儿童肺炎支原体脑炎研究进展

肺炎支原体是儿童社区获得性肺炎的常见致病菌,能引起多种形式的肺外损害.儿童肺炎支原体脑炎是引起神经系统损伤的最常见疾病类型.肺炎支原体脑炎的发病机制仍不清楚,直接侵袭、免疫损伤和神经毒素被认为是可能的发病机制.由于肺炎支原体脑炎具有较高的致死率及神经系统后遗症率,因此提高临床医师对该病的认识,最大限度地避免误诊与漏诊的发生,具有重要意义.     

重视儿童腺病毒肺炎规范诊疗与临床研究

人腺病毒（HAdV）是一种无包膜双链DNA病毒，是引起6月龄至2岁婴幼儿重症肺炎最常见的病毒病原体。2019年以来，中国多个地区发现多例重症HAdV肺炎患儿，对儿童生命健康造成严重威胁。该文就HAdV的基因型、流行趋势、疾病严重度、致病机制以及儿童HAdV肺炎的早期诊断和干预、治疗方法等方面进行介绍。     

非呼吸道合胞病毒性肺炎患儿淋巴细胞亚群变化

引起婴幼儿肺炎的病毒病原中,除呼吸道合胞病毒(RSV)外,还与其他许多病毒如腺病毒、副流感病毒、流感病毒等有关。许多研究表明,RSV可引起急性毛细支气管炎,也与儿童哮喘的发生密切相关,其致喘的发病机制与T辅助淋巴细胞亚群的失衡有关,且以Th2增高为特点。为探讨非RSV病毒性肺炎对机体免疫功能产生的影响,我们对33例非RSV感染的病毒性肺炎患儿的细胞免疫功能进行了研究。1对象与方法1.1研究对象2002～2004年期间在我科住院之非RSV病毒性肺炎33例(为病毒组),男21例,女12例;年龄1～72个月,平均(24.21±21.74)个月。除发热、咳嗽等症状…     

轮状病毒感染和细胞因子相关性研究进展

轮状病毒(rotavirus,RV)是世界范围内引起婴幼儿重症腹泻的最主要病原,每年造成全世界60多万人死亡.控制和预防RV感染有赖于对其发病机制的阐明,但目前仍不十分清楚.国内外研究多集中于环境、感染、免疫等因素,其中细胞免疫反应异常尤为受到重视.已经证实有许多细胞因子参与轮状病毒炎症免疫反应,与发病及转归密切相关.本文就轮状病毒感染过程中几种焦点细胞因子的作用机制综述如下.     

重症腺病毒肺炎临床研究(附37例报告)

目的分析重症腺病毒肺炎(SAP)患儿临床特点。方法 2011年1月至2014年4月广州市妇女儿童医疗中心重症监护室诊断为重症腺病毒肺炎患儿37例。分析重症腺病毒肺炎患儿临床特点、影像学特点、实验室检查、治疗方法及转归。结果 37例重症腺病毒肺炎患儿,男女比例为3.1∶1,2岁以下发病达31例,夏秋季发病共27例,所有患儿均有发热及咳嗽表现,其中并发呼吸衰竭29例,急性呼吸窘迫综合征(ARDS)26例,塑型性支气管炎4例,气胸5例,脓毒症休克26例,多器官功能障碍(MODS)26例。29例予气管插管机械通气,20例行纤维支气管镜灌洗,4例因合并严重脓毒症休克及急性肾损伤行床旁连续性血液净化(CBP)治疗。死亡患儿共6例,死亡组的乳酸脱氢酶、门冬氨酸转氨酶、危重症评分(PCIS)、肺叶受累数量、并发症种类较生存组显著升高,血小板、白蛋白、P/F比值较生存组显著降低,(P均0.05)。结论重症腺病毒肺炎临床表现重,易合并多种并发症,为早期明确诊断,建议尽早完善病原学,积极行肺CT检查,出现低氧血症时尽早机械通气,合并肺不张时行纤支镜灌洗有助于改善通气,出现急性肾损伤时可采取血液净化等综合治疗。     

