Prevalence of respiratory syncytial virus infection among children hospitalized with acute lower respiratory tract infections in Southern India

BACKGROUND Respiratory syncytial virus(RSV) is a leading cause of lower respiratory infections among children.AIM To investigate the proportion of RSV and non-RSV respiratory viral infections among hospitalized children ≤ 5 years.METHODS Hospitalized children aged < 5 years, with a diagnosis of acute lower respiratory infections(ALRI), admitted between August 2011-August 2013, were included.Cases were defined as laboratory-confirmed RSV and non-RSV respiratory viruses by direct fluorescence assay from the nasopharyngeal wash.RESULTS Of 383 1-59 mo old children hospitalized with an acute lower respiratory infection, 33.9%(130/383) had evidence of viral infection, and RSV was detected in 24.5%(94/383). Co-infections with RSV and other respiratory viruses(influenza A or B, adenovirus, para influenza 1, 2 or 3) were seen in children 5.5%(21/383). Over 90% of the RSV-positive children were under 2 years of age. RSV was detected throughout the year with peaks seen after the monsoon season.Children hospitalized with RSV infection were more likely to have been exposed to a shorter duration of breastfeeding of less than 3 mo. RSV positive children had a shorter hospital stay, although there were significant complications requiring intensive care. Use of antibiotics was high among those with RSV and non-RSV viral infections.CONCLUSION Our study provides evidence of a high proportion of RSV and other virusassociated ALRI among hospitalized children in India. RSV infection was associated with fewer days of hospital stay compared to other causes of lower respiratory infections. A high level of antibiotic use was seen among all respiratory virus-associated hospitalizations. These results suggest the need for implementing routine diagnostics for respiratory pathogens in order to minimize the use of unnecessary antibiotics and plan prevention strategies among pediatric populations.

Human bocavirus infection in children hospitalized with lower respiratory tract infections:Does viral load affect disease course?

Objective:To examine the effects of human bocavirus type 1(HBoV1)on the course of lower respiratory tract infections in cases of monoinfection and coinfection,and the effects of HBoV1 viral load on the disease in children under six years old hospitalized with a diagnosis of HBoV1-associated lower respiratory tract infections.Methods:Children under six years of age,who were hospitalized with the diagnosis of lower respiratory tract infection due to HBoV1 between 1 January 2021 and 1 January 2022 were included in the study.Laboratory confirmation of the respiratory pathogens was performed using polymerase chain reaction(PCR).Results:Fifty-four(16.4%)children with HBoV1 among 329 children whose PCR was positive with bacterial/viral agent in nasopharyngeal swab samples were included in the study.There were 28(51.9%)males and 26(48.1%)females with a median age 23.4 months[interquartile range(IQR):13.2,30.0 months](min-max:1 month-68 months).HBoV1 was detected as a monoinfecton in 26(48.1%)children,and as a coinfection with other respiratory agents in 28 children(51.9%).In multiple regression analysis,coinfection(P=0.032)was associated with the length of hospitalization(P<0.001;R^(2)=0.166).There was a negative correlation(r=−0.281,P=0.040)between cough and cycle threshold.Fever was found to be positively correlated with C-reactive protein(r=0.568,P<0.001)and procalcitonin(r=0.472;P=0.001).Conclusions:Although we found a higher HBoV1 viral load in children with more cough symptoms in our study,it had no effect on the severity of the disease,such as length of hospital stay and need for intensive care.Coinfection was found to affect the length of hospitalization.

Burden of respiratory syncytial virus infection in young children

Respiratory syncytial virus(RSV) is the most frequent and important cause of lower respiratory tract infection in infants and children. It is a seasonal virus, with peak rates of infection occurring annually in the cold season in temperate climates, and in the rainy season, as temperatures fall, in tropical climates. High risk groups for severe RSV disease include infants below six mo of age, premature infants with or without chronic lung disease, infants with hemodynamically significant congenital heart disease, infants with immunodeficiency or cystic fibrosis, and infants with neuromuscular diseases. Mortality rates associated with RSV infection are generally low in previous healthy infants(below 1%), but increase significantly in children with underlying chronic conditions and comorbidities. Following early RSV lower respiratory tract infection, some patients experience recurrent episodes of wheezing mimicking early childhood asthma with persistence of lung function abnormalities until adolescence. There is currently no RSV vaccine available, but promising candidate vaccines are in development. Palivizumab, a monoclonal RSV antibody that is the only tool for immunoprophylaxis in high-riskinfants, lowers the burden of RSV infection in certain carefully selected patient groups.

