Objectives To investigate interleukin 36γ (IL-36γ) expression, and analyze the influence of IL-36γ to CD8⁺ T cell activity in chronic obstructive pulmonary diseases (COPD) patients with secondary fungal pneumonia. Methods Peripheral blood was collected from 47 COPD patients, 39 COPD patients with secondary fungal pneumonia, and 20 controls. Bronchial alveolar lavage fluid (BALF) was isolated from 27 COPD patients with secondary fungal pneumonia. CD8⁺ T cells were purified. The levels of four IL-36 isoforms in plasma and BALF were measured by enzyme linked immunosorbent assay (ELISA). CD8⁺ T cells were stimulated with recombinant human IL-36γ. The levels of interferon γ(IFN-γ), tumor necrosis factor α(TNF-α), perforin and granzyme B in the cultured supernatants were measured by ELISA. Recombinant human IL-36γ-stimulated CD8⁺ T cells were co-cultured with NCI-H1882 cells in either direct cell-to-cell contact or Transwell^TM manner. The levels of IFN-γ, TNF-α, and lactate dehydrogenase in the cultured supernatants were assessed. The percentage of target cell death was calculated. Results Plasma IL-36α, IL-36β, and IL-36γ levels were significantly elevated in both COPD group and COPD with secondary fungal pneumonia group compared with those in control group. However, only plasma IL-36γ level was higher in COPD with secondary fungal pneumonia group than that in COPD group [(200.11±99.95)pg/mL vs (53.03±87.18)pg/mL, P=0.023]. There was no remarkable difference in plasma IL-36 receptor antagonist level among three groups. IL-36γ level in BALF from infectious site was higher than that from non-infectious site in COPD with secondary fungal pneumonia group [(305.82±59.60)pg/mL vs (251.93±76.01)pg/mL, P=0.011]. IL-36γ stimulation enhanced IFN-γ, TNF-α, perforin and granzyme B secreted by CD8⁺ T cells. When IL-36γ-stimulated CD8⁺ T cells were directly mixed with NCI-H1882 cells for co-culture, the percentage of cell death was increased [(16.06±3.67)% vs (11.47±2.36)%, P=0.002]. When using Transwell^TM plate for non-contact co-culture, IL-36γ-stimulated CD8⁺ T cell-mediated death of NCI-H1882 cells showed no significant difference compared to that without stimulation [(4.77±0.78)% vs (4.99±0.92)%, P=0.554]. Conclusion IL-36γ level in plasma and infectious site is elevated in COPD patients with secondary fungal pneumonia, which enhances the cytotoxicity of CD8⁺ T cells in peripheral blood and infectious microenviroment.
Humans ; Pulmonary Disease, Chronic Obstructive/complications* ; CD8-Positive T-Lymphocytes/metabolism* ; Male ; Female ; Aged ; Middle Aged ; Interferon-gamma/metabolism* ; Interleukin-1/metabolism* ; Tumor Necrosis Factor-alpha/metabolism* ; Lung Diseases, Fungal/complications* ; Bronchoalveolar Lavage Fluid/chemistry* ; Perforin/metabolism* ; Pneumonia/immunology* ; Granzymes/metabolism*

OBJECTIVES: To investigate the risk factors for plastic bronchitis (PB) in children with macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) and to establish a nomogram prediction model. METHODS: A retrospective analysis was conducted on 178 children with MUMPP who underwent bronchoscopy from January to December 2023. According to the presence or absence of PB, the children were divided into a PB group (49 children) and a non-PB group (129 children). The predictive factors for the development of PB in children with MUMPP were analyzed, and a nomogram prediction model was established. The model was assessed in terms of discriminatory ability, accuracy, and clinical effectiveness. RESULTS: The multivariate logistic regression analysis showed that older age and higher levels of lactate dehydrogenase and fibrinogen were closely associated with the development of PB in children with MUMPP (P<0.05). A nomogram model established based on these factors had an area under the receiver operating characteristic curve of 0.733 (95%CI: 0.651-0.816, P<0.001) and showed a good discriminatory ability. The Hosmer-Lemeshow goodness-of-fit test indicated that the predictive model had a good degree of fit (P>0.05), and the decision curve analysis showed that the model had a good clinical application value. CONCLUSIONS The risk nomogram model established based on age and lactate dehydrogenase and fibrinogen levels has good discriminatory ability, accuracy, and predictive efficacy for predicting the development of PB in children with MUMPP.
Retrospective Studies ; Risk Factors ; Nomograms ; Mycoplasma pneumoniae/isolation & purification* ; Pneumonia, Mycoplasma/microbiology* ; Bronchitis/microbiology* ; Macrolides/therapeutic use* ; Drug Resistance, Bacterial ; Bronchoscopy ; Area Under Curve ; ROC Curve ; Fibrinogen/analysis* ; Age Factors ; Humans ; Male ; Female ; Infant ; Child, Preschool ; Child ; Adolescent ; L-Lactate Dehydrogenase/blood*

