Table of Content

15 July 2020 Volume 38 Issue 7

  

Analysis of risk factors of coronary artery damage in Kawasaki disease

WANG Fujuan, WU Liangxia

Journal of Clinical Pediatrics. 2020, 38(7):  481.  doi:10.3969/j.issn.1000-3606.2020.07.001

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　Objective　To explore the risk factors of coronary artery lesion (CAL) in Kawasaki disease (KD). Methods　The clinical data of KD in 110 children were analyzed retrospectively. According to the results of color Doppler echocardiography, they were divided into two groups: coronary injury group (CAL group, 40 cases) and non-coronary injury group (NCAL group, 70 cases). Results　The median age at KD onset in 110 children (67 males and 43 females) was 1.58 years old (0.92~3.00 years). There were significant differences in the age distribution and the proportions of atypical KD and fever duration> 6 days before intravenous IVIG between CAL group and NCAL group, and the difference were statistically significant (both P<0.05). The levels of C-reactive protein (CRP), interleukin-6 (IL-6), N-terminal brain natriuretic peptide precursor (NTproBNP) and white blood cells count (WBC) in the CAL group were significantly higher than those in the NCAL group (all P<0.05). The area under ROC curve (AUC) predicted by the duration of fever before IVIG, WBC, IL-6, and pro-BNP was 0.97, 0.69, 0.76, and 0.87 respectively in CAL group. The optimal thresholds were 6.5 days, 19.85×109/L, 92.19 pg/mL, and 1122.5 pg/ mL respectively. The sensitivity of predicting CAL in KD was 84.6%, 46.2%, 100%, and 100%, and the specificity was 91.4%, 91.4%, 57.1%, and 71.4% respectively. Conclusion　Age<3 years, fever duration before IVIG > 6.5 days, atypical KD, and significantly increased WBC, IL-6, and NT proBNP were risk factors for the occurrence of CAL in KD.

Clinical characteristics and risk factors of recurrent Kawasaki disease

WU Jiahui, CHENG Fangfang, KONG Xiaoxing, et al

Journal of Clinical Pediatrics. 2020, 38(7):  485.  doi:10.3969/j.issn.1000-3606.2020.07.002

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　Objective　To explore the clinical characteristics and risk factors of recurrent Kawasaki disease（KD). Method The clinical characteristics and risk factors of recurrent KD in children admitted between 2010 and 2018 were retrospective analyzed. Results A total of 2112 children with primary KD were admitted during the study period, 35 of whom were recurrent and a recurrence rate of 1.66%. The median time of KD recurrence in 35 children was 13.5 (4~69) months after the first onset of KD. Compared with the children with initial onset, the fever duration in the children with recurrent onset was shorter, the proportion of edema in extremities was lower, the C-reactive protein was increased, and the serum potassium was decreased, and the differences were statistically significant (all P<0.05). Among 35 children with recurrent KD, 11 had coronary artery lesion (CAL) at the initial stage, 8 of whom had CAL again at the time of recurrence. Multivariate logistic regression analysis showed that Mycoplasma pneumoniae infection and the increased proportion of CD19+CD23+ lymphocyte subsets were independent risk factors for KD recurrence (both P<0.05). The ROC curve was drawn based on the recurrence risk score. The area under the curve was 0.84 (95%CI: 0.76~0.91). When the best critical value was 1.24, the sensitivity and specificity were 0.83 and 0.70, respectively. Conclusions　KD children should be followed up for at least 2 years after onset. Mycoplasma pneumoniae infection and elevated CD19+ CD23+ lymphocyte subsets can be used as predictors of KD recurrence. Children who had CAL at the initial onset of KD are also more likely to have CAL at the recurrence of KD.

