ABSTRACT
Objective:To explore the clinical characteristics and appropriate treatment of occult pneumococcal bacteremia (OPB) in children.Methods:The clinical characteristics, drug sensitivity and antibiotic use of 39 children with OPB who met the inclusion criteria in the Pediatric Internal Medicine Ward of Shenzhen Children′s Hospital from January 2013 to December 2018 were retrospectively analyzed.Results:The median age of onset in OPB in children was 2 years and 4 months, and 74.4% of children(29/39 cases) were between 6 months and 3 years.The average total fever duration was 3.69 days (1-14 days), and the average hospital stay was 6.74 days.Peripheral blood white blood cell count was >15×10 9/L in 89.7% (35/39 cases) of the children, C-reactive protein was increased in 76.9% (30/39 cases) of the children, and procalcitonin > 2 mg/L in 38.9% (14/36 cases) of the children.During hospita-lization, all the children received the treatment of intravenous antibiotics.The antibiotics used initially included Cefuroxime in 11 cases (28.2%), Amoxicillin sulbactam sodium in 10 cases (25.6%), Ceftriaxone sodium in 7 cases (17.9%) and Meloxicillin sulbactam in 6 cases (15.4%). The average fever clearance time after the antibiotic therapy was 1.4 days, and the average intravenous antibiotics treatment time was 6.2 days.The results indicated that the insensitivity rate of Penicillin was 46.2%, the insensitivity rate of Amoxicillin, Ceftriaxone and Cefotaxime were 22.2%, 10.3% and 17.9%, respectively, Erythromycin resistant rate was 100.0%, and no patient was resistant to Vancomycin and Linezolid. Conclusions:OPB occurs most frequently in infants aged from 6 months to 3 years old, with low drug resistance to Amoxicillin, Ceftriaxone and Cefotaxime.Children with complete immunity have shorter fever duration and good prognosis after antibiotic treatment.
ABSTRACT
Objective To understand the epidemiological characteristics, genomic variations and macrolide resistance of Bordetella pertussis ( B. pertussis) strains circulating in Shenzhen with clinical data analysis, genotype profiling, phylogenetic analysis and antimicrobial susceptibility test. Methods Clinical data of patients with pertussis in Shenzhen Children's Hospital were collected from the electronic medical re-cord system. Genome sequences of 31 B. pertussis isolates were analyzed with next-generation sequencing and de novo assembled. Multilocus sequence typing (MLST) was performed to identify their sequences types. Sequence alignment by BLASTn was used to identify virulence genotypes and mutations in 23S rRNA gene. A phylogenetic tree was constructed to analyze the relationships among them. E-test was used to identify ma-crolide resistance. Results All of the 31 B. pertussis strains were identified as sequence type-2 (ST-2) by MLST with diverse virulence genotypes. Two were prn-deficient strains. Based on the phylogenetic tree, all of the isolates were distant from vaccine strains. Nineteen isolates were resistant to erythromycin with A2047G mutation in 23S rRNA. Conclusions The virulence genotypes of B. pertussis strains in Shenzhen were diverse with increasing non-vaccine genotypes. Macrolide-resistant strains were prevalent. This study might provide reference for improving the prevention, management and vaccination strategy of pertussis.
ABSTRACT
Objective This study was to analysis the epidemiologic characteristics of hand-foot-month (HFMD) in Shenzhen during 2015-2016,to provide reference for the prevention and treatment of HFMD.Methods 7 758 statistical data from Shenzhen children's hospital clinical lab during 2015-2016 was included.We used real time fluorescent reverse transcription polymerase chain reaction (RT-PCR) to detect enterovirus general (EV),enterovirus 71 (EV71) and coxsackievirus A group 16 (CoxA16),and analyzed the age,sex and epidemic time of the patients.Results In 2015 and 2016,the positive rate of EV was 67.19％ (2679/3987) and 52.61％ (1 984/3 771) respectively,with statistically significant difference (x2 =71.84,P ＜ 0.05).The radio of male to female children was 1.91∶1 (1 757/922) and 1.83∶1 (l 283/701) in 2015 and 2016,with statistically significant difference (P ＜ 0.05).The age of the children was ＜ 5 years old,accounting for more than 90％ of the total number of patients.April to July and September were the two peaks of HFMD.The enterovirus of hand foot and mouth disease in Shenzhen was dominated by other enteroviruses (more than 82％ of the total number of patients).With the increase of age,the proportion of EV71 in children with severe hand and foot was increasing,and the proportion of other enteroviruses was decreasing.Conclusions Vaccination is one of the important measures of HFMD control.It's beneficial for the diagnosis and treatment of HFMD to collected epidemiologic characteristics data about HFMD in Shenzhen.
