OBJECTIVETo summarize the recent findings on the epidemiology of medically important, opportunistic invasive fungal infections (IFIs) in China and discuss the relevant social, economical reasons and medical factors.

DATA SOURCESWe performed a comprehensive search of both English and Chinese literatures of opportunistic IFIs from China up to April 2012.

STUDY SELECTIONRelevant literatures involving researches and cases/case series were identified, retrieved and reviewed.

RESULTSThe incidence of opportunistic IFIs in China was steadily increasing. The incidence and mortality of IFIs were different in patients with various underlying conditions/diseases, from 4.12% to 41.18% and 9.8% to 60.0%, respectively. Candida species, Aspergillus species and Cryptococcus neoformans species complex were the most frequent isolated pathogens. Other uncommon opportunistic IFIs were also been reported, including trichosporonosis, mucormycosis, hyalohyphomycosis (hyaline hyphomycetes) and phaeohyphomycosis (dematiaceous hyphomycetes). Reports of Chinese patients differed from those of many other countries as there were a higher number of patients without identifiable underlying diseases/conditions.

CONCLUSIONSBecause of the rapid economic development, changing population structure and a growing number of immunocompromised hosts with risk factors, today opportunistic IFIs in China have a significant impact on public health, associated with high morbidity/mortality and higher care costs. Now information related to the epidemiology of opportunistic IFIs in China is still sparse, so we need more organized groups of clinical scientists performing related researches to help the clinicians to obtain more accurate epidemiological characteristics.

China ; epidemiology ; Humans ; Incidence ; Mycoses ; epidemiology ; mortality ; Opportunistic Infections ; epidemiology ; mortality

OBJECTIVETo study the factors influencing short-term prognosis of tuberculous meningitis (TBM) in children.

METHODSThe clinical data of 137 hospitalized children with TBM between January 2007 and February 2011 were retrospectively reviewed. A total of 30 potential factors influencing short-term prognosis of TBM were evaluated by univariate analysis and multivariate logistic regression analysis.

RESULTSClinical staging showed that of the 137 children 21 cases (15.3%) were in the early stage, 67 cases (48.9%) in the medium stage and 49 cases (35.8%) in the late stage of TBM. The univariate analysis revealed 8 factors associated with a poor short-term prognosis: clinical stage of TBM (late), coma, positive Babinski signs, cranial nerve involvements, paralysis, seizures, obvious abnormalities in brain computed tomography (CT) or magnetic resonance imaging (MRI) and elevated protein concentrations in cerebrospinal fluid (CSF). Factors associated with a favourable short-term prognosis for TBM included glucocorticoid steroids therapy, positive reaction of PPD skin test and an increased length of stay in hospital. Multivariate logistic analysis revealed two independent risk factors for a poor short-term prognosis: clinical stage of TBM (late) (OR: 11.168, 95%CI: 3.521-35.426) and positive signs of meningeal irritation (OR: 4.275, 95%CI: 1.043-17.521). An increased length of stay in hospital was shown as a favorable factor (OR: 0.893, 95%CI: 0.825-0.968).

CONCLUSIONSLate-stage TBM and positive signs of meningeal irritation suggest a poor prognosis, while an appropriately longer length of stay in hospital may contribute to a favorable short-term prognosis for children with TBM.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Prognosis ; Retrospective Studies ; Tuberculosis, Meningeal ; complications ; diagnosis

The molecular electronegativity-distance vector (MEDV) was used to describe the chemical structural characterization of 46 components of essential oils in the flower of Rosa banksiae. Various multiple linear regression (MLR) models were created with variable screening by the stepwise multiple regression technique and statistics. The QSRR models of 10 and 6 variables were built by MLR with the correlation coefficients (R) of molecular modeling being 0.906 and 0.903. Cross-validation of the models, which contain selected vectors were performed by leave-one -out procedure (LOO) and the satisfied results with correlation coefficients (Rcv) of 0.904 and 0.903, respectively. The results showed that the models constructed can provide estimation stability and favorable predictive ability.
Flowers ; chemistry ; Linear Models ; Molecular Structure ; Oils, Volatile ; chemistry ; Plants, Medicinal ; chemistry ; Quantitative Structure-Activity Relationship ; Regression Analysis ; Rosa ; chemistry

