OBJECTIVES:To characterize the microbiome shifts and subsequent metabolite alterations associated with recurrent wheezing (RW) in infants. METHODS:A total of 33 subjects were enrolled in this study, including 18 infants diagnosed with RW, and 15 normal infants as controls. Bronchoalveolar lavage (BAL) fluid was collected from all the subjects. Bacterial DNA was then isolated and analyzed by 16S ribosomal RNA sequencing. In addition, the metabolomic profile of BAL fluid samples was analyzed with mass spectrometry using complementary chromatographic methods. Spearman's rank correlation analysis was conducted to explore associations between microbial taxa and metabolites. RESULTS:The study had 21 (63.6%) boys and 12 (36.4%) girls. The mean age was 26.8 ± 4.9 months. Haemophilus (P = 0.003) and Porphyromonas (P = 0.007) genera showed significant difference between the two groups. The metabolites of "starch and sucrose metabolism pathway" and "pentose phosphate pathway" showed significant correlations with the two bacterial genera. For starch and sucrose metabolism pathway, glucose-6-phosphate showed significant positive correlations with Haemophilus (r = 0.44 and P = 0.009) and Porphyromonas (r = 0.45 and P = 0.008). For pentose phosphate pathway, Sedoheptulose 7-phosphate, an intermediate in the pentose phosphate pathway, showed significantly positive correlations with Haemophilus (r = 0.42 and P = 0.02) and Porphyromonas (r = 0.43 and P = 0.01). CONCLUSIONS:Our study provided new evidence that alteration in respiratory tract microbiome could be associated with RW in infants. By elucidating the microbiome and metabolite profile, we identified novel biomarkers potentially useful for personalized management of RW in infants. The future studies should validate the underlying mechanisms in longitudinal cohorts and explore interventions targeting metabolic-microbial crosstalk.

ObjectiveTo report a case of severe Mycoplasma pneumoniae pneumonia complicated with necrotizing laryngotracheobronchitis, and to detail its clinical manifestations, auxiliary examinations and treatment process, so as to enhance clinicians’ understanding of necrotizing laryngotracheobronchitis and emphasize the indispensable role of bronchoscopy in the diagnosis and treatment of necrotizing laryngotracheobronchitis.MethodsReport on a child with severe Mycoplasma pneumoniae pneumonia complicated by necrotizing laryngotracheobronchitis; the child was a 7 - year - old boy; the clinical features included recurrent high fever, cough and hoarseness; physical examination revealed fair spirits, pharyngeal congestion, grade I tonsillar enlargement, coarse breath sounds in both lungs, and no rales heard; auxiliary examinations confirmed Mycoplasma pneumoniae infection; under bronchoscopy, necrosis of the bronchial mucosa and exposure of cartilage were observed, and the pathological examination of the lesion showed inflammatory necrosis; after anti - infection treatment and multiple bronchoscopic lavage treatments, the child's condition improved and he was discharged from the hospital.ConclusionNecrotizing laryngotracheobronchitis can present with diffuse necrosis of the airway mucosa, has an acute onset and a severe disease progression, and can lead to death; in this case, the child developed necrosis of the tracheal and bronchial mucosa after Mycoplasma pneumoniae infection, and there is currently no report of necrotizing laryngotracheobronchitis occurring after Mycoplasma pneumoniae infection; in treatment, anti - infection treatment should be combined with bronchoscopic lavage treatment.

