［Abstract］　Objective　To explore the diagnostic value of S100 calcium-binding protein A8/A9(S100A8/A9) in hypercoagulation state of children with Mycoplasma pneumoniae pneumonia(MPP) and its effect on endothelial cell function. Methods　A total of 87 MPP pediatric patients admitted to the First Affiliated Hospital of Hunan Normal University(People′s Hospital of Hunan Province) from September 2023 to February 2024 were included as the MPP group, and other 30 healthy children were selected as the control group. The MPP group was further divided into non-hypercoagulation group(n=45) and hypercoagulation group(n=42) according to the detection results of blood coagulation indicators［D-dimer(D-D), thrombin time(TT), activated partial thromboplastin time(APTT), prothrombin time(PT), antithrombin-Ⅲ(AT-Ⅲ)］. The differences in the levels of neutrophil-to-lymphocyte ratio(NLR), C-reactive protein(CRP), procalcitonin(PCT), interleukin-6(IL-6), interferon-gamma(IFN-γ) and S100A8/A9 were compared among all the groups, and the role of S100A8/A9 in evaluating MPP hypercoagulation state was analyzed. Human umbilical vein endothelial cells(HUVECs) were stimulated with 100 ng/mL of recombinant human S100A8/A9 for 24 hours to observe its effects on CD31, tissue factor(TF), and vascular endothelial(VE)-cadherin expressions. Results　The levels of CRP, PCT, IL-6 and IFN-γ in the MPP group were significantly higher than those in the control group(P<0.05), and NLR in the MPP group was significantly lower than that in the control group(P<0.05). The levels of CRP, PCT and IFN-γ in the hypercoagulation group were significantly higher than those in the non-hypercoagulation group(P<0.05). The S100A8/A9 level in the MPP group was significantly higher than that in the control group, and the S100A8/A9 level in the hypercoagulation group was significantly higher than that in the non-hypercoagulation group(P<0.05). The results of receiver operating characteristic(ROC) curve analysis showed that the area under the curve of S100A8/A9 was 0.860, with the sensitivity of 71.4% and the specificity of 93.9% in diagnosing hypercoagulation state in the MPP pediatric patients. The results of cell experiment showed that after S100A8/A9 intervention, the expression levels of CD31 and VE-cadherin in HUVECs were significantly decreased, and the expression level of TF in HUVECs in was significantly increased(P<0.05). Conclusion　S100A8/A9 is closely associated with hypercoagulation state of MPP pediatric patients. S100A8/A9 can disrupt the integrity of endothelial cell structure and drive thrombogenesis.]]> 2024/12/12 8:08:13 XU Lu, PENG Li, ZHOU Pei, FENG Xiuqin, Duane Wang, ZHONG Lili 6true ［Abstract］　Objective　To explore the clinical characteristics and prognosis of post-infectious bronchiolitis obliterans in children, and to provide reference for its clinical diagnosis and treatment. Methods　The clinical data of 152 pediatric patients with post-infectious bronchiolitis obliterans who were admitted to Department of Pediatric Respiratory Medicine, the First Hospital of Jilin University from January 2015 to December 2023 were retrospectively analyzed. The outcomes were compared between the patients with wheezing and the patients without wheezing, or between the patients with atopic constitution and the patients without atopic constitution. The outcomes were compared between the patients treated with systemic glucocorticoids and the patients treated with no systemic glucocorticoids. Results　The age of the 152 pediatric patients ranged from 17 months to 17 years, and the age of the majority of the pediatric patients was equal to or more than 6 years(accounting for 69.74%). The clinical manifestations of the pediatric patients were non-specific. All the 152 pediatric patients with bronchiolitis obliterans had recurrent cough and fever in varying degrees. The median time for diagnosis of bronchiolitis obliterans was 19(15.0, 28.5)days. A total of 151 pediatric patients tested positive for pathogens, with 53 cases of single pathogen infection and 98 cases of mixed pathogen infection. A total of 148 pediatric patients were positive for Mycoplasma pneumoniae, and adenovirus infection was the most common infection among the patients with viral infection. All the 152 pediatric patients underwent CT examination of the lungs, and the main findings of the CT examination were consolidation, poor gas content or atelectasis, uneven density, pleural effusion and bronchiectasis. Occlusions of bronchus, segmental bronchus, proximal subsegment or its branches were detected in all the 152 pediatric patients. In the acute