Clinical and molecular characteristics of Streptococcus pneumoniae-associated hemophagocytic lymphohistiocytosis in children / 中华儿科杂志

Objective: To summarize the clinical features of Streptococcus pneumoniae-associated hemophagocytic syndrome (SP-HLH), and the serotypes and drug-resistant characteristics of the isolated strains. Methods: There were 15 children with SP-HLH admitted to the Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital, Capital Medical University from January 2013 to December 2020 were included in this study. Clinical data including children's general characteristics, clinical features, laboratory examinations, treatments, prognosis and the outcomes of follow-up by May 2021 were analyzed retrospectively. The serotypes and drug resistance of the isolated strains were identified. All children were divided into the clinical improvement group and the death group. Mann-Whitney U test, Fisher's exact test were used to compare the data of the two groups. Results: Among the 15 children with SP-HLH, 8 were males and 7 were females. The age of these children was 1.0 (1.0, 2.5) years. Regarding the primary infection, there were 9 cases of severe pneumonia, 3 cases of meningitis and 3 cases of blood stream infection. None of these children had received pneumoniae conjugate vaccine (PCV) and all of them were admitted to the PICU. Respiratory failure was observed in 10 patients, acute renal injury in 5, and hemolytic uremic syndrome in 3 patients. All children received glucocorticoids and high-dose intravenous immunogloblin (IVIG) in addition to anti-infective treatment. Eight of the children were cured while the other 7 died. The neutrophil count in the death group was lower than that in the clinical improvement group ((5.0 (1.7, 9.3) × 109 vs. 5.2 (3.4, 10.5) ×109/L, Z =-2.43, P<0.015), and the length of hospital stay and days of PICU stay in the death group were both shorter than those in the improvement group statistically (3 (1, 11) vs. 39 (34, 48) d, 2 (1, 4) vs. 19 (12, 31) d, Z=-3.25, -3.24, both P=0.001). Ten serotypes of Streptococcus pneumoniae were identified, including 4 strains of 19F, 3 of 19A, 1 of 23F, 1 of 15A and 1 of 14, among which 9 strains (9/10) were covered by PCV13. All strains were resistant to erythromycin yet sensitive to vancomycin and linezolid. Conclusions: SP-HLH is more common in children under the age of 3, with a high mortality rate. The death cases have lower neutrophil count and rapid disease progression. The comprehensive treatment is anti-infective combined with glucocorticoids and high-dose IVIG. The predominant serotypes are 19F and 19A and all isolated strains were susceptible to vancomycin and linezolid.

Therapeutic Observation of Herb-partitioned Moxibustion at Umbilicus for Chronic Prostatitis Due to Kidney-qi Insufficiency / 上海针灸杂志

Objective To observe the clinical efficacy of herb-partitioned moxibustion (HPM) at umbilicus in treating chronic prostatitis due to kidney-qi insufficiency. Method Sixty patients with chronic prostatitis due to kidney-qi insufficiency were randomized into a treatment group and a control group, 30 cases each. The treatment group was intervened by HPM, and the control group was treated with oral medication. The two groups were evaluated by using the National Health Institute-Chronic Prostatitis Symptom Index (NIH-CPSI) and the count of white blood cell of expressed prostatic secretion (EPS-WBC) before and after the intervention, and the clinical efficacies of the two groups were compared. Result The total effective rate was 90.0％ in the treatment group versus 75.9％ in the control group, and the between-group difference was statistically significant (P<0.05). The NIH-CPSI component scores were significantly changed in both groups after the treatment (P<0.01). There were no significant differences in the component scores of NIH-CPSI between the two groups after the treatment (P>0.05). The EPS-WBC count changed significantly in both groups after the treatment (P<0.01). After the intervention, the EPS-WBC count in the treatment group was significantly different from that in the control group (P<0.05). Conclusion HPM at umbilicus is an effective method in treating chronic prostatitis due to kidney-qi insufficiency.