BACKGROUND:The COVID-19 pandemic has affected the epidemiology of Mycoplasma pneumoniae pneumonia (MPP). This study aimed to provide a comprehensive overview of research trends, challenges, and advancements in pediatric MPP, particularly in the post-COVID-19 era. METHODS:A bibliometric analysis of pediatric MPP literature (1992-2025) from the Web of Science was conducted using VOSviewer and CiteSpace. RESULTS:A total of 2357 relevant articles were published by 11,318 authors from 2714 institutions across 94 countries. Publications increased significantly during and after the COVID-19 pandemic. China and the United States were the most influential countries, while Soochow University and Capital Medical University were the most active institutions. The top 10 co-cited references included four research articles and six review articles. Over the past 34 years, the research focus has shifted from community-acquired pneumonia (CAP) and pediatric pulmonary diseases to MPP. Current research hotspots include epidemiology, diagnostics, macrolide resistance, refractory MPP, and co-infections, with recent citation bursts related to COVID-19. CONCLUSION:This bibliometric analysis provides a systematic overview of pediatric MPP research from the 1990s to the post-COVID-19 era. It highlights the need for stronger global collaboration and further epidemiological studies to address MPP-related challenges, especially amid evolving infectious threats like COVID-19. IMPACT:This study offers a comprehensive overview of pediatric Mycoplasma pneumoniae pneumonia (MPP) research from 1992 to 2025, revealing critical changes and advances in the field. Detailed analyses of core contributors, thematic evolution, research hotspots and frontiers advance the overall understanding of pediatric MPP. The findings reveal persistent challenges in epidemiology, diagnostics, macrolide resistance, refractory MPP, and co-infections. This study highlights the necessity of strengthening global collaboration and conducting continuous epidemiological surveillance on MPP amid emerging infectious threats such as COVID-19. These results provide valuable insights for addressing clinical challenges and developing novel therapeutic strategies.

The WHO Southeast Asia and Western Pacific regions, home to more than half of the world's population, bear a disproportionate burden of antimicrobial resistance (AMR), including some of the most severe resistance patterns. The convergence of rapidly growing economies and persistent health system challenges in these regions creates a critical platform for understanding the dynamics of AMR and developing scalable governance approaches relevant to other low- and middle-income countries. This Viewpoint reviews current progress in AMR governance globally and study regions, with a focus on country-specific National Action Plans, and highlights the discrepancies between policy intentions and actual implementation. Implementation science, developed to address research-to-practice gaps, provides a systematic framework for identifying and overcoming barriers to implementation, thereby translating political commitments into actionable interventions. Given the cross-sectoral complexity of AMR, we propose novel strategic priorities to enhance AMR governance by embedding implementation science within the One Health approach. This involves a four-step process: selecting and adapting evidence-based practices, assessing multilevel barriers and enablers, selecting, using and adapting implementation strategies, and evaluating and sustaining their impact. Together, this framework provides a blueprint for localising and operationalising overarching policy concepts into concrete, context-specific actions, with potential lessons for other regions globally.

To assess the prevalence and genetic basis of pretomanid (Pa) resistance, further to generate additional MIC data to support ECOFF/breakpoint setting in the microdilution system. Mycobacterium tuberculosis (MTB) isolates were collected from national drug resistance surveillance regions, with no prior pretomanid exposure. All strains were sub-cultured on Löwenstein-Jensen medium and tested against 12 anti-tuberculosis drugs with the Sensititre® MYCOTB plate. Pretomanid was serially diluted in 7H9 broth supplemented with 10

