Mycoplasma pneumoniae is a well-recognized cause of respiratory infection in children, but its clinical spectrum extends beyond the lungs. Extrapulmonary manifestations may occasionally precede respiratory symptoms or dominate the presentation, making the diagnosis more difficult. This narrative clinical review focuses on nonspecific and extrapulmonary manifestations reported in pediatric patients, including neurological, mucocutaneous, hematological, cardiovascular, hepatic, gastrointestinal, and musculoskeletal complications. Relevant literature published between 2000 and 2026 was reviewed using PubMed/MEDLINE, Scopus, and Google Scholar. Most reported extrapulmonary manifestations appear to be immune-mediated, although direct microbial effects and vascular or prothrombotic mechanisms may contribute in selected cases. Clinical presentations range from prolonged fever and nonspecific systemic symptoms to severe complications such as encephalitis, myocarditis, hemolytic anemia, mucocutaneous disease, and thromboembolic events. Diagnosis can be challenging because respiratory symptoms may be minimal, while laboratory and microbiological findings are not always straightforward to interpret. Positive microbiological findings should be interpreted in the clinical context because currently available tests cannot reliably distinguish active infection from asymptomatic carriage. Recognition of extrapulmonary manifestations is critical for timely diagnosis and appropriate management in pediatric practice. M. pneumoniae should be considered in children with otherwise unexplained extrapulmonary manifestations, particularly when there is a history of recent respiratory illness.
Objective: To investigate predictive factors for seizure recurrence in children with febrile seizures (FS) within a single febrile illness, providing a basis for early clinical identification and preventive measures. Methods: We conducted a retrospective analysis of children with FS admitted to the Department of Pediatrics, Suzhou Hospital Affiliated to Anhui Medical University, from April 2023 to December 2025. A total of 337 children met the inclusion criteria. Children with more than one seizure within the same febrile ilness were classified as the recurrent febrile seizures (RFS) group, and those with a single seizure as the non-recurrent febrile seizures (NRFS) group. Univariate and multivariate analyses identified factors associated with FS recurrence. A predictive model was constructed, and its performance was evaluated using the receiver operating characteristic (ROC) curve. Results: Among the 337 children, 42 were in the RFS group and 295 in the NRFS group. Multivariate logistic regression revealed that a family history of FS in first-degree relatives (OR = 2.853, 95% CI: 1.400-5.817, P = 0.004), body temperature at the first seizure (OR = 0.214, 95% CI: 0.099-0.465, P < 0.001), and serum potassium level (OR = 2.934, 95% CI: 1.227-7.014, P = 0.015) were independent risk factors for RFS. The predictive model demonstrated good discriminatory ability, with an area under the ROC curve (AUC) of 0.808 (95% CI: 0.746-0.869), a sensitivity of 71.4%, and a specificity of 75.7%. Conclusion: A positive family history of FS in first-degree relatives, a lower body temperature at the first seizure, and a higher serum potassium level are significant predictors of FS recurrence. Combining these indicators into a predictive model can effectively identify children at high risk of recurrence, offering a reference for early clinical intervention.
This study retrospectively analyzed the clinical data of two 19-month-old children diagnosed with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) who received treatment with a dexamethasone combined with etoposide (VP-16) regimen. Both children met the early remission criteria for body temperature, IL-10, and IFN-γ within 48-72 hours after treatment initiation, but their clinical outcomes were markedly different. In Case 1, the EBV-DNA load decreased significantly during the initial treatment phase, and platelet counts steadily increased after treatment; the patient had a favorable prognosis at the 2-year follow-up. In Case 2, the EBV-DNA load did not decrease but instead increased during the initial treatment phase, platelet counts remained at extremely low levels with a poor response to treatment, and the patient died due to disease recurrence approximately 70 days after treatment. The comparative analysis of the two cases suggests that the viral kinetics of EBV-DNA load before and after treatment and the speed of platelet recovery may more accurately reflect the body's viral control capability and immune reconstitution status than traditional static risk factors and short-term inflammatory indicators, holding significant clinical value for the early efficacy evaluation and prognosis assessment of EBV-HLH. For children with poor initial treatment response, increasing viral load, and persistently low platelet counts, there should be high vigilance for early recurrence risk and timely adjustment of treatment strategies.