The purpose of this study was to determine whether the fully automated ORTHO AutoVue Innova system, which based on the microcolumn glass sphere technology, is accurate enough to meet immunohematology testing needs at blood banks. 16 IgM anti-C, anti-c, anti-D, anti-E and anti-e dilution series were tested respectively, with corresponding antigen positive red blood cell solutions, by ORTHO AutoVue Innova system and saline medium test. 16 IgG anti-D dilution series were tested respectively with RhD positive red blood cell solutions by ORTHO AutoVue Innova system, polybrene test and antiglobulin test. The accuracies of microcolumn glass sphere technology were analysed, by comparing to the reference assays. The results showed that the sensitivities of the ORTHO AutoVue Innova tests were 1:69.8, 1:33.4, 1:1448.1, 1:139.6 and 1:32.0 for IgM anti-C, anti-c, anti-D, anti-E and anti-e respectively; the corresponding value of saline medium tests were 1:16.7, 1:16.6, 1:430.5, 1:34.9 and 1:9.9. There were statistically significant differences between the groups of each tests (t values were 14.38, 5.48, 10.25, 12.65 and 9.59 for IgM anti-C, anti-c, anti-D, anti-E and anti-e respectively, p < 0.05). For IgG anti-D, the sensitivities of the ORTHO AutoVue Innova test, polybrene test and antiglobulin test were 1:980.6, 1:181.0 and 1:304.4 respectively. There was statistically significant difference among the 3 groups (F = 51.15, p < 0.01). It is concluded the use of ORTHO AutoVue Innova system for blood group compatibility test can obtain more accurate results than traditional tube tests, it is reliable and safe for routine tests performed in immunohematology laboratories.
Blood Grouping and Crossmatching ; methods ; Coombs Test ; methods ; Humans ; Isoantibodies ; blood ; Materials Testing ; Rho(D) Immune Globulin ; Sensitivity and Specificity

BACKGROUNDInitially, Cryptococcus (C.) neoformans was previously divided into two varieties comprising C. neoformans var. neoformans and C. neoformans var. gattii. Currently, taxonomic studies defined C. neoformans as C. species complex, which contains C. neoformans var. neoformans (serotype D), the hybrid isolates (serotype AD), C. neoformans var. grubii (serotype A) and C. gattii (serotypes B and C). However, Liao and his team once isolated a unique C. gattii isolate, namely strain S8012 with unique phenotype from cerebrospinal fluid (CSF) of a 43-year-old male patient in the Shanghai Changzheng Hospital and described as C. neoformans var. shanghaiensis in 1980s. The aim of this study was to explore the genetic background and polymorphism of Chinese clinical C. gattii isolates.

METHODSS8012 was analyzed as representative strain using the M13-polymerase chain reaction (PCR) fingerprinting pattern and multilocus sequence analysis including internal transcribed spacers of rDNA (ITS region), the intergenic spacer 1 regions (IGS1), RPB1, RPB2, CNLAC1, and TEF1 genes.

RESULTSThe PCR fingerprinting pattern results showed strain S8012 belonged to molecular types VGI, and phylogenetic analysis suggested strain S8012 was grouped into the cluster of C. gattii environmental isolates originated from Eucalyptus camaldulensis trees in Australia.

CONCLUSIONC. gattii isolates from Chinese patients expresses high polymorphism on the phenotype, and molecular type VGI isolates from China have a close genetic relationship with the C. gattii isolates from Australia.

Cryptococcus ; classification ; genetics ; Cryptococcus gattii ; classification ; genetics ; DNA, Fungal ; genetics ; DNA, Ribosomal ; genetics ; Phylogeny ; Polymerase Chain Reaction

OBJECTIVETo investigate the clinical features of invasive fungal disease (IFD) in children without underlying diseases.

METHODSThe clinical data of 49 children without underlying diseases who were diagnosed with IFD were retrospectively studied.

RESULTSFungal pathogens were detected in 37 (76%) out of 49 patients, including Cryptococcus neoformans (17 children, 46%), Candida albicans (10 children, 27%), Aspergillus (3 children, 8%), and Candida parapsilosis (3 children, 8%). Fungal pneumonia (17 children, 46%) was the most commonly seen disease, with Candida albicans as the major pathogen (9 children, 53%). The 49 children had at least one high-risk factor for infection, including the use of antibiotics, a long length of hospital stay, and invasive procedures. Of all the children, 82% did not respond well to antibiotic treatment or experienced recurrent pyrexia. Among the 24 children who underwent G tests, 17 (71%) showed positive results. All the children were given antifungal therapy, and among these children, 37 (75%)were cured, 3 (6%) were still in the treatment, 5 (10%) died, and 4 (8%) were lost to follow-up.

CONCLUSIONSIn IFD children without underlying diseases, Cryptococcus neoformans and Candida are the main pathogens, and lung infection is the most common disease. Long-term use of high-dose antibiotics may be an important risk factor for fungal infection. The IFD children without underlying diseases are sensitive to antifungal drugs and have a satisfactory prognosis.

Adolescent ; Antifungal Agents ; therapeutic use ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Invasive Fungal Infections ; diagnosis ; drug therapy ; etiology ; Male ; Risk Factors

OBJECTIVETo investigate the current status of research on infantile cholestatic liver disease in China and future research trends.