To characterize the mutation profile of the ahpC gene in isoniazid resistance (INHr) Mycobacterium tuberculosis (MTB) isolates and to evaluate the correlation between specific mutations and resistance levels, a total of 1,337 INHr MTB isolates were collected through the Chinese Drug Resistance Surveillance Program (2013-2020). The minimum inhibitory concentrations (MICs) for INH, rifampicin (RIF), and ethionamide were determined by broth microdilution, followed by whole-genome sequencing analysis. Among 1,337 INHr-MTB isolates, 45.5% (608/1,337) were multidrug-resistant (MDR), and 54.5% (729/1,337) were RIF-sensitive cases, with lineage 2 predominating (1,013/1,337, 75.8%). Resistance mutations were identified in 79.1% (1,058/1,337) of strains, primarily katG Ser315Thr (65.5%, 695/1,058) and inhA C-777T (19.7%, 208/1,058). Notably, 5.3% (56/1,058) isolates harbored standalone ahpC mutations, with 83.3% (5/6) C-81T, 60.0% (9/15) G-48A, 57.1% (4/7) C-54T, 50.0% (3/6) C-57T, and 42.1% (8/19) C-52T mutations showing high-level INH resistance. Accordingly, 91.7% (11/12) dual katG315+inhA mutations conferred high-level INH resistance, while ahpC C-57T mutants universally exhibited MDR. The ahpC mutations are associated with high-level INH resistance in variants without concurrent katG or inhA mutations. This finding significantly advances our understanding of tuberculosis resistance profiling, enabling more comprehensive detection of INHr-MTB and optimizing therapeutic strategies.IMPORTANCEAmong INH-resistant MTB clinical isolates, mutations in the ahpC promoter region have been considered to occur in combination with other mutations, such as katG and inhA, in a compensatory role. While the ahpC mutations have been incorporated into the World Health Organization (WHO)-recommended rapid diagnostic test, Xpert MTB/extensively drug-resistant tuberculosis (XDR), it has been still ambiguous about the standalone effects on INH resistance spectrum. Our findings demonstrate that the ahpC mutations are associated with high-level INH resistance in variants without concurrent katG or inhA mutations. This finding significantly advances our understanding of TB resistance profiling, enabling a more comprehensive detection of INHr-MTB and optimizing therapeutic strategies.

Background:Antimicrobial resistance (AMR) constitutes a critical global health challenge with major implications for public health and economic stability, increasing infection- and sepsis-related mortality. Despite growing evidence on its contribution to disease burden, comprehensive assessments of long-term trends at the regional level remain limited in the World Health Organization (WHO) Southeast Asia Region (SEAR) and Western Pacific Region (WPR). Methods:We used data from the Global Research on Antimicrobial Resistance (GRAM) Project to evaluate sepsis- and AMR-related deaths and disability-adjusted life-years (DALYs) for 11 infectious syndromes, 22 pathogens, and 84 pathogen-drug combinations across 42 countries and territories in the WHO SEAR and WPR from 1990 to 2021. AMR burden was estimated under two counterfactual scenarios: deaths and DALYs attributable to AMR (representing the burden if drug-resistant infections were replaced by drug-susceptible infections), and deaths and DALYs associated with AMR (representing the burden if infections did not occur at all). We reported numbers, crude rates, and age-standardized rates, and generated forecasts of AMR burden to 2050 using an autoregressive integrated moving average model. Results:In SEAR and WPR, there were 8.36×106 [95% uncertainty interval (UI) 7.93-8.79] sepsis-related deaths in 1990, which decreased to 6.03×106 (95% UI 5.68-6.39) in 2019 before increasing to 8.31×106 (95% UI 7.86-8.76) in 2021. The number of deaths associated with AMR ranged from 2,445,875 (95% UI 2,221,769-2,670,192) in 1990 to 2,358,190 (95% UI 2,173,521-2,545,190) in 2021, while deaths attributable to AMR ranged from 546,479 (95% UI 487,669-605,277) to 587,103 (95% UI 534,165-639,903) over the same period. From 1990 to 2021, deaths attributable to AMR decreased among people <25 years, with a 76.1% [95% confidence interval (CI) 70.6-81.6] reduction occurring among children <5 years, while those among adults aged ≥70 years more than doubled, increasing from 133,013 (95% UI 124,066-141,922) to 298,366 (95% UI 284,023-312,475). The largest increase in the number of deaths attributable to AMR was caused by methicillin-resistant Staphylococcus aureus [from 30,168 (95% UI 24,956-35,351) in 1990 to 66,946 (95% UI 57,544-76,479) in 2021]. In 2021, Kiribati had the highest age-standardized mortality rate (per 100,000 person-years) attributable to AMR [30.9 (95% UI 24.1-37.8)], whereas New Zealand had the lowest [3.2 (95% UI 2.6-3.8)] among the two regions. By 2050, the number of deaths associated with AMR is predicted to reach 3,875,753 (95% UI 1,502,402-9,998,297) in these two regions, of which 952,592 (95% UI 766,353-1,184,090) deaths are attributable to AMR. Conclusions:This study highlights the escalating burden of AMR in SEAR and WPR, emphasizing the urgent need for attention to this persistent and growing crisis. Our analyses underscore the dual challenge of sustaining gains among people <25 years while addressing the alarming increase of AMR in elderly populations. Given the high variability of AMR burden by pathogen, age group, and country, strengthened surveillance and improved laboratory capacity are essential to accurately characterize resistance patterns and guide clinical decision-making.