BackgroundFlexible fiberoptic bronchoscopy is being increasingly carried out under general anesthesia in pediatric patients. However, the optimal anesthetic protocol still remains unclear. This study aims to test the hypothesis that the addition of low-dose rocuronium during laryngeal mask airway-assisted flexible fiberoptic bronchoscopy in children can enhance procedural outcomes and improve overall management.MethodsIn this randomized, double-blind, placebo-controlled trial, 140 children aged 1–6 years scheduled for flexible fiberoptic bronchoscopy under general anesthesia will be randomly allocated in a 1:1 ratio to either the rocuronium group or the normal saline group (n = 70 in each group). All children will receive intravenous propofol at a dose of 3 mg⋅kg–1 and remifentanil at 3 μg⋅kg–1 for anesthesia induction. This will be followed by either intravenous rocuronium at 0.3 mg⋅kg–1 or an equivalent volume of normal saline. Sevoflurane will be titrated to achieve the target anesthesia depth, while remifentanil will be initiated at a rate of 0.05 μg⋅kg–1⋅min–1 and subsequently adjusted as required. Mechanical ventilation will be performed via laryngeal mask airway and the bronchofiberscope is inserted through an adapter connected to the laryngeal mask airway. The primary endpoint, reflecting effectiveness of anesthesia, is the frequency of coughing episodes during the operation. Secondary endpoints include: (1) cumulative remifentanil dosage; (2) failure rate of flexible fiberoptic bronchoscopy operation; (3) hemodynamic changes; (4) cough scores in the post-anesthesia care unit; (5) procedure time; (6) discharge time; (7) adverse events; (8) satisfaction scores of bronchoscopist; (9) satisfaction scores of anesthesiologist; and (10) satisfaction scores of parents 24 h after the operation.DiscussionWe hypothesize that the addition of low-dose rocuronium during laryngeal mask airway-assisted flexible fiberoptic bronchoscopy under general anesthesia may optimize operation conditions, reduce coughing frequency, lower remifentanil dosage and the failure rate, stabilize hemodynamic fluctuations, minimize adverse events and enhance satisfaction, thereby providing valuable reference for clinical anesthesia practice in these procedures.Study Protocol Registrationhttps://www.chictr.org.cn/showprojEN.html?proj=277486, identifier [ChiCTR2500105407].

Background:This study aimed to investigate characteristic changes in the upper respiratory tract (URT) microbiome and metabolome in children with asthma and explore their associations with lung function. Methods:Children with asthma aged 6 years and above admitted to the Children's Hospital of Soochow University from December 2022 to December 2023 comprised the study group. Age-matched healthy children undergoing physical examinations in the Department of Child Health were recruited as controls. Throat swabs were collected for microbiome detection using 16S rDNA sequencing and metabolomics analysis using liquid chromatography-mass spectrometry (LC-MS). Results:(1) Significant differences in alpha and beta diversity were observed among the control group (H), chronic persistent asthma group (CA), and acute exacerbation group (AA). In both CA and AA groups, FVC% predicted (FVC%/Pred) and FEV1% predicted (FEV1%/Pred) were negatively correlated with URT microbiota abundance. Actinobacillus abundance was positively correlated with FEV1%/Pred, FEV1/FVC, FEF25%/Pred, FEF50%/Pred, and FEF75%/Pred. (2) Metabolite differences between CA and AA groups were analyzed, and the top 5 differential metabolites were evaluated for their accuracy as asthma assessment biomarkers. L-carnitine showed an AUC > 0.9, with a sensitivity of 85.7% and specificity of 85%. Other differential metabolites, including monoisobutyl phthalate, 4-hexyl-2,5-dimethyloxazole, and dibutyl phthalate, correlated with several lung function indices. The most relevant differential metabolic pathways included arginine biosynthesis, alanine-aspartate-glutamate metabolism, central carbon metabolism in cancer, and D-amino acid metabolism. Conclusion:The URT microbiota in asthmatic children exhibits alterations in composition, structure, and diversity, with lower diversity in acute asthma compared to chronic persistent asthma. At the genus level, some microbiota (Actinobacillus, Fusobacterium) were correlated with FEV1%/Pred, FEV1/FVC, FEF25%/Pred, FEF50%/Pred, FEF75%/Pred. The differential metabolite L-carnitine may be a potential biomarker for asthma assessment.

Mycoplasma pneumoniae (MP) is a major cause of pediatric respiratory infections, characterized by cyclical epidemics and age- and season-specific patterns. However, long-term epidemiological data spanning multiple epidemic cycles are limited. We conducted a 20-year retrospective study of children (< 18 years) hospitalized with respiratory tract infections and undergoing MP testing at Children's hospital of Soochow University from October 2005 to December 2025. MP infection was defined by positive PCR and/or serological evidence. Positivity was analyzed by age, sex, season, calendar period, and COVID-19 pandemic phase. Among 51,399 specimens, 16,086 were MP-positive (31.30

