Etiology of pulmonary diseases in children in Khabarovsk Region

Microflora of upper respiratory tract in 658 children aged 1 month - 17 years hospitalized with acute pneumonia (AP), acute bronchitis (AB), recurrent obstructive bronchitis (ROB), malformation of lungs (ML) and broncho-alveolar dysplasia (BALD) were studied. Carriage rates of Streptococcus pneumoniae (up to 95%) and Haemophilus influenzae (up to 89%) in 240 children attending daycare centers and schools were determined. Etiology of infectious process was ascertained in 40% of cases. S. pneumoniae was isolated in 45% of acute cases (AP and AB) and in 25% of chronic cases (BALD). H. influenzae was isolated in 8 - 12% of acute cases and in 32% of chronic cases. In 23 - 29% of all cases of pulmonary pathology in children persistence of Enterococcus faecium was determined. There were 13 different serotypes among isolated pneumococci. In patients with pneumonia the rate of detection of S. pneumoniae and H. influenzae DNA fragments by PCR was significantly higher compared with rate of their isolation from sputum.     

Significance of Legionella pneumophila in human respiratory pathology

The etiological structure of acute pneumonia and acute respiratory diseases was studied with a view to establishing the proportion of L. pneumophila among other causative agents of such diseases. A total of 299 patients were examined over time. The etiological diagnosis based on the data of serological examination was made in 70.6% of the patients with acute pneumonia and in 65% of the patients with acute respiratory viral infections and influenza. In the etiology of pneumonia, the leading role was found to belong to influenza A (H3N2) and B viruses, as well as to adenovirus, while in the etiology of acute respiratory viral infections and influenza, to influenza B virus, adenovirus and Mycoplasma pneumoniae. The importance of L. pneumophila in the etiology of acute pneumonia and acute respiratory diseases was shown. The proportion of L. pneumophila proved to be, on the average, 9.9% in acute pneumonia and 9.8% in acute respiratory diseases. L. pneumophila occurred most frequently in mixed infections in combination with adenovirus and influenza B virus. Diseases of Legionella etiology were found to have a seasonal character, occurring mostly in winter and spring.     

社区获得性肺炎非典型病原体分布及其流行特征

目的 了解社区获得性肺炎(CAP)非典型病原体感染的分布情况及其流行特征.方法 收集确诊为社区获得性肺炎患者278例,间接免疫荧光法(IFA)检测人血清中呼吸道9种主要的非典型性病原体的IgM抗体.结果 病原体检测阳性者150例,总阳性率54.O％.单一病原体感染中,肺炎支原体(MP) 125例(45.0％)、呼吸道合胞病毒( RSV) 27例(9.7％)、腺病毒22例(7.9％)、副流感病毒1、2和3型19例(6.8％)、乙型流感病毒16例(5.8％)、嗜肺军团菌血清1型13例(4.7％)、肺炎衣原体2例(0.7％)和甲型流感病毒1例(0.4％).混合感染共63例(22.7％),其中61例(21.9％)为MP与其他病原体的混合感染,病毒感染以RSV最常见,共27例(9.7％).CAP患者患有基础疾病共139例(50％),其余为无基础疾病者.基础疾病中以循环疾病和呼吸疾病最常见,各占总CAP患者的15,1％和13.0％.所有受检者MP阳性率最高,达45％,其中未成年组3～18岁中MP阳性率高达60.2％,而成人组18 ～50岁中MP阳性率高达81.8％.CAP春季病原体阳性检出率为46.9％,冬季病原体阳性检出率为63.8％(x2=7.752,P＜0.05).结论 非典型性病原体(特别是MP)感染在CAP患者中比例较大,其流行与分布跟病原体种类、基础疾病、年龄、季节等有一定的关系.     

Etiological structure of pneumonias in children and adults

The bacteriological study of sputa, nasopharyngeal smears and bronchial washings taken from pneumonia patients has shown that the leading etiological agent was Streptococcus pneumoniae isolated in the diagnostic titre (10(7) bacteria per ml) in 78.1% of the cases. Staphylococcus aureus, Haemophilus influenzae, enterobacteria and yeast-like fungi have been found to play an insignificant role in the etiology of acute pneumonia (2.5 +/- +/- 0.9%). The results of the serological diagnosis by means of the complement fixation test have revealed that, alongside S. pneumoniae, the following infective agents are of etiological importance in cases of acute pneumonia: respiratory viruses (more than 50%), Mycoplasma pneumonia (10%), Chlamydia psittaci (6.4%) and Legionella pneumophila (3.8%). The study has first revealed that, under the conditions of Alma-Ata, serotypes 19, 23, 8 and 4 prevail among circulating pneumococci. This study has also shown that the use of M. pneumoniae antibody erythrocyte diagnosticum enhances the detection rate of mycoplasma infections in pneumonia patients.     

