Min Shu

Safety profile and outcome of mild therapeutic hypothermia in patients following cardiac arrest: systematic review and meta-analysis

Evidence has shown that mild therapeutic hypothermia (MTH) could improve survival and neurological outcome in patients following cardiac arrest. But this therapy may cause some adverse effects. The authors sought to take a systematic approach to describe the safety aspects and outcome of MTH following cardiac arrest to help clinical practice. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, BIOSIS Previews and clinicaltrials.gov were searched up to June 2011. Bibliographies of relevant studies were also reviewed. Comparative studies reporting the mortality or any other studies reporting any kind of adverse events in patients undergoing MTH after cardiac arrest and published in English were included. Of 1742 abstracts, 63 studies were included. Most adverse events potentially associated with therapeutic hypothermia were not significantly different between the hypothermia therapy and the normothermia groups. No significant difference was found in the inhospital mortality, bleeding, pneumonia and bradycardia events between surface and endovascular-cooled groups in this study. Cooling device-related adverse events were generally mild. Serious adverse events potentially attributable to therapeutic hypothermia were seldom reported. MTH was associated with reduced inhospital mortality, mortality at 1 month and at 6 months. Evidence about the safety of MTH in children has been limited. These results suggest that while it may result in some adverse events, MTH is generally safe in patients following cardiac arrest and could improve the short-term and long-term survival of comatose patients after cardiac arrest. But awareness of these adverse events should be kept in mind in clinical practice.

Biogeography and Virulence of Staphylococcus aureus

Background Staphylococcus aureus is commonly carried asymptomatically in the human anterior nares and occasionally enters the bloodstream to cause invasive disease. Much of the global diversity of S. aureus remains uncharacterised, and is not clear how disease propensity varies between strains, and between host populations. Methodology We compared 147 isolates recovered from five kindergartens in Chengdu, China, with 51 isolates contemporaneously recovered from cases of pediatric infection from the main hospital serving this community. The samples were characterised by MLST, the presence/absence of PVL, and antibiotic resistance profiling. Principal Findings Genotype frequencies within individual kindergartens differ, but the sample recovered from cases of disease shows a general enrichment of certain MLST genotypes and PVL positive isolates. Genotypes under-represented in the disease sample tend to correspond to a single sequence cluster, and this cluster is more common in China than in other parts of the world. Conclusions/Significance Virulence propensity likely reflects a synergy between variation in the core genome (MLST) and accessory genome (PVL). By combining evidence form biogeography and virulence we demonstrate the existence of a “native” clade in West China which has lowered virulence, possibility due to acquired host immunity.

Paragonimiasis in Children in Southwest China: A retrospective case reports review from 2005 to 2016

Background: Paragonimiasis infection has no specific symptoms or typical radiologic findings, leading to the possibility of misdiagnosis. Thus, the objective of this study was to analyze clinical and radiological features, and treatment outcome of paragonimiasis in children in Southwest China to improve the awareness of this disease. Methods: We retrospectively reviewed the records of children diagnosed with paragonimiasis in West China Second University Hospital between 2005 and 2016. The confirmed diagnosis of paragonimiasis was based on epidemiology history and seropositivity for paragonimiasis and/or detection of paragonimus eggs. Clinical, laboratory, and imaging findings of patients were examined in order to summarize risk factors, clinical characteristics, and treatment outcomes of these patients. Results: A total of 123 patients were included; of them 112 (91.1%) lived in villages and 72 (58.5%) had a history of consuming freshwater crabs. Patients with paragonimiasis most frequently showed respiratory symptoms, including cough (26.0%, 32/123) and tachypnea (16.3%, 20/123), and gastrointestinal symptoms, including abdominal pain (26.8%, 33/123), abdominal distention (22.8%, 28/123), and vomiting (13.0%, 16/123). Laboratory examination showed elevated white blood cell (WBC) counts in the peripheral blood in 89 (72.4%) patients and eosinophilia in 102 (82.9%) patients. Tuberculosis (TB) coinfection was found in 4 (3.3%) patients. Main imaging findings included: effusions (90.4%), lymphadenopathy (40.4%), pulmonary ground-glass opacities (36.2%), cystic lesions (18.1%), and pleural thickening (17.0%). Twenty-nine patients (23.6%) received more than 1 course of praziquantel (PZQ). Additionally, 4 (19.0%) of 21 patients who were discharged from the hospital without complete treatment required rehospitalization for residual serous effusions. Moreover, patients from pericardial effusion group showed longer hospital stays and less elevated WBC counts than those from nonpericardial effusion group. Conclusion: Paragonimiasis should be considered in patients from endemic areas, especially in those with gastrointestinal and/or respiratory symptoms, elevated WBC count, eosinophilia, and serous effusions. Additionally, longer hospital stay may be necessary in cases of paragonimiasis associated with pericardial effusions.