Clinical Diagnosis and Treatment Characteristics of Acute Respiratory Infections in Children and New Developments in Laboratory Testing

Acute respiratory tract infection (ARTI) in children is the most common infectious disease in childhood, and its pathogens include viruses, bacteria and fungi, mycoplasma, chlamydia and rickettsia. In recent years, with the continuous development of pathogen detection methods, the diagnosis and treatment of acute respiratory infections has received more and more clinical attention. The clinical diagnosis and treatment characteristics of acute respiratory infections in children and the research of clinical laboratory detection methods have also been continuously developed. The author collected references to review the clinical features and new developments in laboratory testing of acute respiratory tract infection in children.

Association between early viral lower respiratory tract infections and subsequent asthma development

BACKGROUND The association between hospitalization for human respiratory syncytial virus(HRSV)bronchiolitis in early childhood and subsequent asthma is well established.The long-term prognosis for non-bronchiolitis lower respiratory tract infections(LRTI)caused by viruses different from HRSV and rhinovirus,on the other hand,has received less interest.AIM To investigate the relationship between infant LRTI and later asthma and examine the influence of confounding factors.METHODS The PubMed and Global Index Medicus bibliographic databases were used to search for articles published up to October 2021 for this systematic review.We included cohort studies comparing the incidence of asthma between patients with and without LRTI at≤2 years regardless of the virus responsible.The meta-analysis was performed using the random effects model.Sources of heterogeneity were assessed by stratified analyses.RESULTS This review included 15 articles(18 unique studies)that met the inclusion criteria.LRTIs at≤2 years were associated with an increased risk of subsequent asthma up to 20 years[odds ratio(OR)=5.0,95%CI:3.3-7.5],with doctor-diagnosed asthma(OR=5.3,95%CI:3.3-8.6),current asthma(OR=5.4,95%CI:2.7-10.6),and current medication for asthma(OR=1.2,95%CI:0.7-3.9).Our overall estimates were not affected by publication bias(P=0.671),but there was significant heterogeneity[I 2=58.8%(30.6-75.5)].Compared to studies with hospitalized controls without LRTI,those with ambulatory controls had a significantly higher strength of association between LRTIs and subsequent asthma.The strength of the association between LRTIs and later asthma varied significantly by country and age at the time of the interview.The sensitivity analyses including only studies with similar proportions of confounding factors(gender,age at LRTI development,age at interview,gestational age,birth weight,weight,height,smoking exposure,crowding,family history of atopy,and family history of asthma)between cases and controls did not alter the overall estimates.CONCLUSION Regardless of the causative virus and confounding factors,viral LRTIs in children<2 years are associated with an increased risk of developing a subsequent asthma.Parents and pediatricians should be informed of this risk.

Viral Acute Respiratory Infections in Central African Republic Children: Epidemiological and Clinical Aspects

Background: Acute respiratory infections (ARI) are recognized as an important cause of morbidity, mortality, and hospitalization among children in developing countries. Objectives: To identify the respiratory viruses circulating in Central African children before the SARS-COV2 pandemic and to assess the clinical manifestations. Methodology: This is a cross-sectional, descriptive, multicenter study, run from March 1, 2019, to March 31, 2020. Children aged 28 days to 15 year-old, with respiratory symptoms ≤10 days had been included. Nasopharyngeal swabs were taken and sent to the Institute Pasteur in Bangui (WHO National Referral Center for influenza). Virus research was done by cell and molecular culture techniques. Data were recorded and processed with Access 2019 software, then analyzed with STATA version 14 software. Chi-square test and ANOVA test were used to compare proportions at the p 0.05 threshold. Results: Out of 659 children included during the study period, viruses were identified in 231 children, for an overall positivity rate of 35.05% (231/659). Rhinoviruses (RV) and influenza viruses were found in 66.23% and 16.88% respectively. Virus-virus co-infections were found in 10 (10/231) children (4.32%). Children under 5 years of age were more represented (78.60%). The main reasons for consultation were: fever (96.20%), cough (95.45%), runny nose (78.5%), and breathing difficulty (30.50%). ILI (Influenza-Like Illness) was found in 71.02% versus 28.98% of SARI (Severe Acute Respiratory Infection). There was a statistically significant association between age 5 years and severity of acute respiratory infection (p = 0.001). The outcome was known for the 122 children at the CHUPB site with a mortality rate of 17.21% (n = 21). Conclusion: Viral ARI is common in children in Central African Republic. Care givers should think about it in order to reduce the inappropriate prescription of antibiotics.