Intravenous immunoglobulin-resistant Kawasaki disease with multiple pulmonary nodules: a case report and literature review

HE Tingyan, LING Jiayun, CHEN Jiehua, et al

Journal of Clinical Pediatrics. 2020, 38(7):  490.  doi:10.3969/j.issn.1000-3606.2020.07.003

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　Objective　To explore the clinical manifestation, treatment and prognosis of Kawasaki disease (KD) complicated with multiple pulmonary nodules. Methods　The clinical data of intravenous immunoglobulin (IVIG)-resistant KD with multiple pulmonary nodules in a child were reviewed and summarized in combination with relevant literature. Results A 3-month-old boy presented with fever and rash as the main manifestations and had erythematous rashes on the face and trunk, bilateral conjunctival congestion, flush and chapped lips, strawberry-like tongue, redness of BCG-vaccinated site, erythema and edema of the palms and soles. Peripheral blood leukocytes and hypersensitive CRP were increased significantly. Chest CT showed multiple nodular high-density shadows in both lungs. Color Doppler echocardiography showed enhanced echo and less smooth wall of coronary artery. Antibiotic treatment was ineffective. After the patient was treated with IVIG 2 g/kg for the first time, body temperature was normal for 5 days and then fever and congestive rash re-appeared. After receiving IVIG 2 g/kg treatment again, the child was discharged after improvement. At 3 month follow-up, no coronary artery damage was found by color Doppler echocardiography and no pulmonary nodule change was found by chest CT. The retrieved Literature revealed 6 KD patients (4 males and 2 females, age at onset ranging from 4 to 6 months) with multiple pulmonary nodules. All of the patients had coronary artery lesions and failed to respond to antibiotics. One of the patients died of cardiac arrest, and the cardiopulmonary damage of the remaining patients recovered well during the follow-up. Conclusion　A small number of children with KD may be complicated with lung involvement, and multiple pulmonary nodules are extremely rare in KD.

Unstable angina pectoris in adulthood resulted from Kawasaki disease complicated with coronary artery disease: a case report and literature review

YANG Yinan, MIN Li, DONG Xiangyu, et al

Journal of Clinical Pediatrics. 2020, 38(7):  493.  doi:10.3969/j.issn.1000-3606.2020.07.004

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　Objective　To explore the correlation between coronary artery disease caused by Kawasaki disease (KD) and acute cardiovascular events in adulthood. Methods　The clinical data of an 18-year-old coronary heart disease patient with a history of KD was retrospective analyzed, and the relevant literature was retrieved and summarized. Results　A female patient, 18-year-old, suffered from chest pain and chest distress after exercise. Cardiac angiography revealed local wall thickening and severe lumen stenosis in the main right coronary artery. The patient had a clear history of KD at the age of 7 years, complicated with a coronary aneurysm. Conclusion　KD in childhood is closely related to cardiovascular diseases in adulthood.

Therapeutic effect of percutaneous intervention on pulmonary artery branch stenosis in children

SUN Chunping, ZHANG Zhiwei, XIE Yumei, et al

Journal of Clinical Pediatrics. 2020, 38(7):  497.  doi:10.3969/j.issn.1000-3606.2020.07.005

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　Objective　To explore the safety and effectiveness of percutaneous intervention for pulmonary artery branch stenosis in children. Methods　The clinical data of pulmonary artery branch stenosis in 40 children under 18 years old who were diagnosed and received percutaneous intervention from January 2012 to December 2017 were retrospectively analyzed and the conditions before and after treatment were compared. Results　In the 40 children (28 males and 12 females) with a median age of 3.5 years (2.0 - 6.8 years), percutaneous balloon angioplasty was performed in 6 cases and covered stent implantation was performed in 32 cases. After stent implantation or balloon angioplasty, the difference in systolic blood pressure was significantly decreased, the minimum diameter of the stenosis segment was significantly increased, and the right ventricular systolic blood pressure was significantly decreased. The differences were statistically significant (all P<0.05). The median follow-up time was 22 months (range 1 - 60 months) and there was no evidence of arterial dissection, aneurysm formation, stent rupture or displacement in 34 patients with stent implantation. The cross-stent differential pressure by echocardiography was 16.50 (9.75-25.50) mmHg immediately after operation and was 23.5 (16.8 - 34.0) mmHg during follow-up. The difference was statistically significant (Z=4.02， P<0.001). The median follow-up time was 13 months (range 1 - 36 months) in 6 children with balloon angioplasty. The cross-stent differential pressure by echocardiography was 33.0 (15.5 - 45.5) mmHg immediately after operation and was 36.0 (16.0- 58.5) mmHg during follow-up. The difference was not statistically significant (Z=1.83, P=0.068). There were no serious adverse events in all children. Conclusion　Both percutaneous stent implantation and balloon angioplasty are effective and safe in the treatment of pulmonary artery stenosis in children.

