住院儿童肺炎发病情况及病毒病原学分析

目的:统计我院1-7岁住院儿童肺炎发病情况并进行病毒病原学分析。方法:收集2015年1月到2017年12月河北省人民医院1-7岁住院儿童8532例的临床资料,统计不同年龄段的肺炎患儿、重症肺炎患儿的发病情况及不同季节肺炎分布特点,统计不同病毒病原体住院肺炎儿童入院时的症状或体征情况,记录住院肺炎儿童并发症发生情况。结果:8532例住院儿童中,肺炎患儿2476例。1岁患儿肺炎、重症肺炎的发病率均最高,分别为54.67%(703/1286)、1.14%(8/703);7岁患儿肺炎发病率最低,为12.52%(126/1006);6岁和7岁重症肺炎发病率均为0.00%。冬季肺炎发病率最高,为33.38%(724/2169),春季、夏季、秋季发病率相当。病毒病原学显示,至少1种病毒检测阳性的有2061例,阳性率为83.24%。腺病毒和偏肺病毒阳性患儿出现发热、呼吸急促和呼吸困难的比例高于其他病毒感染;各种病毒阳性病例中,咳嗽、咳痰、流涕等呼吸道症状出现的频率相当。住院肺炎患儿中出现并发症以呼吸衰竭为主,占比为21.16%,其次是心力衰竭,占比为14.82%,脓毒血症的发生率为8.72%,其他并发症发生率均较低。结论:2015-2017年我院1-7岁住院儿童肺炎和重症肺炎的发生率以1岁最高,且随着年龄的增长发病率呈下降趋势,冬季最多见,病毒病原体中以腺病毒和偏肺病毒感染导致的发热、呼吸急促和呼吸困难症状较多,并发症以呼吸衰竭为主。     

An evaluation of race and sex identification from cranial measurements

A total of 104 adult human crania (95 American Indian and 9 Labrador Eskimo) are used in this evaluation of a discriminant functional analysis for determining race and sex from eight cranial measurements. The methods used are those given by Giles and Elliot ('62). The study shows that non-deformed American Indian crania are racially misclassified as American White and Negro in 35.6% of the cases when using this metrical method. Deformed Indian crania are racially misclassified 60.0% and 4.4% of the time as White and Negro respectively. The determination of sex on male crania, regardless of deformation, is as accurate as, or better than, the visual method of identification. The female crania, however, are shown to be incorrectly sexed in nearly 50% of the cases, with one non-deformed group (Palus) running as high as 80.0%. This evaluation suggests, therefore, that discriminant functional analyses for race and / or sex determinations are not applicable to problems of human identification unless the crania are from that population on which these functions were established.     

Burden of Severe Pneumonia,Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3–3.9 million) episodes of severe pneumonia and 0.35 million (0.31–0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49–0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92–119 thousand) pneumococcal deaths occurred in India. The top contributors to India’s pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results highlight the need to improve access to care and increase coverage and equity of pneumonia preventing vaccines in states with high pneumonia burden.     

Skeletal growth of children from the Iron Age site at K2 (South Africa)

Cross-sectional growth data were obtained from the skeletal remains of children from the Iron Age site of K2 near the Limpopo River. Standard measurements of the diaphyseal lengths of the long bones from both limbs were recorded and compared to published skeletal data. For this purpose, data on Eskimo and Aleut skeletons, Libben skeletons, and skeletons from Indian Knoll and Altenerding were used. An attempt to study growth allometrically was made. K2 children were growing as well as children from these other groups. Comparison of data for K2 children with those on living South African “Cape Coloured” rural children, studied during the late 1980s, shows the similarity of growth of both groups. © 1996 Wiley-Liss, Inc.     

280例呼吸道感染儿童呼吸道病毒病原学检出情况及流行规律分析

目的:了解呼吸道感染儿童呼吸道病毒病原学检出情况及其流行规律,为儿童呼吸道感染的预防、诊断及治疗提供病原学依据。方法:选取2016年1月-2017年12月期间中国人民解放军中部战区总医院收治的280例呼吸道感染患儿为研究对象,分析患儿呼吸道分泌物中呼吸道病毒的检出情况,并分析呼吸道感染儿童呼吸道病毒感染与年龄、季节、疾病类型的关系。结果:280例呼吸道感染患儿中共检出98份阳性标本,阳性率为35.00%,其中有2份标本中检出2种病毒感染,混合感染阳性率为0.71%;在所有病毒类型中,呼吸道合胞病毒(RSV)病毒感染阳性率最高。1岁患儿的病毒感染阳性率最高,与其他年龄段病毒感染阳性率比较差异有统计学意义(P0.05)。呼吸道感染患儿春季、冬季的病毒感染阳性率明显高于夏季、秋季(P0.05)。不同呼吸道感染疾病类型患儿病毒感染阳性率比较差异有统计学意义(P0.05),以喘息性肺炎、毛细支气管炎、肺炎患儿病毒感染阳性率较高。结论:RSV是呼吸道感染儿童呼吸道病毒感染的主要致病病原体,1岁的婴幼儿较易感染,春季、冬季为其高发季节,且以肺炎、毛细支气管炎、喘息性肺炎患儿的病毒感染阳性率较高。     

Placental enzyme polymorphisms in Canadian populations.

