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06 September 2018, Volume 33 Issue 9 Previous Issue    Next Issue

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Advice on the collection，transfer and detection of microbiological testing specimen in children with respiratory infection（focusing on virus） 2018, 33(9): 657-662.  DOI: 10.19538/j.ek2018090601 Abstract ( )

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Advice on the collection，transfer and detection of microbiological testing specimen in children with respiratory infection（focusing on bacteria） 2018, 33(9): 663-669.  DOI: 10.19538/j.ek2018090602 Abstract ( )

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Paying attention to the diagnosis and prevention of bacterial pneumonia in children LI Chang-chong，ZHANG Hai-lin 2018, 33(9): 670-674.  DOI: 10.19538/j.ek2018090603 Abstract ( )   Pneumonia is the leading cause of death among children worldwide，and the highest reason of morbidity and hospitalization in children. Bacterial pneumonia in children has brought heavy burden and harm，so clinicians should try to seek pathogenic microorganism，evaluate the severity and complication in time，choose safe and effective antibiotics reasonably and pay much attention to comprehensive treatment in order to improve the success rate of treatment. Clinicians should learn knowledge related to vaccine prevention and improve the level of scientific use of vaccines.

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Clinical diagnosis and evaluation of bacterial pneumonia in children LU Xiao-xia 2018, 33(9): 675-679.  DOI: 10.19538/j.ek2018090604 Abstract ( )   Bacterial pneumonia remains one of the serious threats to children’s health worldwide. Common pathogens include Streptococcus pneumoniae，Haemophilus influenzae，Moraxella catarrhalis，Staphylococcus aureus，etc. Due to unreasonable use of antibiotics and because it is difficult to obtain the lower respiratory secretion for medical examination，pathogen-specific etiology and clinical diagnosis are still complex and challenging. Future research should focus on identifying bacterial pathogen and making accurate diagnosis and clinical assessment of pneumonia. This can not only determine the severity of the illness，treat it according to the cause，improve the cure rate，but also help to obtain epidemiological data and take preventive measures.

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Radiologic features of pediatric bacterial pneumonia and its clinical value YUAN Xin-yu 2018, 33(9): 679-682.  DOI: 10.19538/j.ek2018090605 Abstract ( )   Pediatric bacterial pneumonia is the important components of community-acquired pneumonia in children，especially in newborn and infants. The mortality is increased if left untreated. The radiologic examination may play a role in diagnosis and treatment of pediatric bacterial pneumonia，and the major signs include alveolar infiltration，atelectasis，pleural effusion，bullae of lung and interstitial changes. To some pneumonias caused by special pathogens，the diagnosis cab be made be the typical radiologic features combined with clinical presentations，which is helpful to the treatment.

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Value of inflammatory indexes in the diagnosis of bacterial pneumonia in children TIAN Man 2018, 33(9): 683-686.  DOI: 10.19538/j.ek2018090606 Abstract ( )   It is difficult to diagnose the etiology of pneumonia in children only by the signs，symptoms and imaging manifestation， routine culture for pathogen  is time-consuming，and the result can be influenced by many factors. The Inflammatory indexes in body fluids are not only helpful for the diagnosis of bacterial pneumonia in children，but also help to evaluate the prognosis of children with bacterial pneumonia and to determine the treatment course of anti-infection. This paper  illustrates the value of inflammatory indexes in diagnosis and treatment of childhood bacterial pneumonia.

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Antimicrobial treatment for community-acquired bacterial pneumonia in children DONG Lin， XIA Yong-qiang 2018, 33(9): 686-691.  DOI: 10.19538/j.ek2018090607 Abstract ( )   Community-acquired pneumonia（CAP） is the leading cause of morbidity and mortality in children under 5 years of age，and bacteria are one of the major causes of CAP. The results of pathogen identification are difficult to obtain in time，so the initial antimicrobial treatment is mostly empirical. The possible pathogens and multi-drug resistance should be judged based on the age，the underlying diseases，the severity of the disease，the history of previous antimicrobial use and the response to the treatment. The antimicrobial drugs can be chosen through combination with the monitoring of local bacteria resistance. After knowing the results of bacterial detection and drug susceptibility，and through combination with the response to the treatment，the regimens should be adjusted timely and the targeted treatment should be adopted. Optimizing antimicrobial regimens may increase the success rate of CAP treatment and help to reduce antimicrobial resistance.

