Etiological and epidemiological features of acute respiratory infections in China

Intestinal microbiota and respiratory system diseases: Relationships with three common respiratory virus infections

In recent years, the role of the intestinal microbiota in regulating host health and immune balance has attracted widespread attention. This study provides an in-depth analysis of the close relationship between the intestinal microbiota and respiratory system diseases, with a focus on three common respiratory virus infections, including respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and influenza virus. The research indicates that during RSV infection, there is a significant decrease in intestinal microbial diversity, suggesting the impact of the virus on the intestinal ecosystem. In SARS-CoV-2 infection, there are evident alterations in the intestinal microbiota, which are positively correlated with the severity of the disease. Similarly, influenza virus infection is associated with dysbiosis of the intestinal microbiota, and studies have shown that the application of specific probiotics exhibits beneficial effects against influenza virus infection. Further research indicates that the intestinal microbiota exerts a wide and profound impact on the occurrence and development of respiratory system diseases through various mechanisms, including modulation of the immune system and production of short-chain fatty acids (SCFAs). This article comprehensively analyzes these research advances, providing new perspectives and potential strategies for the prevention and treatment of future respiratory system diseases. This study not only deepens our understanding of the relationship between the intestinal microbiota and respiratory system diseases but also offers valuable insights for further exploring the role of host-microbiota interactions in the development of diseases.

Integrating multiplex PCR in fever clinics for acute respiratory pathogen-specific diagnosis

The epidemiological patterns of respiratory tract infections (RTIs) have experienced substantial changes due to the influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with a particular focus on acute respiratory infections (ARIs). Challenges in early diagnosis, inadequate triage strategies, and the inappropriate use of antimicrobials or antivirals have compounded the difficulties in accurately diagnosing and managing ARIs in the post-pandemic context. This study aimed to investigate the efficacy of fever clinics equipped with nucleic acid testing capabilities in the precise triage of ARIs. In a cohort of 604 individuals presenting with symptoms of ARIs, we utilized real-time reverse transcription polymerase chain reaction (RT-PCR) technology available in the fever clinic to perform nucleic acid testing for SARS-CoV-2, influenza A virus (Flu A), influenza B virus (Flu B), respiratory syncytial virus, adenovirus, human rhinovirus, and Mycoplasma pneumoniae. Subsequently, statistical methods were employed to analyze the distribution and types of ARIs associated with these pathogens. In fever clinics, most patients presenting with respiratory pathogen infections were diagnosed with non-SARS-CoV-2 respiratory pathogens, with a higher incidence noted among pediatric patients compared to adults. In contrast, SARS-CoV-2 primarily affected the adult population and was linked to more severe clinical outcomes. Consequently, the swift triage of patients exhibiting ARI symptoms in a fever clinic equipped with nucleic acid testing enables the rapid identification and precise treatment of pathogens. This approach alleviates patient discomfort and enhances the efficiency of healthcare resource utilization.

Epidemiology and genetic diversity of common human coronaviruses in Beijing, 2015-2023: A prospective multicenter study

OBJECTIVES

To investigate the epidemiological and genetic features of common human coronaviruses (HCoVs) in Beijing in the context of the COVID-19 pandemic.

METHODS

We collected clinical samples from patients with acute respiratory tract infections (ARTIs) in 35 sentinel hospitals from 2015 to 2023. HCoVs were detected via multiple real-time PCRs, and S gene sequencing and phylogenetic analysis were subsequently performed.

RESULTS

From 2015 to 2023, the combined detection rate of HCoVs was 1.55% (909/58,550). During the COVID-19 pandemic, a significant increase in HCoVs detection was observed (P < 0.001). Overall, the epidemic season of four HCoVs was from July to October, and each HCoV showed different epidemic seasons. Notably, HCoV-NL63 and HCoV-229E exhibited pronounced annual alternations in prevalence. The highest combined detection rates of HCoVs were in the ≥60 years age group (1.85%), followed by the 0-5 years age group (1.48%). HCoV-229E was more prevalent in patients with severe community-acquired pneumonia (sCAP) (P=0.001). Phylogenetic analyses revealed that the four HCoVs were subjected to negative selection pressure, and multiple high-frequency amino acid site mutations were observed. HCoV-229E formed an emerging lineage after 2021.

CONCLUSIONS

This nine-year multicenter study in Beijing systematically elucidated that the four HCoVs exhibit distinct epidemiological characteristics, susceptible populations, and common mutations in amino acid sites, especially in the context of COVID-19. Therefore, continuous epidemiological surveillance and genetic characterization studies are imperative for predictive warning and timely identification of emerging coronavirus.

Development and validation of an early diagnosis model for severe mycoplasma pneumonia in children based on interpretable machine learning

BACKGROUND

Pneumonia is a major threat to the health of children, especially those under the age of five. Mycoplasma  pneumoniae infection is a core cause of pediatric pneumonia, and the incidence of severe mycoplasma pneumoniae pneumonia (SMPP) has increased in recent years. Therefore, there is an urgent need to establish an early warning model for SMPP to improve the prognosis of pediatric pneumonia.

METHODS

The study comprised 597 SMPP patients aged between 1 month and 18 years. Clinical data were selected through Lasso regression analysis, followed by the application of eight machine learning algorithms to develop early warning model. The accuracy of the model was assessed using validation and prospective cohort. To facilitate clinical assessment, the study simplified the indicators and constructed visualized simplified model. The clinical applicability of the model was evaluated by DCA and CIC curve.

RESULTS

After variable selection, eight machine learning models were developed using age, sex and 21 serum indicators identified as predictive factors for SMPP. A Light Gradient Boosting Machine (LightGBM) model demonstrated strong performance, achieving AUC of 0.92 for prospective validation. The SHAP analysis was utilized to screen advantageous variables, which contains of serum S100A8/A9, tracheal computed tomography (CT), retinol-binding protein(RBP), platelet larger cell ratio(P-LCR) and CD4+CD25+Treg cell counts, for constructing a simplified model (SCRPT) to improve clinical applicability. The SCRPT diagnostic model exhibited favorable diagnostic efficacy (AUC > 0.8). Additionally, the study found that S100A8/A9 outperformed clinical inflammatory markers can also differentiate the severity of MPP.

CONCLUSIONS

The SCRPT model consisting of five dominant variables (S100A8/A9, CT, RBP, PLCR and Treg cell) screened based on eight machine learning is expected to be a tool for early diagnosis of SMPP. S100A8/A9 can also be used as a biomarker for validity differentiation of SMPP when medical conditions are limited.

Targeted next-generation sequencing characterization of respiratory pathogens in children with acute respiratory infection

BACKGROUND

Acute respiratory infections (ARIs) pose a significant global health burden, particularly affecting infants and young children with high morbidity and mortality rates. Targeted next-generation sequencing (tNGS) has emerged as a rapid and cost-effective diagnostic tool capable of identifying a broad range of respiratory tract infections.

METHODS

Oropharyngeal swabs and sputum samples were collected from patients and subjected to tNGS and sputum culture, respectively, for diagnosing ARIs. A retrospective analysis was conducted on clinical data to explore the clinical diagnosis and therapeutic application of tNGS.

RESULTS

This study included 336 pediatric patients with confirmed ARIs. tNGS detected 38 potential pathogens, comprising 25 species (15 bacteria and 10 viruses) and 13 viral subtypes. The overall microbial detection rate using tNGS was 100%. The leading bacterial pathogens identified were Streptococcus pneumoniae (36.0%), Stenotrophomonas maltophilia (30.4%), Streptococcus intermedius (29.5%), Moraxella catarrhalis (27.1%), and Hemophilus influenzae (20.2%). The predominant viral pathogens included human adenovirus (31.3%), human rhinovirus (26.5%), human parainfluenza virus (25.0%), cytomegalovirus (19.0%), and human bocavirus (11.0%). Among the 94 patients who underwent simultaneous sputum culture and Gram staining, tNGS exhibited a superior detection rate compared to sputum culture (100% vs. 53.2%). Among the 50 patients with concordant positive results for both tNGS and sputum culture, 80% (40/50) demonstrated full or partial agreement. Additionally, tNGS revealed age-specific heterogeneity in pathogen distribution across different age groups.

CONCLUSION

Traditional diagnostic methods often fall short of meeting the diagnostic demands of ARIs. This study underscores the potential of tNGS in oropharyngeal swabs for enhancing pathogen detection, thereby improving the diagnosis, treatment, and prevention of ARIs.

IMPORTANCE

This study represents the first investigation utilizing oropharyngeal swabs for tNGS in diagnosing and treating ARIs. By analyzing surveillance data from a local hospital's patients with ARIs, we have identified the spectrum of bacterial and viral pathogens and explored demographic differences among patients. These findings underscore the potential of tNGS in ARI surveillance, diagnosis, pathogen detection, and prevention.

Evaluation of a fully automatic nucleic acid amplification system for detecting four respiratory pathogens

BACKGROUND

Respiratory syncytial virus (RSV), adenovirus (ADV), human parainfluenza virus (hPIV), and Mycoplasma pneumoniae (MP) are prevalent pathogens causing acute respiratory infections (ARIs) in children. Prompt and precise detection of these pathogens is essential for early differentiation. This study sought to assess the diagnostic efficacy of a fully automatic real-time fluorescence PCR assay utilizing microfluidic technology (PCR-MT) for the rapid detection of RSV, hPIV, ADV, and MP in children in a hospital setting in Zhejiang, China.

METHODS

The study was conducted on 420 children with ARIs from March to December 2022 at our hospital. Throat swab samples were collected and detected for RSV, hPIV, ADV, and MP using both PCR-capillary electrophoresis fragment analysis (PCR-CEFA) and PCR-MT. The results obtained from the PCR-MT method were compared with those from PCR-CEFA.

RESULTS

With PCR-CEFA as the gold standard, the sensitivity and specificity of the PCR-MT method were as follows: 94.4% and 100.0% for RSV, 96.0% and 99.1% for hPIV, 100.0% and 98.6% for ADV, and 93.5% and 98.8% for MP, respectively.

CONCLUSION

The PCR-MT method demonstrates substantial potential for clinical application in the early diagnosis of RSV, hPIV, ADV, and MP in an outpatient setting, offering robust sensitivity and specificity.