Phenotype distributions and allele frequencies of adenylate kinase and esterase D were determined for four Canadian populations. In two population samples from south-western Ontario, allele frequencies at both loci were similar to those of European populations. In two northern, indigenous populations, the allele AK2 was not detected. There was variation at the EsD locus with EsD2 having a frequency of 0.176 in an Indian population, and 0.156 in an Eskimo population.     

Maxillary first premolar angular differences between North American Indians and non-North American Indians

A quantitative technique for obtaining angular data on human maxillary first premolar teeth is presented. Measurement indicates that North American Indian buccal cusps are either buccolingually compressed mesially, or expanded distally, or both, when compared with non-Indian teeth. Surprisingly, data on Chinese and Eskimo samples are similar to non-Indian teeth rather than Indian teeth. Similar techniques may be applied to the more complex multicusped molar teeth in order to extract quantitative data from them.     

Frontal sinus size in Eskimo populations

The frontal sinuses of 143 Eskimo skulls from two sites in the Hudson Bay region of Canada were examined radiographically. No between-site or sex differences were noted in the size of the sinuses. On average, the sinuses are small and often bilaterally absent. The Canadian samples have smaller sinuses than reported for Alaskan Eskimos or American Indian groups.     

The diagnostic accuracy of high-mobility group box 1 protein and twelve other markers in discriminating bacterial, viral and co-infected bronchial pneumonia in Han children

Pneumonia in children is common and can lead to grave consequences if not addressed in a proper and timely manner. In the management of pneumonia, early identification of the causative infective agent is of obvious importance for treatment, as it allows selection of the appropriate antibiotics. However, such identification requires laboratory test results, which may not be immediately available. The aim of this study was to evaluate the accuracy and usefulness of 13 markers in differentiating between viral and bacterial pneumonia in Han children (34 healthy controls and 78 patients). It was found that WBC counts were more accurate in diagnosis of the type of agent responsible for infection than was the degree of expression of HMGB1. Among the 13 markers investigated, HMGB1 was the best at discriminating between co-infected (bacterium and virus) and single-infected (bacterium or virus) children with bronchial pneumonia. HMGB1 expression of less than 1.0256, excluded most co-infections (the negative predictive value was greater than 89.7%). Diagnosed sole viral pneumonia clinically overlapped with bacterial pneumonia, but bacterial pneumonia was more often associated with higher white blood cell (WBC) counts (WBC ≥ 13,000 cells/mm(3)). When the two marker readouts--HMGB1 < 1.0256 and WBC ≥ 13,000 cells/mm(3)--were combined, the positive predictive value for bacterial pneumonia alone was 92.3%. These findings can help clinicians discriminate between bronchial pneumonia caused by virus, bacterium or both with a high specificity.     

Etiology of pneumonia in children in the absence of pneumococcal and antihaemophilus vaccines

Childhood pneumonia represents an important pathology, a cause of morbidity and mortality worldwide. Our study aims to determine etiology of pneumonia in hospitalized children using several laboratory methods. We performed a prospective study that enrolled 560 children age 1 up to 18 years old all diagnosed with pneumonia by clinical and radiological features. We applied various laboratory methods (serologic, bacteriologic: bronchial aspirate, sputum, pleural effusion and blood culture) in order to identify a pathogen agent that caused pneumonia. Statistics used Statistical Package for Social Science. An etiology was established in 68.92% of all cases included in the study, as follows: in 33.93% viral etiology, in 25.13% we identified Streptococcus pneumoniae, in 20.2% Mycoplasma pneumoniae, Klebsiella pneumoniae in 8.29%, Staphylococcus aureus in 7.51%, Haemophilus influenzae in 4.92%. Mixed bacterial and viral infection was identified in 4.40% of all cases. A potential causative agent of childhood pneumonia was determined in most cases, S. pneumoniae being the main agent involved in community acquired childhood pneumonia in our country.     

Digital dermatoglyphic patterns of Eskimo and Amerindian populations: relationships between geographic, dermatoglyphic, genetic, and linguistic distances.

