It has been revealed that most patients with severe hand,foot and mouth diseases are infected with enterovirus 71 (EV71).The death usually occurs with brain stem encephalitis and neurogenic pulmonary edema.Treatment of hand,foot and mouth disease should be stage-based,mainly includes antivirus treatment and management of impaired cardiopulmonary functions.Neurological damage may regress or disappear with disease recovery in most children,but sequelae may also exist in a few critical cases.This paper reviews the research progress on pathogenesis and treatment of severe hand,foot and mouth diseases.

Objective To investigate the changes of cytokines in hand-foot-and-mouth disease( HFMD) patients.Methods Retrospective analysis was performed on the clinical data of 262 cases of HFMD.All 262 children with HFMD were divided into two groups:severe cases and non-severe cases.Five cytokines( IL-2,IL-6,IL-10,TNF-αand IFN-γ) simultaneously were detected by luminex multiplexed assays.Results There were 153 severe cases and 109 non-severe cases,The results showed that the levels of IL-2,IL-6,IL-10,TNF-αin severe cases were higher than non-severe cases,and the differences were significant (18.02 ng/L vs 22.71ng/L, 28.42 ng/L vs 53.76 ng/L,17.92 ng/L vs 42.37 ng/L,102.29 ng/L vs 207.99 ng/L,P<0.05 ) .No significant difference of IFN-γlevel was found between the two groups(325.51 vs 373.78 ng/L,P>0.05).In 40 critical cases,plasma levels of IL-2,IL-6,IL-10,TNF-α,and IFN-γwere significantly decreased after administration of intravenous immunoglobulin( P<0.05 ) .Conclusion Some cytokines increase in children with severe HFMD, indicating that inflammatory and anti-inflammatory reaction may play importent roles in the pathogenesis of se-vere HFMD.The findings suggest that intravenous immunoglobulin might play a therapeutic role in severe HFMD.

ObjectiveTo explore the clinical characteristics and radiological manifestations of immune reconstitution inflammatory syndrome(IRIS)in acquired immunodeficiency syndrome(AIDS)patients with tuberculosis(TB)during highly active antiretroviral therapy(HAART).MethodsThe clinical and radiological data in 4 AIDS patients with TB who presented IRIS were analyzed retrospectively.ResultsThe clinical presentations of IRIS in 4 patients included fever(4 cases),weakness and weight loss(3 cases),abdominal pain(2 cases),cough with sputum(1 case),dyspnea(1 case).Cervical and(or)supra-clavicular lymph node enlargement were seen in 3 patients,inguinal lymph node enlargement in 1 patient,abdominal lymph node enlargement in 1 patient,hilar or mediastinal lymph node enlargement in 2 patients,pulmonary parenchyma and liver were involved in 2 patients,the involvement of kidney,adrenal gland,mesentery,peritoneum,psoas,brain and cutis was respectively found in 1 patient.The clinical and radiological presentations of IRIS were temporary and self-limited,improvement can be seen with antituberculosis therapy and HAART. ConclusionsIt is possible to have IRIS during HAART in AIDS patients with TB.Imaging examinations play an important role in the early diagnosis,monitoting and evaluating the response to therapy of IRIS.

reproducible, and may cover the major circulating strains in China.

Influenza is a common acute respiratory infectious disease. In recent years, the number of epidemic outbreak cases is high. It is the peak season of the outbreak of influenza when winter turns to spring from 2017 to 2018. This article reviews the current situation of the diagnosis, treatment and nursing of influenza.