Primary cavitating tuberculosis in a 2-month-old infant.

Cavitation in primary pulmonary tuberculosis is rare, particularly in infants. We report a case of a 2-month-old infant with primary cavitating tuberculosis. Computed tomography first showed consolidation of the left upper lobe, and results of a course of antimicrobial therapy demonstrated a cystic lesion. The cyst was demonstrated to be a tuberculous cavity by postoperative histopathologic examination.

Novel Gene Mutation in a Chinese Boy with Severe Congenital Neutropenia

To the Editor: Severe congenital neutropenia (SCN) is a heterogeneous group of bone marrow failure syndromes caused by different gene mutations [1]. We encountered a 2 y and 9mo-old boy presenting with 2 wk of fever. He had a past history of recurrent infection every 1–2 mo after 1 y of age, including recurrent upper respiratory infection, mycotic stomatitis, a perianal abscess, and pneumonia. His development was normal and without any congenital malformation suggestive of specific syndromes. His parents and elder sister were all healthy. The parents were not consanguineous. A physical examination revealed pale skin, cervical lymphadenopathy, weakened breathing sounds in the lef t lung and hepatosplenomegaly. A laboratory examination revealed severe neutropenia [Absolute neutrophil count (ANC) 0.2 × 10/L], mild anemia, increased humoral immunity and normal cellular immunity. Autoantibodies were all negative. A tuberculin skin test was positive. A CT scan revealed a consolidation shadow in the left lower lobe, hilar and mediastinal lymphadenopathy and left pleural effusion (Fig. 1a). Bone marrow aspiration showed maturation arrest at the promyelocyte/myelocyte stage and markedly decreased mature neutrophils. The anti-tubercular treatment was initiated since the administration of broad-spectrum antibiotic was ineffective. The patient’s temperature eventually recovered to a normal level after 25 d of anti-tubercular treatment and the pulmonary lesions returned to normal eventually (Fig. 1b). During treatment, the ANC was always less than 0.5 × 10/L. SCN was suspected and a genetic analysis was undertaken. The exons of ELANE, GFI1, HAX1, G6PC3, WAS, SBDS and their respected flanking regions were amplified by PCR and sequenced by first generation sequencing. A heterozygous mutation located in exon 3 of ELANE (c.290A >C) was found (Fig. 2), which has never been reported in NCBI (dbSNP). Several previous studies have reported series of mutations in ELANE caused by autosomal dominant or sporadic forms [2–5]. In this patient, we considered the novel variant as putative pathogenic mutation because the clinical characteristic was typical. Since the parents were both healthy, the mutation was more likely caused by sporadic form. However, a deletion of 40 bases in intron 3 ofGFI1 (c.298 + 28_68del40) was also found and we could not identify if it can interact with the previous mutation. Developing a functional test to identify the pathogenic mechanisms of novel gene mutation is the aim of our future work on this disease.

Clinical and Epidemiologic Features of Visceral Leishmaniasis in Children in Southwestern China: A Retrospective Analysis From 2001 to 2015.