Clinical characteristics and molecular epidemiology of human metapneumovirus in children with acute lower respiratory tract infections in China, 2017 to 2019: A multicentre prospective observational study

Human metapneumovirus(HMPV) infection is one of the leading causes of hospitalization in young children with acute respiratory illness. In this study, we prospectively collected respiratory tract samples from children who were hospitalized with acute lower respiratory tract infection in six hospitals in China from 2017 to 2019. HMPV was detected in 145 out of 2733 samples(5.3%) from the hospitalized children. The majority of HMPV-positive children were under the age of two(67.6%), with a median age of one year. HMPV can independently cause acute lower respiratory tract infection in young children, while all patients showed mild clinical symptoms. Of all the co-infected patients, HMPV was most commonly detected with enterovirus(EV) or rhinovirus(RhV)(38.0%),followed by respiratory syncytial virus(RSV)(32.0%). The highest detection rate occurred from March to May in both northern and southern China. Out of 145 HMPV positive samples, 48 were successfully typed, of which 36strains were subgrouped into subtypes A2c(75%), eight strains were included in subtype B1(16.7%), and four strains were included in subtype B2(8.3%). Moreover, 16 A2c strains contained 111-nucleotide duplications in the G gene. Twenty-seven complete HMPV genomes were successfully obtained, and 25(92.6%) strains belonged to subtype A2c, whereas one strain was included in subgroup B1 and another was included in subgroup B2. A total of 277 mutations were observed in the complete genomes of 25 A2c strains. All results presented here improve our understanding of clinical characteristics and molecular epidemiology of HMPV infection in children.

A multi-center study on Molecular Epidemiology of Human Respiratory Syncytial Virus from Children with Acute Lower Respiratory Tract Infections in the Mainland of China between 2015 and 2019

Human respiratory syncytial virus(RSV) is a major pathogen of acute lower respiratory tract infection among young children. To investigate the prevalence and genetic characteristics of RSV in China, we performed a molecular epidemiological study during 2015–2019. A total of 964 RSV-positive specimens were identified from 5529 enrolled patients during a multi-center study. RSV subgroup A(RSV-A) was the predominant subgroup during this research period except in2016. Totally, 535 sequences of the second hypervariable region(HVR-2) of the G gene were obtained. Combined with182 Chinese sequences from GenBank, phylogenetic trees showed that 521 RSV-A sequences fell in genotypes ON1(512),NA1(6) and GA5(3), respectively;while 196 RSV-B sequences fell in BA9(193) and SAB4(3). ON1 and BA9 were the only genotypes after December 2015. Genotypes ON1 and BA9 can be separated into 10 and 7 lineages, respectively. The HVR-2 of genotype ON1 had six amino acid changes with a frequency more than 10%, while two substitutions H258 Q and H266 L were co-occurrences. The HVR-2 of genotype BA9 had nine amino acid substitutions with a frequency more than10%, while the sequences with T290 I and T312 I were all from 2018 to 2019. One N-glycosylation site at 237 was identified among ON1 sequences, while two N-glycosylation sites(296 and 310) were identified in the 60-nucleotide duplication region of BA9. To conclusion, ON1 and BA9 were the predominant genotypes in China during 2015–2019. For the genotypes ON1 and BA9, the G gene exhibited relatively high diversity and evolved continuously.