Infants born before 32 weeks of gestation are highly susceptible to late-onset sepsis because of immune immaturity, impaired intestinal barrier function, and frequent broad-spectrum antibiotic exposure. Whether probiotics should be continued or initiated during antibiotic therapy remains unresolved and is often conflated with routine prophylaxis in stable infants. This SANRA-guided structured narrative and translational review synthesized clinical, microbiome, resistome, mechanistic, and safety evidence identified in PubMed/MEDLINE, Scopus, and Web of Science through July 1, 2026, across three contexts: stable antibiotic overlap, suspected sepsis, and confirmed or unstable sepsis. Pooled prophylactic analyses suggest a small, heterogeneous reduction in late-onset infection (risk ratio 0.83, 95% CI 0.72–0.95). However, the 2023 Cochrane review judged that probiotics probably have little or no effect on late-onset invasive infection (risk ratio 0.89, 95% CI 0.82–0.97), the largest randomized trials were neutral, and no benefit has been demonstrated in extremely preterm or extremely low birth weight infants (risk ratio 0.93, 95% CI 0.78–1.09). Direct evidence during systemic antibiotic exposure is limited to microbiome endpoints and does not establish benefit in suspected or confirmed sepsis; no randomized trial has evaluated probiotics as adjunctive treatment for active sepsis. Metagenomic studies suggest that probiotics may attenuate antibiotic-associated dysbiosis and modify the intestinal resistome, but these surrogate effects have not been shown to reduce multidrug-resistant infection. Probiotic-associated bloodstream infection was infrequently reported (8 cases among 20,323 exposed infants), although ascertainment was inconsistent and reported infections may be severe. Current evidence does not support probiotics as treatment for neonatal sepsis or routine initiation during suspected or confirmed sepsis. Prospective strain-specific trials should evaluate these three contexts separately.
Hemophagocytic lymphohistiocytosis (HLH) is a severe inflammatory response syndrome. Common infectious triggers include Epstein Barr virus, cytomegalovirus, bacteria, and other pathogens. We report a case of HLH caused by human herpesvirus-6 (HHV-6) in a pediatric patient. Based on the HLH-2004 diagnostic criteria, the patient fulfilled 5 of 8 criteria, establishing a definitive diagnosis. HHV-6-associated HLH is rarely reported in the literature. The etiological diagnosis was confirmed through metagenomic next - generation sequencing, highlighting its utility in identifying underlying causes of HLH when the etiology remains unknown.
Objective: This study investigated the age-dependent clinical characteristics of Kawasaki disease (KD) in pediatric patients and assessed the influence of age on disease presentation and outcomes. Methods: A retrospective analysis was conducted of 480 children diagnosed with KD who were admitted to Hangzhou First People's Hospital between 2013 and 2022. Subjects were stratified into two cohorts based on age: <2 years and 2-14 years). Demographic data, clinical manifestations, laboratory parameters, comorbidities, and coronary artery abnormalities were comprehensively evaluated across the age groups. Results: Time from symptom onset to diagnosis was significantly prolonged in the older cohort (z=-2.70, P=0.007). The incidence of cervical lymphadenopathy was markedly higher in older children (χ²=15.12, P<0.001), while peripheral extremity changes were significantly less frequent (χ²=5.79, P=0.016). The younger cohort exhibited significantly elevated platelet counts, alanine aminotransferase, and NT-proBNP levels compared to older patients (z=-3.57, P<0.001; z=-2.39, P=0.02; z=-3.59, P<0.001, respectively). Coronary artery dilatation and aneurysm formation occurred more frequently in younger patients (z=7.70, P=0.006; z=14.63, P<0.001). However, coronary artery recovery rates following intravenous immunoglobulin therapy showed no significant inter-group differences (P>0.05). Conclusions: The clinical presentation of KD demonstrates significant age-dependent variation. Clinicians should maintain a high index of suspicion for KD in older children presenting with fever and cervical lymphadenopathy. In younger patients with KD, close monitoring of hepatic function, platelet counts, and NT-proBNP is warranted. The elevated risk of coronary artery complications in younger patients underscores the importance of prompt diagnosis and intervention to optimize clinical outcomes.