Dermatoglyphic traits have been used to assess population affinities and structure. Here, we describe the digital patterns of four Eskimo populations from Alaska: two Yupik-speaking villages from St. Lawrence Island and two Inupik groups presently residing on mainland Alaska. For a broader evolutionary perspective, these four Eskimo populations are compared to other Inuit groups, to North American Indian populations, and to Siberian aggregates. The genetic structures of 18 New and Old World populations were explored using R-matrix plots and Wright's FST values. The relationships between dermatoglyphic, blood genetic, geographic, and linguistic distances were assessed by comparing matrices through Mantel correlations and through partial and multiple correlations. Statistically significant relationships between dermatoglyphics and genetics, genetics and geography, and geography and language were revealed. In addition, significant correlations between dermatoglyphics and geography, with linguistic variation constant, were noted for females but not for males. These results attest to the usefulness of dermatoglyphics in resolving various evolutionary questions concerning normal human variation.     

病毒性心肌炎与支原体肺炎患儿心肌损伤标志物水平的检验意义

目的:探讨病毒性心肌炎与支原体肺炎患者心肌损伤标志物水平检测意义。方法:回顾性分析医院收治的病毒性心肌炎患儿53例和肺炎支原体肺炎患儿49例分别作为病毒性心肌炎组和支原体肺炎组,选取同期体检正常儿童50例作为对照组,分别检测心肌酶指标和心肌蛋白指标。结果:病毒性心肌炎组心肌肌钙蛋白I(c Tnl)、肌红蛋白(MYO)显著高于支原体肺炎组、对照组,差异显著(P0.05);支原体肺炎组和对照组组间差异显著,具有统计学意义(P0.05)。病毒性心肌炎组肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)均显著高于支原体肺炎组、对照组,差异显著(P0.05);支原体肺炎组、对照组组间对比差异显著,具有统计学意义(P0.05)。2组入院10 d c Tnl、MYO均低于入院第1 d,具有统计学意义(P0.05);病毒性心肌炎组入院第10 d c Tnl、MYO显著高于支原体肺炎组,具有统计学意义(P0.05)。2组入院10 d CK、CK-MB、AST、LDH均低于入院第1 d,具有统计学意义(P0.05);病毒性心肌炎组入院第10 d CK、CK-MB、AST显著高于支原体肺炎组,差异具有统计学意义(P0.05)。根据ROC曲线分析临床性能,c Tnl、MYO、CK、CK-MB、AST、LDH的临界值分别为0.38μg/L、56.2μg/L、236.58 U/L、32.8 U/L、71.6 U/L、232.8 U/L,灵敏度分别为82.7%、85.4%、84.8%、89.6%、90.2、79.8%。结论:心肌损伤标志物可作为诊断病毒性心肌炎和支原体肺炎的重要指标,应用ROC回归曲线确定各指标的临界值,还可对两种疾病进行鉴别诊断。     

Procalcitonin and C-reactive protein for invasive bacterial pneumonia diagnosis among children in Mozambique, a malaria-endemic area

Background

Pneumonia is the major cause of mortality and morbidity in children worldwide. Procalcitonin (PCT) and C-reactive protein (CRP) are used in developed countries to differentiate between viral and bacterial causes of pneumonia. Validity of these markers needs to be further explored in Africa.

Methodology and Principal Findings

We assessed the utility of PCT and CRP to differentiate viral from invasive bacterial pneumonia in children <5 years hospitalized with clinical severe pneumonia (CSP) in rural Mozambique, a malaria-endemic area with high HIV prevalence. Prognostic capacity of these markers was also evaluated. Out of 835 children with CSP, 87 fulfilled definition of viral pneumonia and 89 of invasive bacterial pneumonia. In absence of malaria parasites, levels of PCT and CRP were lower in the viral group when compared to the invasive bacterial one (PCT: median = 0.21 versus 8.31 ng/ml, p<0.001; CRP: 18.3 vs. 185.35 mg/l, p<0.001). However, in presence of malaria parasites distribution between clinical groups overlapped (PCT: median = 23.1 vs. 21.75 ng/ml, p = 0.825; CRP: median = 96.8 vs. 217.4 mg/l, p = 0.052). None of the two markers could predict mortality.

Conclusions

Presence of malaria parasites should be taken into consideration, either for clinical or epidemiological purposes, if using PCT or CRP to differentiate viral from invasive bacterial pneumonia in malaria-endemic areas.     