Background: Chlamydia pneumoniae is an atypical respiratory pathogen that contributes to community-acquired pneumonia in children. However,the clinical manifestations are often non-specific, posing challenges for early identification. The purpose of this study is to summarize the Clinical characteristics of Chlamydia pneumoniae pneumonia in children,thereby facilitating its recognition prior to the availability of pathogen detection results. Methods: Children hospitalized with community-acquired pneumonia between January 1, 2023 to April 30, 2025 in the Department of Respiratory Medicine,Children’s Hospital of Soochow University were enrolled. Nasopharyngeal aspirates or BALF were collected for respiratory pathogen detection and medical records of C. pneumoniae infection were retrospectively collected. Results: Of 15144 hospitalized children with community-acquired pneumonia, 260(1.71%,260/15144) had C. pneumoniae infection.After exclusions criteria, 226 cases with complete data were analyzed.Among the 226 children,the male-to-female ratio was 2:1 with a median age of 11.2 (9.5-13.0)years.Of which,206 (91.15%) patients were aged between 6–15 years old .The average length of hospital stay was 6.54±1.59 days.The most common symptoms were cough (100%), yellow sputum (42.60%),fever (39.38%).The median duration from onset to admission was 7(5.0,10.0)days and median pre-admission fever durations of 5.0(3.0,7.0)days. Radiological examination showed that 95.13% had pulmonary parenchymal changes; 9.64% had unilateral involvement.,mostly in the right lower lobe (31.85%)and 49 left lower lobes(21.68%). Lesions in ≥2 lobes occurred in 6.64% Complications included atelectasis（3.98%）,pleural effusion（3.54%）,and bronchiectasia（1.33%）. All cases were treated with azithromycin or doxycycline，51 cases (22.56%)received fiberoptic bronchoscopy and lavage treatment,with full recovery and no severe outcomes. Conclusion:The detection of C. pneumoniae in children has an increasing trend.C. pneumoniae pneumonia mainly occurs in 6–15-years, characterized by cough, yellow sputum, fever, unilateral lower-lobe parenchymal changes on imaging. Inflammatory markers are normal, complications rare. Macrolides/doxycycline work well with good outcomes.

The aim of this study was to investigate the clinical characteristics of severe pneumonia caused by human bocavirus (HBoV) infection to explore the associated risk factors. We conducted a retrospective review of data from children hospitalized with HBoV pneumonia. Based on the severity of pneumonia, patients were categorized into severe pneumonia and non-severe pneumonia groups. Clinical manifestations, laboratory examination results, chest imaging and pathogens were analyzed. Logistic regression was employed to identify the risk factors for severe HBoV pneumonia. A total of 334 patients were admitted, with 44 (13.17

Background:Pollen is a significant contributor to respiratory allergies worldwide, underscoring the importance of understanding its association with childhood sensitization to enhance clinical management. Objective:This study focuses on investigating the prevalence of various airborne pollens and their correlation with clinical characteristics of childhood respiratory allergic diseases in southeastern China. Methods:From November 2020 to October 2021, this research employed Durham monitoring samplers to collect airborne pollen. Simultaneously, skin prick tests (SPTs) were performed on children with respiratory allergic conditions at the Children's Hospital of Soochow University and standardised questionnaires are also administered to assess children's symptoms. Results:Over the course of November 2020 to October 2021, the study identified more than 36 pollen species. Notably, the spring season (March to May) exhibited the highest pollen concentrations, with Broussonetia accounting for 30.04% and Pinus for 26.38%. Similarly, the autumn months (September to October) saw prominent taxa like Humulus scandens (47.55%) and Gramineae (35.93%). Among the patients, a significant 92.7% exhibited positive reactions, with 81.7% showing sensitization to house dust mites (HMD), 17.8% to pollen, and 3.7% to Cockroach. Noteworthy the five most common pollens were observed for Bermuda (6.0%), Elm pollen (6.0%), Birch pollen (4.6%), and Mugwort (4.6%). The study indicated a substantial multisensitized ratio among pollen-sensitized patients in comparison to non-pollen-sensitized ones (97.4% vs 1.6%, P <0.001). Moreover, weekly total airborne pollen concentrations showed positive correlations with weekly admissions due to allergic rhinitis(AR)(r=0.642, P <0.001), bronchial asthma (BA) (r= 0.472, P<0.001), and the coexistence of AR and BA (r=0.485, P <0.001). Conclusion:The findings found that there were two peaks of pollen count in a year during March-May and September-October. The findings emphasize the critical role of specific airborne pollens in driving sensitization and exacerbating respiratory allergic diseases in children.