Although brucellosis is one of the most common zoonotic infections worldwide, the development of a paradoxical reaction during treatment hasrarely been reported in the literature. We present a 17-year-old patient who developed acute sacroiliitis in the second week of treatment for olecranon bursitis brucellosis, despite her initial clinical findings showing signs of improvement. After excluding other potential etiologies for sacroiliitis, clinical and radiological recovery was achieved by adding anti-inflammatory therapy without modifying the existing antimicrobial regimen. Consequently, the clinical picture was evaluated as a paradoxical reaction. This case emphasizes that new symptoms or clinical worsening during brucellosis treatment should not always be interpreted as treatment failure or relapse; the possibility of a paradoxical reaction should be considered.
Objective: To identify a transcriptomic signature associated with EV-A71 infection using peripheral blood mononuclear cells (PBMC) transcriptome profiles from the public dataset GSE135964, which compares samples from subjects with Enterovirus A71 (EV-A71) infection against healthy controls based on bioinformatics and machine learning algorithms, for exploratory biomarker discovery. Methods: The publicly available dataset GSE135964, accessed through the Gene Expression Omnibus (GEO) database WAS analyzed. Differential expression analysis was conducted with a |log2FC| ≥ 0.5 and an adj.P.Val < 0.05 cutoff. The resulting gene set was then visualized through box plots, PCA, volcano plots, and heatmaps. Subsequently, we utilized the random forest algorithm, which quantified gene importance by integrating the mean decrease in both accuracy and the Gini index. This process culminated in the selection of the highest-ranking 10% of genes for subsequent candidacy. Functional characterization of the candidate genes involved Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, alongside the establishment of a protein-protein interaction (PPI) network leveraging the STRING database. Results: Our analysis revealed 438 differentially expressed genes (DEGs), with a marked imbalance towards upregulation (415 genes) compared to downregulation (23 genes). Random forest screening identified 44 candidate genes. PPI analysis identified 23 key genes, and LASSO regression finally pinpointed three feature genes: IFIT5, OASL, and PLSCR1. ROC analysis showed AUC values of 0.964, 0.921, and 0.894 for OASL, PLSCR1, and IFIT5, respectively, indicating a strong association with EV-A71 infection. Enrichment analysis implicated these feature genes in antiviral biological processes, suggesting a core mechanism involving antiviral defense (GO:0051607) to viral RNA binding (GO:0003727). Conclusions: The identified three-gene signature, enriched in antiviral response pathways, provides a theoretical basis for future research into host transcriptomic responses to EV-A71 infection and the RIG-I signaling axis. This transcriptomic signature analysis offers an exploratory resource for understanding EV-A71–associated HFMD.
Objective: Neonatal sepsis continues to be a major cause of morbidity and mortality globally, particularly in developing countries. The rising rate of antimicrobial resistance underscores the urgent need for reliable, practical sepsis prediction tools to optimize antibiotic use. The Sepsis Prediction Score (SPS) integrates clinical and laboratory parameters and has shown a positive impact in simplifying clinical decision-making. This study aimed to evaluate the diagnostic accuracy of the SPS in predicting late-onset sepsis (LOS) in a tertiary referral hospital in Indonesia. Methods: This diagnostic study used a cross-sectional design and was conducted at Dr. Kariadi General Hospital, using medical records and microbiology laboratory data from June 2023 to May 2024. Neonates aged 3–28 days with at least one risk factor for LOS and available culture results were included. The performance of the SPS was analyzed using receiver operating characteristic (ROC) curves, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Of 430 neonates with suspected LOS, 154 met the inclusion criteria, and 137 were included in the final analysis. Culture-proven sepsis was identified in 32.8% of subjects. ROC analysis demonstrated an area under the curve of 0.82 (95% CI: 0.75–0.90). An SPS cut-off score of ≥3 provided a sensitivity of 78%, specificity of 79%, PPV of 65%, and NPV of 88%. Subgroup analysis consistently demonstrated strong diagnostic performance across categories such as birth weight, gestational age, and delivery method. Conclusion: The SPS is a valid, sensitive, and specific tool for predicting late-onset sepsis and helps promote more rational antibiotic use. Its application and feasibility in clinical practice could enhance sepsis management and contribute to antimicrobial stewardship efforts, particularly in resource-limited settings. Prospective and quality improvement studies are required further to evaluate its impact on antibiotic use and neonatal outcomes.
