| Objective:To retrospective hospitalized children with acute respiratory infection in the pediatric ward of our hospital during the last year,to analysis of age and season distribution and epidemic characteristics of acute respiratory tract infection in children,so as to provide diagnostic thinking of pathogen of children in different season and age group with acute respiratory infection,and also provide evidence-based basis in combined modality therapy.Method:Study population:from April 2017 to March 2018,we collected acute respiratory infection from pediatric respiratory ward of our hospital.patients were divide in 4 groups:infants(?1 year),immature children(>1 year,?3 years),preschool-aged children(>3 year,<6years),school-aged children(>6 years).Data collection:collect all patients' sex,age,diagnosis and pathogen,all patients were tested with routine blood test and CRP sputum or(and)blood,broncho-alveolar lavage fluid culture,IgM antibodies of 7 types of virus and Mycoplasma pneumoniae(MP),Chlamydia pneumoniae(CP),Legionella pneumoniae,(LP),sex,age,diagnosis and visit time of patients were collected.Result:1.1049 case were collected with diagnosis of acute respiratory infection,there were 692 males and 357 females(ratio:M:F=1.94:1).Among them 499 cases were infants,286 cases were immature children,152 cases were preschool-aged children,113 cases were school-aged children,the median age was lyears(range:1 month to 14years).2.There were 937 cases with "pneumonia" as first diagnosis,45 cases with"acute upper respiratory infection" as first diagnosis,46 cases with "bronchitis"(include:acute bronchitis,acute bronchiolitis,acute wheezing bronchitis)as first diagnosis,and 15 case with "acute tonsillitis" as first diagnosis.3.There were 424 cases(40.42%)were tested at least one positive pathogen.Among them,90 cases(8.87%)with respiratory virus infection,196 cases(19.31%)with bacterial infection,and 204 cases(20.14%)with atypical pathogen infection.There were 364 case were infected with only one pathogen,20 cases mixed with respiratory virus and bacterial co-infection.4.Among respiratory virus infection patients,there were 73 cases with respiratory syncytial virus(RSV)infection,14 cases with influenza virus(IFV)infection.There was a statistically significant difference in respiratory virus infection in different season groups(x2=13.5,p=0.004),the higher detection rate was in autumn and winter.There was a statistically significant difference in RSV infection in different season groups,RSV infection peak is more common in autumn and winter.There was a statistically significant difference in respiratory virus infection in different age groups(x2=47.736,p=0.000),virus infection peak is more common in infants.5.The top five bacteria was followed by:Streptococcus pneumoniae,Haemophilus influenzae,Staphylococcus aureus,Katabrahan's bacillus and Klebsiella pneumoniae.There was a statistically significant difference in bacteria infection in different season groups(x2=10.922,p=0.012),total bacteria infection peak is more common in spring and winter.There was no statistically significant difference in bacteria infection in different age groups.6.Mycoplasma pneumoniae was the most common infection in atypical pathogen infection.There was no statistically significant difference in atypical pathogen infection in different season groups(p>0.05).There was a statistically significant difference in Legionella pneumoniae infection in different season groups(p<0.05).LP infection peak is more common in autumn and winter.There was a statistically significant difference in MP infection in different age groups(p<0.05).MP infection peak is more common in over 6 years.There was a statistically significant difference in LP and CP infection in different age groups(p<0.05).Conclusion:1.Hospitalized children with acute respiratory tract infection are mainly infants under 3 years of age in our area.The most common pathogen in children with acute respiratory tract infection is atypical pathogen(20.14%),the second is bacteria infection(19.31%),The low detection rate of virus may be related to the detection method.2.There was a statistically significant difference in respiratory virus infection in different age groups and season groups.Infant who under 3 years are mostly infected with respiratory virus.Respiratory virus infection peak is more common in autumn and winter.The most common virus in children with acute respiratory tract infection is RSV in our area.3.The most common bacteria in children with acute respiratory tract infection is Streptococcus pneumoniae,mostly tested by sputum culture,the peak is more common in autumn and winter,and it was no statistically significant difference in different age groups.4.Atypical pathogen has become the most common pathogen in children with acute respiratory tract infection,Mp has become main cause,and is more common in school-aged group.Objective:To analyze the value of IFI44L and FAM89A mRNA expression signature in whole blood to differentiate patients with bacterial infection or virus infection,so as to provide a new method to test of respiratory tract pathogen infection.Method:Study population:from March 2017 to March 2018,we collected children with acute infectious disease from pediatric ward of our hospital.Study method:the information of patients and clinical test result were collected.patients were divide in 2 groups according to the result of pathogen test:bacteria infection group and virus infection group,and normal uninfected children were selected as control group.0.5ml peripheral whole blood were collected all of them to detect FAM89A and IFI44L gene expression by fluorescent quantitation PCR.To analyze the difference of WBC,CRP,FAM89A and IFI44L gene expression in 3 groups,and analyze ROC Curves of FAM89A and IFI44L gene expression.Results:1.There were 43 cases in virus infection group,23 cases in bacteria infection group and 49 cases in normal uninfected children as controls,There were 7 cases with bacteria and virus co-infectious.2.In WBC:There was a statistically significant difference in bacteria infection group and controls(p<0.05).There was no statistically significant difference in bacterial group and virus infection group,so as in virus infection group and controls(all p>0.05).In CRP:There was a statistically significant difference in bacteria infection group and controls,so as in virus infection group and controls.There were no significant in virus infection group and bacterial group.ROC curve was performed of CRP level based on 23 cases bacterial infection groupe and 49 controls,the AUC is 0.895(95%CI:79.8%-99.2%).3.There was a statistically significant difference with FAM89A gene expression in bacteria infection group and controls(p<0.05),and in bacteria infection group and virus infection group(p<0.05).There was no statistically significant difference with FAM89A gene expression in virus infection group and controls(p>0.05).ROC curve was performed of FAM89A gene expression based on 23 cases bacterial infection group and 49 controls,the AUC is 0.67,(95%CI:54.6%-79.3%),Youden index was 0.38,and the value of ?CT of FAM89A was 0.5926,the sensitive of diagnostic bacterial infection is 0.87,and the specificity is 0.49.4.There was a statistically significant difference with IFI44L gene expression in virus infection group and controls(p<0.05),and in bacteria infection group and virus infection group(p<0.05).There was no statistically significant difference with IFI44L gene expression in bacteria infection group and controls(p>0.05).ROC curve was performed of IFI44L gene expression based on 43 cases virus infection group and 49 controls,the AUC is 0.96(95%CI:91.4%-99.7%),Youden index was 0.846,and the value of ?CT of IFI44L was 0.3334,the sensitive of diagnostic bacterial infection is 0.907,and the specificity is 0.939.Conclusion:1.There was a statistically significant difference with FAM89A mRNA gene expression in bacterial infection and no-bacterial infection.FAM89A mRNA gene expression is decreased in bacterial infection,but it has a low sensitivity and specificity,we need more study on the relationship with bacterial infection and the expression of FAM89A.2.There was a statistically significant difference with IFI44L mRNA gene expression in virus infection and no-virus infection.IFI44L mRNA gene expression is increased in virus infection,and it has a well sensitivity and specificity which can be a new method on virus detection.3.This study proved that the expression of host gene can be used to judge bacterial infection and viral infection.Further research needs to be done to evaluate the accuracy and clinical application value of bacterial infection and viral infection in different clinical environments. |
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