ObjectiveThe aim of this study is to investigate the clinical characteristics and pathogens involved in persistent or recurrent pneumonia combined with airway malacia in children. MethodsWe retrospectively reviewed the information of children hospitalised with persistent or recurrent pneumonia, including clinical presentations, laboratory examination results and pathogens. ResultsA total of 554 patients were admitted, 285 (51.44%) of whom were found to have airway malacia. There were 78 (27.37%), 166 (58.25%) and 41 (14.39%) patients with mild, moderate and severe malacia, respectively. Patients with airway malacia were younger than those without malacia (6.0 vs. 12.0 months, p < 0.01) and were more likely to present with wheezing (75.07%), fever (34.39%), dyspnoea (28.77%), cyanosis (13.68%) and wheezing in the lungs (78.95%). The incidence of preterm delivery, oxygen therapy, paediatric intensive care unit (PICU) admission and mechanical ventilation was higher, and the hospital stay (11.0 vs. 10.0 days, p = 0.04) was longer in these patients than in those without malacia. Patients with severe airway malacia were more likely to undergo oxygen therapy, PICU admission, mechanical ventilation and have multiple malacia than were those with mild or moderate malacia. Mycoplasma pneumoniae (30.18%) was the most common pathogen. ConclusionSevere airway malacia likely aggravates conditions combined with pneumonia. The proportion of multisite malacia was greater in severe airway malacia patients.

ObjectiveThis study examines the epidemiology of Mycoplasma pneumoniae (M. pneumoniae) infections among children in Suzhou, China, during various pandemic phases. The goal is to discern evolving epidemic trends and to furnish robust evidence for clinical diagnosis and treatment.MethodsFrom January 1, 2016, to December 31, 2023, 113,625 consecutive patients with respiratory infections from three hospitals in Suzhou, China (Children’s Hospital of Soochow University, Children’s Hospital of Wujiang District, and Affiliated Suzhou Hospital of Nanjing University Medical School), were retrospectively enrolled in a surveillance study. Additionally, in 2023, children hospitalized with M. pneumoniae pneumonia at the Children’s Hospital of Soochow University were tested for genotype (P1 gene typing, SNP genotyping) and macrolide resistance in their bronchoalveolar lavage fluid.ResultsFrom 2016 to 2023, the M. pneumoniae positive detection rate among pediatric respiratory infections fell from a pre-pandemic 21.1% to pandemic lows, then surged to 45.3% post-pandemic. Before the pandemic, peak M. pneumoniae infection rates occurred in summer, followed by autumn. Post-pandemic, the highest peak rates were in autumn. Peak M. pneumoniae detection rates occurred in 2019 and 2023, with a notable increase in children aged 6 and older in 2023. In this study, 200 M. pneumoniae-positive bronchoalveolar lavage fluid (BALF) cases in 2023 were randomly selected and analyzed for P1 genotype and SNP genotype. Among 156 cases, 81.4% were P1 genotype and 18.6% were P2 genotype. The proportion of severe M. pneumoniae pneumonia with the P1 type was significantly higher than that with the P2 type (p < 0.05). Of the 192 samples analyzed, 11 SNP genotypes were identified, with SNP-27 predominating (36.5%), followed by SNP-0 (21.4%), SNP-11 (18.8%), and SNP-34 (17.7%). Of the 192 BALF specimens, 97.3% exhibited macrolide resistance mutations, with A2063G mutations at 96.17%. The mutation rates for the 23S rRNA 2064 and 2,617 were 1.6 and 1.0%, respectively.ConclusionPost-COVID-19 in Suzhou, China, M. pneumoniae infection patterns shifted significantly, with initial NPIs-induced declines followed by a sharp rise in cases, especially impacting school-age children. This trend underscores the importance of ongoing epidemiological surveillance and the development of strategic public health responses.