Human adenovirus(HAdV)infection in children with acute respiratory tract infections in Guangzhou,China,2010–2021:a molecular epidemiology study

Background Human adenovirus(HAdV)infection can cause a variety of diseases.It is a major pathogen of pediatric acute respiratory tract infections(ARIs)and can be life-threatening in younger children.We described the epidemiology and subtypes shifting of HAdV among children with ARI in Guangzhou,China.Methods We conducted a retrospective study of 161,079 children diagnosed with acute respiratory illness at the Guangzhou Women and Children’s Medical Center between 2010 and 2021.HAdV specimens were detected by real-time PCR and the hexon gene was used for phylogenetic analysis.Results Before the COVID-19 outbreak in Guangzhou,the annual frequency of adenovirus infection detected during this period ranged from 3.92%to 13.58%,with an epidemic peak every four to fve years.HAdV demonstrated a clear seasonal distribution,with the lowest positivity in March and peaking during summer(July or August)every year.A signifcant increase in HAdV cases was recorded for 2018 and 2019,which coincided with a shift in the dominant HAdV subtype from HAdV-3 to HAdV-7.The latter was associated with a more severe disease compared to HAdV-3.The average mortality proportion for children infected with HAdV from 2016 to 2019 was 0.38%but increased to 20%in severe cases.After COVID-19 emerged,HAdV cases dropped to 2.68%,suggesting that non-pharmaceutical interventions probably reduced the transmission of HAdV in the community.Conclusion Our study provides the foundation for the understanding of the epidemiology of HAdV and its associated risks in children in Southern China.

小儿清炎合剂(716合剂)治疗呼吸道合胞病毒所致呼吸道感染疗效观察及血清学研究

目的探究小儿清炎合剂(716合剂)治疗呼吸道合胞病毒所致呼吸道感染疗效观察及血清学研究。方法将2023年1月至2023年9月江西省儿童医院收治的呼吸道合胞病毒所致呼吸道感染的80例患儿作为研究对象,根据随机对照表法将其分为观察组40例,对照组40例。对照组采用雾化吸入联合静脉输液进行治疗,观察组在对照组的基础上口服小儿清炎合剂(716合剂)。比较两组的临床疗效,治疗前后炎性因子[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、肿瘤坏死因子-α(TNF-α)],免疫功能水平(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)),恢复情况和不良反应。结果观察组治疗有效率为95.00%,高于对照组的80.00%(P<0.05)。治疗后,两组IL-6、IL-10、CRP、SAA、TNF-α水平均下降且观察组低于对照组(P<0.05);观察组CD4^(+)、CD4^(+)/CD8^(+)水平均高于对照组,而观察组CD8^(+)水平低于对照组(P<0.05)。观察组退热、止咳、平喘以及住院时间均小于对照组(P<0.05)。两组在治疗过程中均未出现任何不良反应。结论小儿清炎合剂(716合剂)能够缓解呼吸道合胞病毒感染患儿的炎性症状,增强患儿免疫功能,促进患儿恢复,安全性良好。

儿童急性呼吸道感染者PA、PSP、CD64、sCD14-ST的变化及其诊断价值

目的 探讨儿童急性呼吸道感染者血前白蛋白(PA)、血清胰石蛋白(PSP)、免疫球蛋白G Fc段受体I(CD64)、可溶性白细胞分化抗原14亚型(sCD14-ST)的变化及其临床诊断价值。方法 回顾性选取2019年9月至2023年3月眉山市四所医院收治的498例儿童急性呼吸道感染患儿作为研究组,根据咽拭子细菌培养结果将其分为细菌感染组232例和非细菌感染组266例;另选取同期体检的健康儿童506例作为对照组。检测所有儿童的血清PA、PSP、外周血sCD14-ST水平、CD64指数。比较三组儿童的临床资料,同时比较研究组和对照组以及细菌感染组和非细菌感染组患儿的血清PA、PSP、外周血sCD14-ST水平、CD64指数;采用受试者工作特征曲线(ROC)分析血清PA、PSP、外周血sCD14-ST水平、CD64指数单独及联合检测对儿童急性呼吸道感染的诊断价值。结果 研究组患儿的血清PA水平明显低于对照组,而血清PSP、外周血sCD14-ST水平、CD64指数则明显高于对照组,差异均有统计学意义(P<0.05);细菌感染组患儿的血清PA水平明显低于非细菌感染组,而血清PSP、外周血sCD14-ST水平、CD64指数则明显高于非细菌感染组,差异均有统计学意义(P<0.05);绘制ROC获得血清PA、PSP、外周血sCD14-ST水平、CD64指数单独及联合检测诊断儿童急性呼吸道感染患儿的AUC分别为0.885、0.780、0.818、0.848、0.934。其中,联合诊断的AUC高于各项单独检测(P<0.05),且联合检测的敏感度和特异度为89.20%,81.40%,诊断价值均较高。结论 儿童急性呼吸道感染者血清PA水平呈低表达,血清PSP、外周血sCD14-ST水平、CD64指数呈高表达;且细菌感染较非细菌感染的儿童急性呼吸道感染患儿血清PA水平降低,而血清PSP、外周血sCD14-ST水平和CD64指数则升高;联合检测血清PA、PSP、外周血sCD14-ST水平、CD64指数有助于诊断儿童急性呼吸道感染。

