages,the difference was statistically significant(P<0.05).The resistance rates of Streptococcus pneumonia to penicillin,erythromycin and clindamycin were 51.0％,97.9％ and 97.1％ respectively;The sensitivity rates to cefotaxime and vancomycin were 71.1％ and 100.0％ respectively.Conclusion The children aged less than 1 years old are at the high risk of Streptococcus pneumonia infection and highest detection rates in winter,it is necessary to perform the drug susceptibility testing in a timely manner so as to choice reasonable antimicrobial agents to control the condition.

Penicillin-binding proteins genotyping of penicillin resistance Streptococcus pneumonia isolated from children in Guangzhou area / 国际检验医学杂志

Objective To understand the molecular epidemiology of penicillin resistance Streptococcus pneumonia (PNSP) isolated from children in Guangzhou area to provide the experimental basis for clinical prevention and control of Streptococcus pneumonia infectious diseases.Methods Specific primers were designed according to Genebank,penicillin binding protein(PBP) genes PBP1A,PBP1B,PBP2A,PBP2B,PBP2X,PBP3 were amplified by PCR.The sequencing analysis was performed.The PCR products were digested by Hinf I,and the restriction fragment length polymorphism (RFLP) was analyzed.Results DNA of PNSP was successfully extracted,the PCR results showed that in 50 strains of PNSP,the positive rates of bacterial strains containing PBP1A,PBP1B,PBP2A,PBP2B,PBP2X and PBP3 were 48.9%,64.4%,71.1%,31.1%,40.0% and 31.1% respectively.The sequencing showed that their homologies with known sequences in GenBank were 99%,98%,100%,97%,95% and 100% respectively.Using RFLP in Hinf I showed that PBP1A,PBP1B,PBP2A and PBP3 only had one kind of genotype,PBP2B and PBP2X had two kinds of genotypes,the positive rates were 71.4%,28.6%,66.7% and 33.3% respectively.Conclusion The gene distribution of PNSP strains among children in Guangzhou is dominated by PBP2A,PBP1B and PBP1A,there are two subtypes in PBP2B,PBP2X when digested by Hinf I,in which the predominant subtype >65%.

Epidemiology and characteristics of antibacterial resistance in China / 中华临床感染病杂志

Currently, bacterial resistance situation in health care settings is very serious in China, and the prevalence of a variety of common multidrug-resistant bacteria and pan-resistant bacteria are relatively high. Drug-resistant bacteria in Gram-positive bacteria are mainly methicillin resistant Staphylococcus aureus ( MRSA ) and macrolide-resistant Streptococcus, while glycopeptide-resistant enterococci are still at a low level.The clonal distribution of MRSA and mechanisms of Streptococcus resistance in China are different from those in European and American countries.Cephalosporins and quinolones resistance are the marked characteristic of Enterobacteriaceae with a high occurrence over 60%. Carbapenem-resistant Klebsiella pneumoniae shows a rapid upward trend, and producing KPC-2 type carbapenemases is the main mechanism of its resistance.Resistance in Pseudomonas aeruginosa is relatively stable, with resistant rates ranging from 20%to 30%.Multi-drug resistant Acinetobacter baumannii is a big problem in clinic.More than 50% Acinetobacter baumannii strains are resistant to carbapenems and cephalosporins, and tigecycline-resistant Acinetobacter baumannii is increasing.This paper systematically reviews the status and characteristics of bacterial resistance in last five years with referring to the surveillance data of antimicrobial resistance and the findings of related mechanisms.

Natural antibacterial remedy for respiratory tract infections

Objective: To evaluate the antibacterial activity of Egyptian honey against bacteria causing respiratory tract infections. Methods: Sputum and throat swab specimens were used, from which five bacterial species were isolated, namely, Klebsiella pneumonia, Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa and Streptococcus pneumonia were isolated, identified and grown on suitable media for further identification or confirmation. Different concentrations (100%, 75% and 25%) of honey and simulated honey solution were used for activity assay and estimation of minimum inhibitory concentration and minimum bactericidal concentration. Results: All the tested bacterial isolates were completely susceptible to the 75% concentrations of honey and to the 100% concentration of the simulated honey solution. This may be due to the high osmotic pressure exerted by the high sugar content in both honey samples. Moderate susceptibility of the isolated bacteria to honey at 100% v/v concentration, and resistance to honey at 25% concentration and the 75% and 25% concentrations of simulated honey solution, indicated the presence of other antimicrobial components responsible for the activity other than the osmotic pressure. Therefore, it was suggested that honey showed distinguished antibacterial activities against the most common bacteria causing respiratory infections with varied sensitivity. Conclusions: Honey, a non-toxic, nutritious, safe for human consumption and cheap natural antibacterial agent, should be globalized.

Serotype prevalence of Streptococcus pneumoniae in Malaysia – the need for carriage studies

Pneumococcal disease, caused by the bacterium Streptococcus pneumoniae, is a major burden to global health. Although the World Health Organisation (WHO) strongly recommends the inclusion of pneumococcal conjugate vaccines in national immunisation programmes (NIP’s) worldwide, this has not occurred in many countries in the WHO South East Asia and Western Pacific regions – particularly longstanding middle-income countries. It is widely accepted that carriage of S. pneumoniae is a precursor to developing any pneumococcal disease. The reduction in pneumococcal disease from vaccine serotypes (VT) following widespread implementation of the pneumococcal conjugate vaccine (PCV) is believed to be through the direct immunogenic protective effect of immunised individuals as well as indirectly through herd immunity diminishing the incidence of disease in nonimmunised individuals. In Malaysia, pneumococcal disease is not included in national surveillance programmes and although PCVs have been licensed, they have not been included in the NIP. Hence, the vaccine is only available privately and the majority of the population is not able to afford it. There is an urgent need to develop surveillance programmes in Malaysia to include pneumococcal serotype data from carriage and invasive disease so that it may help guide national vaccine policy prior to a decision being taken on the inclusion of PCVs in the NIP.