Objective To investigate the incidence and potential risk factors of linezolid (LZD) related thrombocytopenia (TP) in patients with liver cirrhosis (LC). Methods Clinical data of LC patients treated with LZD for at least 1 dose (600 mg per 12 h) between January 2013 and May 2017 were retrospectively collected and analyzed to investigate the incidence and risk factors of LZD-related TP defined as platelet count during LZD therapy ≤ 50×109/L or a decline by ≥25％ of the baseline level. Results A total of 52 patients with LC were included in this study. The cumulative incidence of LZD-related TP was 51.9％ (27/52), of which 85.2％ (23/27) was severe TP (decline of platelet count by ≥50％ of the baseline level). Multivariate logistic regression analysis showed that the baseline platelet count ≤110 ×109/L (OR=6.989, 95％ CI: 1.192-40.971, P=0.031), LZD course ≥ 7 d (OR=9.478, 95％ CI: 1.349-66.587, P=0.024) and LZD dose ≥ 17 mg·kg-1·d-1 (OR=0.062, 95％ CI: 0.010-0.383, P=0.003) were independent risk factors of LZD-related TP in LC patients. Kaplan-Meier analysis revealed that the overall median time from the initiation of LZD therapy to in-hospital death was 18 days in TP patients and 13 days in non-TP patients without significant difference (P＞0.05). Cox proportional-hazards regression revealed no significant correlation between the in-hospital mortality and LZD-related TP in LC patients (P＞0.05). Conclusions Patients with LC are at high risk of LZD-related TP, but not associated with organ hemorrhage during LZD therapy and in-hospital mortality. Platelet count should be monitored more closely during LZD therapy for LC patients with lower baseline platelet count and longer LZD course.

Objective:To analyze the clinical features of an outbreak of extensive drug resistant typhoid fever, and to provide experience for the diagnosis and treatment of drug resistant typhoid fever.Methods:Seven patients with confirmed diagnosis of extensive drug resistant typhoid fever who visited Beijing You′an Hospital, Capital Medical University, from January 27 to February 15, 2022 were included. The clinical characteristics, drug sensitivity tests, consultation and treatment history and prognosis of the patients were analyzed through descriptive study.Results:Of the seven extensive drug resistant typhoid fever patients, three were male and four were female, one of whom was pregnant (at 32-week gestation), aged (29.8±6.8) years, with a range of 22 to 42 years. There were seven cases with fever, and the course of fever ranged from six to 20 days. There were five cases with diarrhea and lack of typhoid-specific manifestations such as rose spot, apathetic facial expression and relatively slow pulse. Four cases were complicated with intestinal bleeding and six cases developed liver function injury. Six cases had loss or decrease in eosinophil ratio and two cases had decreased white blood cell count. The results of drug susceptibility tests showed that seven strains of Salmonella typhi were resistant to chloramphenicol, ampicillin, sulfamethoxazole-trimethoprim, quinolones, ceftriaxone, cefepime, ceftazidime, cefuroxime, and sensitive to carbapenem antibiotics, tigecycline and piperacillin/tazobactam. All seven cases had a history of antimicrobial use before admission. One case was administered with intravenous ceftizoxime for seven days after admission. After discharge, cefixime was administered orally for seven days. Six patients were given intravenous piperacillin sodium/tazobactam sodium for 14 days. All blood/fecal cultures were negative and the patients were cured and discharged. During the follow-up, one patient developed splenic abscess. All the seven patients were residents of the same apartment in Beijing City, and there were water cuts and turbid odors in the incubation period, which were considered as typhoid fever outbreak caused by waterborne transmission. Conclusions:With the use of antimicrobial agents, the typical clinical manifestations of typhoid fever are absent, and the drug resistance rates to quinolone and third-generation cephalosporins increase. Appropriate antimicrobial agents should be selected and the anti-infection course should be prolonged.

