569例呼吸道感染住院儿童7种常见呼吸道病毒病原学分析

目的 了解呼吸道感染住院患儿呼吸道病毒的分布情况。方法 选取2015年7月至2016年6月呼吸道感染的住院患儿病例,抽取鼻咽分泌物,采用直接免疫荧光法检测常见的7种病毒,即呼吸道合胞病毒（RSV）、甲型流感病毒（IVA）、乙型流感病毒（IVB）、副流感病毒1型（PIV1）、副流感病毒2型（PIV2）、副流感病毒3型（PIV3）、腺病毒（IVD）。结果 共有569例样本送检,193例病毒检测阳性（33.92%）,其中有3例为2种病毒的混合感染。男性共369例,女性共200例。其中RSV、PIV3、ADV的感染率居前三位。呼吸道病毒的感染率随着患儿年龄的增长逐渐下降,除新生儿外,6个月内的婴幼儿呼吸道病毒检出率最高。RSV检测阳性率自11月开始呈增高趋势,12月最高,达55.86%。PIV3的检出高峰出现在7月,达13.64%。结论 RSV是本地区儿童呼吸道感染最常见的病毒。呼吸道病毒的检出率与年龄、季节等因素有关。     

儿童下呼吸道感染病原菌分布及耐药性

目的对儿童下呼吸道感染病原菌分布情况及耐药情况进行分析。方法选取延安大学附属医院儿科2012年8月至2014年8月明确诊断的385例下呼吸道感染患儿,对其痰标本的培养结果进行统计,分析其病原菌分布及耐药情况。结果患儿痰培养阳性菌株134例,其中革兰阴性菌91株,以大肠埃希菌为主,占20.9%;革兰阳性菌40株,以金黄色葡萄球菌为主,占9.7%;真菌3株,占2.2%。对5种主要病原菌检出年度情况分析,显示大肠埃希菌、肺炎克雷伯杆菌、鲍曼不动杆菌检出率逐年增加,肺炎链球菌检出率逐年降低,而金黄色葡萄球菌三年无明显变化。婴儿组、幼儿组病原菌检出率显著高于学龄前及学龄组,病原菌检出率在年龄分布上差异有统计学意义(χ2=43.445,P0.01)。不同病原菌对常用抗菌药物呈现不同程度的耐药,革兰阴性菌对亚胺培南、美罗培南均敏感,对氨苄西林耐药率最高;金黄色葡萄球菌及肺炎链球菌对利奈唑胺及万古霉素敏感,对苄青霉素耐药率最高。结论儿童下呼吸道感染病原菌以革兰阴性菌为主,检出率在性别上无差异,婴儿、幼儿检出率高于学龄前及学龄儿童。治疗时应根据药敏试验结果,合理使用抗生素,降低耐药菌株的产生。     

Effect of homoeopathic medicines on daily burden of symptoms in children with recurrent upper respiratory tract infections.

OBJECTIVE--To investigate the intrinsic effects of individually prescribed homoeopathic medicines. DESIGN--Randomised double blind placebo controlled study. SETTING--Paediatric outpatient department of university hospital. PATIENTS--175 children with frequently recurring upper respiratory tract infections. Of the 170 children evaluable, 86 were randomised to homoeopathic medicines (47 boys, 39 girls; median age at start 4.2 years; median number of episodes in past year 4) and 84 to placebo (43 boys, 41 girls; median age at start 3.6 years; median number of episodes in past year 4). MAIN OUTCOME MEASURES--Mean score for daily symptoms, number of antibiotic courses, and number of adenoidectomies and tonsillectomies over one year of follow up. RESULTS--The mean daily symptom score was 2.61 in the placebo group and 2.21 in the treatment group (difference 0.41; 95% confidence interval -0.02 to 0.83). In both groups the use of antibiotics was greatly reduced compared with that in the year before entering the trial (from 73 to 33 in the treatment group and from 69 to 43 in the placebo group). The proportion of children in the treatment group having adenoidectomies was lower in the treatment group (16%, 8/50) than in the placebo group (21%, 9/42). The proportion having tonsillectomies was the same in both groups (5%). CONCLUSION--Individually prescribed homoeopathic medicines seem to add little to careful counselling of children with recurrent upper respiratory tract infection in reducing the daily burden of symptoms, use of antibiotics, and need for adenoidectomy and tonsillectomy.     

