ABSTRACT
Bacillus Calmette- Guérin(BCG) is still an effective way to prevent tuberculosis, but BCG vaccination reaction has various forms, mainly including lymphadenitis associated with BCG vaccination and disseminated BCG disease, the latter is relatively rare, lymphadenitis associated with BCG vaccination is relatively common, it is unclear that diagnosis and treatment, especially the timing of treatment and the choice of treatment methods, and lack of authoritative guidelines.Through further understanding of the pathogenesis, risk factors, clinical classification and diagnosis of this disease, clinicians can choose the optimized treatment plan for this disease.At the same time, the development and use of new vaccines are expected to reduce the occurrence of this disease.
ABSTRACT
Bacillus Calmette-Guérin(BCG) is still an effective way to prevent tuberculosis,but BCG vaccination reaction has various forms,mainly including lymphadenitis associated with BCG vaccination and disseminated BCG disease,the latter is relatively rare,lymphadenitis associated with BCG vaccination is relatively common,it is unclear that diagnosis and treatment,especially the timing of treatment and the choice of treatment methods,and lack of authoritative guidelines.Through further understanding of the pathogenesis,risk factors,clinical classification and diagnosis of this disease,clinicians can choose the optimized treatment plan for this disease.At the same time,the development and use of new vaccines are expected to reduce the occurrence of this disease.
ABSTRACT
Objective To report secondary paroxysmal sympathetic hyperactivity in a patient with tuberculous meningitis and to review the diagnostic criteria, clinical features, possible pathogenesis and management of this condition. Methods The clinical data of a case with paroxysmal sympathetic hyperactivity secondary to tuberculous meningitis was retrospectively analyzed and related literature was reviewed. Results A 1-year-old boy was admitted to our institute with a history of lethargy and vomiting for 3 days. Neurological examination revealed abnormalities. A lumbar puncture revealed the evidence of meningitis. PPD test, T-SPOT.TB and radiological examination revealed tuberculous meningitis. Later, when stayed in the intensive care unit, he developed paroxysmal hypertension, sinus tachycardia, tachypnea, dystonia, and high fever. These episodes improved after administration of propranolol, benzodiazepines and artane. Conclusions Paroxysmal sympathetic hyperactivity is a rare manifestation of tuberculous meningitis, early recognition is very important for avoid misdiagnosis and overtreatment.
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Objective To investigate the prevalence of year-round respiratory viral infection in children with lower respiratory tract infection (LRTI), and the relationship between respiratory viral infection and allergen sensitization in exacerbating asthma. Methods A total of 231 hospitalized children with acute LRTI were investigated from May 2013 to April 2014. The 5 most common respiratory viruses were isolated from nasopharyngeal aspirate using multiplex reverse transcription-polymerase chain reaction, including respiratory syncytial virus (RSV), adenovirus (AV), parainfluenza virus (PIV), influenza virus (IFV) and rhinovirus (RV). Atopic sensitization was defined if more than 1 serum specific immunoglobulin E level measured using immunofluorescence experiment was over 0.35 IU/mL. Results RSV was the most common pathogen of bronchiolitis in hospitalized children through the year. RV or IFV infections were more prevalent in asthma exacerbations compared to other LRTIs. AV was more likely to cause pneumonia. RV and IFV were associated with asthma exacerbations in children with atopic sensitization, but not in nonatopic children. Conclusion RV and IFV are associated with hospitalization for asthma exacerbation in children with atopic sensitization.
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Objective To evaluate the clinical efficacy of tissue-type plasminogen activator (tPA) treatment of children with plastic bronchitis.Methods The study retrospectively reviewed the clinical data of the children with plastic bronchitis who were admitted to Tianjin Children's Hospital from September 2013 to January 2015 and were treated with tissue-type plasminogen activator.This study analyzed the effect and safety of tPA treatment,including clinical and radiological changes and follow-ups.Results A lot of plastic secretions were safely removed from the bronchial tubes in all children and clinical manifestations including breathing,body temperature,transcutaneous oxygen saturation and image changes were significantly improved.Conclusions Bronchoscopy is an effective way to treat plastic bronchitis,but with the use of tPA a better clinical efficacy could be achieved.The method is safe and effective and should be applied early in the patients in order to prevent the occurrence of severe airway obstruction complications.
