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Objective To investigate the clinical characteristics of tuberculous pleurisy(TP) in children in order to provide a good solution to the diagnosis and treatment of this disease.Methods Retrospective analysis was performed on the clinical data of 113 cases confirmed with TP who were admitted to Children's Hospital of Chongqing Medical University from January 2009 to December 2014.Results Among the 113 pediatric inpatients with TP,85 cases (75.2％) were sick for less than 1 month;92.9％ (105/113 cases) age ≥≥5 years old by onset;and 21.2％ (24/113 cases) patients demonstrated the contact with tuberculosis ,among whom 70.8％ (17/24 cases) attributed to linear relatives.The primary clinical manifestations included fever[96.5％ (109/113 cases)], cough [76.1％ (86/113 cases)] and chest pain[38.9％ (44/113 cases)] ,with as high as 89.0％ (87/109 cases) of the patients experiencing moderate or ardent fever.The positive rates of acid-fast bacilli smear and mycobacterium tuberculosis culture were 12.2％ (17/139 cases) and 22.7％ (15/66 cases), respectively;among the 41 patients who received pleural biopsy,40 cases (97.6％) were identified with the typical pathological changes in tuberculosis;and all 11 patients who received acid fast stain test on pleural tissues were positive to the test.Pulmonary parenchymatous lesions were revealed on CT examination in 89.1％ patients(98/113 cases),82.4％ (90/109 cases) of the patients had normal body temperature within a short period,and reduced effusion was revealed in 86 out of 98 patients who received repeated chest imaging examinations.Conclusions TP in children has acute onset typically, and the diagnosis of TP in children is more difficult than in adults,requiring considering multiple factors.Contact history with tubercular patients, etiological examination, pleural biopsy and chest CT are essential for the diagnosis of this disease.
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Objective To evaluate the clinical value of multi-locus polymerase chain reaction (PCR) for identifying Mycobacterium tuberculosis complex isolated in children. Methods The isolates were collected and were first determined by PNB/TCH medium. 7-point PCR sites including 16SrRNA, Rv0577, IS1561, Rv1510, Rv1970, Rv3877/8 and Rv3120, and 4-point PCR sites including ropB, RD1, RD8 (present), RD8 (deleted) were used to amplify them by PCR. Results Total of 204 isolates were collected, in which 199 were Mycobacterium tuberculosis, 3 were Mycobacterium bovis, and 2 were non-tuberculous mycobacteria by the PNB/TCH method. 4-point PCR analysis showed that 196 were Mycobacterium tuberculosis, 2 were Mycobacterium bovis, 3 were BCG species and 3 were non-tuberculous mycobacteria. 7-point PCR analysis showed that 191 were Mycobacterium tuberculosis, 2 were Mycobacterium bovis, 3 were BCG species, 4 were African Mycobacterium type I, 1 was Mycobacterium caprae, 1 was Mycobacterium microti and 2 were non-tuberculous mycobacteria. Conclusion Compared with the conventional method, the PCR identification in 4-point PCR method and 7-point PCR method could rapidly identify the BCG among the complex group in children tuberculosis. 7-point PCR method was able to identify all the subspecies of Mycobacterium, except Africa Mycobacterium. 4-point PCR method would be more rapid and easier in the identification of BCG strains.
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Objective To assess the effect of Marzulene as an adjuvant therapy for peptic ulcer disease in children and the safety of Marzulene.Methods From Dec.2011 to Feb.2013,138 cases of peptic ulcer disease in children from Chongqing,Guiyang,Guangzhou,Chengdu and Xinjiang were randomly divided into trial group (n =75) and control group (n =63).The treatment protocls of the trial group was Marzulene combined with Omeprazole,and the control group gave Omeprazole only,all the cases with Helicobacter pylori (Hp) infection were treated by antibiotics,then clinical manifestations,gastroscopy and laboratory examinations were followed up after 8 weeks.Results The remission rates of clinical manifestations in the trial group were abdominal pain 91.8％ (56/61 cases),vomiting 90.2％(37/41 cases),melena 92.9％ (26/28 cases),nausea 93.1％ (27/29 cases),hematemesis 89.5％ (17/19 cases),abdominal discomfort 100.0％ (19/19 cases),abdominal