肝素结合蛋白对儿童重症腺病毒肺炎的诊断价值

目的 探讨血清肝素结合蛋白（heparin-binding protein,HBP）对儿童重症腺病毒肺炎早期诊断的价值。 方法 前瞻性纳入2019年2月至2021年8月南华大学附属长沙中心医院儿科收治的确诊为腺病毒肺炎的80例患儿为研究对象,按照重症肺炎标准分为重症腺病毒肺炎组（40例）和非重症腺病毒肺炎组（40例）,比较2组入院24 h内的血清HBP、白细胞介素-6（interleukin-6,IL-6）、肿瘤坏死因子-α（tumor necrosis factor alpha,TNF-α）、白细胞计数、血小板（platelet,PLT）、C反应蛋白等炎症指标水平的差异,并采用受试者工作特征（receiver operating characteristic,ROC）曲线分析其对重症腺病毒肺炎的早期诊断价值。 结果 重症腺病毒肺炎组血清HBP水平［（46±16）ng/mL］高于非重症组［（28±13）ng/mL］（P<0.05）;重症腺病毒肺炎组TNF-α、IL-6、PLT水平也更高（P<0.05）。HBP对重症腺病毒肺炎的早期诊断ROC曲线下面积为0.804,取最佳截断值为31.76 ng/mL时,其灵敏度为80.0%,特异度为70.0%。HBP联合其他指标对重症腺病毒肺炎的早期诊断ROC曲线分析显示,HBP+TNF-α、HBP+PLT、HBP+IL-6、HBP+TNF-α+IL-6和HBP+TNF-α+IL-6+PLT的曲线下面积分别为0.866、0.850、0.863、0.886、0.894。 结论 血清HBP可作为重症腺病毒肺炎早期诊断的一个生物标志物,联合TNF-α、IL-6和PLT可提高其诊断价值。 中国当代儿科杂志,2022,24（9）：1014-1019］     

转移因子治疗重症腺病毒肺炎

转移因子治疗重症腺病毒肺炎安徽省蚌埠市妇幼保健院（２３３０００）韩玉秋我们用转移因子治疗重症腺病毒肺炎２２例，取得较好疗效，现报告如Ｆ。临床资料一、２２例中男１３例，女９例，年龄～６个月１７例，～１岁３例，＞２岁２例。病程２．５天～９天，多为冬季发病...     

腺病毒感染

近20年来对腺病毒感染的了解已取得明显进展。腺病毒不仅是常见的呼吸道疾病的重要病原(在我国北方尤为重要),而且也可以导致呼吸道外的其他损害。以腺病毒肺炎的远期肺部后遗症上来看也是值得重视的。7型、3型和21型毒株引起的肺炎可致永久性的肺部损     

儿童腺病毒肺炎肺损伤机制的研究进展

人腺病毒是一种DNA病毒,是我国儿童呼吸道感染的一种常见病原体。腺病毒感染后可触发多种机制,引起肺组织细胞的溶解和坏死,最终导致肺损伤及肺部后遗症,包括急性呼吸窘迫综合征、肺实变等急性期损伤及感染后闭塞性毛细支气管炎、单侧透明肺、支气管扩张、肺间质纤维化等肺部后遗症。现针对腺病毒感染引起儿童肺损伤的发病机制进行综述。     

肺炎支原体肺炎的发病机制

近年来 ,肺炎支原体肺炎 ( Mycoplasmal pneumoniaepneumonia,MPP)的发病率明显增加〔1 ,2〕 ,肺炎支原体 ( My-coplasma pneumonia,MP)已成为小儿呼吸道感染的重要病原之一。MPP肺内炎症有轻、重不同程度的改变 ,而且可引起多系统肺外并发症 ,病程长 ,病情重 ,甚至可引起多器官功能障碍综合征 ( MODS)或多器官功能衰竭 ( MOF) ,甚至死亡 ,已引起广泛关注。迄今 MPP的发病机制仍不十分清楚 ,目前主要倾向于免疫学发病机制、呼吸道上皮细胞吸附和 MP直接侵入学说。1　免疫学发病机制1 .1　体液免疫在 MPP发病机制中的作用　目前认…     

Clinical characteristics of adenovirus associated lower respiratory tract infection in children

Background

Acute lower respiratory tract infection (ALRI) due to adenovirus infection is a low frequency event but often causes severe outcome. This study was undertaken to uncover the clinical and epidemiological features of adenovirus infection in children.