ABSTRACT
The prevalence of various types of mental illness has reached 17.5％, and the current treatment of mental illness generally includes western medicine, psychotherapy and physical therapy. Due to the high disability rate, low cure rate and easy recurrence, mental illness has become a major public health problem that seriously affects human health and social stability. And it has attracted the attention of the government and society. At present, the typical western medicine for treating mental illness has serious side effects, while new types of medicine for treating mental illness has a slow efficacy. Physical therapy has an unstable effect, and the side effects of drugs for treating mental illness lack effective method. These problems are expected to be successfully solved through traditional Chinese medicine, acupuncture and acupoint stimulation. This paper puts forward the integrated traditional Chinese and western medicine for the treatment of mental illness, and strives to build a technical system for the treatment of mental illness with integrated Chinese and Western medicine through the organic combination of multidisciplinary and multi-technology.Meanwhile, it lists some classic cases of treatment in order to provide reference for those who are keen on the integrated Chinese and western medicine in the treatment of mental disease.
ABSTRACT
Objective To establish the pipeline and evaluate the feasibility of high-throughput sequencing method used in the detection of severe pneumonia pathogens.Methods Clinical control study was used.Bronchi alveolar lavage fluids (BALF) samples from 76 patients with severe pneumonia (treatment group) and 18 patients with tracheal malacia (control group) and without clinical detected pathogens were collected during March 2015 to December 2016 in Shenzhen Children′s Hospital.The pathogens in the samples were detected using clinical tests and high-throughput sequencing respectively.The results of high-throughput sequencing were confirmed by real-time quantitative PCR and the high-throughput sequencing method used in the detection of severe pneumonia pathogens was evaluated.The χ2 test was used to analyze the correlation of detection rate between the high-throughput sequencing group and the non high-throughput sequencing group.Results The pipeline and method of high-throughput sequencing used in the severe pneumonia pathogens detection was established.The pipeline included sample collection, DNA extraction, library construction, sequencing, and bioinformatic analysis.In 76 cases of patients with severe pneumonia, the results of high-throughput sequencing in 66 cases of bronchoalveolar lavage fluid specimens were positive.The sensitivity was 86.84%, which was significantly higher than the total sensitivity of traditional clinical detection methods including bacterial culture, immunofluorescence and quantitative PCR(68.42%,52/76),χ2=7.426,P<0.001.A total of 13 pathogens were detected in 66 positive samples of high-throughput sequencing, including Mycoplasma pneumoniae, Streptococcus pneumoniae, Haemophilus influenzae and adenovirus, etc.Nine kinds of pathogens were detected in these samples through non-high-throughput sequencing.In the experimental group, the results obtained by clinical test and high-throughput (80.26%) were entirely consistent in 61 samples and not completely consistent in 15 samples (19.74%) specimens.These inconsistent results were mainly concentrated in the detection of adenovirus, Streptococcus pneumoniae and Haemophilus influenzae through high-throughput sequencing, whereas clinical cultures and immunofluorescence methods were not able to detect these pathogens.PCR validation showed that there was no significant difference between the results of high-throughput sequencing and the PCR tests (χ2=0.517,P=0.472), and the difference between the results of high-throughput sequencing and traditional clinical detection methods was statistically significant (χ2=11.671,P<0.001).Conclusion The method for the detection of severe pneumonia pathogens based on high-throughput sequencing is highly sensitive and can detect unknown pathogens, which is superior to those used in traditional clinical detection.