A Multicenter Study of Viral Aetiology of Community-Acquired Pneumonia in Hospitalized Children in Chinese Mainland

Community-acquired pneumonia(CAP) is one of the leading causes of morbidity and mortality in children worldwide.In this study,we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland.During November2014 to June 2016,the prospective study was conducted in 13 hospitals.The hospitalized children under 18 years old who met the criteria for CAP were enrolled.The throat swabs or nasopharyngeal aspirates(NPAs) were collected which were then screened 18 respiratory viruses using multiplex PCR assay.Viral pathogens were present in 56.6%(1539/2721) of the enrolled cases,with the detection rate of single virus in 39.8% of the cases and multiple viruses in 16.8% of the cases.The most frequently detected virus was respiratory syncytial virus(RSV)(15.2%,414/2721).The highest detection rate of virus was in <6-month-age group(70.7%,292/413).RSV,human metapneumovirus(HMPV),human parainfluenza viruses(HPIVs) and influenza B virus(Flu B) showed the similar prevalence patterns both in north and south China,but HPIVs,Flu A,human bocavirus(HBoV),human adenovirus(HAdV) and human coronaviruses(HCoVs) showed the distinct circulating patterns in north and south China.Human enterovirus/human rhinovirus(HEV/HRV)(27.6%,27/98),HBoV(18.4%,18/98),RSV(16.3%,16/98) and HMPV(14.3%,14/98) were the most commonly detected viruses in severe pneumonia cases with single virus infection.In conclusion,viral pathogens are frequently detected in pediatric CAP cases and may therefore play a vital role in the aetiology of CAP.RSV was the most important virus in hospitalized children with CAP in Chinese mainland.

Low-dose versus high-dose methylprednisolone for children with severe Mycoplasma pneumoniae pneumonia (MCMP): Study protocol for a randomized controlled trial

Background:Severe Mycoplasma pneumoniae pneumonia(MPP)may develop with long-term pulmonary outcomes despite treatment with macrolides.Combined treatment with glucocorticoids can improve this outcome,though the optimal dosage is unknown.The aim of this study was to investigate the effects of low-and high-dose methylprednisolone in reducing the percentage of long-term pulmonary outcomes for children with severe MPP.Methods:A randomized,single-blind,parallel-controlled,multicenter clinical trial,methylprednisolone for children with severe M.pneumoniae pneumonia(MCMP),is being conducted in China.Pediatric patients(≤18 years of age,expected number=402)admitted to the hospital with a clinical diagnosis of severe MPP and fulfilling inclusion and exclusion criteria are randomized(ratio of 1:1)to either a low-dose(2 mg/kg/d)or high-dose(10 mg/kg/d)methylprednisolone treatment group for 3 days followed by tapering of methylprednisolone over 12 days and combined with azithromycin.The primary composite outcome will be incidence of atelectasis,bronchiectasis,or bronchiolitis obliterans at 6-months after treatment.Secondary outcomes include recovery time of patient temperature,proportion of pulmonary lesions absorbed,changes of mucosa identified by bronchoscopy,length of hospital stay,pulmonary function and number of participant(s)needing intensive care.Assessments will be made at baseline,post-treatment and at 1-month,3-month and 6-month follow-ups.Discussion:This is the first randomized clinical trial designed to evaluate the safety and efficacy of low-versus high-dose methylprednisolone for reducing long-term pulmonary outcomes in pediatric patients with severe MPP.The results of this study will provide scientific evidence to guide clinical practice for the treatment of severe MPP.Trial registration:This study is registered at ClinicalTrials.gov(NCT02303587).

Severe cases of BCGosis-susceptible primary immunodeficiency diseases identified by next-generation sequencing:Implications for adjustment of BCG vaccination timing in China

The World Health Organization(WHO)recommends neonatal Bacillus Calmette-Guerin(BCG)vaccination in countries with a high prevalence of tuberculosis(TB),which has been practiced in more than 150 countries(WHO,2004).The prevalence of TB is a serious condition in China,ranking as the second in the high epidemic countries globally(WHO,2018).China initiated a neonatal BCG vaccination program in 1986 and reached an average vaccination rate of 99%in 2016 with a great success in preventing the incidence of TB(WHO,2018).

Epidemiological characteristics and clinical manifestations of pediatric patients with COVID-19 in China: A multicenter retrospective study

Importance:The Coronavirus disease 2019(COVID-19)global pandemic poses a considerable challenge for pediatricians.Objective:This study aimed to identify the epidemiological characteristics and clinical features of pediatric patients with COVID-19 in China.Methods:This multicenter retrospective study included pediatric patients from 46 hospitals in China,covering 12 provinces and two municipalities.Epidemiological,demographic,clinical,laboratory,treatment,and outcome data were analyzed.Results:In total,211 pediatric patients with COVID-19 were included in this study.The median age was 7.0 years(range:22 days to 18 years).Approximately 16.3%of the patients exhibited asymptomatic infections,23.0%had upper respiratory tract infections,and 60.7%had pneumonia,including two with severe pneumonia and one with critical illness.Approximately 78.7%of the pediatric patients occurred in familial clusters.The most three common symptoms or signs at onset in children with COVID-19 were fever(54.5%),cough(49.3%),and pharyngeal congestion(20.8%).Only 17.6%of the patients presented with decreased lymphocyte count,whereas 13.6%had increased lymphocyte count.Among the patients with pneumonia who exhibited abnormal chest computed tomography findings,18.2%(23/127)of the patients had no other symptoms.Generally,the chest radiographs showed abnormalities that affected both lungs(49.6%);ground-glass opacity(47.2%)was the most common manifestation.The cure and improvement rates were 86.7%(183/211)and 13.3%(28/211),respectively.Only one patient with an underlying condition received invasive mechanical ventilation;none of the patients died.Interpretation:Similar to adults,children of all age groups are susceptible to COVID-19.Fortunately,most pediatric patients have mild symptoms or remain asymptomatic,despite the high incidence of pneumonia.Decreased proportions of white blood cells and lymphocytes are less frequent in children than in adults.