IMPACT

Rapid, accurate, and convenient multiple pathogen detection technologies represent a significant area of research in the medical field. The method evaluated in this study enables simultaneous detection of four pathogens on a single chip, covering various subtypes, with results available within half an hour. Although some multi-pathogen detection chips are already commercially available, they may still have limitations such as sensitivity, specificity, and cost. Ongoing technological advancements could make pathogen detection more efficient, accurate, and economical. Continued attention to the development, validation, and optimization of these technologies in clinical practice will better serve patients.

Epidemiological trends and pathogen analysis of pediatric acute respiratory infections in Hanzhong Hospital, China: insights from 2023 to 2024

Background

Acute respiratory infections (ARIs) are a leading cause of morbidity in children. Understanding the distribution of respiratory pathogens is crucial for effective prevention and treatment. This study analyzed the prevalence and epidemiological characteristics of ARIs in children from 2023 to 2024.

Methodology

This study included 9,294 children aged 0-18 years with ARI symptoms who were treated between July 2023 and August 2024. Respiratory samples were tested using polymerase chain reaction (PCR) for eight common viruses. Data were analyzed by age and gender to assess pathogen distribution and demographic patterns.

Results

A total of 14,722 samples were enrolled, with 2,888 (19.62%) testing positive for at least one pathogen. Among these, single-pathogen infections were predominant (97.66%, 2,756/2,822), while co-infections were less frequent (2.34%, 66/2,822). The three most common pathogens were adenovirus (ADV, 33.24%), Mycoplasma pneumoniae (MP, 25.07%), and whooping cough (WC, 22.78%). No significant gender differences were observed in the overall positive rate or pathogen distribution (p > 0.05). Pathogen detection rates varied significantly by age group (χ 2 = 110.03, p < 0.001), with WC and MP being most prevalent in school-age children (χ 2 = 104.58, p < 0.001; χ 2 = 11.546, p = 0.009, respectively) and Flu A more frequent in preschool children (χ 2 = 38.738, p < 0.001). MP, WC, ADV, human rhinovirus, and human metapneumovirus were detected throughout the year.

Discussion

The findings highlight that ARIs in children are primarily caused by single respiratory pathogens, with significant age-related differences in pathogen prevalence. These results emphasize the need for age-specific prevention strategies, such as targeted vaccination programs and public health interventions, particularly for school-age children during peak transmission periods.

Ultrasensitive Love-SAW Biosensor Based on Self-Assembled DMSN@AuNPs with In Situ Amplification for Detecting Biomarker Procalcitonin in Exhaled Breath Condensate

The COVID-19 pandemic has highlighted the importance of early screening and pathogen identification for the effective treatment of pneumonia. Exhaled breath condensate (EBC) provides a noninvasive and easily accessible method for early diagnosis of respiratory diseases, as it captures biomarkers from the airway lining fluid, offering a timely and reliable reflection of respiratory inflammation. Procalcitonin (PCT) is a biomarker widely used to assess infection type and severity, particularly for distinguishing between bacterial and nonbacterial pneumonia. However, detecting PCT especially in EBC is challenging due to its extremely low concentrations. In this work, we developed an ultrasensitive Love-type surface acoustic wave (Love-SAW) biosensor based on self-assembled gold nanoparticles on dendritic mesoporous silica nanoparticles (DMSN@AuNPs) with in situ amplification for PCT detection in EBC. Dendritic mesoporous silica nanoparticles (DMSNs), an emerging porous material with features of large surface area, high thermal stability, and ease of functionalization were employed to load a large amount of AuNPs that can spontaneously grow in situ to further enhance the sensing performance. An automatic detection system was also developed to integrate with the Love-SAW biosensor for multichannel detection of PCT in EBC for pneumonia screening. The DMSN@AuNPs based Love-SAW biosensor demonstrates remarkable performance with a detection range of 0.01-10 ng/mL and detection limit of 3.7 pg/mL, which is about 350 times higher than conventional AuNPs-based methods. These results validate the potential of DMSN@AuNPs based Love-SAW biosensors for ultrasensitive detection of low-concentration biomarkers, providing a promising platform for in vitro diagnostics.

Clinical features of HAdV-55 in children with respiratory tract infections: a retrospective case series and literature review

BACKGROUND

Human adenovirus type 55 (HAdV-55) can lead to acute respiratory diseases, significant morbidity, and mortality in children.

METHODS

Hospitalized children diagnosed with HAdV-55 between September 2016 and March 2024 at the Children's Hospital of Chongqing Medical University were retrospectively analyzed. HAdV-55 was detected through polymerase chain reaction and sequencing. Clinical data were collected, including demographic characteristics, clinical manifestations, laboratory findings, imaging results, treatment history, and prognosis. A literature search was conducted using the PubMed database and China National Knowledge Infrastructure from their inception to June 2024. Search terms included "HAdV-55", "HAdV-11a", "adenovirus type 55" and their derivatives. Clinical features were evaluated in conjunction with literature on HAdV-55 infections in children.

RESULTS

Five children with HAdV-55 infection were identified, including one mild, two severe, and two critical. The two critical patients exhibited progressive declines in total blood cell counts, hemoglobin levels and serum albumin levels within a short period. Adenoviral DNA was detected in pleural fluid or serum for them. They received mechanical ventilation, intravenous immunoglobulin, Methylprednisolone, blood transfusions, and antibiotics, while died for acute respiratory distress syndrome (ARDS). The remaining ones recovered and were discharged with good prognosis. A review of 56 cases, including those from this study, revealed that 61.9% (26/42) of infections were classified as severe or critical, with a mortality rate of 16.4% (9/55). Sequelae included bronchiolitis obliterans and bronchiectasis.

CONCLUSIONS

The genetic inheritance of HAdV-55 remained stable, with an upward trend of HAdV-55 severe infection among children from 2000 to 2019. Early clinical symptoms of HAdV-55 infection were overlapped with other respiratory viral infections. Rapid declines in blood cell counts, hemoglobin levels and serum albumin, along with dynamic monitoring of viral loads in sterile fluids, may serve as prognostic indicators.

Combined NGS and lung biopsy for refractory respiratory failure: a case of HRV and secondary bacterial pneumonia mimicking organizing pneumonia

BACKGROUND

Some studies of community-acquired pneumonia (CAP) have reported that human rhinovirus (HRV) is the most common virus in viral pneumonia in immunocompetent adults. Secondary bacterial and fungal infections are increasingly recognized complications of HRV infection that have substantial morbidity and mortality. We report a novel case of a co-infection of Streptococcus pneumoniae (S. pneumoniae) associated with HRV pneumonia that had successful diagnosis with combined target next generation sequencing (NGS) and percutaneous lung puncture biopsy (PLPB).

CASE PRESENTATION

A 62-year-old female was admitted with productive cough, dyspnea and respiratory failure. She was initially diagnosed with severe pneumonia caused by HRV infection by targeted NGS from bronchial-alveolar lavage fluid. After initial clinical improvement treated by high flow nasal cannula (HFNC) and antibiotics, the patient's condition worsened again after her discharge, with persistent dyspnea and refractory hypoxemia. Chest computed tomography showed areas of consolidation and ground glass opacification. Despite empirical antibiotics for a suspected secondary co-infection, her condition showed no significant improvement. A PLPB was performed, and targeted NGS for the lung tissue was positive only for S. pneumoniae. Targeted NGS of her sputum was positive for S. pneumoniae, Aspergillus fumigatus and type A HRV. The patient was treated with linezolid, voriconazole and methylprednisolone. HFNC was weaned on day 57, and she was discharged with good lung recovery.

CONCLUSIONS

Our case demonstrates the diagnostic utility of combined targeted NGS and CT-guided PLPB in resolving refractory pneumonia with overlapping viral and bacterial etiologies. Co-infection with these two pathogens should be considered in the differential diagnosis of patients with consolidation, wheezing and respiratory failure following severe HRV infection. The combination of targeted NGS and CT-guided PLPB should be reserved for diagnostically challenging cases refractory to conventional methods.

Genetic characterization of coronaviruses causing common cold symptoms based on micro-targeted capture sequencing

A novel micro-targeted capture sequencing method was developed for four coronaviruses that cause common cold symptoms, and its sensitivity and clinical performance were assessed using 14 pharyngeal swab samples. This technique achieved 100% genomic coverage for samples with a cycle threshold (Ct) value of 32 or lower. The genotypes of the clinical isolates were determined by phylogenetic analysis, and unique mutations were identified in the receptor-binding domain (RBD) of the spike protein. Additional N-glycosylation sites were found in some of the isolates. This method offers a sensitive and rapid tool for genetic monitoring of common-cold coronaviruses and aids in their prevention and control.

Activated platelet membrane vesicles for broad-spectrum bacterial pulmonary infections management

The development of new antibiotics has lagged behind the rapid evolution of bacterial resistance, prompting the exploration of alternative antimicrobial strategies. Host-directed therapy (HDT) has emerged as a promising approach by harnessing innate immune system's natural defense mechanisms, which reduces reliance on antibiotics, and mitigates the development of resistance. Building on the important role of platelets in host immunity, activated platelet membrane vesicles (PLTv) are developed here as a host-directed therapy for broad-spectrum antibacterial infection management, leveraging several key mechanisms of action. PLTv neutralizes bacterial toxins, thereby reducing cytotoxicity. The presence of platelet receptors on PLTv enables them to act as decoys, binding bacteria through receptor interactions and facilitating their phagocytosis by neutrophils and macrophages. Additionally, PLTv bound to bacteria promote the formation of neutrophil extracellular traps (NETs), enhancing the immune system's ability to trap and kill bacteria. In mouse models of pulmonary infections caused by the Methicillin-resistant Staphylococcus aureus, P. aeruginosa, and A. baumannii, administration of PLTv significantly reduces bacterial counts in the lungs and protects against mortality. Taken together, the present work highlights PLTv as a promising host-directed therapy for combating broad-spectrum pulmonary drug-resistant bacterial infections, leveraging their ability to neutralize toxins, act as decoys, promote phagocytosis, and facilitate NETs formation.

Changes in children respiratory infections pre and post COVID-19 pandemic

Background

Non-pharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic had a significant impact on the prevalence of various acute respiratory infections (ARIs) pathogens.

Methods

We collected 337,310 real-time PCR results for 13 pathogens from clinical samples between January 2018 and January 2024 to assess the changes of ARIs among children before and after the COVID-19 pandemic.

