Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children.

BACKGROUND: Mycoplasma pneumoniae (M. pneumoniae) is a significant contributor to community-acquired pneumonia among children. Since 1968, when a strain of M. pneumoniae resistant to macrolide antibiotics was initially reported in Japan, macrolide-resistant M. pneumoniae (MRMP) has been documented in many countries worldwide, with varying incidence rates. MRMP infections lead to a poor response to macrolide antibiotics, frequently resulting in prolonged fever, extended antibiotic treatment, increased hospitalization, intensive care unit admissions, and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics. Since 2000, the global incidence of MRMP has gradually increased, especially in East Asia, which has posed a serious challenge to the treatment of M. pneumoniae infections in children and attracted widespread attention from pediatricians. However, there is still no global consensus on the diagnosis and treatment of MRMP in children. METHODS: We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for "macrolide-resistant", "Mycoplasma pneumoniae", "MP", "M. pneumoniae", "pneumonia", "MRMP", "lower respiratory tract infection", "Mycoplasma pneumoniae infection", "children", and "pediatric". RESULTS: Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics. CONCLUSIONS: This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.

Association of pyrethroids exposure with asthma in US children and adolescents: a nationally representative cross-sectional study.

Pyrethroids (PYR) are among the most widely used insecticides in households, leading to substantial exposure. Children and adolescents, especially during growth spurts, have a reduced capacity to effectively metabolize these insecticides. The relationship between PYR exposure and asthma in these age groups remains poorly understood, highlighting the need for further research.We used data from the 2007-2014 National Health and Nutrition Examination Survey, which included 1181 children aged 6-11 years and 1258 adolescents aged 12-19 years. The concentration of the PYR metabolite 3-phenoxybenzoic acid (3-PBA) in urine was quantified using solid-phase extraction-high-performance liquid chromatography-heated electrospray ionization tandem mass spectrometry. Asthma was defined based on self-reported doctor diagnoses from the questionnaire. PYR exposure was measured using urine samples collected simultaneously with the questionnaire. We explored the association between PYR exposure and asthma using multiple logistic regression analyses, adjusting for potential confounders.Multiple logistic regression analyses revealed no significant association between PYR exposure and asthma in children and adolescent boys (all P > 0.05). In contrast, PYR exposure was significantly associated with asthma in adolescent girls aged 12-19 years. Specifically, for "ever asthma," the odds ratios (ORs) were 2.49 (95% CI = 1.03-5.97) in the second quartile of PYR exposure and 2.48 (95% CI = 1.04-5.91) in the third quartile, each in comparison to the first quartile. For "current asthma," in comparison to the first quartile, the ORs were 3.99 (95% CI = 1.55-10.26) in the second quartile of PYR exposure, 3.39 (95% CI = 1.32-8.70) in the third quartile, and 2.93 (95% CI = 1.24-6.90) in the fourth quartile.Conclusions:Our study found a significant association between PYR exposure and asthma in adolescent girls, whereas no significant association was observed in children and adolescent boys. These findings suggest potential sex and age differences in susceptibility to PYR exposure. Further research is warranted to confirm these results and elucidate the underlying mechanisms.

Environmental exposure to per- and polyfluoroalkyl substances mixture and asthma in adolescents.

BACKGROUND: Previous epidemiological studies about the relationship between per- and polyfluoroalkyl substances (PFAS) concentrations and adolescent asthma have typically examined single PFAS, without considering the mixtures effects of PFAS. METHODS: Using data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES), 886 adolescents aged 12-19 years were included in this study. We explored the association between PFAS mixture concentrations and adolescent asthma using weighted quantile sum (WQS) regression and Bayesian kernel machine regression (BKMR) models, respectively. RESULTS: After adjusting for confounders, the results of the WQS regression and BKMR models were consistent, with mixed exposure to the five PFAS not significantly associated with asthma in all adolescents. The association remained nonsignificant in the subgroup analysis by sex. CONCLUSIONS: Our study demonstrated no significant association between mixed exposure to PFAS and adolescent asthma, and more large cohort studies are needed to confirm this in the future.