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Early identification of severe pneumonia in children FU Hong-min，NIE Wen-sha 2018, 33(9): 691-695.  DOI: 10.19538/j.ek2018090608 Abstract ( )   null

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Prevention of bacterial pneumonia in children JIA Ju， YAO Kai-hu 2018, 33(9): 695-698.  DOI: 10.19538/j.ek2018090609 Abstract ( )   Bacteria are also pathogens of pneumonia，especially severe pneumonia. To reduce the impact of pneumonia on children’s health，we must do our best on three aspects protection，prevention and treatment. We should focus on issues such as breastfeeding to ensure children’s nutrition intake. It is also necessary to pay attention to reducing indoor and outdoor air pollution，and vaccinating against Streptococcus pneumoniae，Haemophilus influenzae type b，and pertussis. For children at high risk of infection，there should be a long-term use of antibiotics to prevent bacterial pneumonia. Effective and timely treatment of bacterial pneumonia can prevent the spread of disease and also prevent the secondary infection of other pathogens.

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Intestinal microbiome and bacterial pneumonia in children SUN Xin，ZHANG Juan 2018, 33(9): 699-702.  DOI: 10.19538/j.ek2018090610 Abstract ( )   Intestinal microbiota is a general term of microbial communities that reside in the human intestine， which can affect the systemic immune system by expansion of extra-intestinal T cell populations， production of short-chain fatty acids，development of oral tolerance， and control of inflammation. Intestinal intestinal dysbiosis may be involved in a variety of disease processes. Animal experiments have found that normal intestinal flora is beneficial to increase lung immunity against bacterial pneumonia. This interaction between intestinal and lung is known as "Gut-Lung axis". Although the specific mechanism of the "Gut-Lung axis" is still poorly undertood，the proposal of which provides new insights into the use of microecologic products or fecal bacteria transplantation to regulate or restore the intestinal flora and then to treat lung diseases.

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Etiology of bacterial pneumonia in children LU Min 2018, 33(9): 702-706.  DOI: 10.19538/j.ek2018090611 Abstract ( )   Bacterial pneumonia is the main cause of severe pneumonia in children. It is difficult to collect the samples of children’s respiratory tract infection，especially the acquisition of lower respiratory tract specimens is a challenge for the primary pediatricians，and it also affects the etiological diagnosis of children’s respiratory tract infection. Among children under 5，bacterial pathogens include Streptococcus pneumoniae，Staphylococcus aureus and Streptococcus pyogenes. Streptococcus pneumoniae infection is more common in healthy children aged 5 and above. The etiology of bacterial pneumonia in children was reviewed in this paper.

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Non-HIV disseminated penicillium marneffei in children: A clinical retrospective analysis of 15 cases JIN Ying-kang，WU Shang-zhi，GU Shu-jun，et al 2018, 33(9): 707-711.  DOI: 10.19538/j.ek2018090612 Abstract ( )   Objective　To analyze the characteristics of disseminated penicillium marneffei（PSM） in children and to deepen the understanding of PSM in the context of non-HIV. Methods　The clinical data，treatment program and prognosis of 15 children were retrospectively analyzed，who were diagnosed with non-HIV disseminated PSM in the First Affiliated Hospital of Guangzhou Medical University from Jan. 2005 to June 2016. Results　The 15 children（male∶female＝9∶6） had a median age of 23 months with a range of 3 months to 4 years and 10 months of age. All of them had clinical manifestations of fever and hepatomegaly on admission，which were often associated with cough，tachypnea，splenomegaly and lymphadenectasis. ESR was elevated by 93.3%（14/15） in laboratory tests，80%（8/10） was positive in fungal G tests，and 87.5%（7/8） in fungal GM tests. Chest imaging studies revealed that the lungs were all involved and showed various forms. Bone marrow culture and lymph node biopsy showed the highest positive rate of PM，more than 90%. The prognosis was related to the duration of the disease and  anti-fungal treatment. The duration of the death group（n＝7） was significantly longer than that of the cured group（n＝8）（P＜0.05）. The duration of anti-fungal treatment  for death groups was less than 2 weeks with the main death reason of septic shock and multiple organ failure. The cured group was given amphotericin B or voriconazole intravenously 2-4 weeks and later it was changed to itraconazole for oral maintenance；there was no recurrence after six months of follow-up. Conclusion　Non-HIV disseminated PSM in children occurs more often in infants under 3 years of age，and clinical and laboratory diagnosis lack specificity. Multi-site culture or biopsy（especially bone marrow culture and lymph node biopsy） can help confirm the diagnosis. Patients with long course of disease without timely anti-fungal treatment are associated with infectious shock and multiple organ failure，which are the main cause of death.