Plastic bronchitis (PB) is a rare respiratory condition which can result in severe respiratory complications such as respiratory failure and death. Mycoplasma pneumoniae infection is a main etiology cause of plastic bronchitis. However, the pathogenesis of plastic bronchitis complicated by Mycoplasma pneumoniae pneumonia (MPP) has not yet been fully elucidated. Our article aims to explore biomarkers for early prediction of MPP cases complicated with plastic bronchitis. We utilized a protein chip to screen for significantly different proteins among the groups of healthy, general Mycoplasma pneumoniae pneumonia (GMPP) and refractory Mycoplasma pneumoniae pneumonia (RMPP) patients, where layilin exhibited a potent change across biology information technology. Next, we demonstrated the high expression of MUC5AC, MUC5B, and layilin in bronchoalveolar lavage fluid (BALF) of MPP cases complicated with plastic bronchitis. Further study suggested that the level of layilin had a positive correlation with both MUC5AC and MUC5B. A receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of MUC5AC, MUC5B, and layilin in MPP cases with PB. Data show that the three indicators have similar diagnostic ability for MPP children with plastic bronchitis. Then, we used different concentrations of community-acquired respiratory distress syndrome (CARDS) toxin or lipid-associated membrane proteins (LAMPs) to simulate an in vitro experiment. The in vitro assay revealed that CARDS toxin or LAMPs induced A549 cells to secrete MUC5AC, MUC5B, layilin, and proinflammatory factors. These findings suggest that MUC5AC, MUC5B, and layilin are correlated with MPP. The high expression of MUC5AC, MUC5B, and layilin play an essential role in prediction in the development of plastic bronchitis caused by MPP. The high expression of MUC5AC, MUC5B, and layilin may be relevant to the severity of illness.

目的 分析住院腺病毒肺炎患儿选择纤维支气管镜检查和治疗的影响因素.方法 回顾性分析114例住院腺病毒感染肺炎患儿临床资料.其中,23例实施了纤维支气管镜检查和治疗(气管镜组),91例未行支气管镜检查(非气管镜组).分析影响实施纤维支气管镜检查和治疗的因素.结果 两组患儿性别构成比、年龄、发热、咳嗽及喘息的发生率比较均无统计学意义(P＞0.05).Logistic回归分析显示,入院诊断为重症肺炎、住院时间长、CD19+比例高为住院腺病毒肺炎患儿实施纤维支气管镜检查和治疗的影响因素(P＜0.05).结论 住院腺病毒感染肺炎患儿诊治中,对重症肺炎和CD19+比例异常增高者需要考虑实施纤维支气管镜检查和治疗.

目的:研究金蝉口服液的制备及其对社区获得性肺炎(CAP)患者治疗药物经济学的价值.方法:采用水提法和醇沉法,从金银花、黄芩、柴胡、蝉衣等中药中提取有效成分,制备其口服液;收集2018年3-8月间来自住院的CAP患儿80例资料,将其随机分为A组和B组,每组40例;B组患者给予常规治疗,A组患者在B组患者基础上加用金蝉口服液治疗;比较两组患者治疗后的总有效率、临床各指标的复常时间差异,以及分析其药物经济学的成本-效益.结果:A组患者治疗后的总有效率、临床各指标(体温、咳嗽)复常时间、住院总费用、住院天数等方面优于B组(P＜0.05).结论:金蝉口服液的制备工艺简单,在治疗儿童CAP感染中费用较低,缩短住院时间和改善临床指标.

肺动静脉瘘(pulmonary arteriovenous fistula,PAVF)是一种较为少见的肺部血管性疾病,PAVF指肺动脉及分支不经毛细血管而直接与肺静脉相通从而导致肺循环异常“短路”,形成心外型右向左分流,典型的三联征包括劳累性呼吸困难、紫绀和杵状指(趾),并可引起脑梗死、脑脓肿和咯血等并发症[1].PAVF可分为单纯性、复杂性及弥漫性等3种类型,其中弥漫性PAVF更为罕见,临床表现无特异性,误诊率较高.现将我科收治的1例以突发性大咯血为表现的PAVF病例报告如下,并进行文献复习,以提高对本病的认识.