儿童反复呼吸道感染与肠道微生态变化的相关性

目的研究儿童反复呼吸道感染与患儿肠道微生态平衡紊乱的关系。方法选择102例反复呼吸道感染患儿为研究组,167例急性肺炎患儿为肺炎对照组,142例健康体检儿童为正常对照组。采用16S rRNA荧光定量PCR检测3组对象肠道双歧杆菌及大肠埃希菌数量,计算B/E值,并比较3组研究对象细胞免疫功能。结果正常对照组、肺炎对照组以及研究组儿童肠道双歧杆菌数量依次降低,大肠埃希菌依次增多,B/E值依次降低,差异均有统计学意义(均P0.05)。正常对照组、肺炎对照组以及研究组儿童血液中CD3~+、CD4~+细胞水平以及CD4~+/CD8~+依次降低,CD8~+细胞水平依次增高,差异均有统计学意义(均P0.05)。结论儿童反复呼吸道感染与肠道微生态失衡具有一定相关性,肠道微生态稳态的维持可为反复呼吸道感染的防治提供新思路。     

儿童呼吸道感染时呼吸道分泌物的病原菌分布及其耐药性分析

【摘 要】目的 了解本地区儿童呼吸道感染病原菌种类、分布特点及其耐药性,为临床合理应用抗菌药物提供参考。方法 对2009年5月至2012年5月间本地区两家医院儿科住院患者送检的共1350份呼吸道分泌物的细菌培养结果及要检出菌的耐药情况,进行回顾性分析。结果 从1350份标本中共分离出384株病原菌,检出率为28.4%,革兰阴性杆菌258株,占67.2%,革兰阳性球菌95株,占24.7%,厌氧菌17株,占4.4%,真菌14株,占3.6%;革兰阴性前三位杆菌肺炎克雷伯杆菌、大肠埃希菌和解鸟氨酸克雷白杆菌对氨苄西林、哌拉西林耐药率均大于50%以上,共分离出产ESBLs菌57株,阳性率为43.2%;革兰阳性前三位球菌肺炎球菌、金黄色葡萄球菌和表皮葡萄球菌对青霉素、红霉素耐药率达50%以上。结论 本地区儿童呼吸道感染主要病原菌是革兰阴性杆菌,加强细菌培养和耐药性监测对临床合理使用抗生素有重要意义。     

Deficiency in interferon production by leukocytes from children with recurrent respiratory infections

In vitro interferon production by peripheral blood mononuclear cells from 50 children suffering from recurrent upper respiratory tract infections was examined, and compared with that of 50 healthy children. Five respiratory pathogenic viruses and Mycoplasma pneumoniae were used as inducers. Cells from every child responded to at least three out of the six inducers by interferon production. As a group, cultures prepared from patient cells showed decreased production of IFN when stimulated with adeno, rhino, corona or RS viruses or with the mycoplasma. Similar trend between the two groups of children was seen as regards influenza A virus induced IFN production in leukocyte cultures. These results corroborate our previous findings that relative deficiency in interferon production appears to be inducer-specific, and suggest that this phenomenon may have a role in the pathogenesis of recurrent respiratory infections.     

503例儿童急性呼吸道感染常见病毒的检测结果分析

目的通过对503例急性呼吸道感染患儿进行7种常见病毒[流感病毒A、B型（IVA、IVB）,腺病毒（ADV）,副流感病毒1、2、3型（PIV1、PIV2、PIV3）及呼吸道合胞病毒（RSV）]的检测,了解本地区2013年急性呼吸道感染患儿的病毒感染状况。方法应用免疫荧光法对503例急性呼吸道感染患儿的咽拭子进行7种常见病毒的检测。结果 503例患儿中有55例检出病毒阳性,总阳性率为10.93%,均为单一病毒感染。7种常见病毒中,RSV的感染率最高,为76.36%。在各年龄组中,〈1岁组的病毒检出率最高,为29.41%,随着年龄的增长,检出率逐渐降低。从季节分布来看,春季的感染率最高,为23.08%,其次为冬季,感染率10.13%。结论 RSV是2013年本地区儿童急性呼吸道感染的主要病毒,〈1岁组患儿的病毒检出率最高,春季为感染的高发季节。     

肺炎支原体和沙眼衣原体致儿童急性下呼吸道感染的研究

本文旨在研究儿童社区获得性急性下呼吸道感染(ALRTI)中肺炎支原体(MP)和沙眼衣原体(CT)的感染特征。采用实时荧光定量聚合酶链反应(PCR)检测2006年10月～2008年2月因ALRTI收入复旦大学附属儿科医院的患儿呼吸道标本中MP和CT的DNA,并分析2种病原体感染患儿的临床特征与实验室检查结果。在1312份深部鼻咽分泌物标本中,MP和CT检出率分别为7.85%(103/1312)和2.97%(39/1312)。MP在5岁以上患儿中的检出率为33.33%(30/90),而CT在3个月以内患儿中的检出率为6.28%(31/494)。MP感染后易出现40℃以上高热,较少发生发绀与重症呼吸道感染;白细胞计数常无明显升高,但C反应蛋白升高较多见。CT感染后40℃以上高热和重症呼吸道感染少见,C反应蛋白升高也较少见。结果提示,在5岁以上儿童的社区获得性ALRTI中,MP是重要的病原体;而在3个月以内儿童中,CT为常见病原体之一。     