北京地区住院患儿WU多瘤病毒感染的流行病学研究

自2007年Gaynor A M等人通过高通量测序在肺炎患儿呼吸道样本中发现了WU多瘤病毒(Washington University polyomavirus,WUPyV)以来,WUPyV在世界各地被广泛检出。为了解北京地区急性呼吸道感染住院儿童中WUPyV感染情况及其临床特征,收集北京地区2017年4月至2018年3月共1 276份呼吸道感染住院患儿的鼻咽抽吸物样本,使用real time PCR方法对样本进行WUPyV检测,同时对WUPyV阳性样本进行17种常见呼吸道病毒筛查。共检出WUPyV阳性样本76份(5.96%,76/1 276),4岁以下儿童居多(92.11%,70/76);WUPyV感染全年可见,无显著季节性;多伴随其他呼吸道病毒混合感染(60.53%,46/76),最常见混合感染为鼻病毒和A型流感病毒;WUPyV单一感染者与混合感染者病毒载量无显著性差异,临床诊断和表现基本一致;WUPyV感染患儿的常见诊断为支气管炎(68.42%,52/76)和肺炎(30.26%,23/76);临床症状主要表现为高热、咳嗽、咳痰。研究结果提示WUPyV是北京地区急性呼吸道感染住院患儿呼吸道样本中常见病毒之一,多见于4岁以下儿童。     

The role of Chlamydia pneumoniae in etiology of acute bronchitis in children

During examination of 60 children aged 3-15 years with manifestations of acute bronchitis Chlamydia pneumoniae antigen was detected in their nasal and pharynx smears in 11.7% of cases with the use of enzyme immunoassay and indirect immunofluorescence test. In 10% of cases chlamydial pneumonia was diagnosed serologically. In the course of complex laboratory diagnostics C. pneumoniae was detected in 13.3% of cases. The most complete information could be obtained by a combination of different methods of the antigen detection as well as specific IgG and IgM antibodies.     

Environmental exposures to Florida red tides: Effects on emergency room respiratory diagnoses admissions

Human exposure to Florida red tides formed by Karenia brevis, occurs from eating contaminated shellfish and inhaling aerosolized brevetoxins. Recent studies have documented acute symptom changes and pulmonary function responses after inhalation of the toxic aerosols, particularly among asthmatics. These findings suggest that there are increases in medical care facility visits for respiratory complaints and for exacerbations of underlying respiratory diseases associated with the occurrence of Florida red tides.This study examined whether the presence of a Florida red tide affected the rates of admission with a respiratory diagnosis to a hospital emergency room in Sarasota, FL. The rate of respiratory diagnoses admissions were compared for a 3-month time period when there was an onshore red tide in 2001 (red tide period) and during the same 3-month period in 2002 when no red tide bloom occurred (non-red tide period). There was no significant increase in the total number of respiratory admissions between the two time periods. However, there was a 19% increase in the rate of pneumonia cases diagnosed during the red tide period compared with the non-red tide period. We categorized home residence zip codes as coastal (within 1.6 km from the shore) or inland (>1.6 km from shore). Compared with the non-red tide period, the coastal residents had a significantly higher (54%) rate of respiratory diagnoses admissions than during the red tide period. We then divided the diagnoses into subcategories (i.e. pneumonia, bronchitis, asthma, and upper airway disease). When compared with the non-red tide period, the coastal zip codes had increases in the rates of admission of each of the subcategories during the red tide period (i.e. 31, 56, 44, and 64%, respectively). This increase was not observed seen in the inland zip codes.These results suggest that the healthcare community has a significant burden from patients, particularly those who live along the coast, needing emergency medical care for both acute and potentially chronic respiratory illnesses during red tide blooms.     