Pediatric postinfectious bronchiolitis obliterans (PIBO) is a long-term sequela of severe lower respiratory tract infection. However, the underlying pathogenic mechanisms within the airways remain poorly understood. Bronchoalveolar lavage fluid (BALF) from six children with PIBO and three control children was subjected to transcriptomic, proteomics and untargeted metabolomics analyses. Integrated analysis identified key differentially expressed candidates, among which protein candidates were subsequently validated by ELISAs. Transcriptomic analysis revealed altered pathways in the BALF of children with PIBO, including pathways related to epithelial differentiation, inflammatory responses, and metabolic processes involving amino acids, purines, lipids, and vitamins. Proteomic analysis further revealed epithelial injury, inflammatory activation, tissue remodeling, and metabolic dysregulation in PIBO patients. Protein–protein interaction (PPI) network analysis identified CXCL8 (interleukin-8, IL-8) as the central hub. Integrative transcriptomic-proteomic correlation analysis further revealed that CXCL8 transcript levels were correlated with the greatest number of differentially expressed proteins (DEPs). Subsequent ELISA validation confirmed elevated CXCL8 protein levels in children with PIBO, which were positively correlated with the predicted FEV1

This comprehensive interpretation of the World Health Organization’s Global Tuberculosis (TB) Report 2025 integrates data from 2024 to appraise worldwide and Chinese TB epidemic trends, progress in control measures, and persisting challenges. The estimated 10.7 million incident cases and 1.23 million deaths worldwide correspond to decreases of only 12% in incidence and 29% in mortality since 2015, far short of the 2025 End TB milestones of −50% and −75%. Drug resistant tuberculosis (DR-TB) remains a formidable obstacle: 390,000 people developed multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB), only 42% of whom accessed treatment, and China accounted for 7.1% of this burden. Although China achieved the target 20% decrease in incidence, its 696,000 cases, including 28,000 with MDR/RR-TB, still ranked among the highest worldwide, and the 2.4-million global case-detection gap underscored diagnostic deficits. Herein, we synthesize advances in rapid molecular assays, 6-month all-oral regimens (BPaLM/BPaL), 18 novel vaccine candidates (six in phase III), shorter preventive therapy, and digital adherence tools. Moreover, we map fragile health systems, comorbidities, catastrophic costs, and a funding shortfall of US $16 billion. Finally, we propose multi-sector accountability, universal health coverage, social protection scale-up, and sustained research and development investment to accelerate progress toward the 2030 elimination goal.