Serum perfluoroalkyl substances and growth and development in US adolescents: a nationally representative cross-sectional study.

Per- and polyfluoroalkyl substances (PFAS), synthetic organic chemicals, have been discovered in the blood of both humans and animals throughout the world. This has raised widespread concerns about its toxicity, especially for growing children and adolescents. Most research on growth and development to date has concentrated on children at birth and during the first two years, while few studies have analyzed weight, height, and Body Mass Index (BMI) changes in children later in life. The present study aims to assess the association between serum PFAS levels and growth and development in adolescents. Through multiple linear regression, we explored the relationship between serum PFAS levels and weight, height, and BMI in adolescents (aged 12 to 19 years) participating in the 2015-2018 National Health and Nutrition Examination Survey (NHANES). After covariate adjustment, serum perfluorooctane sulfonic acid (PFOS) was associated with decreased weight-for-age z-score in females (tertile 2 of PFOS: ß = - 0.22, 95% CI: -0.68, 0.23; tertile 3 of PFOS: ß = - 0.78, 95% CI: -1.20, - 0.36; P for trend = 0.009), while serum perfluorononanoic acid (PFNA) was associated with decreased weight-for-age z-score in males (tertile 2 of PFNA: ß = 0.09, 95% CI: -0.40, 0.58; tertile 3 of PFNA: ß = - 0.44, 95% CI: -0.86, - 0.03; P for trend = 0.018).In addition, serum PFOS was associated with decreased BMI z-score in all participants (tertile 2 of PFOS: ß = - 0.15, 95% CI: -0.46, 0.16; tertile 3 of PFOS: ß = - 0.63, 95% CI: -1.06, - 0.20; P for trend = 0.013). CONCLUSION: Our findings indicate a negative association between serum PFAS levels and weight, and BMI among adolescents, and we observed that the negative association was sex-specific in weight. WHAT IS KNOWN: • Wide exposure to PFAS has led to concerns about its adverse effects, especially for children during their growth and development. • So far, much research has evaluated the effects of prenatal PFAS exposures on children, and the current results are mixed, with some research showing that there are sex differences. WHAT IS NEW: • This study investigated the relationship between serum PFAS levels and height and weight in adolescents and is a good addition to current research. • Our study found that exposure to PFAS negatively affects adolescent growth and development and that this effect is sex-specific.

Association between PFAS congeners exposure and asthma among US children in a nationally representative sample.

Over the past few decades, contamination with perfluorinated and polyfluoroalkyl substances (PFAS) has gradually become a worldwide problem. Now that common PFAS such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) are being phased out and replaced, people may be exposed to other PFAS congeners, and their potential hazards should be fully studied. We assessed the association of serum PFAS levels (as biomarkers of exposure) with asthma, including 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (Me-PFOSA-AcOH), pefluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), using data from participants aged 3-11 from the 2013-2014 National Health and Nutrition Examination Surveys (n = 525), where PFAS was modeled as a binary variable.Me-PFOSA-AcOH (1.36; 95% CI 0.77, 2.38), PFDA (1.33; 95% CI 0.76, 2.33), and PFUnDA (1.89; 95% CI 0.83, 4.35) were nonsignificantly associated with increased odds of asthma. Age, sex, and race/ethnicity modified associations between serum PFUnDA, not other serum PFAS congeners exposure, and odds of asthma. Specifically, for male participants, the OR = 3.06 and 95% CI 1.23-7.62 for serum PFUnDA exposure; for participants aged 3-7 years old, the OR = 3.55 and 95% CI 1.04-12.10 for serum PFUnDA exposure; for non-Hispanic White participants, the OR = 3.44 and 95% CI 1.14-10.36 for serum PFUnDA exposure, all of which exhibited a significantly positive relationship. This cross-sectional study provides some evidence for associations between exposure to PFAS congeners and asthma in children. We believe this relationship deserves further exploration. More large-scale epidemiologic studies are needed to evaluate the association of serum PFAS congeners, especially for PFUnDA exposure, with asthma among children.

[Efficacy and safety of vitamin D as adjuvant therapy for childhood pneumonia: a Meta analysis].