Objective: Non-responsive Kawasaki disease to intravenous immunoglobulin (IVIG) increases the risk of coronary artery damage in pediatric patients. There is an urgent clinical need for adjunctive therapies that can improve outcomes in these high-risk children. Dipyridamole, with its antiplatelet and vasodilatory effects, may improve outcomes in such patients, but prospective research evidence is currently lacking. Methods: This multicenter, randomized, open-label trial enrolled 144 pediatric patients with IVIG-resistant Kawasaki disease. Participants were randomly allocated to receive either standard therapy supplemented with oral dipyridamole (2 mg/kg, three times daily), or standard therapy alone. The primary endpoint was the change in mean coronary artery Z-score at 12 weeks. Secondary outcomes included time to fever resolution, changes in inflammatory biomarkers (C-reactive protein, erythrocyte sedimentation rate), platelet count, length of hospitalization, and drug safety. Results: At 12 weeks follow-up, the mean improvement in coronary artery Z-score was significantly greater in the dipyridamole group than in the control group (-0.81 ± 0.83 vs. -0.41 ± 0.80, P=0.004). Additionally, children in this group experienced shorter fever resolution times (19 vs. 25 hours, P=0.007), lower C-reactive protein levels at 72 hours post-treatment (19.3 ± 13.1 vs. 29.1 ± 15.8 mg/L, P<0.001) and erythrocyte sedimentation rate at one week (36.8 ± 17.2 vs. 46.2 ± 19.0 mm/h, P<0.001) were significantly lower, and the median length of hospital stay was shorter (6 vs. 7 days, P=0.043). When evaluating safety outcomes, there was no significant difference in the rate of serious adverse events between the two groups. However, the dipyridamole group had a higher incidence of headache (13.9% vs. 2.8%, P=0.017). Conclusion: The adjunctive use of dipyridamole improves coronary artery status and accelerates clinical recovery in children with IVIG-resistant Kawasaki disease. Given its acceptable safety profile, this medication represents an effective and readily accessible adjunctive treatment option for this patient population.
Objective: Neonatal sepsis is a leading cause of mortality and morbidity in neonatal units. Neonates are often exposed to prolonged periods of antibiotics, leading to adverse outcomes. This study aimed to assess the time to positivity (TTP) in early-onset neonatal sepsis (EONS) and late-onset neonatal sepsis (LONS) and its impact on the duration of empirical antibiotics. Methods: A retrospective cohort review was conducted from January 1, 2021, to December 31, 2023, at Al Qassimi Women’s and Children’s Hospital, Sharjah, United Arab Emirates. Neonates admitted to the neonatal intensive care unit (NICU) with positive blood cultures and confirmed EONS or LONS were included. Contaminants and Candida species were analyzed separately due to their distinct growth kinetics. An independent t-test was employed to compare the TTP between contaminants and true pathogens. A multivariate linear regression model was developed to investigate predictors of TTP. Results: We included 138 neonatal sepsis cases with positive blood cultures. Of these, 36 cases of EONS (26%) and 102 cases of LONS (74%) were identified. The TTP for contaminants (mean = 75.8 h) and Candida (mean = 68.5 h) were significantly longer compared to other pathogens (p < 0.001). In EONS, 100% (36/36) yielded positive bacterial growth within 36 hours. For LONS, 100% (102/102) yielded positive bacterial growth within 48 hours. Only 5% of bacteria (5 coagulase-negative staphylococci) yielded positive growth between 36 and 48 hours. Multivariate linear regression analysis showed longer TTP was associated with gram-positive pathogens and antibiotic pretreatment (p < 0.05). Neonatal risk factors and laboratory markers did not significantly affect TTP. Conclusion: In our cohort, a 36-hour incubation period was adequate to detect pathogenic bacteria in EONS, while LONS required 48 hours. TTP remained an intrinsic characteristic of bacterial species and was unaffected in the absence of antibiotic pretreatment.