OBJECTIVES:Non-sputum based, child-friendly triage tests are urgently needed to achieve accurate diagnosis and monitoring of tuberculosis (TB) in children. We aimed to assess an Xpert MTB Host Response (MTB-HR) assay, which provides a TB score based on the mRNA expression level of three host genes, for diagnosis and differentiation TB in children and adolescents. METHODS:The multicenter, prospective study was conducted in four provinces of China among children and adolescents who were admitted to hospitals for TB or latent tuberculosis infection (LTBI) screening. Subjects were included in the evaluation of Xpert-MTB-HR from February 2020 to December 2021. Baselines of TB scores were analyzed in healthy children and adolescents with various ages. Accuracy was evaluated in subjects with various TB status, including microbiological data, disease severity and age. RESULTS:Based on a composite clinical reference standard, among 780 patients enrolled, 403, 41, 109, and 227 were diagnosed as TB, LTBI, non-TB infectious diseases (DC) and healthy controls (HC), respectively. The mean TB scores decreased from 4 (IQR, 3·54-4·46) in infants to 0·91 (IQR, -0·23-2·04) in adolescents aged 17-18 years old. Using the composite clinical reference standard, the area under curves (AUCs) of the MTB-HR assay in discriminating ATB from HC, LTBI, and DC were 0·786 (95% CI, 0·749-0·823), 0·652 (95% CI, 0·559-0·744) and 0·771 (95% CI, 0·718-0·823), respectively.The optimal cutoff value was less than or equal to 2·675, resulting a sensitivity of 75·9% (95% CI, 67·0%-80·9%) and specificity of 70·5% (95%CI, 60·3%-76·7%) in TB diagnosis. The MTB-HR assay showed better auxiliary effect for diagnosis of ATB in children younger than five years of age (AUC, 0·885, 95% CI, 0·824-0·945, P=0·0006). The mean TB scores elevated at one month (P=0·0009) and three months (P=0·0061) after anti-TB treatment initiation. CONCLUSIONS:The MTB-HR assay showed potential for ATB diagnosis and treatment monitoring in children and adolescents, especially in ages under five years old.

Child-friendly triage tests that do not rely on sputum for diagnosing active tuberculosis (ATB) in children are urgently required. This study aimed to assess a chemiluminescence-based urinary lipoarabinomannan test (AIMLAM) for diagnosing tuberculosis (TB) in children in China. Among the 579 children enrolled, 331 had TB, 169 had infectious diseases, and 79 were healthy controls. The area under the ROC curve of the AIMLAM test for distinguishing TB from non-TB (children with infectious diseases and healthy controls) was 0.74 (95% confidence interval [CI], 0.70-0.78), with a sensitivity of 52.2% (95% CI, 46.6%-57.6%) and a specificity of 91.9% (95% CI, 87.6%-94.9%). In 288 children with clinically diagnosed TB, the sensitivity of the test was 50.0% (95% CI, 44.1%-55.9%). LAM concentrations in extrapulmonary TB were significantly higher than those in pulmonary TB (P = 0.003), which resulted in a higher sensitivity of 63.6% (95% CI, 54.7%-72.1%). The diagnostic sensitivity of AIMLAM was significantly superior to that of Xpert (P = 0.004) and Ultra (P = 0.002). The sensitivity of AIMLAM is moderate but highest in extrapulmonary TB patients. The test appears to be promising for the rapid diagnosis of TB in children, especially in those with negative bacteriological results. IMPORTANCE:This study of a large-sample cohort of children in China assessed the diagnostic accuracy of the AIMLAM test kit as an auxiliary tool for childhood TB, and to determine an age-specific reference interval for LAM concentrations in children. Our findings showed that the overall sensitivity of AIMLAM was moderate, whereas a higher sensitivity was observed in patients with bacteriologically confirmed and severe TB. Age-specific cutoff values may be needed to optimize the diagnostic model in children. These results provide preliminary evidence for a method of diagnosing ATB in pediatric patients with samples that are difficult to obtain.