Objective:To understand the clinical characteristics of patients with Corona virus Disease 2019 (COVID-19) so as to further provide practical references for clinical practice through collecting and analyzing the clinical data of COVID-19 patients admitted to Beijing Yuoan Hospital.Methods:The clinical data were summarized and analyzed for COVID-19 classified as severe patients and critically ill patients between January 28, 2020 and February 12, 2020 in Beijing Youan Hospital, including their age, gender, course of disease, epidemiological history, previous history, clinical symptoms, laboratory tests, CT findings of lungs, treatment and clinical outcomes. Statistical processing was performed using SPSS software (version 22.0).Results:Nineteen patients were included in this study and divided into two groups by investigators, i. e. ten of the patients had severe type and 9 had the critically ill type of the disease. The average age of the patients was 75 years (range from 58 to 94 years), including 10 males and 9 females. Their course of diseases varied from 1 day to 14 days with a median of 5 days. Among these patients, 4 patients resided in Wuhan, 13 patients had been in close contact with confirmed patients (including family gatherings, during meals, living in the same room, etc.), and 2 patients had no relevant epidemiological history. Fourteen patients suffered from underlying chronic diseases (including 11 cases with hypertension, 4 cases with coronary heart disease, 4 cases with cardiac insufficiency, 3 cases of chronic obstructive pulmonary disease, 2 cases of previous anterior myocardial infarction, 3 cases of arrhythmia, 1 case of heart valve disorders, 2 cases of diabetes mellitus, 2 cases of chronic renal disease, etc.), and 4 patients had 3 or more underlying diseases at the same time. The first symptoms at onset of illness were fever in 18 cases, cough in 13 cases, and dyspnea in 8 cases. Seventeen patients had absolute lymphocyte count (ALC) lower than the normal range. Eleven patients experienced different degrees of hepatic injury, 10 patients had renal injury, 7 patients had abnormal myocardial enzymes to a varying degree. C-reactive protein was increased in 18 patients.12 patients received hormone therapy, 4 patients were treated with gamma globulin, 3 patients used non-invasive ventilator mechanical ventilation, and 7 patients used an invasive ventilator to assist ventilation. Moreover, 1 patient received continuous renal replacement therapy (CRRT), and 1 patient was treated with extracorporeal membrane oxygenation (ECMO). As of February 17, 2020, 10 patients had recovered or been discharged upon treatment, 4 patients were still in the intensive care unit (ICU), and 5 patients had died.Conclusions:The elderly and individuals who had underlying diseases were considered as independent predictors for developing severe and critical disease, and were at higher risk of increased mortality. The decrease of ALC and the increase of C-reactive protein levels in the patients, and the abnormality of liver function, renal function and myocardial enzyme spectrum to different degrees suggest the correlation with severe cases. Steroids and ventilator are effective in the treatment of severe cases.

Objective:To conduct a series case study on hospitalized anthrax cases in five hospitals in North China, to share clinical experiences in the diagnosis and treatment of cutaneous and pulmonary anthrax.Methods:A retrospective, multicenter cohort study was conducted on the anthrax patients admitted to five hospitals in North China from August 2018 to March 2022. Forty patients were divided into severe and mild groups. The clinical features, treatment and prognosis of the patients were collected and analysed. Statistical evaluations included independent sample t test, Mann-Whitney U test, and chi-square test. Results:Among the 40 patients with anthrax, 10(25.0%) were severely ill and 30(75.0%) were mildly ill. According to the sites of infection, 40 patients were classified as 39 cutaneous anthrax cases (one case had secondary pulmonary anthrax) and one pulmonary anthrax case. The rates of chills and fever, lymphadenopathy, liver dysfunction and hypoalbuminemia in the severe group were all higher than those in the mild group, with statistically significant differences ( χ2=5.71, 6.54, 4.68 and 9.22, respectively, all P<0.05). The peripheral white blood cell count, neutrophil count, neutrophil/lymphocyte ratio and C-reactive protein were (11.8±4.9)×10 9/L, (9.5±5.1)×10 9/L, 8.6±7.3, 27.9(8.6, 167.7) mg/L, respectively, which were all higher than those in mild disease group ((7.5±2.4)×10 9/L, (5.0±2.1)×10 9/L, 3.2±2.3, 3.5(1.2, 14.7) mg/L), with statistically significant differences ( t=2.66, t=2.71, t=2.32 and Z=-3.01, respectively, all P<0.05). The albumin level in the severe group was (35.5±8.1) g/L, which was lower than that of the mild group ((43.7±3.2) g/L), and the difference was statistically significant ( t=-3.13, P=0.011). The severe cases were more likely to have skin lesions greater than four centimetre in diameter, multiple, vesicular, or edematous, with a significant difference ( χ2=6.01, P=0.014). Among 39 patients with cutaneous anthrax, 28(71.8%) in the mild group were treated with penicillin alone, and nine (23.1%) in the severe group were treated with penicillin, ofloxacin, piperacillin/tazobactam combined with one of linezolid, doxycycline, or clindamycin for anti-infection treatment. The two patients with pulmonary anthrax were treated with closed thoracic drainage for pleural effusion and pneumothorax, and were treated with two bactericidal and one protein synthesis inhibitor antibiotics. All 40 anthrax patients were cured and discharged from hospital. Conclusions:Patients with mild cutaneous anthrax can generally be treated with single penicillin, and patients with severe cutaneous anthrax and pulmonary anthrax should be treated with combined antibiotics.