Background: Visceral leishmaniasis (VL) is a life-threatening parasitic infection transmitted by phlebotomine sandflies. We undertook this study to analyze the clinical features of pediatric VL in a population of Chinese children. Methods: A retrospective study was performed with pediatric patients (⩽14 years) diagnosed with VL based on bone marrow biopsy, serology and diagnosis based on clinical manifestation and the improvement after the experimental drug when negative bone marrow and serology results were shown in West China Second Hospital, between January 2001 and December 2015. Results: A total of 43 patients were determined as having a VL infection (ranging from 4 months to 12 years with a slight male preponderance). Sixty-seven percent were less than 5 years of age and 74% of patients resided in endemic regions. The average time to diagnosis from the onset of symptoms was 37.5 days (ranging from 5 days to 6 months). The main clinical manifestations were fever (98%), splenomegaly (98%), hepatomegaly (74%), pancytopenia (72%), pallor (33%), cough (33%) and lymphadenopathy (33%). Hepatic dysfunction was also found in 24 patients (68%). All patients were treated with meglumine antimonite; only 1 child was treated with liposomal amphotericin B after resistance to meglumine antimonite was discovered. Patients were clinically cured except for 1 patient, who died from hemorrhagic shock because of refusal of standard treatment. Conclusions: Although there were no specific clinical manifestations of pediatric VL, a characterization of the overall symptoms may lead to an improved awareness of VL by clinicians and prompt early diagnosis and treatments. Presently, pentavalent antimony remains the first-line drug and there is low resistance in China.

Serious Adverse Reactions from Anti-Tuberculosis Drugs Among 599 Children Hospitalized for Tuberculosis.

Background: The purpose of the study was to summarize the clinical characteristics of serious adverse reactions (ARs) related to anti-tuberculosis (TB) drugs in children hospitalized for TB. A comprehensive understanding of these drug-related ARs may serve to improve patient prognosis. Methods: Inpatients diagnosed with TB from 2008 to 2013 were enrolled retrospectively. The patients’ demographics, diagnosis and ARs were recorded and analyzed for comprehensive evaluation. Results: Of the 599 enrolled patients, 3.51% (21 of 599) developed serious ARs related to anti-TB drugs. Hepatotoxicity was the most common reaction (1.84%, 11 of 599). The incidence of rash with or without fever was 1% (6 of 599), and that of auditory impairments and renal injury was 0.33% (2 of 599) and 0.17% (1 of 599), respectively. One patient experienced hepatotoxicity, rash and fever. Hospital stay of inpatients with serious ARs was significantly longer (median: 24 days; range: 8–62 days) than that of those without reactions (median: 11 days; range: 1–83 days), though no distinctions were observed between the 2 groups with regard to average age, gender or involved organs. Hepatotoxicity occurred 6–30 days after the start of anti-TB treatment (median: 6 days) and 75% of the inpatients remained asymptomatic. Hepatotoxicity was traced to the drugs isoniazid, rifampin and pyrazinamide, while fever was mainly linked to pyrazinamide. In addition, streptomycin and amikacin led to auditory impairments and renal injury, respectively. Serious ARs of all inpatients were controlled and managed successfully. Conclusions: The incidence of serious ARs from anti-TB drugs among children inpatients was 3.5% and mainly consisted of hepatotoxicity. Inpatients with serious ARs tended to have longer hospital stays.

Staphylococcus aureus nasal carriage and its antibiotic resistance profiles in children in high altitude areas of Southwestern China.

BACKGROUND/AIM To describe the epidemiological profile of nasal carriage of Staphylococcus aureus (S. aureus) strains, its antibiotic resistance and mecA and Panton Valentine leukocidin (PVL) genes presence, in school children residing in high altitude areas of Southwestern China. METHODS The cross sectional study screened nasal swabs taken from students for S.aureus. PCR was performed to identify mecA and PVL genes. RESULTS Of the total 314 children 5.10% (16/314) was detected S.aureus. The resistance of isolated strains to penicillin, erythromycin, clindamycin, rifampicin and cefoxitin was 100%, 81.3%, 81.3%, 0.0%, and 6.3% respectively. No strains demonstrated resistance to vancomycin; expression of mecA gene was detected in 3 isolates and 10 isolates were PVL-positive. CONCLUSION S. aureus was detected in 5.10% (16/314) of the study population; 0.96% (3/314) had methicillin resistant S.aureus (MRSA); expression of the mecA and PVL genes were detected in 3 and 10 isolates respectively.

C-reactive protein concentrations can help to determine which febrile infants under three months should receive blood cultures during influenza seasons

We explored whether C‐reactive protein (CRP) concentrations could indicate which infants with fever without source (FWS) should receive undergo blood culture tests during influenza seasons.