OBJECTIVES: To study the risk factors for hypoxemia in children with severe Mycoplasma pneumoniae pneumonia (SMPP). METHODS: A retrospective collection of clinical data from children diagnosed with SMPP at the Third Affiliated Hospital of Zhengzhou University from June to December 2023 was conducted. The patients were categorized into hypoxemia and non-hypoxemia groups. Logistic regression analysis was used to assess the risk factors for hypoxemia, and receiver operating characteristic (ROC) curve analysis was employed to analyze the diagnostic performance of various indicators. RESULTS: A total of 113 children with SMPP were included. Univariate logistic regression analysis showed that ferritin, aspartate aminotransferase, creatinine, creatine kinase isoenzyme, lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, immunoglobulin G, complement C3, complement C4, age, extrapulmonary complications, and a chest computed tomography (CT) scan showing a bronchiolitis pattern were significant factors for hypoxemia in children with SMPP (P<0.05). Multivariate logistic regression analysis revealed that elevated ferritin levels, presence of extrapulmonary complications, and a bronchiolitis pattern on lung CT were independent risk factors for hypoxemia in these patients (P<0.05). The ROC curve analysis indicated that the combination of these three indicators for predicting hypoxemia had a sensitivity of 71.9%, a specificity of 95.1%, and an area under the curve of 0.888 (95%CI: 0.809-0.968). CONCLUSIONS In children with SMPP, when there are elevated ferritin levels, a bronchiolitis pattern on chest CT, and the presence of extrapulmonary complications, there should be a high level of vigilance for the potential development of hypoxemia.
Humans ; Pneumonia, Mycoplasma/complications* ; Male ; Female ; Risk Factors ; Child, Preschool ; Hypoxia/etiology* ; Retrospective Studies ; Child ; Logistic Models ; Infant ; ROC Curve ; Adolescent

OBJECTIVES: To study the characteristics of bronchoalveolar lavage fluid (BALF) microbial distribution at different stages of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and its relationship with immune function. METHODS: A total of 108 children with RMPP were enrolled. The relative abundance, richness, and diversity of BALF microbiota, as well as immune function, were compared between the acute phase (n=61) and recovery phase (n=47). The correlations between the richness and diversity of BALF microbiota and immune function were analyzed. RESULTS: The relative abundance of Propionibacterium, as well as the Simpson index, Shannon index, Chao1 index, and Observed species index of BALF microbiota in the acute phase were significantly lower than those in the recovery phase (P<0.05). The relative abundances of Streptococcus and Prevotella, as well as the levels of complement C3, complement C4, immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM), were significantly higher in the acute phase than in the recovery phase (P<0.05). Simpson, Shannon, Chao1, and Observed species indices were negatively correlated with levels of complement C3, complement C4, IgA, IgM, and IgG (P<0.05). CONCLUSIONS In children with RMPP, the relative abundance of Propionibacterium and the richness and diversity of BALF microbiota in the acute phase are lower than those in the recovery phase, while the relative abundances of Streptococcus and Prevotella are higher in the acute phase. Microbial richness and diversity are closely related to immune function.
Humans ; Male ; Pneumonia, Mycoplasma/microbiology* ; Female ; Bronchoalveolar Lavage Fluid/microbiology* ; Child, Preschool ; Child ; Infant ; Microbiota

In order to enhance the ability of primary healthcare providers to recognize and manage neonatal infectious pneumonia, and to reduce the incidence and mortality of severe neonatal pneumonia, the Subspecialty Group of Neonatology, Society of Pediatrics, Chinese Medical Association convened a panel of experts to review and synthesize the latest clinical evidence on neonatal infectious pneumonia. After thorough discussion, this guideline was developed to address 10 common clinical issues faced by primary healthcare providers regarding neonatal infectious pneumonia, resulting in 18 recommendations.
Humans ; Infant, Newborn ; Pneumonia/therapy* ; Primary Health Care

BACKGROUND

Differentiating bacterial from aseptic meningitis in children is critical for optimal treatment. While symptoms overlap, bacterial meningitis demands immediate antibiotics. Traditionally, CSF culture has been the gold standard for diagnosis, but its yield has declined with widespread vaccination. Consequently, some children with negative cultures may still have bacterial meningitis. The Bacterial Meningitis Score (BMS), a validated clinical prediction rule, offers a valuable tool, particularly in resource-limited settings, to better identify high-risk children and guide more effective treatment strategies.