Objective: Epstein-Barr virus (EBV) infection is linked to multiple pediatric disorders, and COVID-19 control measures may have modified its epidemiological profiles. This study analyzed EBV infection characteristics and distribution changes among children in Hangzhou before and after the promulgation of the ‘10 prevention and control measures,’ comparing the strict (2022) and relaxed (2023) pandemic periods. Methods: A retrospective analysis was conducted on 38,086 children with suspected EBV-related diseases who underwent EBV serological antibody testing via chemiluminescence immunoassay at Children's Hospital of Zhejiang University School of Medicine between January 2022 and December 2023. The percentages and distributions of Seropositive across years, age groups, and months were statistically analyzed. Results: The number of tested children in 2023 was significantly higher than in 2022, with 3-6 y as the predominant group. Primary infection and EBV reactivation increased by 41% and 47%, respectively, in 2023 compared with 2022. Seropositive rates rose with age, ranging from 18.62% (6-12 m) to 90.64% (>9 y). Notably, the number of Seropositive (Primary infection, Past infection and EBV reactivation) from February to December 2023 was significantly higher than in the corresponding period of 2022. Conclusion: Our findings confirm that adjustments to COVID-19 control policies exerted a measurable impact on the epidemiology of EBV infection in children in Hangzhou.
Objective: Severe pneumonia (SP) accompanied by high fever is frequently encountered in pediatric emergency and intensive care settings and is associated with unfavorable short-term outcomes. Early identification of factors associated with poor prognosis may support timely risk recognition and nursing awareness. Methods: This retrospective observational study included 195 children with SP complicated by high fever who were admitted to the Pediatric Intensive Care Unit (PICU) or the Emergency Department of our hospital between January 2019 and January 2022. Demographic characteristics, baseline clinical indicators, and laboratory parameters at admission were extracted from medical records. Poor prognosis was determined according to predefined short-term outcome criteria during hospitalization and follow-up. Univariable and multivariable logistic regression analyses were performed to identify factors associated with poor prognosis. An exploratory nomogram based on the multivariable model was constructed. Results: Among the 195 children, 33 experienced poor prognoses. Univariable analyses showed that younger age, longer fever duration, higher respiratory rate, lower peripheral oxygen saturation (SpO₂), higher C-reactive protein (CRP), lower lymphocyte counts, and lower platelet count were associated with poor prognosis. In multivariable analysis, higher respiratory rate (OR = 1.240, 95% CI 1.041-1.478, P = 0.015) and elevated CRP (OR = 1.429, 95% CI 1.257-1.623, P < 0.001) remained independently associated with poor prognosis, while age showed a non-significant trend. An exploratory nomogram incorporating age, respiratory rate, and CRP was developed for illustrative purposes. Conclusion: In children with SP complicated by high fever, higher respiratory rate and elevated CRP at admission were independently associated with poor prognosis. These findings may support early risk recognition and inform clinical monitoring and nursing awareness. The exploratory nomogram provides a visual summary of associated factors and is not a validated prediction tool; prospective studies are warranted to evaluate risk-guided nursing strategies.
Objective: In adolescents, pertussis commonly presents with a mild, atypical picture that can delay diagnosis, lead to its exclusion from the differential diagnosis list, and sustain community transmission. Typical paroxysms and laboratory abnormalities are frequently absent or subtle. We aimed to describe qPCR-confirmed adolescent cases and highlight diagnostic challenges. Methods: We retrospectively reviewed electronic records of patients presenting to general pediatrics and pediatric infectious diseases clinics between January 2019 and August 2025. Adolescents with a multiplex respiratory panel positive only for Bordetella pertussis were included; co-detections and incomplete data were excluded. Demographics, symptoms, examination and imaging findings, laboratory results, treatment, and disposition were evaluated. Results: Forty-one patients were included (51.2% male); all had received childhood pertussis vaccination. Median age was 15 years (IQR 13–17). Fever and dyspnea were each present in 12.2%; vomiting was not reported. Cough occurred in the 73.2%; among those with cough, duration was ≥2 weeks in the 40.0% and <2 weeks in the 60.0%. No apnea/cyanosis or cough-related facial flushing was documented. On auscultation, crackles were noted in the 4.8% (both diagnosed as pneumonia) and rhonchi with wheeze in the 2.4%. Chest radiography was performed in the 56%; the 39% were abnormal, most commonly increased reticular markings. Routine laboratory parameters were nonspecific. Empiric antibiotics were initiated in the 53% of patients; macrolides were added post-confirmation when initially absent. Conclusion: In adolescents, pertussis often presents atypically with nonspecific examination/laboratory findings, and cough duration alone is insufficiently informative. Reliance on classic features or routine labs risks missed diagnoses. Pertussis should remain in the differential for any adolescent with respiratory symptoms, irrespective of cough duration; clinically suspected cases warrant prompt molecular testing and timely management.