stage, phlegm clots or mucus phlegm obstruction in the lumen were showed in 114 cases, plastic bronchitis in 10 cases, rice soup-like lavage fluid and bloody or purulent lavage fluid in 38 cases, subsequently, the manifestations of varying degrees in diseased airway mucosa necrosis, paleness, erosion, peeling or ulceration, and prone to bleeding upon touch in 55 cases, bronchial lumen cartilage structure damage, lumen softening, collapse, twisting, spiral and circular stenosis in 98 cases and fishbone-like changes in 2 cases. Among the 86 patients who were followed up, the improvement rate of lung imaging in the systemic corticosteroids group(69 cases)(73.91%) was higher than that in the non-systemic corticosteroids group(17 cases)(52.94%). The proportion of the patients with atelectasis or poor gas content, uneven ventilation density and bronchiectasis in the systemic corticosteroids group was lower than that in the non-systemic corticosteroids group, but the difference was not statistically significant(P>0.05). The improvement rate of lung imaging in the non-wheezing or atopic constitution group(66 cases)(78.79%) was higher than that in the wheezing or atopic constitution group(20 cases)(40.00%), and the proportion of uneven ventilation density in the non-wheezing or atopic constitution group was lower than that in the wheezing or atopic constitution group, and the differences were statistically significant(P<0.05). Conclusion　When the clinical manifestations of the pediatric patients are repeated fever, cough, wheezing during the course of the disease or the pediatric patients have atopic constitution, early bronchoscopy findings of airway mucosal necrosis, erosion, lumen stenosis, formation of mucus or sputum embolus, Mycoplasma pneumoniae and/or adenovirus and other pathogenic infections, poor inflammatory resorption of lung imaging and uneven ventilation, clinicians need to pay attention to the possibility of post-infectious bronchiolitis obliterans.]]> 2024/12/12 8:08:13 PIAO Meiying, ZHANG Li, LI Chunyan, LIU Junhui, LIU Na, WANG Lijun, MENG Fanzheng 5true ［Abstract］　Objective　To analyze the epidemic trend and clinical features of Chlamydia pneumoniae(Cpn) infection in children in Hangzhou area, and to provide reference for prevention, control, early diagnosis and treatment of Cpn infection. Methods　From February 2022 to June 2024, the case data of 71 669 pediatric patients who visited their doctors and were treated in Children′s Hospital Zhejiang University School of Medicine for fever, cough, nasal congestion, runny nose, wheezing and chest pain or for endotracheal intubation due to surgical diseases were collected, and all of the pediatric patients underwent respiratory pathogen testing. The epidemic trend of Cpn infection and the clinical features of the infected patients were analyzed. Results　Among the 71 669 padiatric patients tested, 121 padiatric patients were positive for Cpn nucleic acid, with a detectable rate of 0.17%. One case was detected in 2022, and 31 cases were detected in 2023, and 89 cases were detected just in the first 6 months of 2024, showing an increasing trend year by year. There were 13 Cpn-carrying patients, accounting for 10.74% of the total detected patients. The patients were followed up after discharge, and none of them developed respiratory symptoms within 1 week, and Cpn IgM was negative. There were 45 cases in the simple Cpn infection group and 63 cases in the Cpn mixed infection group. Compared with that in the Cpn mixed infection group, the proportion of females in the simple Cpn infection group were higher. Compared with those in the Cpn mixed infection group, the patients in the simple Cpn infection group were older and had a longer time required for diagnosis, lower fever rate, shorter fever duration, lower proportion of the dominated patchy shadows in the lungs and lower proportion of fiberoptic bronchoscopic treatment but higher proportion of lung consolidation lesions and Cpn IgM positivities, and differences were statistically significant(P<0.05). All the pediatric patients with Cpn infection were treated with azithromycin or doxycycline, and 19 pediatric patients presented with atelectasis and received treatment of fiberbronchoscopy. Except for 1 patient who died due to uncontrolled multiple pathogenic infections after medullary tumor surgery and 1 patient who needed long-term anti-tuberculosis treatment due to mixed tuberculosis infection, the other patients showed relief in clinical symptoms after follow-up confirmation. For some patients whose lung imaging did not fully improve, their follow-up was extended to 3 months after discharge until their lung imaging returned to normal. Conclusion　In Hangzhou area, the detectable rate of Cpn in children is low, but there is an increasing trend. The typical characteristics of Cpn pneumonia are that older children are susceptible, with cough as the main manifestation, short fever time, easy to appear lung consolidations, and the treatment effects of azithromycin and doxycycline are good.]]