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Objective To identify the risk factors for severe acute lower respiratory infections (ALRI) in children and to provide scientific basis for prevention and treatment of ALRI. Methods Several databases including Pubmed, Databases-Medline (Ovid), Embase, CINAHL and Global Health Library, CNKI, VIP and Wanfang Date were searched (1990.1-2014.12) for references. All selected studies were about risk factors of ALRI in children. The screening and quality evalua? tion of the literature data was conducted independently by two reviewers according to the inclusion and exclusion criteria. Stata 11.0 software was used for Meta-analysis. Results Meta-analysis of 27 included literature showed that seven risk fac?tors were significantly associated with severe ALRI:low birth weight, lack of exclusive breastfeeding, crowded household, ex?posure to indoor air pollution, malnutrition, living in a house with smokers or smoking in pregnant and HIV-exposed unin?fected condition. Conclusion The above seven risk factors play the important role in the development of ALRI in children. Furthermore, it emphasizes the need for further studies investigating other potential risk factors to decrease the possibility of childhood ALRI.
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Objective To investigate the distribution, clinical diagnosis and treatment methods of the extrapulmo-nary complications in children with mycoplasma pneumoniae (MP). Methods The clinical data of 1 100 patients confirmed the diagnosis of mycoplasma pneumonia and with the positive serum MP-IgM test were collected in this study. The distribu-tion and clinical characteristics and MP-DNA detection rates were compared between 417 patients with extrapulmonary com-plications and 683 cases without complications. The occurrence of various complications in a four-year period was analyzed. Clinical data were compared between fiberoptic bronchoscopy lavage group and non-surgical group. Results The MP-DNA detection rate and the length of hospital stay were higher in patients with pulmonary complications than those of patients without complications. The most common types of extrapulmonary complications were liver damage, skin rashes and gastrointestinal reactions , but less severe. Encephalitis, nephritis and myocarditis were rare complications, but severe and occult. The fatal hemophagocytic lymphohistiocytosis (HLH) was also visible in patients. Bronchoscopy lavage was conducive to the recovery of the disease. Conclusion MP pneumonia showed high incidence and risks of extrapulmonary complica-tions, which required careful clinical observation and inspection, the dynamic monitoring laboratory markers and comprehen-sive treatment as well.
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OBJECTIVE: To analyse the five-point tuberculosis (TB) strategy, DOTS, 10 years after its implementation in one-half of China's population, and to suggest lessons for future implementation of the DOTS strategy. METHODS: We analysed trends in case-finding and treatment outcome over time following implementation of the DOTS strategy in each county, using routine reporting data from the Infectious and Endemic Disease Control (IEDC) project (1991 - 2000). We also determined the proportion of counties with different levels of case-finding for the fifth and sixth years of DOTS implementation. FINDINGS: From 1991 to 1995, DOTS expanded rapidly to cover more than 90% of target population and counties. By 2000, 8 million TB suspects had received free diagnostic evaluation: 1.8 million TB cases were diagnosed, free treatment was provided to 1.3 million smear-positive cases, and more than 90% were cured. During DOTS implementation, the percentage of previously treated cases decreased among all smear-positive cases and treatment outcomes improved. Despite these achievements, the detection rate for new smear-positive cases in the project was estimated to be only 54% in 1998, and 41.2% of the counties had a below average or low level of case-finding (with substantial variation between provinces). CONCLUSIONS: The IEDC project demonstrated that it is feasible to rapidly expand DOTS on a large scale. The global target of an 85% cure rate was quickly achieved, and the level of drug-resistance was probably reduced by this project. However, case-detection did not reach the 70% global target, and more research is needed on how to enhance this.