儿科呼吸道疾病中肺炎支原体感染的结果分析

目的探讨儿科肺炎支原体（MP）感染特点,辅助临床医师早期诊断,合理用药。方法测定我院一年来2013例儿科呼吸道疾病患儿的肺炎支原体抗体（IgM）。结果2013例呼吸道感染患儿,检出肺炎支原体抗体（IgM）阳性者769例,占38.2%,769例阳性分别表现为肺炎369例（48%）,支气管炎238例（31%）,咽炎92例（12%）,哮喘70例（9%）。其中,肺炎组与各组相比较,具有统计学意义。MP IgM感染的检出率明显高于其他各组（P〈0.01）。结论MP感染是患儿不可忽视的病原体,检测患儿血清MP抗体能够及早诊断,指导治疗。     

Respiratory moisture loss and possible pathways of its regulation

Examination of healthy men and those suffering from nonspecific pulmonary diseases has shown that respiratory moisture loss is induced by situation and While "lifting" examinees in the altitude chamber 5000 m upwards intensity of the moisture loss increases to 158%. Essential individual variations of the response are shown. Pulmonary diseases (chronic bronchitis, pneumonia, lecithin synthesis disturbances) make the moisture loss higher. It is concluded that lung surfactants participate in regulation of the respiratory moisture loss. participate in regulation of the respiratory moisture loss.     

Etiology of acute pneumonia occurring against a background of influenza and other acute respiratory viral infections

The etiology of acute pneumonia (AP) was studied in 229 patients who had the disease simultaneously with influenza (106 patients), other viral and mycoplasmal infections (48 patients), and without concomitant acute viral infections (75 patients). The use of the quantitative microbiological method and the indirect immunofluorescence test with autostrains or Streptococcus pneumoniae strains of serotypes 2, 3, and 6, prevailing in Leningrad in patients with acute inflammatory diseases of the lungs, made it possible to find out the pneumococcal etiology of AP in 95% of patients irrespective of the presence of acute respiratory viral infections. The etiological role of opportunistic bacteria was revealed in 13 AP patients (5.7%); in 2 of them the causative agent of AP was Staphylococcus aureus and in 11, various species of Gram-negative enterobacteria. The latter were the cause of complications in 8 cases of pneumococcal pneumonia.     

Impaired interferon status in children with acute respiratory infection and its correction with bifidumbacterin-forte

The state of interferon status was studied in 46 hospitalized children: 33 patients with complicated forms of acute respiratory virus infection (ARVI), such as pneumonia, bronchitis, etc., and 13 patients with vegetovascular dystonia (used as a comparison group). The study revealed that in patients with acute infections of the upper and lower respiratory tract considerable changes in their interferon system were registered. Children with ARVI were treated with Bifidumbacterin forte, a probiotic preparation, in large doses. Bifidumbacterin forte was found to produce a regulatory effect on the interferon system by enhancing the induction of alpha- and gamma-interferon and decreasing the production of serum interferon. The experience of using Bifidumbacterin forte in large doses proved that the preparation was well tolerated and could be used for the correction of interferon status.     

Application of different methods in the diagnosis of respiratory mycoplasmosis

A complex of methods for the detection of Mycoplasma pneumoniae and Mycoplasma hominis in children and adults with respiratory diseases (acute, chronic and obstructive bronchitis, pneumonia, recurring croup, bronchial asthma), as well as in children frequently having acute respiratory diseases, has been worked out and tested. Both infective agents are frequently detected in the above mentioned pathological processes as monoinfection or mixed infection. Mycoplasma antigens are capable of prolonged (up to 1 year) persistence in the patient body in spite of etiotropic therapy and the presence of specific antibodies. The method of the preliminary treatment of specimens for the polymerase chain reaction is proposed: the specimens are subjected to prolonged deproteinization, which makes it possible to detect M. pneumoniae in some cases of chronic infection when it cannot be detected by routine methods.     

The Interaction Effects of Temperature and Humidity on Emergency Room Visits for Respiratory Diseases in Beijing,China

Few epidemiological studies have been reported as to whether there was any interactive effect between temperature and humidity on respiratory morbidity, especially in Asian countries. The present study used time-series analysis to explore the modification effects of humidity on the association between temperature and emergency room (ER) visits for respiratory, upper respiratory tract infection (URI), pneumonia, and bronchitis in Beijing between 2009 and 2011. Results showed that an obvious joint effect of temperature and humidity was revealed on ER visits for respiratory, URI, pneumonia, and bronchitis. Below temperature threshold, the temperature effect was stronger in low humidity level and presented a trend fall with humidity level increase. The effect estimates per 1 °C increase in temperature in low humidity level were ?2.88 % (95 % confidence interval (CI) ?3.08, ?2.67) for all respiratory, ?3.24 % (?3.59, ?2.88) for URI, ?1.48 % (?1.93, ?1.03) for pneumonia, and ?3.79 % (?4.37, ?3.21) for bronchitis ER visits, respectively. However, above temperature threshold, temperature effect was greater in high humidity level and trending upward with humidity level increasing. In high humidity level, a 1 °C increase in temperature, the effect estimates were 1.84 % (1.55, 2.13) for all respiratory, 1.76 % (1.41, 2.11) for URI, and 7.48 % (4.41, 10.65) for bronchitis ER visits. But, there was no statistically significant for pneumonia. This suggests that the modifying effects of the humidity should be considered when analyzing health impacts of temperature.     