> 2024/12/12 8:08:13 1,2, WANG Yingshuo^1,2]]> YANG Dehua^1,2, WANG Yingshuo^1,2 4true ［Abstract］　Objective　To explore the clinical features, treatment and prognosis of Talaromyces marneffei(TM) infection in non-HIV-associated children. Methods　The clinical data of 9 HIV-negative pediatric patients with TM infection who were admitted to Department of Pediatrics, the First Affiliated Hospital of Guangzhou Medical University from October 2015 to October 2023 were retrospectively analyzed. The clinical data of the pediatric patients included clinical manifestations, lung imaging, pathogen detection, histopathological features, treatment and prognosis. Results　Among the 9 non-HIV-associated pediatric patients with TM infection, the most patients were male, with a median age of 40(3-164)months. The main clinical manifestations of the pediatric patients included fever, cough, large superficial lymph nodes, skin rash, hepatosplenomegaly, abdominal pain or rare diarrhea. Elevated C-reactive protein, procalcitonin and erythrocyte sedimentation rate, with a decrease in hemoglobin were found in most of the pediatric patients. Immunoglobulin G and immunoglobulin A levels were reduced to varying degrees in 8 pediatric patients with TM infection. The results of chest computed tomography(CT) scan showed diffuse or solid lesions in the lungs of the pediatric patients. The TM culture of sputum/blood showed positive results in 8 pediatric patients. Six pediatric patients underwent bronchoscopic lung tissue biopsy(one of them undergoing lymph node biopsy simultaneously), and among the 6 pediatric patients, 2 pediatric patients had granulation tissue formation in lung tissue pathology, and 1 pediatric patient had circular or sausage-like and spore-like substance with transverse septate in lymph node and lung tissue cytoplasm, and the other 3 pediatric patients had non-specific inflammatory lesion tissues in lung tissue pathology. Eight pediatric patients underwent whole-exome sequencing, and 5 of them were found to have clear pathogenic genes. All the 9 pediatric patients were treated with intravenous voriconazole in the initial treatment, among whom 4 pediatric patients had a good prognosis, and 2 pediatric patients were improved after switching to amphotericin B treatment, and 3 pediatric patients died due to disease progression. Conclusion　The onset of TM in non-HIV-associated pediatric patients is obscure and the course of the disease is long, so attention should be paid to the tracking of the primary disease in the pediatric patients. Blood and bronchoalveolar lavage fluid culture can help to diagnose TM infection as early as possible, and antifungal treatment as early as possible can improve the prognosis.]]> 2024/12/12 0:00:00 LI Hongwei, WANG Yanhong, WU Shangzhi, CHEN Xiaowen, HU Yingjie, HUANG Zhanhang, LU Chengyu, CHEN Dehui 3true ［Abstract］　Objective　To analyze the species distribution of other pathogens co-detected in pediatric patients with adenovirus pneumonia in Guangxi region and to analyze the pediatric patients′ clinical characteristics, providing reference for clinical diagnosis and treatment. Methods　The clinical data of 169 pediatric inpatients with adenovirus pneumonia in 5 hospitals in Guangxi region from January 2019 to February 2022 were retrospectively analyzed. According to whether other pathogens were co-detected in the pediatric patients, they were divided into simple adenovirus infection group(26 cases) and other pathogens co-detected group(143 cases). The distribution of co-detected pathogens and the clinical characteristics of the pediatric patients were analyzed, and effects of the co-detected pathogens on the clinical outcomes of the pediatric patients were analyzed. Results　Among the 169 pediatric patients with adenovirus pneumonia, 100 patients(59.2%) were mild and 69 patients(40.8%) were severe, and 26 patients(15.4%) were infected with adenoviruses alone, and 143 patients(84.6%) were co-detected with other pathogens. Among other co-detected pathogens in the 143 pediatric patients, one kind of pathogen co-detected was most common(52.4%, 75/143) and co-detected bacteria alone were most common(25.9%, 37/143), and the