急性下呼吸道感染患儿中RSV的分离鉴定及分析

目的对2015年兰州单中心急性下呼吸道感染患儿中呼吸道合胞病毒(respiratory syncytial virus,RSV)进行分离鉴定及分析。方法收集临床急性下呼吸道感染患儿痰分泌物226份,在HEP-2细胞中连续盲传培养3代,收获的培养物用半巢式RT-PCR进行检测,选取强阳性样品进行测序以确定其型别,并对其流行病学特征进行分析。结果 226份样品中RSV阳性样本为76份(阳性率为34%)。RSV阳性患儿中,男女性别比为3∶1;年龄分布6月龄患儿占45%,6月龄~2岁占35%,2~5岁的占20%。冬季为发病高峰。76例RSV阳性患儿中,临床诊断依次为毛细支气管炎31例(40.79%)、喘息性支气管炎21例(27.36%)、支气管肺炎20例(26.32%)和支气管哮喘4例(5.26%)。40份强阳性RSV样品经测序确定为B亚型。结论 RSV是引起婴幼儿急性下呼吸道感染的重要病原之一,2015年RSV的流行株主要为B亚型。     

小儿下呼吸道感染痰培养标本病原菌构成分析

目的了解小儿下呼吸道感染病原菌的分布及对常用抗菌药物的耐药状况。方法对2710例小儿下呼吸道感染患者痰标本进行培养,用VITEK-2Compact微生物鉴定系统鉴定菌种和药敏试验,WHO-NET5．4软件对数据进行分析。结果共分离病原菌675株,革兰阴性杆菌457株,占67．7％,主要为大肠埃希菌、肺炎克雷伯菌;革兰阳性球菌159株,占23．5％,主要为金黄色葡萄球菌、肺炎链球菌;真菌59株,占8．7％,主要为白色假丝酵母菌。结论小儿下呼吸道感染病原菌以革兰阴性杆菌为主,耐药性较为严重,应不断加强耐药性监测,合理使用抗菌药物。     

Pathogens isolated from patients with community-acquired lower respiratory tract infections

The aim of the study was to assess the prevalence and antimicrobial susceptibility of pathogens in patients hospitalized in Clinic of Pneumology and Alergology University Clinical Hospital No 1 in ?od? in 2006-2008 period, due to community-acquired lower respiratory tract infections. In this samples of sputum, bronchoaspirate and BAL's were evaluated. The most frequent pathogens isolated from all examinated patients were Gram-negative rods. This bacteria were susceptible in most to imipenem (91%), ceftazydym (71%), amikacin (67%), ciprofloxacin (63%) and to amoxicillin with clavulanic acid only in 18%. This study show high prevalence of Gram-negative rods in patients hospitalized due to community-acquired lower respiratory tract infections.     

Hypoxaemia in young Kenyan children with acute lower respiratory infection.

OBJECTIVES--To determine the prevalence, clinical correlates, and outcome of hypoxaemia in acutely ill children with respiratory symptoms. DESIGN--Prospective observational study. SETTING--Paediatric casualty ward of a referral hospital at 1670 m altitude in Nairobi, Kenya. SUBJECTS--256 Infants and children under 3 years of age with symptoms of respiratory infection. MAIN OUTCOME MEASURES--Prevalence of hypoxaemia, defined as arterial oxygen saturation < 90% determined by pulse oximetry, and condition of patient on the fifth day after admission. RESULTS--Over half (151) of the children were hypoxaemic, and short term mortality was 4.3 times greater in these children. In contrast, the relative risk of a fatal outcome in children with radiographic pneumonia was only 1.03 times that of children without radiographic pneumonia. A logistic regression model showed that in 3-11 month old infants a respiratory rate > or = 70/min, grunting, and retractions were the best independent clinical signs for the prediction of hypoxaemia. In the older children a respiratory rate of > or = 60/min was the single best clinical predictor of hypoxaemia. The presence of hypoxaemia predicted radiographic pneumonia with a sensitivity of 71% and specificity of 55%. CONCLUSIONS--Over half the children presenting to this referral hospital with respiratory symptoms were hypoxaemic. A group of specific clinical signs seem useful in predicting hypoxaemia. The clear association of hypoxaemia with mortality suggests that the detection and effective treatment of hypoxaemia are important aspects of the clinical management of acute infections of the lower respiratory tract in children in hospital in developing regions.     

Activation of alveolar macrophages after lower respiratory tract infection.

Alveolar macrophage function has been studied in relation to bacterial infection of the lower respiratory tract. First, LRT macrophages were examined after exposure of rabbits to Listeria monocytogenes aerosols. Macrophages obtained from the LRT of animals 10 to 48 days after infection were activated, as evidenced by greater adherence to culture dishes and increased ability to ingest and kill both the original infecting organism and unrelated organisms, when compared to normal alveolar macrophages. Next, the in vitro effects on normal alveolar macrophages of incubation supernatants of control and antigen-stimulated lymphocytes (LRT and lymph node) from animals infected with L. monocytogenes or Streptococcus pneumoniae were evaluated. As manifested by increased adherence and phagocytosis, and an enhanced nonspecific bactericidal activity, alveolar macrophages were activated by the antigen-stimulated supernatants. These stimulated lymphocyte supernatants contain lymphokines (MIF), but the exact nature of the alveolar macrophage activating factor(s) remains to be determined. These observations, together with recent evidence that alveolar macrophages respond to lymphokines (MIF), suggest that the effector mechanism for cell-mediated immunity in the LRT is intact.