ChemR23 dampens lung inflammation and enhances anti-viral immunity in a mouse model of acute viral pneumonia

Viral diseases of the respiratory tract, which include influenza pandemic, children acute bronchiolitis, and viral pneumonia of the elderly, represent major health problems. Plasmacytoid dendritic cells play an important role in anti-viral immunity, and these cells were recently shown to express ChemR23, the receptor for the chemoattractant protein chemerin, which is expressed by epithelial cells in the lung. Our aim was to determine the role played by the chemerin/ChemR23 system in the physiopathology of viral pneumonia, using the pneumonia virus of mice (PVM) as a model. Wild-type and ChemR23 knock-out mice were infected by PVM and followed for functional and inflammatory parameters. ChemR23(-/-) mice displayed higher mortality/morbidity, alteration of lung function, delayed viral clearance and increased neutrophilic infiltration. We demonstrated in these mice a lower recruitment of plasmacytoid dendritic cells and a reduction in type I interferon production. The role of plasmacytoid dendritic cells was further addressed by performing depletion and adoptive transfer experiments as well as by the generation of chimeric mice, demonstrating two opposite effects of the chemerin/ChemR23 system. First, the ChemR23-dependent recruitment of plasmacytoid dendritic cells contributes to adaptive immune responses and viral clearance, but also enhances the inflammatory response. Second, increased morbidity/mortality in ChemR23(-/-) mice is not due to defective plasmacytoid dendritic cells recruitment, but rather to the loss of an anti-inflammatory pathway involving ChemR23 expressed by non-leukocytic cells. The chemerin/ChemR23 system plays important roles in the physiopathology of viral pneumonia, and might therefore be considered as a therapeutic target for anti-viral and anti-inflammatory therapies.     

Distribution of albumin variants Naskapi amd Mexico among Aleuts, Frobisher Bay Eskimos, and Micmac, Naskapi, Mohawk, Omaha, and Apache Indians

In order to help define the boundaries of the distribution of the albumin variants Naskapi and Mexico which are polymorphic among several American Indian groups, we examined sera from Micmac, Mohawk, Northwest River Naskapi, Omaha and Apache Indians, and from Aleuts and Eskimos. Sera from a total of 1,524 individuals were examined. Using a cellulose acetate membrane electrophoretic system with Tris-Citric acid at pH 5.4 we were able to distinguish normal albumin and both variants in the same run. Naskapi and Mexico variants were absent from Aleut, Eskimo, Micmac, Mohawk and Omaha samples. The albumin Naskapi variant was present in an allele frequency of 0.03 in the Naskapi Indian sample. Albumin variants Naskapi and Mexico were found in the Apache sample at frequencies of 0.016 and 0.037, respectively. This report supersedes that previously published by Schell and Agarwal ('76). Generally, within an area there is a correspondence between changes in the frequency of albumin variants and changes in the ethnic background and history of the area's populations. At the same time, when viewing widely separated areas, relationships between distant groups based on linguistic and cultural similarities are paralleled on a biologic level by the distribution of normal albumin and variant albumins.     

Changes among wild House mice (Mus musculus) bred for ten generations in a cold environment, and their evolutionary implications

Wild House mice, Mus musculus , bred at 23°C (controls) changed little in reproductive performance over ten generations. Similar mice bred at 3°C (Eskimo) became more fertile and heavier. Eskimo body fat also rose. Control adrenal weights declined; Eskimo adrenal weights were heavier than those of controls, but only during the first four generations. The Eskimo phenotype after ten generations was a combined result of a direct response to cold, parental effects and genetical changes in the Eskimo population. Maternal effects were probably especially important. In such conditions, the minimum unit of selection that it is useful to consider is the female and her litter.     

Viral and atypical bacterial detection in acute respiratory infection in children under five years

Background

Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil.

Methods

Clinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA.

Findings

407 children with a median age of eight months were recruited. Pathogens were detected in 85·5% samples with co-infection being particularly common (39·5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia.

Interpretation

This study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively.     

Pathogens in children with severe combined immune deficiency disease or AIDS.

We evaluated the frequency and severity of illnesses caused by various microbial pathogens in 15 children with severe combined immune deficiency disease (SCID) and 8 with acquired immune deficiency syndrome (AIDS). There were 35 viral, 23 bacterial, 19 mycotic and 13 parasitic infections. Nineteen of the 23 patients died of infection; Pneumocystis carinii pneumonia, giant-cell pneumonia due to paramyxoviruses and various disseminated viral infections were responsible for most deaths in both groups. The emerging role of paramyxoviruses was illustrated by the fact that they were responsible for giant-cell pneumonia in seven patients. Viral enteric infections were frequent in both groups. The variety of infectious microorganisms and the severity of resulting illnesses in the patients with AIDS were similar to those in the patients with SCID.