distension 100.0％ (11/11 cases),sour regurgitation 100.0％ (9/9 cases),ozostomia 90.0％ (9/10 cases),eructaion 88.9 ％ (8/9 cases),bloody stools 100.0％ (4/4 cases),poor appetite 50.0％ (1/2 case),and abdominal tenderness 89.3 ％ (50/56 cases) ;the remission rates of clinical manifestations in the control group were abdominal pain 90.4％ (47/52 cases),vomiting 89.7％ (26/29 cases),melena 96.4％(27/28 cases),nausea 87.5 ％ (21/24 cases),hematemesis 92.9 ％ (13/14 cases),abdominal discomfort 58.3 ％ (7/12 cases),abdominal distension 85.7％ (12/14 cases),sour regurgitation 100.0％ (13/13 cases),ozostomia 80.0％(8/10 cases),eructaion 100.0％ (8/8 cases),bloody stools 100.0％ (4/4 cases),poor appetite 33.3％ (1/3 case),and abdominal tenderness 90.0％ (45/50 cases).Abdominal discomfort,abdominal distension,ozostomia,eructaion and poor appetite had significant statistical disparity between control group and trial group (P ＜ 0.05).One hundred and thirty-one cases reviewed gastroscopy,in the control group their ulcer clearance rate was 65.1％ (41/63 cases) ;the remission rates of gastroscopic manifestations were edema 54.8％ (34/62 cases),hyperemia 51.7％ (31/60 cases),areola 76.0％ (19/25 cases),atrophy 0％ (0/1 case),and hemorrhage 85.7％ (12/14 cases),the Hp clearance rate in the control group was 67.9％ (19/28 cases).In the trial group the ulcer clearance rate was 66.2％ (45/68 cases),and the remission rates of gastroscopic manifestation were edema 63.0％ (46/73 cases),hyperemia 64.7 ％ (44/68 cases),areola 86.1％ (31/36 cases),atrophy 50.0％ (1/2 case),and hemorrhage 100.0％ (19/19 cases) ;the Hp clearance rate in the trial group was 72.7％ (24/33 cases),and the remission rates of atrophy and hemorrhage had significant disparity between the control group and the trial group.The clinical effective rates of the trial and the control groups were 98.7％ (74/75 cases) and 98.4％ (62/63 cases),and the gastoscopic detection rates were 98.5％ (67/68 cases) and 96.8％ (61/63 cases).There was no adverse reaction in the trial group due to using marzulene for 8 weeks and 4 weeks' follow-up after its withdrawal.Conclusions Marzulene is helpful for improving the clinical and gastroscopic manifestations of peptic ulcer disease in children,and is effective and safe as an adjuvant therapy in children.
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Objectives To summarize the clinical features and relevant factors of 203 cases with infantile pulmonary tuberculosis. Methods Clinical data of 203 infantile with pulmonary tuberculosis were retrospectively reviewed. Results Among 203 infants, 127 (62.6%) were from country, 76 (37.4%) from city;64.5%of city infants have received BCG vaccination, which is higher than 46.5%in country infants;78 cases (38.4%) have clear evidence for active tuberculosis exposure, 26 cases (12.8%) have suspicious tuberculosis exposure;175 cases (86.2%) have fever, 165 cases (81.3%) have respiratory symptoms, 107 cases (52.7%) have pulmonary signs, 80 cases (39.4%) have hepatosplenomegaly;Etiology was conifrmed in 91 cases (44.8%);54.7%of patients were found with concurrent extrapulmonary tuberculosis, and the most commonly seen was formis tuberculous meningitis. In this study, the misdiagnosis rate is 39.9%, and 84.0%patients were often misdiagnosed as bronchial pneumonia;Vaccinated BCG rate is lower in infants with severe tuberculosis (44.83%) than that of infants with mild tuberculosis (74.14%). Conclusions Infantile pulmonary tuberculosis is featured with acute onset, severe clinical performance and easily complicated with extrapulmonary tuberculosis, atypical clinical performance, and high misdiagnosed rate which needs early detection and diagnosis. Unvaccinated BCG and active tuberculosis exposure were important clues for the diagnosis of infantile pulmonary tuberculosis.
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Childhood tuberculosis remains a serious public health threat which draws more and more attention.The unspecific symptoms or signs and the paucibacillary nature of childhood tuberculosis make it hard to diagnose which delays appropriate treatment and increases disease burden and mortality.Molecular methods such as polymerase chain reaction (PCR),real-time PCR,and DNA line probe based on mycobacterium tuberculosis specific nucleotide sequence will make a quick and reliable diagnosis of childhood tuberculosis.