Results

A variety of ARIs pathogens, including Influenza A (Flu A), Influenza B (Flu B), Adenovirus (ADV), Rhinovirus (RhV), and Respiratory Syncytial Virus (RSV), as well as co-infecting bacterial such as Klebsiella pneumoniae (KPN), Pseudomonas aeruginosa (PAE), Streptococcus pneumoniae (SP), Haemophilus influenzae (HI), and Listeria monocytogenes (LP), reached a peak positive rate at the age of 3. The susceptible age of Mycoplasma pneumoniae (MP) was from 3 to 7 years old. Compared to the pre-COVID pandemic period, the positive rates of Flu A, MP, ADV, SP, HI, Staphylococcus aureus (SA) and KPN decreased during the COVID-19 pandemic. And the positive rates of Flu B and PAE increased. Compared to the period during the COVID-19 pandemic, the positive rates of Flu A, ADV, RSV, RhV, SP, HI, KPN, PAE and SA were increased after the pandemic. Conversely, the positive rates of MP, Flu B, and Parainfluenza virus (PIV) decreased.

Conclusions

The implementation of NPIs interrupted the circulation of ARIs pathogens. However, release of NPIs and the reduced baseline of population immunity, may contribute to a resurgence of ARIs pathogens among children.

Viral metagenomics reveals diverse viruses in the fecal samples of children with acute respiratory infection

Introduction

Changes in the gut microbiome have been associated with the development of acute respiratory infection (ARI). However, due to methodological limitations, our knowledge of the gut virome in patients with ARIs remains limited.

Methods

In this study, fecal samples from children with ARI were investigated using viral metagenomics.

Results

The fecal virome was analyzed, and several suspected disease-causing viruses were identified. The five viral families with the highest abundance of sequence reads were Podoviridae, Virgaviridae, Siphoviridae, Microviridae, and Myoviridae. Additionally, human adenovirus, human bocavirus, human astrovirus, norovirus, and human rhinovirus were detected. The genome sequences of these viruses were respectively described, and phylogenetic trees were constructed using the gene sequences of the viruses.

Discussion

We characterized the composition of gut virome in children with acute respiratory infections. However, further research is required to elucidate the relationship between acute respiratory infection and gut viruses.

Epidemiology and Mortality Risk of Severe Viral Pneumonia During the Pre-Pandemic, COVID-19 Pandemic and Post-Pandemic Era: A Retrospective Study of Hospitalized Children in ShenZhen, China Between 2017 and 2023

PURPOSE

This study aims to investigate the spectrum of viruses leading to severe viral pneumonia (SVP) and the associated risk factors for mortality among pediatric patients in the pediatric intensive care unit (PICU).

METHODS

Taking the outbreak and end of the COVID-19 pandemic as a aboundary, The pre-pandemic period of COVID-19 spans from 01/2017 to 12/2019, the pandemic period from 01/2020 to 12/2021, and the post-pandemic period from 01/2022 to 12/2023. Patients were subsequently stratified into survivor and non-survivor groups based on clinical outcomes.

RESULTS

A total of 1007 patients (median age 1.42 years, range 0.58-4.00; male: female ratio 1.7:1) diagnosed with SVP. Cases were stratified into pre-pandemic (n = 419, 41.6%), pandemic (n = 272, 27.0%), and post-pandemic (n = 316, 31.4%) periods. Viral predominance varied across phases: Pre-pandemic: Influenza A (IVA, 37.0% [155/419]), respiratory syncytial virus (RSV, 29.8%), adenovirus (19.8%), and influenza B (15.5%). Pandemic phase: Human rhinovirus (HRV, 40.1% [109/272]), RSV (33.1%), parainfluenza viruses (11.4%), and bocavirus (HBoV, 10.7%). Post-pandemic: HRV (24.4% [77/316]), RSV (22.8%), HBoV (14.2%), and IVA (13.6%). Comparative analysis revealed significant intergroup differences in the proportion of patients aged < 3 years, primary immunodeficiency disorders (PIDs), and sepsis between pure viral infection deaths and coinfection-associated fatalities among SVP cases. Logistic regression identified eight independent mortality predictors: acute leukemia, other malignant tumors, PIDs, moderate-to-severe underweight, rhabdomyolysis, acute respiratory distress syndrome (ARDS), infection-related encephalopathy, and multiorgan dysfunction syndrome (MODS). The prediction model demonstrated robust discriminative capacity for SVP mortality: sensitivity 73.8%, specificity 90.2%, and AUC 0.888 (95%CI 0.838-0.938) via ROC curve analysis.

CONCLUSIONS

The COVID-19 pandemic has altered the landscape of respiratory viruses causing SVP in children. The presence of underlying health conditions, particularly acute leukemia, other malignancies, and immunodeficiency, significantly increases the risk of death in children with viral pneumonia. The risk prediction model offers a reliable tool for clinical practice to predict mortality in these patients.

Characterization of the epidemiology, susceptibility genes and clinical features of viral infections among children with inborn immune errors: a retrospective study

BACKGROUND

Although viral infections are one of the common clinical manifestations in patients with inborn errors of immunity (IEIs), little is known about the epidemiology, susceptibility genes, and clinical status of viral infections in patients with IEIs.

METHODS

The demographic information, clinical diagnoses, and laboratory findings of 931 IEI patients who underwent viral testing from January 2016 to December 2022 were collected and analyzed.

RESULTS

In total, 47.15% (439/931) patients with IEI tested positive for at least one virus during hospitalization. There were a total of 640 viral infections during the study period, mainly from EBV 131 (20.47%), HRV 102(15.94%), CMV 100(15.63%), and RV 84(13.13%). CMV and RV infections were more common in the combined immunodeficiencies (IEI_I) group during the infant stage, whereas EBV infection was more common in the immune dysregulation (IEI_IV) group during the preschool stage. Mutations in SH2D1A (57.14%), PIK3CD (56.41%) and LRBA (50%) make individuals susceptible to EBV infection; mutations in WAS (30%) make individuals susceptible to CMV infection; and mutations in IL2RG (56.52%) and RAG1 (37.5%) make individuals susceptible to RV infection. Joinpoint analysis revealed trends in viral positivity in different years.

CONCLUSION

These data suggest that it is possible to target the prevention, treatment, and management of IEI patients who are infected with a virus by accounting for the age at infection, type of IEI, and mutant genes, but special attention needs to be paid to viral infections in IEI_I and IEI_IV patients during the infant stage.

Epidemiological and molecular characteristics of human parainfluenza virus in southern China during 2016-2020

Human parainfluenza viruses (HPIV) are common viral pathogens in acute respiratory infection (ARI). We aimed to describe the epidemiological and molecular characteristics of HPIV from ARI patients. This cross-sectional study was conducted using respiratory samples from 9,696 ARI patients between 2016 and 2020 in southern China. All samples were analyzed by quantitative real-time polymerase chain reaction to determine the presence of HPIV and other common respiratory viruses. Descriptive statistics were performed to determine the temporal and population distribution of HPIV. The full-length hemagglutinin-neuraminidase (HN) gene of HPIV3-positive samples was sequenced for phylogenetic analysis. A total of 577 (6.0%) patients tested positive for HPIV, with HPIV3 being the predominant serotype, accounting for 46.8% of cases. Notably, 66.0% of these HPIV-positive cases were children aged 0-2 years. The prevalence of HPIV infections showed a decreased trend and altered peak during 2016-2020. Cough, fever, sputum production, and rhinorrhea were common respiratory symptoms in HPIV-positive patients. The majority of cases had pneumonia (63.4%). Human rhinovirus (HRV) and human coronavirus (HCoV) were the most common coinfection viruses in HPIV-positive cases, with proportions of 20.1% and 14.4%, respectively. Phylogenetic analysis revealed that the predominant lineage of HPIV3 was C3f (86.0%), followed by lineage C3a (8.0%), C3d (4.0%), and C3b (2.0%). These findings help to better understand the epidemiology of HPIV, and improve public health strategies to prevent and control HPIV infections in southern China.

Effect of A1 protein-free formula versus conventional formula on acute respiratory infections and diarrhea in toddlers: A Randomized Controlled Trial

OBJECTIVES

Acute respiratory infections (ARIs) and diarrhea are common in toddlers. Milk free of A1 β-casein (A1PF milk) may support the immune system, but few studies have investigated A1PF milk in toddler formula and any potential effects on ARI/diarrhea. This study's objective was to investigate the incidence of ARI and diarrhea with two toddler formulas, A1PF formula (A1PF) or conventional formula (CON), which differed in milk base and nutrient composition.

METHODS

This randomized, open-label, multicenter study (19 December 2022 to 17 May 2023) evaluated the occurrence of ARI and/or diarrhea in toddlers (aged 2-3 years) who consumed A1PF or CON over 90 days.

RESULTS

A total of 200 toddlers were enrolled, and 180 completed the study. The relative risk of ARI or diarrhea in the A1PF group versus the CON group did not differ significantly, but the median (interquartile range) ARI duration was significantly shorter in the A1PF group (3 [2-4] days vs. 5 [3-6] days, p = 0.012). At Day 90, toddlers consuming A1PF had significantly less severe bloating, gassiness, and fewer regurgitation events (all p < 0.05). Both formulas were well tolerated, and no serious adverse events were reported.

CONCLUSION

Toddlers who consumed A1PF had a reduced duration of ARI and improved diarrhea outcomes, reducing the burden on their families compared with toddlers who consumed CON. Although this is consistent with other studies, further research is required to determine whether these effects are solely attributable to the A1PF milk base or other differences between the formulas.

Virus profiling of bronchoalveolar lavage fluid in hospitalized non-COVID-19 adult patients with pulmonary infection from November 2020 to November 2021

Identifying the cause of respiratory tract infections is important for reducing the burden of diagnosis and treatment. To assess viral etiologies of hospitalized patients with pulmonary infection, bronchoalveolar lavage fluid (BALF) specimens were collected from non-COVID-19 adult patients (n ​= ​333, including patients with lower respiratory tract infection, tuberculosis, lung cancer, and pulmonary nodules) between November 2020 and November 2021. Multiple common respiratory pathogens were detected using multiplex reverse-transcription polymerase chain reaction. The result showed that at least one virus was identified in 35.44% (118/333) of the cases. Among these, influenza virus was the most commonly identified, followed by the parainfluenza virus, coronavirus, human rhinoviruses, and human respiratory syncytial viruses. The tuberculosis group demonstrated the highest viral detection rate, yet paradoxically exhibited the lowest co-infection rate. In contrast, the highest co-infection frequency was observed in the pulmonary nodules group. Patients with viral infections exhibited more severe clinical symptoms compared to those without detected viral infections. However, this observation was only noted in the lower respiratory tract infection group among the different disease groups. Notably, among patients infected with a specific virus, there were no significant differences in viral load between single and co-infections. Our study identified the major causative agents in hospitalized adult patients with pulmonary infection, offering insights for precise disease diagnosis and the prevention of unnecessary use of antimicrobial drugs.