co-detected bacteria alone were Streptococcus pneumoniae and Haemophilus influenzae, but no drug-resistant bacteria were detected. The proportion of pediatric patients with severe disease in the other pathogens co-detected group(43.4%, 62/143) was higher than that in the simple adenovirus infection group(26.9%, 7/26), and the difference was statistically significant(P<0.05). In the other pathogens co-detected group, the proportions of severe disease pediatric patients with co-detected bacteria alone, co-detected fungi+bacteria, and co-detected fungi+Mycoplasma pneumoniae were 64.9%(24/37), 100.0%(13/13) and 100.0%(6/6), respectively, which were higher than those in the simple adenovirus infection group(P<0.05). Among the mild disease pediatric patients with co-detected pathogens, the top 3 co-detected pathogen combination were Mycoplasma pneumoniae+other viruses(34.0%, 34/100), co-detected other viruses alone(18.0%, 18/100), and co-detected bacteria alone(13.0%, 13/100). The pediatric patients with the co-detected bacteria were more likely to experience respiratory distress and lung consolidation. Conclusion　In children with adenovirus pneumonia, the detectable rate of the co-detected other pathogens is high. The most common co-detected pathogens are bacteria, mainly Streptococcus pneumoniae and Haemophilus influenzae. No drug-resistant bacteria are detected. The co-detected pathogens are mainly co-detected viruses and co-detected Mycoplasma pneumoniae in the children with mild adenovirus pneumonia. The children with adenovirus pneumonia are more likely to progress to severe disease when co-detected with bacteria, fungi+bacteria, and fungi+Mycoplasma pneumoniae. Understanding the pathogen spectrum co-detected in children with adenovirus pneumonia can provide reference for rational use of antibacterial agents.]]> 2024/12/12 0:00:00 1,2, LONG Xingjiang³, HUANG Xiaoli⁴, LAO Jinquan⁵, LIN Kun⁶, CHEN Jianping⁴, WEI Xiaohong³, YANG Changrong¹, TAN Junyin², LI Kai⁷, JIANG Min¹]]> QIN Xia^1,2, LONG Xingjiang³, HUANG Xiaoli⁴, LAO Jinquan⁵, LIN Kun⁶, CHEN Jianping⁴, WEI Xiaohong³, YANG Changrong¹, TAN Junyin², LI Kai⁷, JIANG Min¹ 2true ［Abstract］　Objective　To explore the risk factors of severe Mycoplasma pneumoniae pneumonia(SMPP) in children, and to provide reference for early diagnosis and treatment of SMPP for clinicians. Methods　The clinical data of 399 pediatric patients with Mycoplasma pneumoniae pneumonia(MPP) who were admitted to Department of Pediatrics, the People′s Hospital of Guangxi Zhuang Autonomous Region from April 2023 to June 2024 and tested positive for Mycoplasma pneumoniae(MP) DNA by using bronchoalveolar lavage fluid(BALF) were retrospectively analyzed. The pediatric patients were divided into severe group(230 cases) and mild group(169 cases) according to disease condition. The differences in laboratory indicators, MP-DNA loads in BALF and positive rate of mutation in MP drug-resistant gene 23S rRNA locus(A2063G) were compared between the two groups. The risk factors affecting the occurrence of SMPP were analyzed. Results　The levels of percentage of neutrophils(NEU%), neutrophil-to-lymphocyte ratio(NLR), C-reactive protein(CRP), procalcitonin(PCT), interleukin-6(IL-6), lactate dehydrogenase(LDH), D-dimer(D-D) and positive rate of mutation in MP drug-resistant gene 23S rRNA locus(A2063G) in the pediatric patients of the severe group were higher than those in the pediatric patients of the mild group, and the levels of percentage of lymphocytes(LYM%) and albumin(ALB) in the pediatric patients of the severe group were lower than those in the pediatric patients of the mild group, and differences were significant(P<0.05). The results of multivariate logistic regression analysis showed that the elevated levels of CRP［OR(95%CI): 1.085(1.051-1.120)］, LDH［OR(95%CI): 1.031(1.022-1.040)］, and D-D［OR(95%CI): 40.359(9.417-172.975)］, as well as the mutation in MP drug-resistant gene 23S rRNA locus(A2063G)［OR(95%CI): 2.677(1.372-5.222)］ were independent risk factors for SMPP(P<0.05), and the results of receiver operating characteristic(ROC) curve analysis showed that CRP(AUC=0.761), LDH(AUC=0.809), and D-D(AUC=0.817) had moderate diagnostic value for SMPP. Conclusion　The inflammatory indicators of SMPP pediatric patients are significantly elevated, and the elevated levels of CRP, LDH and D-D, as well as the mutation in MP drug-resistant gene locus(A2063G) are risk factors for SMPP, which have reference value for the diagnosis of SMPP.]]> 2024/12/12 8:08:13 YANG Caiqiong, ZHANG Min, ZHANG Diwen, WANG Suili, LU Yanlian, WEN Xiaoling, CHEN Junyu, WEN Zhihong 1true