Primary chylopericardium in children: a case report and literature review

ZHANG Luyan, QIN Yuming, YANG Shiwei

Journal of Clinical Pediatrics. 2020, 38(7):  501.  doi:10.3969/j.issn.1000-3606.2020.07.006

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Objective To explore the clinical characteristics, diagnosis and treatment of primary chylopericardium in children. Methods　The clinical data of primary chylopericardium in a child were analyzed retrospectively. And the key words of “children primary chylopericardium”, “pediatric primary chylopericardium” were used to search in Wanfang database, CNKI and PubMed to collect and analyze the reported cases of primary chylopericardium in children at home and abroad. Results　A girl, aged 3 years and 11 months, had cough, chest tightness, chest pain and dyspnea. The girl also had dilated cardiac dullness, distant heart sounds, regular cardiac rhythm, and no murmurs. Chest radiograph showed an enlarged heart shadow and color Doppler echocardiography indicated a large amount of pericardial effusion. Chylous fluid was drained by pericardiocentesis. After symptomatic support treatment, the child's condition improved, but there was still fluid in the pericardial cavity. The amount of pericardial effusion decreased gradually during the follow-up of more than one year, and the child had no special discomfort. Conclusion　Primary chylopericardium is rare in children. It is necessary to be alert of it when dyspnea and distant cardiac sound occur for unknown reasons, and pericardiocentesis is needed for diagnosis.

Radiofrequency ablation for preexcitation cardiomyopathy: a case report and literature review

LIU Guolin, XU Xin, LIU Qian, et al

Journal of Clinical Pediatrics. 2020, 38(7):  505.  doi:10.3969/j.issn.1000-3606.2020.07.007

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　Objective　To explore the pathogenesis, diagnosis and radiofrequency ablation effect of preexcitation cardiomyopathy in children. Method　The clinical data of a preexcitation cardiomyopathy in a child was analyzed retrospectively. Results　In a 12-year-old boy, electrocardiogram showed type B Wolff-Parkinson-White syndrome. Echocardiography showed dilated cardiomyopathy without tachycardia attack during the course of the disease. Electrophysiological examination revealed right posterior septal accessory pathway. After radiofrequency ablation, electrocardiogram showed that the delta wave disappeared and echocardiography showed that the left ventricle size shrank and the cardiac function improved and the clinical symptoms were significantly improved. Conclusion　The non-synchronization of excitation-mechanical contraction coupling in left ventricle caused by ventricular preexcitation may be the most important pathogenesis of preexcitation cardiomyopathy, in which the overt accessory pathway in the right septum is the most common. Radiofrequency ablation is effective and has a good prognosis.

Infantile hepatic hemangioendothelioma with heart failure in 2 cases

WANG Pengpeng, ZHU Xiaodong, RAO Weiwei, et al

Journal of Clinical Pediatrics. 2020, 38(7):  508.  doi:10.3969/j.issn.1000-3606.2020.07.008