A study of etiology and asthma risks in infants and toddlers hospitalized for recurrent or persistent wheezing

Objective

To study the etiology of recurrent and persistent wheezing in infants and toddlers, and identify the risk factors for infantile asthma.

Methods

We retrospectively analyzed the data of 612 children (aged 0-36 months) hospitalized for recurrent or persistent wheezing between 2019.09.01 and 2022.08.31. We comparatively analyzed their clinical, laboratory, imaging, and lung-examination data between different groups. Multivariate logistic regression analysis was used to identify risk factors for asthma.

Results

The etiologies of recurrent and persistent wheezing significantly differed (P < 0.05). The top 3 causes of recurrent wheezing were viral infections (48.4%), infantile asthma (28.0%), and protracted bacterial bronchitis (PBB; 9.5%), whereas the top 3 causes of persistent wheezing were PBB (67.5%), tracheomalacia (22.2%), and infantile asthma (15.9%). The distribution of etiologies varied by age. Bronchoscopy was performed for 181 children, and mainly showed purulent changes (34.3%), tracheomalacia (27.1%), and positive pathogenic bronchoalveolar lavage fluid (25.4%). Older age, admission to the intensive care unit (ICU), positive modified Asthma Prediction Index (mAPI), and food allergy were risk factors for asthma. The odds ratio of mAPI was 4.066. The area under the receiver operating characteristic curve of the risk factors for predicting asthma was 0.8016.

Conclusion

Wheezing phenotype and age may partly guide the etiological diagnosis of recurrent/persistent wheezing in infants and young children. Bronchoscopy is important for the diagnosis of refractory recurrent/persistent wheezing, while mAPI aids in the diagnosis of asthma. When infants and children with recurrent or persistent wheezing have the characteristics of older age, ICU admission, positive mAPI, and food allergy, the possibility of asthma may be considered.

Epidemiological trends and serological profiles of respiratory pathogens in Guangzhou: an 11-year retrospective study from 2013 to 2023

Background

Respiratory pathogens pose significant public health challenges globally, particularly in densely populated urban areas. This study aimed to analyze the epidemiological trends of multiple respiratory pathogens in Guangzhou, China, from 2013 to 2023, and investigate associated serological profiles to inform clinical management and public health interventions.

Methods

We conducted a retrospective analysis of 96,927 cases with suspected respiratory infections (SRIs) (defined by fever >37.5 ℃, cough, dyspnea, and/or chest pain) at The First Affiliated Hospital of Guangzhou Medical University. Clinical data were extracted from electronic medical records, and immunofluorescence assays were used to detect immunoglobulin M (IgM) antibodies against nine respiratory pathogens.

Results

Of the cases analyzed, 18.01% (17,454/96,927) tested serologically positive for at least one respiratory pathogen. Mycoplasma pneumoniae (MP) was the predominant pathogen (76.51% of serologically positive cases), followed by parainfluenza viruses (PIVS) (9.75%). The highest serologically positive rate was observed in the 5-14 age group (36.01%). Females exhibited a significantly higher overall serologically positive rate (21.30%) compared to males (15.97%, P<0.001). Serological analysis revealed profiles in confirmed infections, with significantly lower coagulation-related parameters (P<0.001) and some elevated inflammatory markers compared to suspected cases.

Conclusions

This comprehensive study provides crucial insights into the changing landscape of respiratory pathogen infections in Guangzhou over an 11-year period. The predominance of MP, particularly among school-age children and females, highlights the need for targeted interventions. The unexpected coagulation profiles in confirmed infections suggest complex pathophysiological mechanisms that warrant further investigation. These findings have important implications for clinical management, diagnostic approaches, and public health strategies in urban settings.

Hidden in plain sight: the impact of human rhinovirus infection in adults

BACKGROUND

Human rhinovirus (HRV), a non-enveloped RNA virus, was first identified more than 70 years ago. It is highly infectious and easily transmitted through aerosols and direct contact. The advent of multiplex PCR has enhanced the detection of a diverse range of respiratory viruses, and HRV consistently ranks among the most prevalent respiratory pathogens globally. Circulation occurs throughout the year, with peak incidence in autumn and spring in temperate climates. Remarkably, during the SARS-CoV-2 pandemic, HRV transmission persisted, demonstrating its resistance to stringent public health measures aimed at curbing viral transmission.

MAIN BODY

HRV is characterised by its extensive genetic diversity, comprising three species and more than 170 genotypes. This diversity and substantial number of concurrently circulating strains allows HRVs to frequently escape the adaptive immune system and poses formidable challenges for the development of effective vaccines and antiviral therapies. There is currently a lack of specific treatments. Historically, HRV has been associated with self-limiting upper respiratory infection. However, there is now extensive evidence highlighting its significant role in severe lower respiratory disease in adults, including exacerbations of chronic airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD), as well as pneumonia. These severe manifestations can occur even in immunocompetent individuals, broadening the clinical impact of this ubiquitous virus. Consequently, the burden of rhinovirus infections extends across various healthcare settings, from primary care to general hospital wards and intensive care units. The impact of HRV in adults, in terms of morbidity and healthcare utilisation, rivals that of the other major respiratory viruses, including influenza and respiratory syncytial virus. Recognition of this substantial burden underscores the critical need for novel treatment strategies and effective management protocols to mitigate the impact of HRV infections on public health.

CONCLUSION

This review examines the epidemiology, clinical manifestations, and risk factors associated with severe HRV infection in adults. By drawing on contemporary literature, we aim to provide a comprehensive overview of the virus's significant health implications. Understanding the scope of this impact is essential for developing new, targeted interventions and improving patient outcomes in the face of this persistent and adaptable pathogen.

Development and validation of an automated and high-throughput quadruplex RT-ddPCR assay for the detection of influenza A, influenza B, respiratory syncytial virus, and SARS-CoV-2

The main detection method for viral respiratory infections is reverse transcription polymerase chain reaction (RT-PCR), but it is susceptible to sample inhibitors and relies on a standard curve and subjective thresholds to quantify nucleic acid targets. However, droplet digital PCR (ddPCR), the third generation of PCR with higher sensitivity and accuracy, is an effective tool for the detection and absolute quantification of respiratory viruses. In this study, we introduced AHQR-ddPCR, which is an automated and high-throughput quadruplex reverse transcription ddPCR assay based on the QX ONE platform for the detection of influenza A, influenza B, respiratory syncytial virus, and SARS-CoV-2 in a single reaction. The AHQR-ddPCR assay had analytical sensitivity as low as 0.65-0.78 copies/μL for four respiratory viruses, and exhibited excellent analytical specificity, intraassay and interassay precision, and a wide linear range for each viral target. The results in clinical samples showed that the assay had good concordance and better diagnostic sensitivity compared to RT-PCR. In short, the highly sensitive and absolutely quantitative AHQR-ddPCR assay has excellent analytical and clinical performance, and the advantage of detecting weakly positive samples, which can effectively reduce false-negative results and is a powerful complement to RT-PCR. In addition, it has great value for virology research and the development of automated molecular assays.

Modulating oxidative stress: a reliable strategy for coping with community-acquired pneumonia in older adults

Community-acquired pneumonia (CAP) remains one of the leading respiratory diseases worldwide. With the aging of the global population, the morbidity, criticality and mortality rates of CAP in older adults remain high every year. Modulating the signaling pathways that cause the inflammatory response and improve the immune function of patients has become the focus of reducing inflammatory damage in the lungs, especially CAP in older adults. As an important factor that causes the inflammatory response of CAP and affects the immune status of the body, oxidative stress plays an important role in the occurrence, development and treatment of CAP. Furthermore, in older adults with CAP, oxidative stress is closely associated with immune senescence, sarcopenia, frailty, aging, multimorbidity, and polypharmacy. Therefore, multiple perspectives combined with the disease characteristics of older adults with CAP were reviewed to clarify the research progress and application value of modulating oxidative stress in older adults with CAP. Clearly, there is no doubt that targeted modulation of oxidative stress benefits CAP in older adults. However, many challenges and unknowns concerning how to modulate oxidative stress for further practical clinical applications exist, and more targeted research is needed. Moreover, the limitations and challenges of modulating oxidative stress are analyzed with the aim of providing references and ideas for future clinical treatment or further research in older adults with CAP.

Clinical evaluation of negative mNGS reports in sterile body fluids and tissues

Regarding metagenomics next-generation sequencing (mNGS) negative literature, there have been much discussions about methodology; thus, we collected clinical and laboratory information for retrospective evidence-based research. We retrospectively analyzed 150 negative mNGS results of patients suspected of having aseptic body fluid infections and divided them into a plasma group, cerebrospinal fluid (CSF) group, and others group according to the sample types. Based on the final laboratory and clinical diagnoses, the diagnostic accuracy of excluding infections in the plasma, CSF, and others groups of negative mNGS results were 72.0%, 40.4%, and 30.2%, respectively. The false-negative rates of the CSF and others group were relatively high. The positive impact rates of clinical application in the plasma, CSF, and others groups were 68.0%, 40.4%, and 25.6%, respectively. Three factors, including patient department distribution, admission symptoms, and doctors' judgment of patient infection were used to analyze the reasons for uncertain negative or false-negative results in mNGS. The clinical information analysis of false-negative patients' aims were to reduce the false-negative rate and improve the diagnostic accuracy of mNGS. On the selection of sampling timing in mNGS, within half a month after a patient develops suspected symptoms of infection, the earlier the mNGS test, the higher the true-negative rate.IMPORTANCEThere has been little research carried out on the diagnostic value of negative metagenomics next-generation sequencing (mNGS) results in clinical practice, especially for sterile body fluids. In the present study, plasma negative mNGS results showed the highest diagnostic accuracy for excluding infection. However, the cerebrospinal fluid and other mNGS false-negative rates were 59.6% and 69.8%, respectively. Our findings emphasized the role of negative mNGS results in practical clinical applications and clarified that patients, mNGS sampling time, and doctor's decision making were the key factors for the diagnosis of clinical infections. More attention should be paid to the diagnostic role of mNGS true negatives, the analysis of clinical patterns of false negatives, and improving the diagnostic accuracy of mNGS.