To evaluate the clinical utility and diagnostic accuracy of the BMS in identifying pediatric patients at high risk for bacterial meningitis.

This retrospective cross-sectional study included 75 pediatric patients (aged 29 days to 18 years) with suspected meningitis seen at the Emergency Room of the Pediatrics Department in Mariano Marcos Memorial Hospital and Medical Center from March to November 2023. Eligible patients underwent lumbar puncture for CSF analysis. The BMS, a five-variable clinical tool including CSF Gram stain, CSF absolute neutrophil count, CSF protein, peripheral absolute neutrophil count, and seizure, were used to classify patients as very low risk (BMS=0) or not very low risk (BMS ≥1).

The diagnostic performance of the Bacterial Meningitis Score (BMS) across different cut-off thresholds is as follows: At a cutoff of ≥1, sensitivity is 100%, specificity is 36.80%, positive predictive value (PPV) is 33.3% (95% CI: 22% – 46%), negative predictive value (NPV) is 100% (95% CI: 84.5% – 100%), positive likelihood ratio (LR+) is 1.58 (95% CI: 1.29 – 1.93), negative likelihood ratio (LR–) is 0 (95% CI: 0 – NaN), and Youden’s index is 0.36. For a cut-off of ≥2, sensitivity is 88.90%, specificity is 78.90%, PPV is 57% (95% CI: 39% – 73%), NPV is 95% (95% CI: 85% – 98%), LR+ is 4.21 (95% CI: 2.48 – 7.16), LR– is 0.14 (95% CI: 0.03 – 0.52), and Youden’s index is 0.67. At a cut-off of ≥3, sensitivity drops to 61.10%, specificity increases to 98.20%, PPV rises to 91% (95% CI: 64% – 98%), NPV is 88%(95% CI: 78% – 94%), LR+ is 33.94 (95% CI: 4.82 – 251.61), LR– is 0.39 (95% CI: 0.22 – 0.70), and Youden’s index is 0.59. Finally, at a cut-off of ≥4, sensitivity is markedly low at 5.56%, specificity is perfect at 100%, PPV is 100% (95% CI: 20% – 100%), NPV is 77% (95% CI: 66% – 85%), LR+ is not applicable, LR– is 0.94 (95% CI: 0.84 – 1.05), and Youden’s index is 0.056. The optimal cutoff based on Youden’s index (0.67) was BMS ≥2, providing a more balanced trade-off between sensitivity (88.90%) and specificity (78.90%).

The BMS is a highly sensitive initial screen for bacterial meningitis in children, but its low specificity at the ≥1 cutoff necessitates a more judicious approach. Employing a ≥2 cutoff (Youden index 0.67) significantly improves diagnostic accuracy, optimizing resource utilization and enabling targeted interventions. While definitive diagnosis requires confirmatory testing, the BMS strategically guides initial triage, particularly crucial in resource-constrained environments.

INTRODUCTION

Respiratory infections are a leading cause of pediatric hospitalizations, particularly pneumonia. In Metro Manila, many cases lack identifiable causes, underscoring the need for advanced diagnostics. The RT-PCR Respiratory Panel 2.1 enables rapid pathogen detection, improving diagnosis and treatment. Examining demographic and clinical factors linked to severe outcomes provides valuable local insights.

This study aimed to identify and compare respiratory pathogens detected by the RT-PCR panel and determine demographic and clinical factors associated with severe outcomes in pediatric patients at a private tertiary hospital in the Philippines.

A retrospective cohort study was conducted, analyzing pediatric patients (0–18 years) admitted for respiratory infections from August 2023 to August 2024. Descriptive statistics summarized patient characteristics, while regression analyses identified factors linked to mechanical ventilation, oxygen use, and prolonged hospital stays.