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Objective　To explore the clinical features, treatment and prognosis of infantile hepatic hemangioendothelioma (IHHE) with heart failure. Method　The clinical data of IHHE with heart failure in 2 infants were retrospectively analyzed, and relevant literature was reviewed. Results　In case 1 (female), her prenatal ultrasonography showed a heterogenous echogenicity in the left abdomen of the fetus and it was confirmed by magnetic resonance and CT on the 5th day after delivery, clinical appearance of cardiac failure on the 7th day. The resection was performed by surgical operation and the diagnosis of IHHE was confirmed by pathological examination on the 15th day after birth. Reexamination at age of 2 months showed no abnormality. Case 2 (male) was admitted to hospital on the 15th day of birth due to neonatal jaundice, and heart failure occurred rapidly. IHHE was diagnosed clinically by MRI and CT. Due to the rapid progression of the disease, the child died of preoperative decompensated heart failure and respiratory failure. Conclusion　The mortality of infantile IHHE with heart failure is high. Early recognition, early intervention and multidisciplinary intervention can improve the prognosis.

Clinical characteristics of obstructive sleep apnea hypopnea syndrome in children

XU Xueyun, HAO Chuangli, HE Yanyu, et al

Journal of Clinical Pediatrics. 2020, 38(7):  512.  doi:10.3969/j.issn.1000-3606.2020.07.009

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　Objective　To analyze the clinical and polysomnography (PSG) characteristics of obstructive sleep apnea hypopnea syndrome (OSAHS) in children. Methods　The children with symptoms of snoring or/with open mouth breathing from December 2016 to April 2019 were selected as the research object, and their clinical data and PSG monitoring results were collected. According to the PSG results, the patients were divided into OSAHS group, primary snoring (PS) group and snoring with hypoxia group, and the clinical data and PSG results of the three groups were analyzed. Results　A total of 408 (260 boys and 148 girls) children were enrolled and median age was 5 years (4~7 years). There were 99 cases of OSAHS, 201 cases of PS and 42 cases of snoring with hypoxia. Compare with PS group, the proportion of tonsillar enlargement and adenoid hypertrophy, the proportion of nocturnal snoring, laborious breathing, apnea and nocturia were higher, and the proportion of rhinitis/sinusitis was lower in OSAHS group. The rate of daytime drowsiness in OSAHS group was higher than that in PS group and snoring with hypoxia group, and there were significant differences (all P<0.05). The sleep time of no rapid eye movement (NREM1) and snoring index monitored by PSG were higher in OSAHS group than those in PS group, and the proportion of stage 3 NREM sleep was lower than that in PS group. The lowest blood oxygen saturation (LSaO2) of OSAHS group and snoring with hypoxia group was lower than that of PS group, and the difference was statistically significant (P<0.05). OSAHS group had the highest apnea hypopnea index (AHI) and the longest time of apnea, followed by snoring with hypoxia group, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that adenoid hypertrophy, obesity and the presence of allergic rhinitis/sinusitis were independent risk factors for OSAHS in children (P<0.05). Conclusion　Children with OSAHS have disordered sleep structure, mainly the prolonged sleep time of NREM1 and shortened time of NREM3. Obesity, adenoid hypertrophy, rhinitis or sinusitis are risk factors for OSAHS.

Clinical risk factors and short-term outcome of parenteral nutrition associated-cholestasis in preterm low birth weight infants

LI Tong, LI Dong

Journal of Clinical Pediatrics. 2020, 38(7):  518.  doi:10.3969/j.issn.1000-3606.2020.07.010