Clinical characteristics of severe community-acquired pneumonia in children with virus mono-detection versus co-detection with bacteria

BACKGROUD

By analyzing the etiological distribution and clinical characteristics of severe community-acquired pneumonia in children with virus mono-detection and co-detection with bacteria and other pathogens, to explore the clinical characteristics that can help identify mixed infections, thereby providing a basis for the more precise use of antimicrobial drugs.

METHODS

A retrospective study was conducted on hospitalized children aged 1 month to 14 years with severe community-acquired pneumonia who underwent bronchoscopy in Shenzhen Children's Hospital from January to December 2018. The distribution of 19 pathogens detected by nucleic acid detection in bronchoalveolar lavage fluid was analyzed. Clinical data of children were obtained from the hospital electronic patient dossiers. Data were analyzed to describe the difference between viral mono-detection and co-detection.

METHODS

A retrospective study was conducted on hospitalized children aged 1 month to 14 years with severe community-acquired pneumonia who underwent bronchoscopy in Shenzhen Children's Hospital from January to December 2018. The distribution of 19 pathogens detected by nucleic acid detection in bronchoalveolar lavage fluid was analyzed. Clinical data of children were obtained from the hospital electronic patient dossiers. Data were analyzed to describe the difference between viral mono-detection and co-detection.

RESULTS

A total of 479 children with severe community-acquired pneumonia were enrolled from January to December 2018, at least one pathogen was detected in 375 cases (78.3%), including 247 cases (51.6%) of viruses, 111 cases (23.2%) of atypical pathogens, and 98 cases (20.5%) of bacteria. Among all positive cases, 274 cases (73.1%) had a single pathogen detected, and 101 cases (26.9%) had co-detection (≥ 2 pathogens). Among these co-detection, 51 cases (50.5%) were virus-bacteria co-detection, and 20 cases (19.8%) were virus-atypical pathogens co-detection. There was no significant difference in the detection rates of different types of pathogens between male and female patients (p > 0.05). There were no significant differences in clinical presentation, signs, inflammation and organ function indicators, pulmonary complications, antibiotic use, glucocorticoid use, intravenous immunoglobulin use, PICU admission rate, need for mechanical ventilation, and length of hospital stay among children with virus-bacteria co-detection, virus-atypical pathogens co-detection, and virus mono-detection (p > 0.05).

CONCLUSION

Virus-bacteria co-detection or virus-atypical pathogens co-detection are common in children with severe community-acquired pneumonia. Clinical features alone cannot distinguish between viral mono-infection and mixed bacterial or atypical pathogen infections.

The relationship between authenticity and death anxiety in individuals with Acute Respiratory Tract Infections

BACKGROUND

Acute Respiratory Tract Infections (ARTI) affect millions of people worldwide every year and leave irreversible damage. The consequences of the disease cause patients to experience death anxiety. The aim of this study was to determine the relationship between authenticity and death anxiety in ARTI hospitalized patients.

METHODS

The participants were 400 ARTI hospitalized patients in one of the hospitals in eastern Iran who were selected by sequential convenience sampling method. Data collection tools were Authenticity Inventory and Death Anxiety Questionnaire.

RESULTS

The results showed that there was a significant inverse correlation between authenticity and death anxiety in patients (p < 0.05). Also, authenticity level predicted death anxiety.

CONCLUSIONS

Based on the results of this study, it seems necessary to design professional and specialized mental health services for ARTI patients in order to increase authenticity and reduce death anxiety.

Development of machine learning-based differential diagnosis model and risk prediction model of organ damage for severe Mycoplasma pneumoniae pneumonia in children

Severe Mycoplasma pneumoniae pneumonia (SMPP) poses significant diagnostic challenges due to its clinical features overlapping with those of other common respiratory diseases. This study aims to develop and validate machine learning (ML) models for the early identification of SMPP and the risk prediction for liver and heart damage in SMPP using accessible laboratory indicators. Cohort 1 was divided into SMPP group and other respiratory diseases group. Cohort 2 was divided into myocardial damage, liver damage, and non-damage groups. The models built using five ML algorithms were compared to screen the best algorithm and model. Receiver Operating Characteristic (ROC) curves, accuracy, sensitivity, and other performance indicators were utilized to evaluate the performance of each model. Feature importance and Shapley Additive Explanation (SHAP) values were introduced to enhance the interpretability of models. Cohort 3 was used for external validation. In Cohort 1, the SMPP differential diagnostic model developed using the LightGBM algorithm achieved the highest performance with AUCROC = 0.975. In Cohort 2, the LightGBM model demonstrated superior performance in distinguishing myocardial damage, liver damage, and non-damage in SMPP patients (accuracy = 0.814). Feature importance and SHAP values indicated that ALT and CK-MB emerged as pivotal contributors significantly influencing Model 2's output magnitude. The diagnostic and predictive abilities of the ML models were validated in Cohort 3, demonstrating the models had some clinical generalizability. The Model 1 and Model 2 constructed by LightGBM algorithm showed excellent ability in differential diagnosis of SMPP and risk prediction of organ damage in children.

The epidemiology and burden of respiratory syncytial virus and influenza infections in hospitalized children under 5 years old in Zhejiang, China (2018-2023)

Objective

Estimate changes in hospital-based respiratory syncytial virus (RSV) disease burden before and after the COVID-19 pandemic and compare this burden with influenza among children younger than 5 years old in China's Zhejiang Province.

Methods

We enrolled hospitalized children under 5 years old from eight hospitals in Zhejiang Province. Multiple testing methods were used to compare epidemiological characteristics, and multivariate logistic regression analyses were used to estimate the odds ratio (OR) and 95% confidence interval (CI) between the two groups.

Results

In this study, of the 7,857 RSV and 2,571 influenza patients, the median age of the children was significantly lower for RSV infection than for influenza. Inpatients with RSV had longer hospitalization durations (mean: 5.66 days vs. 5.04 days; p < 0.001) and hospitalization costs (mean: 5,616.12 RMB vs. 5,352.99 RMB; p = 0.023) than those with influenza. RSV inpatients increased from 1,081 before the COVID-19 pandemic to 6,776 after the pandemic (p < 0.001), with 526.8% more hospitalizations than before the pandemic (p < 0.001). During 2020-2023, hospitalized children were older (16.86 months vs. 10.09 months; p < 0.001) and had a higher proportion of pneumonia (82% vs. 75% of hospitalized patients; p < 0.001) than during pre-pandemic seasons for children admitted due to RSV infection. However, the average RSV hospitalization cost was much lower after the pandemic (4,299.29 RMB vs. 5,697.51 RMB; p < 0.001). Compared with the prepandemic years (2018-2019), the influenza groups showed a similar trend; the number of inpatients increased during the 2020-2023 season (1,949 vs. 622, p < 0.001), with older ages (33.13 months vs. 27.42 months, p < 0.001), a lower proportion of pneumonia (38% vs. 45%, p < 0.001), and lower costs (3,631.03 RMB vs. 3,742.59 RMB, p < 0.001). RSV infection was related to a higher risk of hospitalization in all age groups, and the greatest risk was observed in the 6-12 month age group (OR = 23.1; 95% CI, 18.0-29.6), followed by the 5 months and younger group (OR = 22.4; 95% CI, 17.3-28.9), compared with influenza infection.

Conclusion

RSV is a significant contributor to disease burden in hospitalized children under 5 years old, outweighing influenza. The COVID-19 pandemic impacted the epidemiological characteristics and disease burden of hospitalization for RSV and influenza infections. A more effective prevention strategy for both infections in young children, especially vaccinations against RSV and influenza, is urged.

Interpretation of pathogenicity and clinical features of multiple pathogens in pediatric lower respiratory tract infections by tNGS RPTM analysis

BACKGROUND

To characterize the epidemiology of pathogens in children with lower respiratory tract infections (LRTI) using targeted next-generation sequencing (tNGS), assess the correlation between reads per ten million (RPTM) of co-detected pathogens, identify common co-detection patterns, and explore their clinical significance.

METHODS

Children aged 29 days to 14 years hospitalized for LRTI at the Department of Pediatrics, Zhongnan Hospital of Wuhan University, from April 2023 to August 2024 were included. Bronchoalveolar lavage fluid (BALF) or nasopharyngeal swab (NS) samples were tested for pathogens using tNGS, and clinical data were collected. The data and RPTM were statistically analyzed based on lung X-ray and CT scan results, classifying cases as pneumonia or lung consolidation/pulmonary atelectasis (LC/PA).

RESULTS

Among 1118 children, the highest pathogen detection rate was Mycoplasma pneumoniae (MP) at 60.20%, followed by Haemophilus influenzae (HI) at 42.40% and Streptococcus pneumoniae (SP) at 35.42%. In children under 4 years old, common pathogens were HI, Rhinovirus (RhV), and Respiratory syncytial virus (RSV). For those over 4 years old, MP and HI were predominant. In common pneumonia cases, MP, HI, and RhV were frequent, with MP being the primary pathogen in LC/PA. 80.70% of respiratory samples detected two or more pathogens, and viruses were more frequently detected in NS than in BALF. Correlation analysis showed that MP RPTM was negatively correlated with other co-detected pathogens' RPTM, SP was negatively correlated with RSV but positively correlated with Influenza virus (flu virus), HI was positively correlated with Adenovirus (ADV) and flu virus, RhV was negatively correlated with flu virus. Clinical characteristics of co-detected pathogens showed no significant differences in acute LRTI symptoms among different combinations.

CONCLUSION

Co-detection of pathogens in children's LRTI using tNGS was common, with MP and bacterial infections being predominant. There were synergistic and competitive relationships between the RPTM of co-detected pathogens.

Integrating DNA and RNA sequencing for enhanced pathogen detection in respiratory infections

BACKGROUND

The clinical value of shotgun metagenomic next-generation sequencing (mNGS) in improving the detection rates of respiratory pathogens is well-established. However, mNGS is complex and expensive. This study designed and evaluated the performance of targeted NGS (tNGS) in diagnosing respiratory infections.

METHODS

We retrospectively included samples from 281 patients with lower respiratory tract infections to establish thresholds of pathogens. Subsequently, target pathogens were selected and a probe hybridization system was established. The performance and clinical manifestations of tNGS for 306 pathogens were evaluated using clinical and simulated samples.