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Objective To analyze the molecular characterization of PrM/C and E genome of Japanese encephalitis virus(JEV) strain,CQ11-66,a newly strain isolated from patients with epidemic encephalitis B Chongqing Municipal.Methods The samples were collected from Children's Hospital of Chongqing Medical University,and inoculating BHK-21 cells were used to detect and isolate the Japanese encephalitis virus(JEV) strain,computer analysis of the phylogenetic,nucleic acid data and deduced amino acid sequence was accomplished using the Clustal X(1.8) and MEGA5 programs.Results Only one JEV strain was isolated from patient's cerebrospinal fluid specimen,named CQ11-66.Comparison of the PrM/C genome sequence of strain CQ11-66 with other 31 JEV isolates showed a 74.8％-97.4％ nucleotide sequence homology among them,which resulted in 85.6％-98.7％ amino acid sequence homology; Meanwhile,comparison of the E genome sequence of strain CQ11-66 with other 35 JEV isolates showed a 81.6％-99.6％ nucleotide sequence homology among them,which resulted in 94.8％-99.6％ amino acid sequence homology.There were high homology between CQ11-66 and JEV isolates from Fujian province on nucleotide sequence and amino acid sequence.Phylogenetic analysis of PrM/C and E genome showed that the CQ11-66 belonged to genotype Ⅲ.Conclusion Only one JEV strain was isolated from patient's cerebrospinal fluid specimen.There were some differences between CQ11-66 strain and other JEV isolates,and CQ11-66 strain belonged to genotype Ⅲ.
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ObjectiveTo study the main bacterial species,distribution and drug sensitivity of nosocomial bacterial infections after living donor liver transplantation (LDLT) in children.Methods The clinical data of the incidence,pathogen distribution and antibiotic-sensitivity of early postoperative bacterial infection occurring in 41 cases of LDLT were retrospectively analyzed.ResultsThe bacterial infections rate after LDLT was 80.5％,and 71.3％ of bacterial infections occurred in the first two weeks after LDLT. The most common sites of bacterial infection were lower respiratory tract,abdomen andbiliarytract, andPseudomonasAeruginosa, Staphylococcusepidermidis, and Escherichia coli were the most common bacterial pathogens. 101 microorganisms were found and gram-negative bacteria (73.3％) predominated over gram-positive bacteria (26.7％).The detectable rate of ESBLs in gram-negative bacteria was 81.1％.Moreover,the detectable rate of MRCNS in gram-positive bacteria was 59.3％,and 11.1％ of gram-positive bacteria were HLAR Enterococcus.Most gram-negative bacteria had high drug-resistance rate of β-lactam inhibitors and cephalosporins (more than 60％),but were sensitive to imipenem and meropenem (less than 10％). ESBLs and AmpC-lactam,mediated by Chromosomal and plasmid,could not damage the structure of imipenem and meropenem.Pseudomonas aeruginosa was highly resistant to imipenem,meropenem,and most antibiotics used for pediatrics. Coagulase-negative staphylococcus was sensitive to vancomycin,linezolid,quinupristin/dalfopristin.ConclusionThe bacterial infection rate was high after LDLT in children.Most of the pathogens were antibiotics multi-resistant.Effective prevention of infection,early diagnosis and appropriate use of antibiotics are the key to control the infection.
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In recent years the incidence rate of tuberculosis (TB) has gone up.It was estimated that 1/3of people had asymptomatic latent tuberculosis infection globally.The current widespread use of Bacillus calmetteguerin (BCG) vaccine program against tuberculosis in children has a good preventive effect,but due to the limited duration of the immune responses induced by BCG,there also had situation of prevent failure,so researchers begin to explore new TB vaccines,such as live attenuated mutant strains,subunit vaccines and DNA vaccines,and achieved certain results.For the pure protein derivative tuberculosis skin test positive and immunosuppressed children,in addition to active immunization would also need anti-TB medicine for chemoprophylaxis.
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Objective To study the extraintestinal lesions induced by rotavirus(RV)infection and explore the pathogenesis.Methods Simian rotavirus SA11 was cultured in MA-104 cells.After inoculation,the pathological changes in brain,lung,heart,liver,pancreas and kidney tissues were observed,the RV antigens detected,and the apoptotic cells observed.Besides,we stained the filamentous actin(F-actin)with Phalloidine-TRITC,and then quantified the F-actin amount.Results Several pathological changes,inclusive of myocardial interstitial edema,granular degeneration in cardiacytes,hepatic congestion,and hepatocellular vacuolar degeneration,were found,but not found in the brain,lung,and pancreas tissues.Meanwhile,several ultrastructural changes,inclusive of dissolved myocardial F-actin,extended smooth endoplasmic reticulum,swollen mitochondria,and widened perinuclear space,were found.No difference was found in the quantity of myocardial F-actin.Apoptosis was found in liver cells,but not in myocardial cells.RV RNA was detected in tissues such as brain,lung,heart,liver and pancreas tissues.Conclusion All the results suggest that RV may spread from the intestine to various extraintestinal organs and hence induce injury.Filamentous actin depolymerization,cytoskeleton damage and apoptosis induced by RV infection are the important mechanism not only in intestinal damages,but also in extraintestinal lesions.