Methods

Hospitalized children with ALRI were analyzed through continuous monitoring from 2006 to 2012. Nasopharyngeal aspirates were examined by direct immunofluorescence to detect respiratory agents including respiratory syncytial virus, adenovirus, influenza virus types A/B, parainfluenza virus types 1/2/3. Chlamydia pneumonia, Mycoplasma pneumonia and Chlamydia trachomatis were determined by real-time PCR. A retrospective analysis was made of 479 patients with positive infection of adenovirus.

Results

The positive detection rate of adenovirus was 0.63% in patients with ALRI. The incidence rate of adenovirus-associated acute lower respiratory tract infection peaked at the second six months of life. The morbidity was much higher in winter, spring and summer than in autumn. Patients with pneumonia accounted for 73.90% of the patients. More than one-third of the patients developed severe pneumonia, whereas no death was found. Features of severe adenovirus-associated lower respiratory tract infection included persistent high fever with serious infective symptoms, and hepatic dysfunction was one of the most common complications. Mixed infection of atypical pathogens was common (18.58%) in this study.

Conclusions

Adenovirus is a critical pathogen that can cause severe respiratory infections even in immunocompetent children. Coinfection of adenovirus with atypical pathogens is common. Antibiotic treatment with azithromycin or erythromycin is necessary in patients with mixed infection of atypical pathogens.     

Outbreak of adenovirus type 30 in a neonatal intensive care unit

OBJECTIVES: To describe an outbreak of adenovirus, type 30, in a neonatal intensive care unit (NICU). STUDY DESIGN: This was a retrospective, observational study. RESULTS: An outbreak of adenovirus infection occurred in an NICU. It lasted 6 months and involved 21 of 333 (6.3%) infants. The introduction of infection control measures controlled the outbreak; however, premature discontinuation of the measures resulted in a second wave of cases. The virus caused pneumonia in 7 infants, conjunctivitis in 7 infants, pneumonia and conjunctivitis in 1 infant, and upper respiratory tract illness in 1 infant. Infection was asymptomatic in 5 infants. Six infants died. Death was associated with the presence of pneumonia ( P = .0001), administration of steroids ( P = .003), and mechanical ventilation ( P = .02). Investigation into the origin of the outbreak suggested that the virus may have been introduced and spread during ophthalmologic procedures. CONCLUSIONS: Adenovirus type 30 can cause severe disease among premature infants in an NICU. Infants with severe bronchopulmonary dysplasia requiring mechanical ventilation are more likely to have development of adenovirus pneumonia and die. Standard infection control measures are effective in controlling an outbreak. Ophthalmologic procedures continue to be a potential source of adenovirus outbreaks.     

小儿重症腺病毒肺炎混合感染及高危因素分析

目的：了解小儿重症腺病毒肺炎混合感染情况及高危因素分析。方法：回顾性收集2009年6月至2011年6月756例小儿腺病毒肺炎临床资料,对其重症者（216例）进行病原及高危因素分析。结果：重症腺病毒肺炎216例患儿中,6个月至2岁者有138例（63.9%）,冬春季患病有161例（74.5%）;177例(81.9%)合并其他病原感染,其中74例（34.3%）合并一种致病原感染,最多可达五重感染。216例呼吸道分泌物及血清共检出334株病原,细菌163株（48.8%）,以革兰阴性菌为主（124株）;病毒108株(32.3%);真菌40株（12.0%）。Logistic 多因素分析显示,先天性心脏病、先天性气道发育异常、营养性贫血、反复肺部感染及既往有手术病史是小儿重症腺病毒肺炎的独立危险因素,OR值分别为3.3、11.1、7.2、14.3、12.9(P<0.05）。结论：重症腺病毒肺炎多见于6个月至2岁患儿,冬春季易感,多与其他病原混合感染,以革兰阴性菌为主。先天性心脏病、先天性气道发育异常、营养性贫血、反复肺部感染、既往有手术病史是儿童重症腺病毒肺炎独立危险因素。     