Objective To summarize the epidemiology and evaluate possible age-related differences in the presenting clinical features in three year-old children with Mycoplasma pneumoniae pneumonia(MPP)during 2009 to 2014.Methods The medical records of 17855 children with community-acquired pneumonia enrolled by Children′s Hospital of Soochow University during 2009 to 2014.Totally 1145 younger than three year-old children with MPP were enrolled,and they were classified into three groups of 1 month to 1 year-old group (n=512),1 to 2 year-old group (n=393) and 2 to 3 year-old group (n=240).The epidemiology and possible age-related differences in the presenting clinical features,main laboratory and imaging results in three year-old children with MPP were summarized.Results (1) The highest infection rate of different reasons in Suzhou was in autumn(10.46%),and the lowest was in spring(6.95%),The highest infection rate of different ages was 2 to 3 year-old group(11.61%),and the difference was statistically significant (P<0.05).(2) Compared with 1 month to 1 year-old group(n=512,4.31%) and 1 to 2 year-old group (n=39,10.09%),2 to 3 year-old group (n=240,11.61%) had higher infection rate,more patients with fever(53.9% vs. 77.1% vs. 85.4%) and high fever(16.8% vs. 30.5% vs. 41.4%),longer time to normalization of temperature(3d vs. 5d vs. 6d),but less patients with wheezing(61.3% vs. 52.4% vs. 42.9%) and dyspnea(7.6% vs. 4.6% vs. 3.8%).(3) The differences were statistically significant in the percentage of neutrophils,lymphocytes,CRP and platelet count between different ages(P<0.001).(4) The incidences of large area of lesions in chest X-ray examination among different ages had significant differences(P<0.001).Conclusions MP is one of the important pathogens of respiratory tract infection in younger than 3 year-old children.It can occur in every season,and the highest infection rate of MP is in autumn and spring.In younger than 3 year-old,older patients are more vulnerable to infection of MP,the number of fever and high fever are more,fever duration is longer,but younger patients are more vulnerable to virus infection and prone to dyspnea.Chest X-ray examination shows small patchy shadow in most cases,the younger children are more easily to have large area of lesions and pleural effusion.

OBJECTIVETo study the epidemiological characteristics of respiratory adenovirus (ADV) infections in children from the Suzhou area, China.METHODSThe clinical data of ADV-positive children out of 35 529 children with respiratory tract infections who were hospitalized in the Children's Hospital of Soochow University between January 2006 and December 2015 were retrospectively studied.RESULTSOf the 35 529 children with respiratory tract infections, 440 (1.24%) were ADV-positive. There was no significant difference in the rate of ADV infections between boys and girls (1.18% vs 1.34%). The ADV infection rates of children at the age of <1 year old, 1-3 years old, 3-7 years old and 7-14 years old were 0.39% (71/18 002), 1.12% (103/9 191), 3.14% (201/6 398), and 3.35%( 65/1 938) respectively and the rate increased with age (P<0.01). The ADV infection rates in spring [1.85%(60/8 658)] and summer [2.20%(189/8 606)] were significantly higher than in autumn [0.30%(27/8 952)] and winter [0.69%(64/9 313)] (P<0.01).CONCLUSIONSThe ADV infection rate is increased with age in the children from the Suzhou area, but it is not associated with gender. ADV infections are more common in spring and summer.

We aimed to find the relationship between the clinical characteristics and mucus plug formation and developed models to predict mucus plug formation in refractory Mycoplasma pneumoniae pneumonia (RMPP) infection. Methods: RMPP patients treated with bronchoscopy were retrospectively enrolled in the study between November 2011 and November 2015. Multivariate logistic regression was performed to identify independent predictors of mucus plug formation. Results: Of the 173 RMPP patients enrolled, the mucus plug group accounted for 82 (47.4%) cases. Multivariate logistic regression analysis identified age, fever duration, C-reactive protein (CRP) and lactic dehydrogenase (LDH) as independent risk factors for mucus plug. We assigned one point for age, length of fever and CRP and two points for LDH. Using this predicted score, we identified patients with mucus plug with 71.8% sensitivity and 78.9% specificity. Conclusions: Our predictive models based on demographic and laboratory variables accurately predicted mucus plug formation in initial treatment of patients with RMPP.