呼出气一氧化氮、肺泡一氧化氮和嗜酸性粒细胞对3~6岁儿童呼吸系统疾病的鉴别诊断价值

目的探讨呼出气一氧化氮(FeNO)、肺泡一氧化氮(CaNO)和嗜酸性粒细胞(EOS)在甘肃省兰州市3~6岁儿童呼吸系统疾病鉴别诊断中的应用价值。方法选取确诊哮喘或过敏性鼻炎或下呼吸道感染的360例3~6岁儿童作为研究对象,采用斯皮尔曼秩相关系数评估FeNO、CaNO、EOS的相关性,通过随机森林模型、受试者工作特征(ROC)曲线、多因素逻辑回归分析评估FeNO、CaNO和EOS对3种疾病的鉴别诊断价值。结果哮喘患儿的FeNO、CaNO中位数高于其他疾病患儿,过敏性鼻炎患儿的EOS中位数最低,下呼吸道感染患儿的FeNO、CaNO中位数最低。相关性分析结果显示,FeNO与CaNO呈正相关(r=0.59,P<0.05),FeNO与EOS呈负相关(r=-0.61,P<0.05),CaNO与EOS呈负相关(r=-0.63,P<0.05)。随机森林模型显示,FeNO在疾病分类中的重要性最高。ROC曲线分析结果显示,3种疾病中,FeNO、CaNO、EOS对下呼吸道感染的诊断效能均最高(曲线下面积分别为0.86、0.91、1.00)。多因素逻辑回归模型诊断哮喘的曲线下面积为0.96,灵敏度为0.902,特异度为0.881。结论FeNO、CaNO和EOS在鉴别诊断兰州地区3~6岁儿童哮喘、过敏性鼻炎、下呼吸道感染方面展现出较好的潜力,且基于三者构建的多因素逻辑回归模型可有效提升对哮喘的诊断准确性。

Lung Function in Wheezing Infants after Acute Lower Respiratory Tract Infection and Its Association with Respiratory Outcome

Background： Wheezing is common in early childhood and remains an important health concern. The aim of this study was to assess the lung function of wheezing infants and to investigate the relationship between lung function and respiratory outcome. Methods： Infants 〈2 years of age with acute lower respiratory tract infection （ALRTI） who had undergone lung function tests were included in the study. They were assigned to wheeze or no wheeze group based on physical examination. Infants without any respiratory diseases were enrolled as controls. Lung function was measured during the acute phase and 3 months after ALRTI. One-year follow-up for infants with ALRTI was achieved. Results： A total of 252 infants with ALRTI who had acceptable data regarding tidal breathing were included in the final analysis. Compared with the control and the no wheeze groups, infants in the wheeze group had significantly decreased time to peak tidal expiratory flow as a percentage of total expiratory time （TPTEF/TE） （20.1 1 6.4% vs. 34.4 ± 6.2% and 26.4 ±8.3%, respectively, P 〈 0.0001） and significantly increased peak tidal expiratory flow （PTEF） （90.7 ± 26.3 ml/s vs. 79.3 ± 18.4 ml/s and 86.1 ± 28.0 ml/s, respectively, P 〈 0.01）, sReff and Reff. The infants in the wheeze group still had lower TPTEF/TE and volume to peak tidal expiratory flow as a percentage of total expiratory volume （VPTEF/VE） than the no wheeze infants 3 months after the ALRT1. Moreover, there was a significant inverse relationship between TPTEF/TE, VPTEF/VE, and the recurrence of wheezing and pneumonia. Conclusions： Impaired lung function was present in wheezing infants with ALRTI and the deficits persisted. In addition, the lower level of TPTEF/TE and VPTEF/VE was a risk factor for poor respiratory outcome.