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Study of mixed coinfections in children with pertussis XUE Li-ming*，WANG Yu-qing，HAO Chuang-li，et al 2018, 33(9): 712-716.  DOI: 10.19538/j.ek2018090613 Abstract ( )   Objective　To explore the clinical characteristics of coinfections in children with pertussis. Methods　From February 2016 to September 2017，198 cases with pertussis-like symptom were tested for PCR，bacterial culture，respiratory virus antigen and serum mycoplasma pneumoniae antibody in Children’s Hospital of Soochow University. Results　Totally 198 patients were enrolled and 105 patients were B.Pertussis positive. Single infection was in 37 cases（35.2%）. Coinfections were observed in 68（64.8%） children with pertussis，including co-infection with one pathogen in 51 cases（75.0%）. The most frequent co-infection pathogen was rhinovirus（50.9%，26 cases），followed by Mycoplasma pneumoniae（13.7%，7 cases） and Streptococcus pneumoniae（11.8%，6 cases）. There was no statistical difference in the coinfection rate among different age groups（P = 0.08）. Pertussis coinfection with MP was increased with age. Coinfections patients were older than those with single infections［（11.77±2.32） months vs. （6.74±8.07） months，P = 0.017］. Fever，dyspnea，and positive signs of lung in chest imang were more common in children with mixed infections（0 vs. 10.3%；20.6% vs. 5.4%；76.5% vs. 36.4%，P＜0.05）. Chest imaging showed pathy shadow in most cases. There was no significant difference in lab tests，such as white blood cell counts，neutrophil counts，C-reactive protein（CRP），course of disease prior to admission or hospital stay between patients with pertussis only and those with mixed-pathogen infections（P＞0.05）. Patients older than 3 months（OR＝3.0，95%CI 1.1-8.5，P＝0.03） and fever（OR＝2.5，95%CI 1.1-6.7，P＝0.03） were the independent risk factors for mixed infections. Conclusion　There is a higher proportion of coinfection in hospitalized children with pertussis，most commonly co-infected with rhinovirus，followed by Mycoplasma pneumoniae and Streptococcus pneumoniae. Coinfections are found to aggravate pertussis. Fever and being older than 3 months are risk factors of mixed infection.

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Clinical study on the relationship between serum albumin levels and disease severity in children with severe sepsis FAN Jiang-hua，LUO Hai-yan，XU Zhi-yue，et al 2018, 33(9): 717-720.  DOI: 10.19538/j.ek2018090614 Abstract ( )   Objective　To explore  the relationship between  hypoalbuminemia  and disease severity and the prognosis in children with severe sepsis. Methods　From June 1，2015 to June 1，2017，119 cases diagnosed as sepsis complicated by hypoalbuminemia by retrospective were accepted PICU admission in Hunan Provincial Children’s Hospital. According to albumin levels in 24 h PICU admission into severe hypoalbuminemia group（≤ 25 g/L），moderate hypoalbuminemia group（～30 g/L），mild hypoalbuminemia group（～35 g/L） and albumin normal group（＞35 g/L）. To analyze the changes of the severity and prognosis of severe sepsis in children with different albumin levels. Results　The incidence of hypoalbuminemia in children with severe sepsis was 71.43%.  ①For children with severe sepsis，the lower the albumin levels，the higher the number of organ failure，and the higher the mortality，It’s negatively correlated（r＝-0.457，P＝0.000）. ②Single factor analysis found that with the serum albumin levels decreasing，the PRISMⅢ score was increased，the PICS score was decreased，the mechanical ventilation time，the hospital stay and PICU stay were increased. ③Multiple factor analysis showed that albumin level ≤ 25 g/L and MODS≥ 3 was independent risk factors for the prognosis of children with severe sepsis. Conclusion　The incidence of hypoalbuminemia in patients with severe sepsis is higher. The serum albumin level was inversely associated with the number of organ failure and  disease severity，the lower albumin levels，the higher the  illness，the worse prognosis.

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Research progress in coinfection with influenza virus and bacteria LIN Li，YU Meng-fei 2018, 33(9): 721-725.  DOI: 10.19538/j.ek2018090615 Abstract ( )

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Research progress in the diversity of lower respiratory tract bacterial flora and the mechanism of its influence on helper T cells differentiation HOU Ling-yun，GE Dan-dan，WU Jin-zhun 2018, 33(9): 726-730.  DOI: 10.19538/j.ek2018090616 Abstract ( )

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One case report of bronchial pulmonary arteriovenous fistula manisfested as massive hemoptysis WANG Yu-qing，HAO Chuang-li，GUO Wan-liang，et al 2018, 33(9): 731-733.  DOI: 10.19538/j.ek2018090617 Abstract ( )

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Two case report of Community acquired Pseudomonas aeruginosa pneumonia in children with pulmonary hemorrhage DUAN Yuan-yuan，JIN Dan-qun，YIN Chuan-gao 2018, 33(9): 734-736.  DOI: 10.19538/j.ek2018090618 Abstract ( )