The present study evaluated the association between different Mycoplasma pneumoniae (M. pneumonia) genotypes and clinical features of pediatric patients. Subjects were children diagnosed with community-acquired pneumonia at the Children's Hospital of Soochow University (Suzhou, China) from January 2012 to December 2013. Clinical and laboratory tests were conducted and clinical samples positive for M. pneumoniae were genotyped by nested-multiplex polymerase chain reaction. Three type I strains and three type II strains were also randomly selected for sequencing. A total of 335 clinical samples positive for M. pneumoniae were obtained. The average age of M. pneumonia-infected pediatric patients was 4.8±3.3 (years). Genotyping results identified 304 positive samples as group I strains and 30 samples as group II strains, in which 1 sample was type II variant 2a. It was also observed that point mutations were more likely to occur in type I strains compared with type II strains. Although clinical pulmonary infection scores between patients with type I and type II strains did not significantly differ, patients with type I strains had a higher risk of developing severe M. pneumoniae pneumonia (SMPP) and extrapulmonary complications, and had significantly higher percentages of peripheral blood neutrophils than patients with type II strains (P<0.05). Collectively, these data indicate that the predominant strains of M. pneumoniae in Suzhou between 2012 and 2013 were type I, and that pediatric pneumonia patients with type I strains of M. pneumoniae were more likely to progress to SMPP.

OBJECTIVE:To explore the distribution and clinical manifestations of rhinovirus infection in wheezing children, and compare the clinical differences between rhinovirus- and respiratory syncytial virus-induced wheezing. MATERIALS AND METHODS:This prospective cohort study was carried out in Children's Hospital of Soochow University from Dec 2012 to Nov 2014. We enrolled consecutive hospitalized children <60 months of age presented with wheezing. Clinical data including cough, fever, dyspnea, crackles were recorded by pediatricians on the first day of admission. Meanwhile, nasopharyngeal aspirates were obtained to test for respiratory viruses, by using polymerase chain reaction method for rhinovirus, human bocavirus, and human metapneumovirus, and direct immunofluorescence assay to test for respiratory syncytial virus, adenovirus, parainfluenza virus types 1-3, and influenza virus types A and B. RESULTS:Rhinovirus was a main causative agent isolated in 14.7% of the hospitalized wheezing children in Suzhou, China, being second to respiratory syncytial virus (21.0%). Different from respiratory syncytial virus infection, which peaked in winter months, rhinovirus could be detected all year round, peaked between July and September, and in November. Children with rhinovirus infection were older and presented with more often allergic sensitizations, blood eosinophilia, and leukocytosis than those of respiratory syncytial virus infection. Logistic regression analysis revealed that rhinovirus-infected children experienced earlier wheezing more often than respiratory syncytial virus children (odds ratio, 3.441; 95% confidence interval, 1.187-9.979; p=0.023). CONCLUSION:Rhinovirus was a main viral pathogen in wheezing children, especially in summer time. Rhinovirus-induced wheezing was different from respiratory syncytial virus, apart from seasonal epidemics; these two groups differed with regard to age, allergic sensitizations, laboratory test, and history of wheezing episodes.

OBJECTIVETo analyze the clinical characteristics of protracted bacterial bronchitis (PBB) in children.METHODThe clinical data of patients seen from October, 2010 to March, 2014 in Department of Respiratory Diseases of our hospital were retrospectively analyzed. Inclusion criteria were over 4 weeks cough, receiving fiberoptic bronchoscopy, positive bacterial culture and (or) the increased percentage of neutral granulocytes in bronchoalveolar lavage fluid (BALF).RESULTTwenty eight patients were involved, 26 were male (93%) and two were female (7%). The median age of patients was 8.5 months. The median duration of cough was four weeks. The average length of hospital stay was (8.3 ± 3.9)days. The main clinical feature was wet cough in 28 cases, wet cough with wheezing was seen in 21 cases. The wet cough phase distribution was irregular in 21 cases. The crackles with wheeze (in 21 cases) was main signs of PBB. The percentage of CD3⁻ CD16⁺ 56⁺ cells increased in peripheral blood. The fiberoptic bronchoscopic manifestations of PBB were luminal mucosal edema. Eleven patients also had airway malacia. The neutrophil median in BALF was 0.2. The positive rate of bacterial culture of BALF was 36%. The main bacteria were Streptococcus pneumoniae (50%) and Haemophilus influenzae (30%). The main treatment for PBB patients included amoxycillin/clavulanate potassium and second-generation cephalosporins. The average duration of treatment was (17.3 ± 3.2)days, the prognosis was good.CONCLUSIONPBB is common in male infants. Persistent wet cough with wheezing was the main characteristic of PBB. PBB is commonly accompanied by immune dysfunction and airway malacia, and the pathogens were Streptococcus pneumoniae and Haemophilus influenzae.