METHODSA co-word analysis was performed in October 2016. Document retrieval and screening were performed in the Chinese databases CNKI and Wanfang Data using "cholestasis" and "infant" as key words. Excel 2010 was used to establish a co-occurrence matrix of high-frequency key words, and Ucinet 6.0 and Netdraw were used to develop a visualized network of these high-frequency key words.

RESULTSA total of 383 articles were included. The co-occurrence analysis showed that "infant" and "cholestasis" were the core of research in this field, and "infantile hepatitis syndrome", "neonate", "intrahepatic", "biliary atresia", "heredity and metabolism", "hepatitis", "cytomegalovirus", "jaundice", and "conjugated bilirubin" were main research topics. Most of the other articles focused on "parenteral nutrition", "hepatobiliary imaging", "gene mutation", and "liver biopsy". There were relatively few articles on surgical diagnostic techniques and treatment for this disease.

CONCLUSIONSThe research on infantile cholestatic liver disease in China focuses on etiology and differential diagnosis, and genetic diagnosis has become a hot topic in recent years. The research on treatment should be enhanced, and new diagnostic techniques are the research interest in future.

Cholestasis, Intrahepatic ; diagnosis ; etiology ; genetics ; therapy ; Humans ; Infant

OBJECTIVETo study the relationship between nasal carriage and Staphylococcus aureus (S. aureus) infection in hospitalized children.

METHODSFifty-six hospitalized children infected with S. aureus were recruited in this study. Nasal swabs were collected and cultured, and the nasal carriage rate of S. aureus was examined. PVL virulence gene and mecA resistance gene were both detected in clinical strains and nasal carriage strains by PCR.

RESULTSTwenty-two (39%) of the 56 children had nasal carriage of S. aureus, and most of them (18 cases) were younger than one year. Among these 22 children, 11 (50%) had previous hospitalization over the past year. In the infected strains, the rate of methicillin-resistant S. aureus (MRSA) was 29% (16/56), while it was 32% (7/22) in carriage strains. The mecA positive results in clinical strains were consistent with the results in nasal carriage strains. Among 5 PVL-positive nasal carriage strains, 4 (90%) could be matched with their clinical strains, all of which were MRSA.

CONCLUSIONSNasal carriage is a potential risk factor for S. aureus infection. Nosocomial transmission may lead to nasal carriage, which can cause S. aureus infection. The isolation rate of MRSA is high in hospitalized children infected with S. aureus, which implies that more attention is needed for this situation. The isolates from noses may be clonally identical to the isolates from clinical secretions, and the homology between them needs to be confirmed by multi-locus sequence typing.

Bacterial Proteins ; genetics ; Carrier State ; microbiology ; Child ; Child, Hospitalized ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Methicillin-Resistant Staphylococcus aureus ; isolation & purification ; Nose ; microbiology ; Penicillin-Binding Proteins ; Staphylococcal Infections ; microbiology ; Staphylococcus aureus ; isolation & purification

Objective To explore the infection distribution and drug resistance of pathogens in patients with severe liver disease,and provide reference for clinical medication.Methods Retrospective analysis of the microbiological specimens from patients with severe liver disease in Department of Infection of our hospital from August 2014 to November 2016 and the drug susceptibility testing were carried out by means of K-B disc diffusion method after bacterial culturing,and the distribution and drug resistance of pathogens were analyzed.Results Totally 17 of 73 patients with severe liver disease developed hospital infection (23.3％).104 strains of bacteria were isolated and 78 strains out of them were multidrug-resistant bacteria (75.0％).Among them,28(26.9％) strains were gram-positive coccus,mainly consisting of Staphylococcus aureus and Staphylococcus epidermidis,and 58(55.8％) were gram-negative coccus,mainly composed of Escherichia coli,Klebsiella pneumonia and Acinetobacter baumannii,and 18(17.3％) strains fungi.S.aureus and enterococci were resistant to penicillin,erythromycin and levofloxacin,the resistance rates were above 80.0％,but had low resistance rates to vancomycin,teicoplanin and tigecycline.The resistance rates of E.coli and K.pneumoniae to piperacillin,cefazolin and cefuroxime sodium were above 85.0％,but they had lower resistance rates to tigecycline and amikacin.Acinetobacter baumannii was 100％ resistant to piperacillin and tazobactam,ceftazidime,imipenem and amikacin,but had low resistance to tigecycline and minocycline.Conclusions Multi-drug resistant bacteria are the main bacterial pathogens in patients with severe liver disease and have a high resistance rate to commonly used antibiotics,empirical treatment in the population at high risk of multidrug-resistant bacteria infections requires the use of broad-spectrum or high-grade antibiotics (e.g.carbapenems or tigecycline) and drugs against specific pathogenic bacteria (glycopeptides,linezolid,and amikacin etc).Early de-escalation policies are recommended to prevent the spread of multidrug-resistant bacteria in cirrhosis.