血清MyD88和TRAF-6联合检测在儿童重度急性呼吸道感染诊断和预后评估中的价值

目的探讨血清髓系分化初级反应蛋白88(MyD88)、肿瘤坏死因子受体相关因子6(TRAF-6)在儿童重度急性呼吸道感染辅助诊断和预后评估中的价值。方法选取2020年1月—2022年6月南阳市中心医院儿童急性呼吸道感染患儿80例(急性呼吸道感染组)。根据病原学检测结果分为非细菌感染组(42例)和细菌感染组(38例)。根据患儿病情严重程度分为轻度组(28例)、中度组(20例)、重度组(32例)。根据患儿预后情况分为预后良好组(58例)和预后不良组(22例)。以同期80名体检健康儿童为正常对照组。采用多因素Logistic回归分析评估急性呼吸道感染患儿预后的影响因素。采用受试者工作特征(ROC)曲线评价各项指标诊断儿童重度急性呼吸道感染和评估预后的效能。结果急性呼吸道感染组血清MyD88、TRAF-6水平显著高于正常对照组(P<0.001)。细菌感染组血清MyD88、TRAF-6水平显著高于非细菌感染组(P<0.001)。轻度组、中度组、重度组血清MyD88、TRAF-6水平依次升高(P<0.001)。ROC曲线分析结果显示,血清MyD88、TRAF-6单项检测和联合检测诊断重度急性呼吸道感染的曲线下面积(AUC)分别为0.762、0.734、0.876。预后不良组细菌感染、下呼吸道感染、重度病情所占比例和白细胞(WBC)计数、反应蛋白(CRP)、MyD88、TRAF-6水平均显著高于预后良好组(P<0.05)。多因素Logistic回归分析结果显示,重度病情、CRP升高、MyD88升高、TRAF-6升高均是儿童急性呼吸道感染预后不良的危险因素[比值比(OR)值分别为1.693、1.864、3.218、2.869,95%可信区间(CI)分别为1.142~2.510、1.228~2.830、1.561~6.633、1.511~5.446,P<0.05]。ROC曲线分析结果显示,血清MyD88、TRAF-6、CRP单项检测和联合检测判断急性呼吸道感染患儿预后的AUC分别为0.848、0.900、0.817、0.951。结论急性呼吸道感染患儿血清MyD88、TRAF-6水平显著升高,联合检测对儿童重度急性呼吸道感染的辅助诊断和预后评估均有较高的临床价值。

某基层医院与三甲儿童医院儿童呼吸道感染病原谱比较

目的 比较分级诊疗下某基层医院和三甲儿童医院的儿童急性呼吸道感染病原谱差异。方法 收集2021年11月至2022年3月北京某基层医院及某三甲儿童医院临床诊断为急性呼吸道感染患儿的呼吸道标本,采用多重逆转录-聚合酶联反应(RT-PCR)与毛细电泳联用技术检测13种呼吸道病原,统计学方法分析两家医院急性呼吸道感染儿童病原谱差异。结果 基层医院纳入患儿112例,男女比例为1∶1,呼吸道病原总阳性检出率为71.43%(80/112),单种病原感染72例(64.29%,72/112),混合感染8例(7.14%,8/112,均为2种病原);三甲儿童医院纳入患儿115例,男女比例1.02∶1,呼吸道病原总阳性检出率为70.43%(81/115),单种病原感染66例(57.39%,66/115),混合感染15例(包括2种病原感染12例,10.43%,12/115;3种病原感染3例,2.61%,3/115)。0~3岁婴幼儿中,基层医院与三甲儿童医院HMPV阳性检出率(52.9%,9/17;5.3%,4/75)差异有统计学意义(χ^(2)=38.10,P<0.05);三甲儿童医院儿童RSV阳性检出率(44.0%,33/75)高于基层医院(23.5%,4/17),但差异无统计学意义(χ^(2)=2.415,P>0.05)。4~15岁儿童中,基层医院Flu B阳性检出率为31.58%(30/95),三甲儿童医院为20.0%(8/40),差异有统计学意义(χ^(2)=6.96,P<0.05);三甲儿童医院MP阳性检出率为37.5%(15/40),基层医院未检出,差异有统计学意义(χ^(2)=40.08,P<0.05)。结论 2021-2022年冬春季节北京某基层医院与三甲儿童医院的儿童呼吸道感染病原谱构成存在差异,各年龄段病原谱分布也不同,提示分级诊疗以及基层医院开展核酸检测的必要性。