RESULTS

The tNGS method took 16 h with sequencing data sizes of 5 M reads. The limit-of-detection of tNGS was 100-200 CFU/mL, respectively. Bioinformatics simulation confirmed the method's high specificity and robustness. In 281 patients of clinical validation cohort, tNGS exhibited a sensitivity of 97.73% and specificity of 75.41% compared to the composite reference standard, which notably surpasses those of culture-based and conventional microbiological methods (CMT). In detecting bacterial and viral infection, tNGS demonstrated superior sensitivity relative to CMT. Notably, 61.40% of target viruses were subtype-resolved with the initial establishment of reliable typing cutoffs, with the subtyping results being completely consistent with the PCR results. tNGS allowed for concurrent identification of antimicrobial resistance (AMR) markers and viral subtyping. 80.56% of AMR markers identified by tNGS were consistent with antimicrobial susceptibility testing.

CONCLUSION

This research established the robust performance of our tailored tNGS assay in the simultaneous detection of DNA and RNA pathogens, underscoring its prospective suitability for widespread use in clinical diagnostics.

Epidemiological and Clinical Characteristics of Human Metapneumovirus-Associated Acute Respiratory Tract Infection Cases in the Pudong New Area, Shanghai, from 2014 to 2023

BACKGROUND

This study characterized Human metapneumovirus (HMPV) infection epidemiology and clinical features in patients with acute respiratory infections (ARIs) in Pudong New Area, Shanghai, China, compared by pre- and post-COVID-19 periods.

METHODS

Between January 2014 and December 2023, the basic and clinical information, as well as respiratory tract specimens from ARIs, were collected at 14 sentinel hospitals in Shanghai Pudong. Specimens were tested for HMPV and other respiratory pathogens. The positivity rates were analyzed by age, period (pre- and post-COVID-19), season, and case type. Clinical characteristics of HMPV-infected versus non-infected cases were compared.

RESULTS

14,488 ARI patients were enrolled, with a 1.77% HMPV-positive rate (257/14,488). Among the age groups, the highest positive rate was 5.39% (11 /204) in the 6-11-month age group, and all the HMPV-positive cases in the 6-11-month-old age group were inpatients. Among the < 6 months old, 1-2 years old, 3-5 years old, 6-14 years old, 15-64 years old, and ≥ 65 years old groups, the positivity rates were 1.92% (6/313), 2.92% (23/788), 2.21% (33/1494), 1.08% (25/2311), 1.46% (94/6443) and 2.21% (65/2935), respectively. HMPV-positive patients showed higher proportions of cough (p < 0.001), runny nose (p = 0.048), and sore throat (p = 0.0175) than HMPV-negative patients in children. Compared to HMPV-negative patients, there was a significant difference in pneumonia diagnosis in both children and adults (p < 0.001, p = 0.004). Before COVID-19, HMPV infection peaks occurred mainly in February and March. In October 2023, a significant peak (4.37%, 10/229) was observed.

CONCLUSIONS

Young children and elderly individuals are at higher risk for HMPV infection, with a reversal of seasonal patterns observed post-COVID-19. Surveillance of HMPV in children and the elderly is crucial for future epidemic Preparedness.

Exploring the Preventive Potential of Solubilized Sturgeon Oil on Acute Infection with Respiratory Viruses

Acute respiratory viral infections (ARIs) represent a significant global health challenge, contributing heavily to worldwide morbidity and mortality rates. Recent efforts to combat ARIs have focused on developing nasal spray formulations that effectively target the nasal mucosa. However, challenges such as irritation, discomfort, and safety concerns highlight the need for natural, eco-friendly ingredients. In this study, we evaluated the efficacy of solubilized sturgeon oil (SSO), prepared as an oil-in-water nanoemulsion from Siberian sturgeon, as an eco-friendly preventive nasal spray agent against ARIs. Intranasal pre-treatment with SSO effectively inhibited respiratory infections caused by SARS-CoV-2, influenza A virus (IAV), and respiratory syncytial virus (RSV). Additionally, it suppressed viral replication in both nasal and lung tissues. This antiviral effect was linked to reduced pulmonary inflammation, characterized by decreased infiltration of Ly-6C+ monocytes and Ly-6G+ neutrophils, along with lower pro-inflammatory cytokine levels. Histopathological analyses confirmed that nasal SSO administration significantly mitigated lung inflammation progression caused by viral infections. Notably, the protective effects of SSO against SARS-CoV-2, IAV, and RSV persisted for at least six hours following nasal application. These findings highlight SSO as a promising eco-friendly and safe candidate for nasal spray formulations, providing a potential frontline defense against ARIs.

C-reactive protein-induced injury in Mycoplasma pneumoniae-infected lung epithelial cells is mediated by the P38 MAPK/mitochondrial apoptosis pathway

Patients with Mycoplasma pneumoniae (MP) infections have markedly higher C-reactive protein (CRP). We investigated how CRP contributes to lung epithelial cell death following MP infection. CRP levels were assessed in children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) and A549 lung epithelial cells infected with MP. A549 cells were genetically modified to overexpress CRP. Effects on cell viability, apoptosis, reactive oxygen species (ROS) and mitochondrial membrane potential (ΔΨm) were evaluated. The expression of proteins implicated in the p38 MAPK/mitochondrial apoptotic pathway was analyzed. The protective effects of the p38 MAPK inhibitor SB203580 and the mitochondrial protector cyclosporin A (CsA) were assessed. CRP levels were elevated in both MPP patients and MP-infected A549 cells compared to controls. Increased apoptosis and reduced cell viability were observed in MP-infected cells. CRP overexpression led to upregulation of proteins in the p38 MAPK/mitochondrial apoptosis pathway, increased cytoplasmic Cyt C, decreased Tom 20 and ΔΨm, and elevated ROS. Pretreatment with SB203580 or posttreatment with CsA reduced apoptosis and mitochondrial damage and enhanced cell survival. Increased CRP levels during MP infection promote lung epithelial cell death by activating the p38 MAPK/mitochondrial apoptosis pathway. Targeting this pathway could offer therapeutic potential to reduce lung damage in MPP patients.IMPORTANCEThis study provides critical information in understanding the pathophysiological mechanisms for MP infections concerning CRP in mediating lung epithelial cell injury. This study outlines the significant increase in MP-infected patients and shows its direct involvement in cell apoptosis through the p38 MAPK/mitochondrial apoptosis pathway. By explaining this pathway, the possibility of targeting CRP and its connected signaling mechanisms to devise therapeutic interventions for the amelioration of lung damage in MP-infected patients is brought to light. The implications of such data are not merely in the added knowledge for disease pathobiology but also it brings new promise for novel intervention strategies to result in improved clinical outcomes. The elucidation of specific molecular targets inside the apoptosis pathway heralds a new area regarding the direction of future research and clinical application for humanity in general and concerning the broader relevance and impact of this study on respiratory diseases.

Long-term antibody trajectories after PPSV23 in elderly: Results from a 4-year follow-up study

BACKGROUND

The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for standalone or sequential use in the elderly in many countries to prevent pneumococcal disease, making it crucial to assess vaccine response and long-term persistence.

PURPOSE

We aimed to describe the trajectories of circulating antibody levels to the PPSV23 in the elderly following immunization.

METHODS

Eligible individuals aged 65 to 70 years were enrolled and vaccinated with one dose of PPSV23. Blood samples were collected at baseline (day 0), 4-6 weeks, one year, two years, three years, and four years after vaccination from November 2019 to December 2023. Serotype-specific IgG antibodies were measured for 7(4,6B,9 V,14,18C,19F and 23F) out of the 23 vaccine serotypes. Group-based trajectory modeling (GBTM) was applied to identify distinct trajectories of IgG concentration at each visit after immunization.

RESULTS

A total of 237 participants completed all six visits over the four-year follow-up period, and the geometric mean concentrations (GMC) of antibodies against the seven serotypes remained elevated above the baseline levels by the fourth year. Females and those with a body mass index (BMI) over 25 have generally higher antibody levels pre- and post-immunization across the seven serotypes, with serotypes 6B, 18C show significant difference in higher BMI individuals, and serotype 9 V show significant difference in females after immunization. Based on GBTM, we identified two or three distinct trajectory types of IgG concentration changes across serotypes, with the exception of serotype 4, and we found that participants who showed a more rapid decline in antibody levels two years after vaccination had significantly higher baseline antibody levels.

CONCLUSION

Pneumococcal IgG antibody levels persist for a minimum of four years post-vaccination; Our findings indicate that BMI, gender, and pre-vaccination antibody concentrations should be considered when developing vaccination and revaccination strategies in the elderly.

Nonbacterial Respiratory Pathogens Following the Easing of COVID-19 Restrictive Measures

Nonbacterial respiratory pathogens are major acute respiratory infection (ARI) agents in children. We aimed to characterize the epidemiological changes in 11 common nonbacterial pathogens after easing COVID-19 restrictions in Zhejiang, China, to guide prevention and treatment. A retrospective study was conducted on children with ARIs at Children's Hospital, Zhejiang University School of Medicine in 2023, and epidemiological characteristics were analyzed for gender, age, month, sampling method, and immune status. In total, 59.48% of the children identified pathogens, and Mycoplasma pneumoniae ranked first. Various pathogens showed new features regarding detection rates, seasonal patterns, and susceptible populations. The host age, onset time, sampling method, and immunity status affected the mixed infection rate and unusual coinfection pairs emerged. The epidemiology of respiratory pathogens among children in Zhejiang has changed with local characteristics, and possible preventive actions are needed.

Clinical application of Myxovirus resistance protein A as a diagnostic biomarker to differentiate viral and bacterial respiratory infections in pediatric patients

Background

Differentiating between viral and bacterial respiratory tract infections in pediatric patients remains a significant diagnostic challenge, often leading to the overuse of antibiotics. Myxovirus resistance protein A (MxA) has been identified as a promising biomarker for viral infections. This study aimed to assess the fluctuations in blood MxA levels among children with viral respiratory infections and to explore the differences in MxA levels between viral and bacterial infections, focusing on clinical implications for antibiotic use.