腺病毒肺炎12例临床特点和鉴别诊断分析

目的提高对腺病毒肺炎的再认识。方法选取2001年3月至2005年4月确诊的12例腺病毒肺炎患儿为对象,对其临床特点和辅助检查进行分析,并且与10例肺炎链球菌肺炎、10例呼吸道合胞病毒肺炎患儿的临床特点进行比较。结果12例腺病毒肺炎患儿均持续高热、有细湿罗音,10例(83.3%)患儿有持续性的喘鸣音、并出现合并症,其中合并心力衰竭10例(83.3%),呼吸衰竭6例(50.0%),中毒性肝炎6例(50.0%),脑病2例(16.7%),心肌炎1例(8.3%)。死亡2例。影像学特点:为假大叶5例,有大片影5例,小片融合灶1例,薄片影1例,有肺气肿9例,有肺门增大7例。10例(83.3%)患儿的胸片示病灶逐渐增多成为多叶的病灶。与其他两种肺炎比较,腺病毒肺炎合并症发生率高,需用IVIG和全身激素的比率明显较对照组为高。结论腺病毒肺炎的合并症发生率高,病死率高,治疗难度大。     

Participation of immune complexes in adenovirus infection

To determine the participation of immune complexes during adenovirus infection, we evaluated serum and necropsy specimens of patients with confirmed adenovirus infection of the lower respiratory tract. In lung and kidney from seven dead patients, immunofluorescence revealed the presence of hexon, immunoglobulins and complement. These patients had clinical manifestations of kidney dysfunction. In dead patients (3/3 in whom serum was available) neither anti-adenovirus antibodies nor adenovirus-specific immune complexes could be found in the final stage of the infection. However, two of these patients had anti-adenovirus antibodies and immune complexes in samples obtained early in the infection. Most patients (16/19) who survived the infection had circulating anti-adenovirus antibodies. Half also had immune complexes specific for adenovirus in some moment of the illness. This suggests that immune complexes arise during respiratory infection by adenovirus, probably contributing to its clinical picture.     

肺泡灌洗液二代基因测序对儿童重症肺炎病原学诊断应用观察

目的　探讨肺泡灌洗液二代基因测序（mNGS）在儿童重症肺炎病原学诊断中的应用。方法　回顾性分析2018年9月至2019年3月于吉林大学第一医院小儿呼吸二科住院治疗的34例重症肺炎患儿临床资料,收集其肺泡灌洗液进行mNGS结果分析。结果　34例中检出病原32例（94.1%）。单一病原体检出结果：肺炎支原体19例（55.9%）,人类腺病毒7型6例（17.6%）,福赛斯坦纳菌1例（2.9%）,金黄色葡萄球菌1例（2.9%）,未检出1例（2.9%）。混合感染病原体检出结果：人类腺病毒7型+肺炎支原体2例（5.9%）,人类腺病毒7型+流感嗜血杆菌1例（2.9%）,人类腺病毒7型+烟曲霉3例（8.8%）。经抗感染及对症支持治疗后,33例好转出院,1例死亡。结论　mNGS可提高重症肺炎的病原诊断准确率,对临床治疗有指导作用。     

上海西南地区儿童肺炎非细菌病原研究

目的了解上海西南地区12岁以下肺炎患儿的病原状况,探讨不同病原致儿童肺炎的不同临床特征。方法采集2002年7月~2004年12月因肺炎住我院儿科的187例患儿血清,应用间接免疫荧光法检测8种常见呼吸道病毒病原体和3种肠道病毒的抗体:呼吸道合胞病毒(RSV)、腺病毒3(ADV3)、流感病毒(IFV)A和B型、副流感病毒(PIV)1~4型、柯萨奇病毒A(CoxA)1、7型、埃可病毒(ECHO)7型的特异型IgM抗体。利用致敏粒子与人血清肺炎支原体(MP)抗体发生凝集反应的原理,检测MP抗体。结果1.在8种常见呼吸道病毒感染中90例阳性(48.13%),其中RSV阳性最多为37例(19.79%),其次为流感病毒B型31例(16.58%)。2.检出MP抗体阳性154例,占肺炎患儿总数的14.21%。结论RSV是上海西南地区冬春季节婴幼儿肺炎的主要病原。MP已成为学龄期儿童肺炎的重要致病原。     