This study examined 79 endocrine-disrupting chemicals (EDCs) in 99 normal and 53 paired malformed pediatric lung tissues with congenital pulmonary airway malformation (CPAM). In normal tissues, 35 EDCs were identified in over 50 % of cases. The most abundant compounds were phthalates (216-9395 ng g-1 ww) and their metabolites (24.1-421 ng g-1 ww), followed by organophosphate esters (66.4-2678 ng g-1 ww) and their metabolites (14.2-283 ng g-1 ww). Other EDCs with detection frequencies higher than 50 % included 3 parabens, 2 bisphenols, 2 alkylphenols, benzophenone-3, and triclosan, indicating a complex exposure scenario in pediatric lungs. Although only four targeted EDCs might pose gender-specific risks, more than half of these EDCs exhibited age or developmentally dependent distribution patterns, highlighting the impacts of physiological factors on EDC exposure in children. Besides, 20 out of 35 EDCs differed significantly between normal and adjacent malformed tissues, with 17 elevated in malformed tissues (p < 0.05). Transcriptome analysis was performed in 8 samples and identified 62 differentially expressed genes associated with CPAM. Exposure levels of 19 out of 20 EDCs correlated significantly with these genes, which may be involved in pathways of chemical carcinogenesis, cytokine and hormone signaling. These findings highlight the vulnerability of pediatric lungs to EDC mixtures and emphasize the need for exploration the underlying mechanisms of EDC exposure in respiratory diseases in children.

To investigate the ascending aorta (AAO)–descending aorta (DAO) outer/internal distance index (AAO–DAO ODI/IDI) prediction value for fetal complete transposition of the great arteries (D-TGA). Selected D-TGA fetuses between January 2019 and June 2024 as the D-TGA group and an equal number of normal fetuses (gestational age (GA) matched ± 1 week) as the control group. The AAO–DAO outer/internal distance (AAO–DAO OD/ID) and DAO diameter were measured in the aortic arch long-axis view, and the AAO–DAO ODI/IDI were calculated, which are the ratios of AAO–DAO OD/ID to DAO. The relationship between AAO–DAO OD/ID and AAO–DAO ODI/IDI and GA of the normal group was analyzed. The differences in AAO–DAO ODI/IDI between the D-TGA and the normal fetuses were compared, and the difference between the D-TGA with intact ventricular septum (D-TGA-IVS) and the D-TGA with ventricular septal defects (D-TGA-VSD) was compared. The sensitivity and specificity of the receiver operating characteristic (ROC) curve were applied to analyze the discrimination ability of AAO–DAO ODI/IDI for D-TGA and normal fetuses and D-TGA-IVS and D-TGA-VSD. In the normal control group, the DOA ICC was 0.972 (95

Background:Lower respiratory tract infections (LRTI), which are most commonly caused by Streptococcus pneumoniae (SP) and respiratory syncytial virus (RSV), pose a substantial global health burden in children. However, the causal pathways of bacterial-viral co-infections, particularly the mechanisms by which commensal microbiota could modulate SP-RSV-associated LRTI outcomes remain to be elucidated. Methods:A population-based cross-sectional study was conducted on children aged 0-18 years who were admitted to Beijing Children's Hospital and Baoding Children's Hospital in China from September 2021 to August 2022. Children with LRTI who underwent respiratory pathogen testing were divided into SP single infection and SP-RSV co-infection groups, with sex- and time-matched non-LRTI children as controls. Sputum and LRT secretion samples were collected for microbiota analysis using 16S rRNA sequencing, and child characteristics were obtained from medical records and pharmacy data. Results:A total of 125 children with LRTI (84 with SP infection and 41 with SP-RSV co-infection) and 87 children without LRTI were recruited for this study. We found that LRT microbiota composition was strongly related to age, with a more pronounced increase in Shannon index within the first 5 years of life. Children with SP and RSV infection exhibited significantly altered microbiota composition in comparison to children without LRTI, particularly a higher abundance of Streptococcus. The competitive interactions among respiratory bacteria were found to be more complex in the SP single-infection group and simpler in the SP-RSV co-infection group. Conclusion:Our findings show that RSV co-infection exacerbates SP-induced LRTI microbiota disorder and disease severity. This study may help us to better understand the characteristics of SP-RSV interaction and provide direction for the pathogen diagnosis of LRTI.