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Objective　To explore the clinical risk factors and short-term outcome of parenteral nutrition associatedcholestasis (PNAC) in preterm low birth weight infants. Methods　The clinical data of 114 preterm infants with low birth weight who were admitted to neonatal intensive care units and had parenteral nutrition (PN) ≥14 days and birth weight < 2500 g were analyzed retrospectively. According to the level of direct bilirubin (DB) in preterm infants, it was divided into PNAC group (DB> 34 μmol/L, 27 cases) and non PNAC group (87 cases). Alanine aminotransferase > 50 U/L was used as the standard for combined liver injury. And the differences were compared between the two groups. Results　The incidence of PNAC was 23.6%, and it occurred (32.8±12.5) d after PN application, and recovered (52.2±29.5) d after PN cessation. In the PNAC group, liver injury occurred in 14 patients (51.8%), and the occurrence time was (42.0±14.7) d after PN application. The duration of liver injury was 70.5 d (56.0~77.7 d), and the duration of cholestasis was (90.2±42.1) d. The hospitalization time, antibiotic application time, mechanical ventilation time, PN duration and fasting time in PNAC group were longer than those in non PNAC group, the age of starting feeding was later than that in non PNAC group, the cumulative dose of amino acid and lipids was larger than that in non PNAC group, and the proportions of necrotizing enterocolitis (NEC) and septicemia were higher than those in non PNAC group, and the differences were statistically significant (P all < 0.05). Multivariate logistic regression analysis showed that fasting time, PN duration and NEC were independent risk factors for PNAC (all P< 0.05). Conclusions　PNAC is a common complication of premature low birth weight infants during PN. Long time fasting, long duration of PN and complicated NEC increased the risk of PNAC. After treatment, the prognosis of PNAC is good.

Clinical analysis of early-onset and late-onset group B Streptococcus sepsis in 71 infants

PENG Haibo, ZHAN Yuanli, WU Lijuan, et al

Journal of Clinical Pediatrics. 2020, 38(7):  524.  doi:10.3969/j.issn.1000-3606.2020.07.011

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Objectives　To explore the clinical characteristics and inflammatory indexes of early-onset and late-onset group B Streptococcus (GBS) sepsis in infants. Methods　The clinical data of infants diagnosed with GBS sepsis admitted from January 2011 to December 2019 were analyzed retrospectively. According to the onset age they were divided into earlyonset group (within 7 days) and late-onset group (rang 7 to 89 days). The perinatal factors, clinical characteristics and related inflammatory indexes between the two groups were compared. Results　There were 71 infants with GBS sepsis, including 43 in the early-onset group and 28 in the late-onset group. The median age at onset was 5 hours in the early-onset group and 17 days in the late-onset group. The incidence of primiparity, preterm delivery, premature rupture of membranes (PROM), PROM≥18h, tachypnea/grunting, pneumonia and thrombocytopenia in the early-onset group were higher than those in the late-onset group. The incidence of fever, the time to reach the lowest number of leukocytes and the lowest value of platelets were lower than those in the late-onset group, and the difference were statistically significant (P<0.05). Four children died, all of whom were in early onset group and 3 of whom were very low birth weight infants. The sensitivity of the two groups of infants to penicillin, ceftriaxone, vancomycin was 100%. Conclusions　Early-onset GBS sepsis often has respiratory symptoms as the primary manifestation, is prone to thrombocytopenia, and has a high mortality in very low birth weight infants. Fever is the primary symptom of late-onset GBS sepsis. The sensitivity of blood and cerebrospinal fluid culture strains to penicillin, ceftriaxone, and vancomycin was 100%.

Analysis of clinicopathological characteristics and prognostic factors of Ewing’s sarcoma family tumor in 50 children

DONG Yushuang, TAN Zhen, ZHANG Qin, et al

Journal of Clinical Pediatrics. 2020, 38(7):  530.  doi:10.3969/j.issn.1000-3606.2020.07.012