Methods

We conducted a retrospective study using enzyme-linked immunosorbent assay (ELISA) to measure MxA levels in a cohort of 314 children with respiratory tract infections and 89 healthy controls. The study compared MxA levels across children with viral, bacterial, and mixed infections. Diagnostic accuracy was evaluated using receiver operating characteristic (ROC) curve analysis to distinguish between viral and bacterial infections or between viral and co-infections, with additional comparisons to other established infection biomarkers.

Results

MxA levels were significantly elevated in children with viral infections (n=205) compared to bacterial infections (n=21) (p<0.0001). The ROC curve analysis demonstrated that MxA had an area under the curve (AUC) of 0.8019 (95% CI: 0.6989 to 0.9049) for distinguishing viral from bacterial infections. Combining MxA with C-reactive protein (CRP) further enhanced diagnostic performance, achieving an AUC of 0.8713 (95% CI: 0.7916 to 0.9510). However, the use of MxA or MxA/CRP alone is insufficient to differentiate viral and viral - bacterial coinfection. The AUC of MxA is 0.5161 (95% CI: 0.4392 to 0.5930), and the AUC of MxA/CRP is 0.5429 (95% CI: 0.4705 to 0.6153).

Conclusions

This study highlights the diagnostic potential of MxA as a biomarker for differentiating viral from bacterial respiratory infections in children. The combined use of MxA and CRP offers a novel approach to improve diagnostic accuracy. Still, a combination with other clinical and laboratory markers remains required to determine whether to administer antibiotics to children with respiratory tract infections.

Discovery of viruses and bacteria associated with swine respiratory disease on farms at a nationwide scale in China using metatranscriptomic and metagenomic sequencing

Respiratory disease (RD) is a worldwide leading threat to the pig industry, but there is still limited understanding of the pathogens associated with swine RD. In this study, we conducted a nationwide genomic surveillance on identifying viruses, bacteria, and antimicrobial resistance genes (ARGs) from the lungs of pigs with RD in China. By performing metatranscriptomic sequencing combined with metagenomic sequencing, we identified 21 viral species belonging to 12 viral families. Among them, porcine reproductive and respiratory syndrome virus, influenza A virus, herpes virus, adenovirus, and parvovirus were commonly identified. However, emerging viruses, such as Getah virus and porcine respiratory coronaviruses, were also characterized. Apart from viruses, a total of 164 bacterial species were identified, with Streptococcus suis, Mycoplasma hyorhinis, Mycoplasma hyopneumoniae, Glaesserella parasuis, and Pasteurella multocida being frequently detected in high abundances. Notably, Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, and Klebsiella pneumoniae were also highly detected. Our further analysis revealed a complex interaction between the identified pathogens in swine RD. We also conducted retrospectively analyses to demonstrate the prevalent viral genotypes or bacterial serotypes associated with swine RD in China. Finally, we identified 48 ARGs, which conferred resistance to 13 predicted antimicrobial classes, and many of these ARGs were significantly associated with a substantial number of mobile genetic elements, including transposons (e.g., tnpAIS1, tnpA1353, int3, and ISCau1) and plasmids (e.g., Col(BS512), Col(YC)]. These findings will contribute to further understanding the etiology, epidemiology, and microbial interactions in swine RD, and may also shed a light on the development of effective vaccines.IMPORTANCEIn this study, we identified viruses and bacteria from the lungs of pigs with RD in China at a nationwide farm scale by performing metatranscriptomic sequencing combined with metagenomic sequencing. We also demonstrated the complex interactions between different viral and/or bacterial species in swine RD. Our work provides a comprehensive knowledge about the etiology, epidemiology, and microbial interactions in swine RD and data reference for the research and development of effective vaccines against the disease.

Trends and Dynamics of Respiratory Viruses in Hospitalized Children of Fuzhou: Insights Into the Impact of COVID-19 Pandemic Control Measures

Purpose

This study aimed to investigate the prevalence of common respiratory viruses among children with acute respiratory infections in Fuzhou from 2017 to 2023, considering the varying Corona Virus Disease 2019 (COVID-19) epidemic control measures in place.

Patients and Methods

This study retrospectively analyzed the detection of respiratory viruses in children diagnosed with acute respiratory infections at a tertiary hospital in Fuzhou during the study period. The analysis covers three distinct phases: Phase I (2017-2019), Phase II (2020-2022), and Phase III (2023). The subjects of this study included adenovirus (ADV), influenza A virus (Flu A), influenza B virus (Flu B), parainfluenza virus types 1, 2, and 3 (PIV-1, PIV-2, PIV-3), and respiratory syncytial virus (RSV).

Results

A total of 24,838 throat swab samples were collected, resulting in an overall positive detection rate of 17.87% (4439/24,838). The positive detection rates of respiratory viruses among hospitalized children in Phases I, II, and III were 18.51%, 18.27%, and 15.90%, respectively, demonstrating a statistically significant decreasing trend over the years (P < 0.001). Among the detected viruses, RSV, PIV-3, and Flu A were the most prevalent. RSV infections was most common in children under six years of age. Seasonal trends for Flu A, PIV-3, and RSV varied throughout the outbreak; specifically, the detection rate of Flu A increased during March and April in 2023, while RSV detection rebounded sharply from April to June. The incidence of mixed respiratory virus infections was 0.40% (100/24,838), the most common being PIV-3 and RSV.

Conclusion

Using COVID-19 safety rules has helped stop the spread of some viruses in kids. But these rules have not made much difference in how often RSV and PIV-3 viruses show up.

Panoramic quantitative and visualization-based bibliometric analysis of Mycoplasma pneumoniae

PURPOSE

Severe pneumonia, refractory pneumonia and extrapulmonary complications caused by mycoplasma pneumoniae infection were increasing, posing a serious threat to health. This study aimed to explore a breakthrough for further investigations in further.

METHODS

The Web of Science Core Collection was queried using the search term TS = "mycoplasma pneumoniae" for articles from January 1, 2009, to September 24, 2024. Bibliometric indicators were analyzed using VOSviewer, Pajek, and Scimago Graphica, while CiteSpace was utilized for visual analyses, including the contributions of different countries/regions, institutions, authorship patterns, journals, co-citations, keywords, and genes.

RESULTS

3,093 articles were collected and showed an increase interest in MPP research. China was the most prolific contributor, and the USA demonstrated the strongest collaboration willingness. The USA and China had the highest cooperation frequency and closest research relationship. The UK had the highest single-article citation count. Fudan University had the greatest total link strength. The top keywords were "Mycoplasma Pneumoniae" and "community-acquired pneumonia", with "children" being particularly prominent throughout the literatures. "risk factors" and "plastic bronchitis" may represent emerging hotspots in MPP research. Antibiotic therapy, herpes simplex virus infections, and serology detection were the high interest surrounding topics over past decade. mNGS, severe community-acquired pneumonia, co-infections of adenovirus or RSV may become focal points in future. CRP and IL-17 A represented significant genes among MP infection. Positive regulation of cytokine production played a critical role in MP infection.

CONCLUSION

This bibliometric analysis provides insights into its status, frontiers, and hotspots, offering essential guidance to address challenges in MP.

The value of common blood parameters for the differential diagnosis of respiratory tract infections in children

Mycoplasma pneumoniae and influenza A virus are common pathogens that cause respiratory tract infection in children. Both pathogens present with similar clinical symptoms, and their epidemic periods often overlap. Consequently, it is challenging for clinicians to make a rapid preliminary diagnosis. However, common blood tests is simple and efficient, Therefore, the purpose of this study is to preliminarily distinguish Mycoplasma pneumoniae and influenza A virus infection in children by analyzing the results of common blood tests, thereby guiding clinical diagnosis and treatment.The results showed that, compared with children in the influenza A virus-positive group, children in the Mycoplasma pneumoniae-positive group had higher white blood cell (WBC), red blood cell (RBC), haemoglobin (HGB), platelet (PLT) counts, lymphocyte (LYM) and eosinophil (EOS) counts and ratios, as well as higher concentrations of C-reactive protein (CRP) and serum amyloid A (SAA), while neutrophil (NEU) and monocyte (MONO) counts and ratios, Neutrophil to Lymphocyte ratio( NLR) were lower, in addition, LYM, EOS counts and ratios, and NLR were all more effective in differentiating between the two pathogen infections, A combined analysis of these indicators further improved the differentiation efficacy. Therefore, LYM and EOS counts and ratios, along with NLR, can serve as effective blood parameters for differentiating Mycoplasma pneumoniae infections from influenza A virus infections in children.

Respiratory pathogen spectrum and epidemiological trends in Hainan Province: a retrospective analysis from 2017 to 2023

BACKGROUND

Respiratory tract infections (RTIs) pose a significant global health burden, caused by various pathogens. The COVID-19 pandemic and non-pharmaceutical interventions (NPIs) have created unprecedented challenges for public health systems, inadvertently altering the dynamics of other respiratory pathogens. This study aims to illustrate changes in the pathogen spectrum among RTI patients in Hainan Province before and during the pandemic.

METHODS

A retrospective study was conducted to demonstrated the epidemiology characteristics of respiratory pathogens across pre-COVID-19, NPI and COVID-19 pandemic in Hainan from 2017 to 2023. A total of 21,036 patients with RTI of all age groups were enrolled and tested for nine common pathogens: influenza A virus (Flu-A), influenza B virus (Flu-B), parainfluenza virus (PIV), Adenovirus (AAV), respiratory syncytial virus (RSV), Q fever Rickettsiae (Q Fever), Legionella pneumophila (L. pne), Chlamydia pneumoniae (C. pne), and Mycoplasma pneumoniae (M. pne).

RESULTS

During 2017-2023, the number of RTI patients and pathogen detection rate was gradually decrease from 33.30% (3,886/11,670; pre-COVID-19), to 30.81% (2,034/6,602; NPI) and 22.43% (620/2,764; COVID-19). M. pne (25.52%), Flu-B (3.9%), and PIV (3.12%) were identified as the most prevalent pathogens across three periods. However, the infection rate for M. pne was significantly decrease, and the infection rate for Flu-B and Flu-A were a notable increased in NPI and COVID-19 pandemic. Children aged 0-5 years account for the largest proportion of all RTI patients with the highest infection rate, especially in NPI and COVID-19 pandemic. Flu-A, Flu-B, and RSV exhibited spring-specific seasonal prevalence during NPI and COVID-19 pandemic. Co-infection pattern analysis showed that "M. pne-dominant viruses" co-infection type was prevalent across all three time periods.