Of 118 patients, 85.6% tested positive for respiratory pathogens, predominantly viral (RSV 23.7%, human rhinovirus/enterovirus 22.9%), with cases peaking in late 2023. Most patients had elevated WBC with neutrophilic redominance. Oxygen support was required in 22.9% of cases, primarily in infants under six months with RSV, who had a four-fold increased risk. Difficulty breathing was the strongest predictor of oxygen use, while the presence of neurological conditions (e.g., cerebral palsy, seizure disorders) were significantly associated with mechanical ventilation and prolonged hospital stays.

Seizure disorder, cerebral palsy, and younger age influenced severe outcomes. Pathogen specific trends in demographics, clinical findings, and oxygen support needs may help guide physicians in recognizing illnesses caused by the most common viral respiratory pathogens identified by the RT-PCR Respiratory Panel 2.1

BACKGROUND AND OBJECTIVE

COVID-19 contributes significantly to global morbidity and mortality. Age-related comorbidities elevate the risk of severe cases. Studies have recently demonstrated that widely available medications, including tocilizumab (TCZ), can manage severe symptoms. However, its effectiveness is unclear, particularly among the older population. Therefore, this review aimed to evaluate TCZ’s efficacy in managing severe pneumonia in individuals aged 50 and older.

We systematically search several databases and gray literature including Web of Science, CINAHL, Academic Search Complete, PsycINFO, PsycArticles, SocINDEX, CENTRAL/Cochrane Library, PubMed/MEDLINE for original research articles in English across several study designs published in the year 2020-2022. A narrative synthesis was conducted to summarize the evidence. We employed the NIH quality assessment tool for observational cohort studies to evaluate risk of bias. Additionally, we utilized GRADE to appraise the certainty of evidence.

Among 539 screened articles, only five studies met the selection criteria. Tocilizumab's impact on severe COVID-19 pneumonia revealed a diverse effect on mortality rate, with 29% in the TCZ group, and 40% in the controls died within 30 days of intubation (OR 0.61; 95% CI, 0.27-1.36). It is also reported that TCZ was not associated with mortality, despite faster decline in pulmonary function and prolonged fever. Hospital mortality in the TCZ group was significantly lower than in the controls, and age over 60 was the only significant risk factor. Moreover, administering TCZ reduced mechanical ventilation needs, with 82% extubated compared to 53% in controls. However, 45% in TCZ group was associated with a higher ventilator-associated pneumonia rate than in the untreated group which was 20% (P CONCLUSIONS

The effects of tocilizumab on reducing mortality risk and improving the survival rate of COVID-19 patients with pneumonia remained inconclusive. Yet, the majority of results suggested that giving tocilizumab leads to shorter hospital stays, lowers the requirement for mechanical ventilation, and decreases the likelihood of ICU transfer. Tocilizumab is linked to the incidence of secondary infections; hence, this medication should be closely monitored for side effects.

BACKGROUND AND OBJECTIVES

The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.

A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).

There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).

Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

BACKGROUND: Whether adherence to a healthy lifestyle is associated with a lower risk of developing pneumonia and a better long-term prognosis remains unclear. This study aimed to investigate associations of individual and combined lifestyle factors (LFs) with the incidence risk and long-term prognosis of pneumonia hospitalization. METHODS: Using data from the China Kadoorie Biobank study, we used the multistate models to investigate the role of five high-risk LFs, including smoking, excessive alcohol drinking, unhealthy dietary habits, physical inactivity, and unhealthy body shape, alone or in combination in the transitions from a generally healthy state at baseline to pneumonia hospitalization or cardiovascular disease (CVD, regarded as a reference outcome), and subsequently to mortality. RESULTS: Most of the five high-risk LFs were associated with increased risks of transitions from baseline to pneumonia and from pneumonia to death, but with different risk estimates. The greater the number of high-risk LFs, the higher the risk of developing pneumonia and long-term mortality risk after pneumonia, with the strength of associations comparable to that of LFs and CVD. Compared to participants with 0-1 high-risk LF, the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for transitions from baseline to pneumonia and from pneumonia to death in those with five high-risk LFs were 1.43 (1.28-1.60) and 1.98 (1.61-2.42), respectively. Correspondingly, the respective HRs (95% CIs) for transitions from baseline to CVD and from CVD to death were 2.00 (1.89-2.11) and 1.44 (1.30-1.59), respectively. The risk estimates changed slightly when further adjusting for the presence of major chronic diseases. CONCLUSION In this Chinese population, unhealthy LFs were associated with an increased incidence and long-term mortality risk of pneumonia.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Cardiovascular Diseases/etiology* ; China/epidemiology* ; Life Style ; Pneumonia/etiology* ; Prognosis ; Risk Factors ; Smoking