Etiology of acute bronchitis in adults

A total of 126 adult patients with acute bronchitis were subjected to microbiological, virological and immunological examination. Influenza and other acute respiratory viral infections were detected in 104 (82.5%) cases of acute bronchitis. The results of microbiological examination and the study of local and systemic immunity showed that in 94.4 +/- 2.6% of the patients the development of acute bronchitis was linked with the appearance of acute pneumococcal infection irrespective of the presence, or absence, of virologically and serologically confirmed acute viral or mycoplasmal infections.     

Physical exercise and the quantitative characteristics of moisture- excreting function of the lungs

Physical loading has been used as a test to study the regulation of moisture excretion in the act of breathing in 101 healthy students, 62 men with external risk factors, and in 73 patients with respiratory diseases (chronic bronchitis, acute pneumonia, bronchial asthma). The correlation of moisture excretion with the parameters of ventilation, age, sex, body weight of examinees proved that physical loading in the age-groups above 50 with excess body weight and with hyperventilation resulted in blocking effect on the volume of moisture loss during breathing. Thus, these endogenic factors determine the individual reaction in dynamics of moisture loss during physical loading and could be considered as risk factors in deteriorations of moisture excreting function of lungs.     

Etiological structure of respiratory infections in different variants of acute bronchitis

The microbiological and virological examination of 87 acute bronchitis patients (36 patients with the prolonged course and 31 patients with the relapsing course of the disease) was carried out. All forms of bronchitis were characterized by a high degree of infection with respiratory viruses and pneumococci. Haemophilus influenzae (type b) infection was registered rather rarely and only in combination with pneumococcal one. The highest characteristics of viro-bacterial associations were found in patients with acute bronchitis and with prolonged form of acute bronchitis, viral associations--with the prolonged and relapsing forms of the course of acute bronchitis in the presence of the bronchoobstructive syndrome.     

呼吸道感染与甲型链球菌的相关性研究

目的：探讨呼吸道感染与甲型链球菌的相关性。方法 对呼吸道感染患者和健康对照组口腔咽后壁取样进行分析。结果 健康对照组中甲型链球菌检出率（５０％）明显高于呼吸道感染病人组（２５．７５％）,且各疾病组甲型链球菌检出率均有显著性差异（Ｐ＜０．０５）,如肺内感染１６．６７％,支气管炎１７．２４％,具有显著性差异（Ｐ＞０．０５）,但肺炎患者甲型链球菌检出率５３．８５％与健康人相比无显著性差异（Ｐ＞０．０５）     

Early induction of interleukin-5 and peripheral eosinophilia in acute pneumonia in Japanese children infected by pandemic 2009 influenza A in the Tokyo area

A novel influenza A (2009 H1N1) virus has led to a worldwide pandemic. A significant number of patients with pneumonia have been reported, although its pathogenesis remains to be elucidated. To determine its pathogenesis, we evaluated serum interleukin (IL)-5 and peripheral eosinophil counts in patients with acute pneumonia caused by the 2009 H1N1 virus. During the period from October to December 2009, 40 patients with laboratory-confirmed 2009 H1N1 pneumonia were under investigation. Their mean age at presentation was 6.8 years. The most characteristic finding was the early development of hypoxemic respiratory distress in the first 24 hr after the onset of fever. Bronchial mucous plugs included eosinophils in addition to neutrophils, even in patients without allergies. Serum IL-5 levels were elevated in 20 out of 24 patients (83%) whose samples were obtained in the first 24 hr after the onset of fever (26.5 ± 20.1 pg/mL), independent of the presence of underlying allergies. In contrast, induction of IL-5 was not documented in sera from eight patients with laboratory-confirmed 2009 H1N1 virus who developed neurological complications, but without lower respiratory infection (2.1 ± 0.7 pg/mL, P < 0.001 vs acute pneumonia). Peripheral eosinophilia was characteristic in acute pneumonia, but not in patients without a lower respiratory infection. There was a marked difference in the induction of IL-5 in 2009 H1N1 patients who developed acute pneumonia, compared with those without a lower respiratory infection. IL-5 may play a role in the early phase of acute pneumonia caused by the 2009 H1N1 virus in Japanese children.