CONCLUSION

M. pne, Flu-B, Flu-A, and PIV were found to be the main causative pathogens of RTI patients in Hainan Province, and their prevalence levels and seasonal patterns had changed during large-scale NPI and COVID-19 pandemic.

Trends in Mycoplasma pneumoniae infections in pediatric patient preceding, during, and following the COVID-19 pandemic: a comprehensive longitudinal analysis

This study investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic and its associated restrictive measures on Mycoplasma pneumoniae infections in children with acute respiratory tract infection. The study aimed to elucidate the epidemiological characteristics of M. pneumoniae infections before and during the pandemic and following the easing of restrictive measures. Pharyngeal secretions were collected from 1,0174 pediatric patients with acute respiratory infection (ARI) who were admitted to Shaoxing Maternity and Child Health Care Hospital (Shaoxing, China) between May 2018 and December 2023. The analysis concentrated on M. pneumoniae detection rates, epidemiological features, and clinical characteristics. Among 10,174 samples collected from 2018 to 2023, 1,060 strains of M. pneumoniae were detected, resulting in an overall positive rate of 10.42% (n = 1,060 out of 1,0176). Further breakdown revealed positive rates of 8.25% (n = 279 out of 3,381) in phase I (May 2018-December 2019), 2.40% (n = 87 out of 3,623) in phase II (January 2020-November 2022), and 21.89% (n = 694 out of 3,170) in phase III (December 2022-December 2023). In comparison to phase I, a noteworthy decline in the positive rate of M. pneumoniae was found during phase II, followed by a substantial increase during phase III (P < 0.05). Furthermore, the positive rate of M. pneumoniae exhibited a significantly greater surge during the summer-autumn period in contrast to the winter-spring (P < 0.05). Additionally, the risk of M. pneumoniae infection in children who aged 7 years surpassed that of the age group of 0-3 years. Throughout the phases preceding, during, and after the COVID-19 pandemic, discernible fluctuations in both age distribution and seasonality of M. pneumoniae infections were identified among hospitalized children with ARI in the East China.

IMPORTANCE

The resemblance between the transmission pathways of M. pneumoniae and those of COVID-19 suggests that non-pharmaceutical interventions may have comparable effects on both. This study aimed to analyze the epidemiological characteristics of children with M. pneumoniae infections in Shaoxing, China, from 2018 to 2023. This study explored how the COVID-19 pandemic has influenced the prevalence of M. pneumoniae and provided guidance for disease treatment and infection prevention.

The global burden of human metapneumovirus-associated acute respiratory infections in older adults: a systematic review and meta-analysis

BACKGROUND

The human metapneumovirus (hMPV)-associated disease burden in older adults remains under-researched. We aimed to systematically estimate the global burden of hMPV-associated disease in older adults.

METHODS

We searched MEDLINE, Embase, Global Health, CINAHL, Web of Science, and Global Index Medicus in February, 2023, November, 2023, and October, 2024; and CNKI, Wanfang, and CQVip, in April, 2024, and October, 2024. We included studies conducted over at least 12 consecutive months, reporting on adults aged 60 years or older, and with laboratory-confirmed hMPV infections. Critical appraisal of included studies was conducted using the Joanna Briggs Institute critical appraisal tools. To estimate the hMPV pooled proportions positive in acute respiratory infections (ARIs), random effects meta-analyses were conducted. Using Monte Carlo simulation, we estimated the hMPV-associated hospitalisations globally and separately in high-income countries, low-income and middle-income countries, and the USA in individuals aged 65 years or older in 2019, as most studies reported on this age group. The hMPV-associated ARI incidence in countries other than the USA and in outpatient or community settings in the USA was summarised narratively due to scarcity of data. The review protocol was registered on PROSPERO (CRD42023422325).

FINDINGS

46 studies conducted between 2005 and 2023, and reporting on hMPV proportion positive estimates (n=36, with 29 866 laboratory tests), hospitalisation rates in the USA (n=4), and hMPV incidence (n=6) were included. We estimated 473 000 (95% CI 396 000-777 000) hMPV-associated hospitalisations globally, of which 185 000 (105 000-340 000) were in high-income countries (n=6 studies), and 288 000 (193 000-436 000) in low-income and middle-income countries (n=10 studies) in people aged 65 years or older in 2019. In the USA, the pooled hMPV-associated hospitalisation rate was 231 (95% CI 41-421) per 100 000 people in adults aged 65 years or older, representing approximately 122 000 (41 000-398 000) hospital admissions in this population in 2019.

INTERPRETATION

hMPV-associated ARIs contribute to a substantial disease and hospitalisation burden in older adults. However, more large-scale surveillance studies and greater investment in research and diagnostic methods are required to develop reliable estimates.

FUNDING

Icosavax, a member of the AstraZeneca group.

Rapid and facile detection of Mycoplasma pneumoniae 16S rRNA based on CHA-FICA system

Mycoplasma pneumoniae (MP) is a major a rapid, sensitive and reliable method for the detection of 16S ribosomal RNA (16S rRNA) was developed based on catalytic hairpin assembly (CHA) technology and digoxine-biotin double-labeled fluorescence immunochromatography (FICA) strip. The signal amplification achieved by CHA avoids the dependence on expensive thermal cycling equipment. The method can obtain the results within 1 h in the absence of an enzyme, and the minimum detection limit can reach 1 pM. It has good specificity and can effectively distinguish target sequences from non-target sequences. After verification with adult samples and pediatric samples, it was found that CHA-FICA detection was highly consistent with those of PCR detection, indicating that it has clinical application potential and is expected to be used in clinical screening and treatment detection of mycoplasma pneumoniae (MP) infection.

How can traditional Chinese medicine enhance the efficacy of antibiotics in the treatment of MRSA-infected pneumonia: An experimental study on the combination of Reyanning mixture (RYN) and linezolid

ETHNOPHARMACOLOGICAL RELEVANCE

The Reyanning Mixture (RYN) is a Chinese patent medicine widely used in the treatment of respiratory inflammatory diseases in China and has potential in the treatment of bacteria-infected pneumonia.

AIM OF THE STUDY

The present study aimed to demonstrate the therapeutic potential of RYN in combination with linezolid for the treatment of MRSA-infected pneumonia and to explore the mechanisms of action and active components.

MATERIALS AND METHODS

The pharmacodynamics of RYN alone and in combination with linezolid was investigated in a rat model of MRSA-induced pneumonia. Transcriptomics, ELISA, Western blot and qRT-PCR were used to explore and verify the pharmacological mechanism of the anti-inflammatory effect of RYN. UPLC-MS and molecular docking were used to explore the anti-inflammatory components of RYN for the treatment of MRSA-infected pneumonia.

RESULTS

In vivo, RYN reduced lung injury and inflammation in rats with pneumonia. In particular, the combination of RYN and linezolid enhanced the therapeutic effect compared to that of either treatment alone. Further research suggests that the synergistic therapeutic effect of the combination may be related to the inhibition of the inflammatory response by RYN and the enhancement of linezolid inhibition and clearance of MRSA in lung tissues by RYN. RYN plays an anti-inflammatory role in MRSA-infected pneumonia by inhibiting the TLR2/NF-κB/NLRP3 pathway, with 7 active components that may play a dominant role.

CONCLUSIONS

These results indicate that RYN may serve as an adjuvant drug to antibiotics for the treatment of MRSA-associated pneumonia. Exploration of its mechanisms and active components is conducive to the clinical application and quality improvement of RYN. More importantly, this study showed that the synergistic therapeutic effect of the combination of traditional Chinese medicine and antibiotics may be a valuable therapeutic strategy.

The difference of oropharyngeal microbiome during acute respiratory viral infections in infants and children

Acute respiratory infections (ARI) with multiple types of viruses are common in infants and children. This study was conducted to assess the difference of oropharyngeal microbiome during acute respiratory viral infection using whole-genome shotgun metagenomic sequencing. The overall taxonomic alpha diversity did not differ by the types of infected virus. The beta diversity differed by disease severity, disease-related symptoms, and types of infected virus. Nine species had significantly higher abundance in outpatients than in inpatients, with five of them in the genus Achromobacter. Three microbial community types were identified. The prevalence of community type (CT) 1 was higher among patients with influenza virus, enterovirus, and human adenvirus; CT2 was higher among patients with human metapneumovirus; and CT3 was higher among patients with respiratory syncytial virus and human adenvirus infections. Our results suggest that the oropharyngeal microbiome is associated with ARI disease severity, disease-related symptoms, and the types of infected virus.

Respiratory Pathogen Profiles of Patients - Beijing Municipality, China, November 2023-April 2024

Introduction

Respiratory pathogens pose a complex challenge for public health systems. In the winter of 2023, multiple respiratory pathogens showed staggered epidemic waves. Additionally, co-infections involving various pathogens were observed, resulting in significant disease burdens. Understanding the epidemiological dynamics of these pathogens is essential for supporting public health systems in the prevention and control of respiratory infectious diseases.

Methods

Respiratory samples were collected from patients in Beijing presenting with influenza-like symptoms to detect 27 respiratory pathogens using multiplex qPCR.

Results

Four distinct epidemic waves were identified. The first wave was a pre-winter outbreak of Mycoplasma pneumoniae (M. pneumoniae). This was then followed by successive waves of influenza A and B viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exhibited a resurgence by the end of February 2024. Age-dependent susceptibility varied, with SARS-CoV-2 and influenza A/B peaking in the 30-40-year age group. Conversely, adenovirus, rhinovirus, M. pneumoniae, Moraxella catarrhalis (M. catarrhalis), and Haemophilus influenzae (H. influenzae) were more common in adolescents and the elderly. Furthermore, 18.8% of cases were identified as co-infections with more than two pathogens. H. influenzae was found to frequently co-infect with viral and bacterial pathogens.

Conclusions

Respiratory pathogens exhibited different prevalence trends during the first influenza season following the COVID-19 pandemic. Influenza viruses showed a higher peak incidence and delayed seasonality. Moreover, the co-circulation of viral and bacterial infections increased the complexity of respiratory infections. Interestingly, staggered epidemic waves between SARS-CoV-2 and influenza A/B viruses were observed. Consequently, SARS-CoV-2 may become a seasonal virus, causing epidemics alongside influenza viruses. However, further research is needed to elucidate its epidemiological patterns. The co-circulation of these epidemic viruses and other respiratory pathogens underscores the need for enhanced diagnostic and intervention strategies, including vaccination campaigns.