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Objective　To explore the clinical, pathological, molecular phenotypic characteristics and prognosis of childhood Ewing's sarcoma family tumor (ESFT). Methods　The clinical and pathological data of ESFT in 50 children from August 2008 to December 2018 were analyzed retrospectively. Results　In the 50 children (29 males and 21 females), median age at onset was 8 years (7 days to 14 years) and the median follow-up time was 35 months (1 to 137 months). The first symptom of 23 cases was local pain, 21 cases presented with painless mass (19 cases had mass ≥ 8 cm), and 6 cases presented with lower limb dyskinesia, fever, snoring, etc. Fifteen children had metastasis at initial diagnosis. Immunohistochemistry showed that 100% of the 50 children (50/50) were positive for CD99, 80% (20/25) for FLI-1 and 80% (4/5) for NKX2.2. Thirty-two children (32/35, 91%) had EWSR1 fusion gene translocation. Thirty-two of the 50 children received surgery combined with chemotherapy and radiotherapy. The 3-year overall survival rate (3y-OS) was (68.2±6.9) %, including (78.7±7.2) % in the non-metastatic group and (20.6±16.1) % in the metastatic group (P<0.001). The Log-Rank test results showed that children with no metastasis, tumor <8 cm in diameter, limb being primary, complete resection, combined treatment and combined radiotherapy had a longer survival time, and the differences were statistically significant (P<0.05). Cox regression analysis showed that distant metastasis, incomplete surgical resection and no combination therapy were independent risk factors for poor prognosis of ESFT children (all P<0.05). Conclusions　Combination of EWSR1 gene translocation and CD99, FLI-1, NKX2.2 molecular expression can improve the accuracy of ESFT diagnosis. Distant metastasis, incomplete resection of the mass and failure to receive multidisciplinary treatment at the first diagnosis are the adverse factors of the prognosis of the patients.

Spontaneous remission of acute monoblastic leukemia in children: a case report and literature review

CHEN Shiyang, YUAN Xiuli, FU Xiaoying, et al

Journal of Clinical Pediatrics. 2020, 38(7):  536.  doi:10.3969/j.issn.1000-3606.2020.07.013

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　Objective　To explore the inducement and possible mechanism of spontaneous remission in acute myeloid leukemia. Method　The clinical data of acute monoblastic leukemia in a child with spontaneous remission were reviewed, and the possible mechanism of spontaneous remission was discussed in combination with relevant literature. Results　A year and 4 months old boy was diagnosed with acute monoblastic leukemia and had a spontaneous remission without chemotherapy. About 1 year later, the boy relapsed with myeloid sarcoma and received HLA haploidentical hematopoietic stem cell transplantation. The prognosis was good. Previous studies showed that most patients with spontaneous remission had a history of fever that was usually caused by infection, but could also be caused by drug withdrawal or blood transfusion. Conclusion　Spontaneous remission of acute myeloid leukemia is extremely rare. Immunotherapy may be employed to treat leukemia in the future.

Analysis of the clinical manifestations and gene mutations from 5 families with tuberous sclerosis

LI Min, ZHANG Jiyao, DONG Wei, et al

Journal of Clinical Pediatrics. 2020, 38(7):  541.  doi:10.3969/j.issn.1000-3606.2020.07.014

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　Objective　To evaluate the clinical manifestations and the frequency of gene mutations that associated with tuberous sclerosis from 5 families. Method　Peripheral blood samples from 5 families of the tuberous sclerosis family were collected, genomic DNA was extracted, then analying the clinical manifestations and mutations. Results　A heterozygous nonsense mutation of c.2074C>T in the TSC1 was detected in the proband of family 1, but the same mutation was not found from their parents.A c.2545+10C>T heterozygous mutation in the TSC2 gene, which was a new spilcing mutation, was found in the proband of family 2. The same mutation was found from her father. A c.2497C>T heterozygous mutation in the TSC1 gene was found in the proband of family 3, as well his mother and sister. A c.4375C>T heterozygous mutation in the TSC2 gene, as a newly discovered nonsense mutation, was found in the proband of family 4, and the mother, sister and brother were heterozygous mutations at this position. A mutation that clearly caused the disease was not found in the proband of family 5. The affected members of the five families performed multiple seizures of different severity, depigmentation macula, and intellectual disability. Conclusion　The pathogenicity of gene mutations in family 2 and 4 have not been reported, which is a new pathogenic mutation. The clinical manifestations of individuals with the same mutation site in the same family are of great different; the family 5 does not detect a pathogenic mutation, but clinical manifestations are typical, considering the possibility of mosaicism mutations.