Background/Objectives The conclusions regarding PD-1/PD-L1 expression and its role as a predictive biomarker for treatment efficacy had been inconsistent in previous clinical trials of PD-1 monoclonal antibodies therapy for hepatocellular carcinoma (HCC). Therefore, this study aimed to analyze the expression of PD-1/PD-L1 in HCC patients treated with PD-1 in real-world settings and to evaluate its predictive value for treatment outcomes. Methods: A retrospective study was conducted on 59 pathologically confirmed HCC patients. PD-1/PD-L1 expression in tumor tissues was assessed via immunohistochemical staining. Clinical characteristics, laboratory parameters, pathological features, and therapeutic outcomes were compared between two groups. Results: Among 59 patients, 12 (20.33%) were PD-1-positive and 18 (30.51%) were PD-L1-positive. The PD-1-positive group exhibited a higher incidence of lymph node metastasis (41.7% vs. 14.9%, P = 0.040) and lower neutrophil counts (3.32 ± 1.19 vs. 4.02 ± 2.22, P = 0.020) compared to the negative group. The PD-L1-positive group showed increased lymph node metastasis (41.2% vs. 14.3%, P = 0.024), reduced platelet counts (136.41 ± 38.18 vs. 148.17 ± 64.13, P = 0.020), higher proportions of poorly differentiated histology (91.7% vs. 44.7%, P = 0.002), and elevated Ki67 expression (54.2 ± 29.3 vs. 37.8 ± 22.4, P = 0.039). However, no significant differences were observed in objective response rate or progression-free survival between PD-1/PD-L1 positive and negative groups(P>0.05). Conclusions: PD-1/PD-L1 expression in HCC tissues is associated with distinct clinicopathological features but demonstrates no significant predictive value for anti-PD-1 therapy efficacy.

BACKGROUND:Pneumothorax in intensive care units (ICU) patients is frequently associated with increased mortality. The serum anion gap (AG) is widely used in clinical practice as an indicator of acid-base disturbances and metabolic acidosis. The association between serum AG and 28-day mortality in critically ill patients with pneumothorax has not been well established. OBJECTIVE:This study aims to investigate the impact of serum AG on 28-day mortality in critically ill patients with Pneumothorax. METHODS:A retrospective cohort study was conducted involving 1844 participants diagnosed with Pneumothorax and admitted to ICU. Vital signs, laboratory parameters and comorbidities were collected for all participants to analyze the association between AG levels and 28-day mortality. RESULTS:A total of 1844 critically ill patients with pneumothorax were included in the study. The mean age was 59.6 years, and 62.4 % were male. The overall 28-day mortality rate was 16.5 %. A greater AG on admission was significantly associated with increased 28-day mortality in unadjusted analysis (hazard ratio [HR] 1.13; 95 % confidence interval [CI] 1.12-1.15; p < 0.001). After adjusting for all confounders, the association remained significant (adjusted HR 1.04; 95 % CI 1.01-1.07; p = 0.003). When AG was converted into categorical variables (quartiles), the risk of 28-day mortality in the greatest Q4 group was significantly higher compared with that in the lowest Q1 group (Model 4: HR = 3.3, 95%CI: 1.89-5.75, p < 0.001). CONCLUSION:A greater AG on admission was independently associated with increased 28-day mortality in critically ill patients with pneumothorax.Further research is needed to explore the underlying mechanisms of these associations.