Objective: Before the coronavirus disease 2019 pandemic, respiratory syncytial virus (RSV)-related hospitalizations followed a predictable seasonal pattern in Anhui, China, typically beginning in November and lasting until March of the following year. However, city-specific data for Anhui were limited. This study investigated the epidemiological patterns and risk factors associated with severe RSV-associated lower respiratory tract infection (LRTI) among hospitalized children in our centre. Methods: We reviewed the records of children aged ≤14 years who were hospitalized with RSV lower respiratory tract infection between June 2023 and May 2025. RSV infection was confirmed using reverse transcription-polymerase chain reaction testing. Data on demographics, clinical presentation, and laboratory findings were extracted from electronic medical records. We analyzed seasonal trends and used logistic regression to identify independent predictors of severe RSV infection. Results: Among 5,755 children tested for respiratory pathogens, 448 tested RSV-positive (overall positivity rate 7.79%). The positivity rate increased from 6.47% (194/3,000) in 2023–2024 to 9.22% (254/2,755) in 2024–2025. A marked epidemiological shift was observed: the 2024–2025 RSV seasonal outbreak began approximately one month earlier and persisted approximately one month longer than that of the prior season. After excluding ten patients with incomplete data, 438 children were included in the clinical analysis; of these, 82 (18.72%) had severe disease. Multivariable logistic regression analysis identified that age under 6 months, congenital heart disease, and preterm birth were each independent risk factors for severe RSV-associated LRTI. Conclusion: The overall RSV positivity rate among hospitalized children with respiratory symptoms was 7.79%, which increased from 6.47% in 2023–2024 to 9.22% in 2024–2025. Infants younger than six months, preterm neonates, and children with congenital heart disease remain the most vulnerable to severe RSV infection. These high-risk groups may warrant prioritization in future immunoprophylaxis strategies.
Objective: Trimethylamine N-oxide (TMAO), a metabolite derived from gut microbiota, has been linked to various chronic inflammatory conditions. However, its potential role in acute inflammation, such as pediatric acute appendicitis, remains unclear. This exploratory diagnostic study aimed to assess the preliminary diagnostic performance of serum and urinary TMAO levels in differentiating appendicitis subtypes. Methods: In this prospective study, 137 pediatric patients who underwent surgery for suspected acute appendicitis were included. Based on histopathological findings, patients were categorized into negative, non-complicated, and complicated appendicitis groups. Serum and urinary TMAO levels were measured using liquid chromatography–tandem mass spectrometry. Group comparisons were performed using appropriate parametric and non-parametric tests. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression models were constructed to identify independent predictors of complicated appendicitis. Results: Urinary TMAO levels were mildly elevated in patients with non-complicated appendicitis compared to both negative and complicated cases, representing a statistically significant but modest difference (median [Q1–Q3]: 30,100 [11,500–58,220.9] ng/mL vs. 22,500 [6,537.46–34,563.2] ng/mL,p = 0.046). In contrast, serum TMAO levels did not differ significantly among the study groups (p = 0.292). ROC analysis demonstrated modest discriminatory performance of urinary TMAO in differentiating complicated from non-complicated appendicitis, whereas serum TMAO showed no diagnostic utility. In multivariable logistic regression analyses, C-reactive protein emerged as the only independent predictor of complicated appendicitis, while neither serum nor urinary TMAO was independently associated with disease severity. Conclusion: Urinary TMAO levels may reflect early-stage metabolic or microbiota-related alterations in pediatric acute appendicitis but demonstrate limited discriminatory power when used in isolation. These findings suggest that urinary TMAO should be considered a hypothesis-generating, adjunctive metabolic marker rather than a standalone diagnostic tool. Further multicenter studies incorporating dietary, microbiota, and renal function assessments are warranted to clarify its clinical relevance.