快速Pitt菌血症评分联合乳酸预测急性下呼吸道感染患者的死亡风险

目的分析快速皮特菌血症(qPitt)评分联合急诊常用指标是否可作为急性下呼吸道感染患者28 d死亡风险的预测因素。方法以2018年7月1日至2023年12月31日收治于首都医科大学附属北京朝阳医院急诊科的急性下呼吸道感染患者为研究对象,以入院后28 d死亡为终点,将研究对象分为存活组和死亡组。使用单因素分析比较两组qPitt评分和临床指标的差异,并通过Logistic回归筛选影响急性下呼吸道感染患者28 d死亡的独立相关因素,建立联合预测模型,使用受试者工作特征(ROC)曲线评价独立相关因素及联合变量预测模型对急性下呼吸道感染患者28 d死亡的预测价值。结果共纳入患者696例,其中28 d存活组445例(63.9%)和28 d死亡组251例(36.1%)。死亡组年龄、降钙素原、D-二聚体、血乳酸(lactate,LAC)、血肌酐(SCr)及qPitt评分均高于存活组(均P<0.05),淋巴细胞计数和血小板计数均低于存活组(均P<0.05)。Logistic回归分析得出LAC(OR=1.258,95%CI 1.143~1.384,P<0.001)、年龄(OR=1.021,95%CI 1.008~1.034,P=0.001)及qPitt评分(OR=1.923,95%CI 1.597~2.317,P<0.001)是预测急性下呼吸道感染患者28 d死亡风险的独立因素。年龄、LAC与qPitt评分联合变量预测模型的ROC曲线下面积(area under curve,AUC)为0.746(95%CI 0.708~0.784),高于LAC(AUC=0.692,95%CI 0.650~0.733)和qPitt评分(AUC=0.702,95%CI 0.660~0.743),且其预测效能优于单独应用LAC(Z=2.888,P=0.004)和qPitt评分(Z=3.850,P<0.001)。结论qPitt评分和LAC是急性下呼吸道感染患者死亡的独立危险因素,二者与年龄构建的联合变量预测模型可有效预测28 d死亡风险。

百蕊颗粒治疗儿童急性上呼吸道感染疗效及安全性系统评价

目的系统评价百蕊颗粒治疗儿童急性上呼吸道感染(AURTI)的疗效及安全性。方法通过计算机系统检索中国知网、万方数据与维普网数据库自建库至2022年9月有关百蕊颗粒治疗儿童AURTI的随机对照研究,并按照Cochrane质量评价标准对纳入研究的方法学质量进行评估,运用RevMan 5.4软件进行Meta分析。结果纳入文献10篇,涉及患儿1257例。Meta分析显示百蕊颗粒组总有效率高于对照组(OR=4.26,95%CI:2.94~6.16,P<0.00001)。依据疾病类型、治疗疗程进行亚组分析,结果显示,疱疹性咽峡炎患者与非疱疹性咽峡炎患者百蕊颗粒组总有效率均高于对照组(OR=5.34,95%CI:3.23~8.84,P<0.00001;OR=3.12,95%CI:1.80~5.42,P<0.0001);疗程3~5 d与6~7 d百蕊颗粒组总有效率均高于对照组(OR=5.24,95%CI:3.20~8.59,P<0.00001;OR=3.14,95%CI:1.79~5.52,P<0.0001)。百蕊颗粒组退热时间、咽喉部症状消退时间短于对照组(MD=-1.23,95%CI:-1.78~-0.68,P<0.0001;MD=-1.38,95%CI:-1.65~-1.11,P<0.00001)。百蕊颗粒组与对照组不良反应总发生率比较差异无统计学意义(OR=2.09,95%CI:0.69~6.33,P=0.19)。结论百蕊颗粒治疗儿童AURTI疗效较好,且不会增加不良反应。