OBJECTIVE: To study the efficacy and safety of vitamin D as an adjuvant therapy for childhood pneumonia through a systematic review. METHODS: Cochrane Library, PubMed, EMbase, CNKI, Wanfang Data, and Weipu Data were searched for randomized controlled trials (RCTs) of vitamin D as the adjuvant therapy for childhood pneumonia published up to August 2019. Literature screening, quality assessment, and data extraction were performed based on inclusion and exclusion criteria. Revman 5.3 was used to perform the Meta analysis of outcome indicators. RESULTS: A total of 7 RCTs with 1 527 children were included, with 762 children in the vitamin D adjuvant therapy group and 765 children in the control group. The results of the Meta analysis showed that vitamin D adjuvant therapy had no effect on recovery time (P=0.67), length of hospital stay (P=0.73), and time to relief of fever (P=0.43). Furthermore, it did not reduce the recurrence rate (P=0.14), rate of adverse events (P=0.20), and mortality rate (P=0.98) of childhood pneumonia. CONCLUSIONS: Current evidence shows that vitamin D adjuvant therapy has no marked efficacy in the treatment of childhood pneumonia.

Diagnosis and treatment of herpangina: Chinese expert consensus.

BACKGROUND: Herpangina is a common infectious disease in childhood caused by an enterovirus. This consensus is aiming to standardize and improve herpangina prevention and clinical diagnosis. METHODS: The Subspecialty Group of Infectious Diseases, the Society of Pediatric, Chinese Medical Association and Nation Medical Quality Control Center for Infectious Diseases gathered 20 experts to develop the consensus, who are specialized in diagnosis and treatment of herpangina. RESULTS: The main pathogenic serotypes of herpangina include Coxsackievirus-A, Enterovirus-A and Echovirus. Its diagnosis can be rendered on the basis of history of epidemiology, typical symptoms, characteristic pharyngeal damage and virological tests. The treatment is mainly symptomatic, and incorporates topical oral spray with antiviral drugs. The course of herpangina generally lasts 4-6 days with a good prognosis. CONCLUSION: The consensus could provide advices and references for the diagnosis, treatment and management of herpangina in children.

Risk factors for and expression of immune and inflammatory factors in atopic dermatitis in Chinese population: A birth cohort study.

OBJECTIVE: To explore the risk factors for atopic dermatitis (AD) and disclose the relationship between immune inflammatory factors (Immunoglobulin E (IgE), interleukin (IL)-4, IL-18) and the prevalence of AD in a Chinese population. METHODS: To evaluate the risk factors for infant AD, a total of 921 mother-newborn pairs were recruited through a questionnaire survey conducted during 2009-2011. Venous blood was collected from the mothers during birth hospitalization and umbilical cord blood was collected during delivery. Thirty-five infants with AD paired with their mothers served as the patient group. Thirty-five non-AD pairs were selected randomly and were used as the control group. Enzyme-linked immunosorbent assay (ELISA) was performed to detect the levels of IgE, IL-4, and IL-18. The relationship between the prevalence of AD and the levels of IgE, IL-4, and IL-18 was analyzed. The risk factors for allergy were assessed in IgE positive cases. RESULTS: Family income, parental history of atopy, age of menarche, performing housing renovation before pregnancy, instance of a virus infection during pregnancy, and calcium supplementation during pregnancy were potential factors determining the incidence rate of infant AD. Compared with the control group, the AD patient group showed higher levels of IgE and IL-4 in both the maternal serum and umbilical cord blood (P < 0.01). In the cases with AD, IL-8 was increased only in the maternal serum (P < 0.01). In addition, the allergens dust mite, mugwort pollen, and mycete spores were risk factors for the incidence of IgE-positive AD. CONCLUSION: IgE and IL-4 levels in the maternal serum and umbilical cord blood as well as IL-18 level in the maternal serum are related to the occurrence of childhood AD. Potential factors for infant AD include family income, parental history of atopy, age of menarche, housing renovation before pregnancy, virus infection, and calcium supplementation during pregnancy.