Bronchiectasis, although less common in children than in adults, is an important long-standing respiratory disease marked by permanent enlargement of the bronchi and impaired airway function. The main symptom is a chronic wet cough. This condition presents a considerable health challenge in children, especially in developing countries where access to healthcare may be limited. Although cystic fibrosis (CF)-related bronchiectasis is relatively common, non-CF bronchiectasis, often triggered by post-infectious causes, predominates in pediatric populations. The diagnosis of bronchiectasis is confirmed by demonstrating a bronchoarterial ratio > 0.8 on high-resolution computed tomography. Medical treatment includes mucolytic agents, bronchodilators and antibiotics. Surgical resection of affected lobes may be necessary in cases of severe, localized disease or recurrent hemoptysis, though this is rare in children. Timely diagnosis and well-directed management are crucial to prevent further clinical deterioration and to maintain optimal pulmonary function.
Objective: This study examines whether the oral mycobiome of pediatric patients with newly diagnosed hematologic or oncologic malignancies differs from that of healthy children before treatment begins. Methods: The study included 117 children under 18 years of age: 67 patients and 50 healthy controls. Oral swab/rinse samples were cultured on various agar media, and fungal species were identified using conventional methods, API ID 32C, and MALDI-TOF MS. Antifungal susceptibility testing of non-albicans Candida (NAC) isolates was performed using VITEK2. Results: Yeast growth was observed in 58.2% of patients and 68% of healthy children. Candida albicans was the most frequently isolated species in both groups (43.2% in patients, 40% in controls), followed by Candida kefyr (8.95% and 6%, respectively). The patient group showed higher C. albicans colonization, while the control group had more NAC and mixed yeast colonization. Non-Candida yeasts were isolated only in healthy children (6%). However, none of these differences were statistically significant. Antifungal susceptibility testing revealed one C. kefyr isolate from a patient had a high MIC for amphotericin B (MIC=16 mu g/mL). C. glabrata isolates from one patient and one healthy child were dose-dependent susceptible to fluconazole. A Candida haemolunii isolate from a healthy child had high MIC values for both fluconazole and amphotericin B (MIC=8 mu g/mL). No molds were isolated. Malassezia spp. was detected in only one healthy child. Conclusion: While some differences were observed in yeast colonization rates and species distribution, the overall oral mycobiome of untreated pediatric malignancy patients did not differ significantly from that of healthy children. Further studies are required.
Objective: Meteorin-like protein (METRNL), soluble CD14 subtype (presepsin), and bone morphogenetic protein 9 (BMP9) show promising for sepsis diagnosis and prognosis assessment in children. Their diagnostic and prognostic utility is comprehensively assessed in this study. Methods: A total of 360 children, aged 3-14 years, with sepsis, infection, and healthy groups were retrospectively analyzed. Receiver Operating Characteristic curve evaluated the diagnostic performance of METRNL, presepsin, and BMP9 for sepsis. The 28-day prognostic information was collected for the sepsis group. Risk factors for poor prognosis in the sepsis group were analyzed using logistic regression. A nomogram prediction model for prognostic prediction in the sepsis group was developed. Results: In differentiating healthy from infection, the combination diagnostic of METRNL, presepsin, and BMP9 showed excellent accuracy with an area under the curve (AUC) of 0.969 (95% CI: 0.952-0.987, P < 0.001), sensitivity of 0.925, and specificity of 0.908. In differentiating healthy from sepsis, the combination diagnostic showed enhanced performance with an AUC of 0.999 (95% CI: 0.996-1.000, P < 0.001), sensitivity of 0.983, and specificity of 1.000. In differentiating infection from sepsis, the combination diagnostic showed an AUC of 0.971 (95% CI: 0.950-0.993, P < 0.001), sensitivity of 0.883, and specificity of 1.000. In the sepsis group, 91 patients achieved a favorable prognosis, while 29 had a poor prognosis. The logistic regression analysis identified that METRNL, presepsin, and BMP9 were risk factors for poor prognosis. The nomogram prediction model incorporating these biomarkers showed good prognostic performance with an AUC of 0.823 (95% CI: 0.725-0.922). Conclusions: The METRNL, presepsin, and BMP9 panel offers high clinical value for sepsis diagnosis and prognosis in children. The developed nomogram prediction model provides a useful instrument for early risk assessment and personalized management.