Tuberculosis screening in pediatric lupus nephritis (LN) patients presents unique diagnostic challenges. This study aimed to analyze the frequency of indeterminate QuantiFERON-TB Gold Plus (QFT-Plus) results among children with LN and the potential influence factors. A retrospective cohort study was conducted among patients under 18 years old with a confirmed diagnosis of LN screened for tuberculosis infection from January 2023 and August 2024. Demographic and clinical data were extracted from their electronic medical record, with categorical variables presented as frequencies and continuous variables as medians. Using SPSS 18.0 (Chicago, IL), we first performed univariate logistic regression to identify factors associated with indeterminate IFN-γ results (P < 0.05), then entered significant variables into multivariate models to determine independent predictors, reporting results as ORs, with statistical significance set at P < 0.05. Of 111 patients with LN, 49 (44.14

Difficulties in microbiologically confirming childhood tuberculosis (TB) can result in delayed treatment and increased disease severity. In this study, we for the first time used whole genome next-generation sequencing (NGS) to detect cell-free DNA (cfDNA) from Mycobacterium tuberculosis (MTB) in plasma from children. We enrolled 94 children with active TB and 32 children with other respiratory infections. Combining NGS with probe capture enrichment (targeted cfNGS) showed higher coverage and detecting capability than did NGS alone. The targeted cfNGS showed slightly lower sensitivity (31.9

The human gut microbiota is an important modulator of host immune responses and has a crucial role in the development of tuberculosis (TB). Evidences suggest that metabolites may function as a bridge between gut microbiome and TB progression in children. However, the underlying interactive mechanisms are not well explored. The results may provide useful insight into the role played by the gut microbiome in pulmonary TB in children. To explore the gut bacterial features and its interaction with plasma lipid metabolisms in children with TB. We enrolled children aged younger than 14 years old from Beijing Children’s Hospital and West China Second Hospital between January 2020 and June 2021. We investigated the gut bacterial community using 16S rRNA sequencing of 98 children with active TB, 37 other infectious diseases, and 80 healthy children. The plasma lipids were further analyzed using ultra-high-performance liquid chromatography coupled with mass spectrometry. Children with TB showed decreased diversity and species richness indices compared to healthy children. Significant increases in the abundance of Firmicutes and Actinobacteriota combined with a decrease in the abundance of Bacteroidetes and Proteobacteria were also observed in TB children when compared with healthy controls. Among children with TB, gut bacterial composition differed in subgroups with pulmonary and extrapulmonary TB, or subgroups with different Mycobacterium tuberculosis (MTB) load. Children with TB had a higher risk of fever (OR = 3.02, P = 0.005) and poor appetite (OR = 2.96, P = 0.02) than the controls. Several bacterial genera were associated with severe illness and clinical indices, such as aspartate aminotransferase levels and fever. The plasma lipids showedc difference between TB patients and the children with other infectious diseases. Eight genera with the highest relative abundance strongly correlated with the plasma lipids. The gut microbiome is compromised in TB children, with a correlation with the plasma lipid metabolites and clinical presentations. Integrating analysis of microbiome and metabolism may help improve precise diagnosis, treatment, and mechanism study for TB in children.