婴幼儿重点呼吸道病毒感染性疾病预防健康教育专家共识

婴幼儿是呼吸道病毒感染性疾病的高发群体。健康教育是传播疾病防控知识、预防疾病发生发展的有效措施之一。当前,公众对婴幼儿呼吸道病毒感染预防的关注度日益提高,但有关健康教育指导材料相对缺乏。中国疾病预防控制中心妇幼保健中心、中华预防医学会儿童保健分会组织专家,从健康教育基本内容、健康教育应用场景、健康教育实施方法、健康教育效果评价多个维度着手制定本共识,以提高各级医疗卫生机构医务人员的健康教育水平,促进全社会对婴幼儿呼吸道病毒感染性疾病的关注,预防疾病发生,降低疾病重症率,保障婴幼儿健康。

外周血炎症指标联合检测在儿童下呼吸道早期感染中的诊断价值

目的探讨血清白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、全血中性粒细胞与淋巴细胞比值(NLR)联合检测在儿童下呼吸道细菌和病毒早期感染中的鉴别诊断价值。方法收集自贡市第一人民医院2023年1—10月初诊入院的急性下呼吸道感染儿童215例为研究对象,根据感染病原体的类型将其分为细菌感染组(117例)和病毒感染组(98例)。对两组患儿血清IL-6、hs-CRP和全血NLR检测结果进行回顾性分析。采用受试者工作特征曲线(ROC)评估血清IL-6、hs-CRP和NLR及三者联合检测的诊断价值。结果细菌感染组IL-6、hs-CRP和NLR指标均高于病毒感染组,差异有统计学意义(P<0.05);IL-6、hs-CRP和NLR的ROC曲线下面积(AUC)分别为0.839(95%CI:0.765~0.913)、0.783(95%CI:0.693~0.873)和0.840(95%CI:0.769~0.912)。IL-6、hs-CRP和NLR联合检测的AUC为0.875(95%CI:0.810~0.940)。IL-6、hs-CRP和NLR的最佳截断值分别为33.54 ng/L、32.15mg/L、9.62;IL-6单独诊断的灵敏度为67.1%、特异度为91.6%、约登指数为0.587;hs-CRP单独诊断的灵敏度为80.6%、特异度为72.9%、约登指数为0.600;NLR单独诊断的灵敏度为67.2%、特异度为91.7%、约登指数为0.589。三者联合诊断的灵敏度为79.2%、特异度为82.1%、约登指数为0.613。结论血清IL-6、hs-CRP和全血NLR测定均可用于儿童急性下呼吸道细菌感染和病毒感染的早期鉴别诊断,但三者联合检测诊断效能更高。

AECOPD机械通气病人下呼吸道感染风险预测Nomogram模型的构建

目的:构建慢性阻塞性肺疾病急性加重(AECOPD)机械通气病人下呼吸道感染的风险预测Nomogram模型。方法:回顾性选取2019年1月—2022年12月在本院行机械通气的417例AECOPD病人,将所有病人按照2∶1比例随机分为训练集(278例)和验证集(139例)。收集病人资料,统计AECOPD机械通气病人下呼吸道感染发生率,采用单因素分析和多因素Logistic回归分析AECOPD机械通气病人下呼吸道感染的影响因素,应用R软件构建下呼吸道感染风险预测Nomogram模型并进行验证。结果:下呼吸道感染发生率为51.80%(216/417);多因素Logistic回归分析结果显示,年龄、合并糖尿病、机械通气持续时间、气管插管、合并低蛋白血症、抗菌药物使用时间、抗菌药物使用种类≥2种均是AECOPD机械通气病人下呼吸道感染的独立影响因素(P<0.05);基于多因素Logistic回归分析筛选出的7个影响因素构建风险预测Nomogram模型,该模型在训练集和验证集中预测的曲线下面积分别为0.873[95%CI(0.831,0.915)]、0.858[95%CI(0.791,0.914)];训练集和验证集校准曲线和Hosmer-Lemeshow检验(P>0.05)均显示预测值和实际值具有良好一致性;决策曲线显示,当训练集阈概率在4%~90%、验证集阈概率在9%~78%时该模型的净收益高。结论:基于7项影响因素[年龄、合并糖尿病、机械通气持续时间、气管插管、合并低蛋白血症、抗菌药物使用时间、抗菌药物使用种类(≥2种)]构建的AECOPD机械通气病人下呼吸道感染的风险预测Nomogram模型具有良好区分度和一致性,且具有临床应用价值。