Adenovirus respiratory infection in hospitalized children in Hong Kong: serotype–clinical syndrome association and risk factors for lower respiratory tract infection

Lower respiratory tract infections (LRTI) caused by adenovirus can be severe with resultant chronic pulmonary sequelae. More than 50 serotypes have been recognized; however, the exact association of serotype with clinical phenotype is still unclear. There have been no reports on the adenovirus serotype pattern in Hong Kong, and their relationships with disease manifestations and complications are not known. Clinical and epidemiological data on 287 children (<6 years old) admitted with adenovirus respiratory infections from 2001 to 2004 were reviewed. Common presenting symptoms included fever (97.9 %) and cough and rhinitis (74 %). Extra-pulmonary manifestations were present in 37.3 %. The clinical picture mimicked bacterial infection for its prolonged high fever and neutrophilic blood picture. Forty-two patients (14.6 %) had LRTI, either pneumonia or acute bronchiolitis, but none had severe acute respiratory compromise. Children aged 1 to 2 years old were most at risk for adenovirus LRTI (adjusted p?=?0.0165). Serotypes 1 to 7 could be identified in 93.7 % of the nasopharyngeal specimens, with serotypes 2 and 3 being the most prevalent. Different serotypes showed predilection for different age groups and with different respiratory illness association. The majority of acute bronchiolitis (71.4 %) were associated with serotype 2 infection, and this association was statistically significant (p?<?0.0001). Serotype 3 infection accounted for over half of the pneumonia cases (57–75 %) in those aged 3–5 years old. Only one patient developed mild bronchiectasis after serotype 7 pneumonia. Children aged 1 to 2 years old were the at-risk group for adenovirus LRTI, but respiratory morbidity was relatively mild in our locality. There was an apparent serotype–respiratory illness association.     

Contribution of viruses to severe pneumonia in children

ObjectiveCommunity acquired pneumonia (CAP) accounts for more than two million deaths per year in children less than 5 years of age, mostly in developing countries. Viruses causing CAP have been identified in up to 50% of patients in studies using the real-time polymerase chain reaction (PCR). This study aimed at screening of viral etiology among hospitalized children with severe pneumonia.MethodsIn this prospective study conducted at Cairo University Children’s Hospital from 31st March 2010 to 1st April 2011 on 733 children admitted with a clinical and radiological diagnosis of pneumonia, nasopharyngeal or throat swabs were analyzed for common respiratory viruses, including respiratory syncytial virus (RSV), human metapneumovirus (hMPV), influenza B (Flu B), human parainfluenza virus (hPIV), influenza A (H1N1) and adenovirus (ADV) using the real time PCR technique.ResultsOne or more respiratory viruses were detected in 311 patients. RSV was the most commonly detected virus isolated in 197(63.3%) followed by hPIV in 38(12.2%), hMPV in 34(10.9%) and ADV in 26(8.4%) patients. Six cases were positive for H1N1 making the virus the second least common, after Flu B, identified in a single patient in our study. Mixed infection with more than one respiratory virus was detected in 156(45%) cases.ConclusionRSV was the most predominantly isolated virus from all patients in addition to being the most common single virus to cause pneumonia in children with chronic diseases. Although the most commonly isolated virus in our study, RSV came third in causing complications following hPIV & H1N1, but this observation cannot be applied to the community.     

Severe adenovirus pneumonia with hemophagocytic syndrome and respiratory failure

We report the case of an 18-month-old infant with severe serotype 3 adenovirus pneumonia, exceptionally associated with hemophagocytic syndrome. Treatment included cidofovir and mechanical ventilation for 13 days. The child developed chronic respiratory insufficiency due to bronchiectasis and bronchiolitis obliterans.