Background:Mycoplasma pneumoniae (M. pneumoniae) is a leading cause of community-acquired pneumonia in children. Post-COVID-19, a significant resurgence of M. pneumoniae infections has been observed in China, but whole-genome analyses on the genetic mechanisms driving this resurgence remain limited. Methods:We performed whole-genome sequencing on 169 M. pneumoniae isolates from Beijing and Baoding, collected before and after COVID-19. All M. pneumoniae genomes from GenBank were included for analysis. Genotypes were identified using multilocus variable-number tandem-repeat analysis (MLVA), multilocus sequence typing (MLST), phylogenetic analysis. Genomic conservation and transmission patterns were assessed via SNP distance. Findings:We identified a post-COVID-19 resurgence of M. pneumoniae infections among children, with infection rates peaking at 60%-70% in late 2023, higher than during the pandemic (10%-20%) and pre-pandemic (∼30%). Genomic analysis revealed distinct genotypes, with T1-2 (4-5-7-2) dominating in Beijing, and both T1-2 and T2-2 (3-5-6-2) prevalent in Baoding. Minimal SNP distances and genomic conservation indicated rapid spread of M. pneumoniae. Genomic analysis uncovered key genetic factors driving the outbreak: near-100% macrolide resistance and increased prevalence of the 4-5-7-2 genotype (enriched in virulence and metabolism-related genes). Interpretation:This study provides a comprehensive genomic analysis of genetic factors driving the outbreak. With near-100% macrolide resistance in China, urgent changes in treatment policies are needed. The rising prevalence of 4-5-7-2 and its functional advantages warrant close monitoring. Our findings offer insights into the outbreak causes and guide future prevention and control strategies. Funding:National Key R&D Program of China; Training Plan for High level Public Health Technical Talents.

BACKGROUND:Mycoplasma pneumoniae (MP) is a major cause of pediatric respiratory tract infections (RTIs), with recent increases in incidence and macrolide resistance. The epidemiology of MP, macrolide-resistant MP (MRMP), co-infection patterns, and their relationship with disease severity in the post-COVID era remain poorly understood. We analyzed temporal trends in MP infection and MRMP prevalence and assessed their association with severe community-acquired pneumonia (SCAP). METHODS:Children aged < 18 years hospitalized with RTIs at Beijing Children's Hospital were retrospectively enrolled during 2018-2024. Respiratory samples were tested for MP and macrolide resistance mutations. Data on co-infecting bacterial and viral pathogens were collected in clinical practice and retrospectively included in this study. We analyzed temporal trends and risk factors for SCAP. RESULTS:Among 8,453 children, MP-positive patients accounted for 39.7%, declining to 17.0% in 2021 and rising sharply to 62.8% in 2024. The highest MP-positivity rates were seen in children aged 5-9 years, although a notable increase occurred in children aged < 5 years in 2024. MRMP was detected in 96.9% of MP-positive cases, with resistance rates > 95% from 2022. After 2021, co-infections were detected in 19.9% of cases tested for bacterial and viral pathogens, most commonly involving human rhinovirus-MP, Haemophilus influenzae-MP, and Streptococcus pneumoniae-MP. Risk factors for SCAP included female sex, age > 5 years, cold season onset, pure MP infection, and MP co-infection. MRMP was not an independent predictor of SCAP. CONCLUSIONS:The burden of MP infection has resurged post-COVID, with sustained high macrolide resistance and evolving co-infection patterns. Our findings underscore the importance of ongoing surveillance and tailored management strategies for pediatric MP infections.

The World Health Organization (WHO) “Global Tuberculosis Report 2024” underscores the ongoing challenges and progress in the global fight against tuberculosis (TB). Despite a slowdown in the annual increase in TB cases and a decline in TB-related deaths, the disease remains a significant public health threat with 10.8 million new cases reported in 2023. The report reveals a persistently high burden of TB, especially in low- and middle-income countries, and highlights the escalating issue of drug-resistant TB. The report also emphasizes the critical need for increased funding, improved diagnostics, and more effective TB treatment regimens. The impact of the COVID-19 pandemic on TB control has been substantial, disrupting healthcare services and exacerbating existing challenges. This paper provides an in-depth interpretation of the report, analyzes global TB trends, updates the status of drug-resistant TB, discusses the intersection between TB and HIV, and summarizes the implications of the pandemic on TB control efforts. The report concludes with a call for intensified global action, including increased investment in research and innovation, to achieve the United Nations’ Sustainable Development Goals related to TB control. The stakes are high, but with concerted efforts, the goal of ending the TB epidemic is within reach.