Familial Mediterranean fever in two children: two cases report and literature review

SHEN Leilei, SUN Xiaodong, ZHENG Ruixue, et al

Journal of Clinical Pediatrics. 2020, 38(7):  545.  doi:10.3969/j.issn.1000-3606.2020.07.015

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Objective　To explore the clinical characteristics, diagnosis and treatment of familial Mediterranean fever (FMF) in children. Method　The clinical data and the variation of MEFV gene in two FMF children were analyzed, and the related literature was reviewed. Results　Case 1 was a 6-year- and 3-month-old female, and case 2 was a 3 year old male. Both patients presented with recurrent fever and increased non-specific inflammatory indicators. The MEFV complex heterozygous mutation was confirmed by gene sequencing in case 1, and the clinical symptoms were relieved after colchicine treatment. The MEFV nucleic acid site mutation was confirmed by gene sequencing in case 2, but the corresponding protein was not changed, and his fever improved significantly after colchicine treatment. Conclusion　It is necessary to be aware of FMF in children with recurrent fever and increased nonspecific inflammatory index after routine treatment.

Clinical analysis and literature review of 3 cases of Penicilliosis marneffei in non-AIDS children

LUO Xiangqin, LIANG Ying, LING Yesheng, et al

Journal of Clinical Pediatrics. 2020, 38(7):  550.  doi:10.3969/j.issn.1000-3606.2020.07.016

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　Objective　To analysis the clinical characteristics and therapeutic outcomes of Penicilliosis maneffei (PSM) in 3 non-AIDS children. Methods　A retrospective study of the clinical characteristics and treatment results of 3 children with PSM were analyzed. Results　There were 1 female and 2 males, with an age of 5 months, 1 year and 5 months, 3 years and 2 months respectively. All 3 cases were characterized by recurrent fever with cough, shortness of breath, progressive aggravation of the disease, and ineffective of anti-infection therapy. Chest computed tomography (CT) showed diverse manifestations in the lung. One was in the induction remission chemotherapy stage of acute lymphocytic leukemia, other two had congenital biliary atresia. The diagnoses were made by blood culture, sputum culture, or next-generation sequencing (NGS) of pathogen in the serum and bronchoalveolar lavage fluid (BALF). The conditions of 3 cases were improved after amphotericin B-based treatment. Conclusion　PSM can occur in non-AIDS children with lung being the main target organ. For immunocompromised children in epidemic areas, clinicians should be aware of PSM and take pathogenic examination early.

Progress in diagnosis and treatment of abnormal reactions after BCG vaccination in children

LI Xiaoying

Journal of Clinical Pediatrics. 2020, 38(7):  554.  doi:10.3969/j.issn.1000-3606.2020.07.017

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　BCG vaccine is the only vaccine currently available for clinical prevention of tuberculosis. Though relatively safe, the common or severe adverse events after BCG and their managements should be paid attention and familiarized by pediatricians. Common abnormal reactions of BCG vaccine include local abscess, lymphadenitis, tuberculid (scleroderma erythema, tinea of the scrotum and papulonecrotic tuberculid), osteomyelitis and systemic disseminated BCG infection. In this paper, the diagnosis and treatment of these common abnormal reactions will be reviewed.

Microorganisms are closely related to human health

LI Haiqi

Journal of Clinical Pediatrics. 2020, 38(7):  558.  doi:10.3969/j.issn.1000-3606.2020.07.018

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　Microbes accompany humans throughout their lives and participate in the physiological regulation of the host and is one of the key determinants of human health and disease. Intestinal microbiota affects human immune status, prevents colonization of pathogenic microorganisms, and has certain metabolic and nutritional functions. The infancy is called "the best window period for the development of intestinal microorganisms" and is the critical period for the establishment and stability of intestinal microbiota. Each person has their own unique makeup of gut microbes, like a person's fingerprint or identity card. The gut microbiome, which may play a key role in brain development and maintenance, is called the “microbiota-gut-brain axis”