Investigation of the use of multiplex PCR in childhood diarrhea with clinical and epidemiological features.

To evaluate the accuracy of several methods aimed to detect Helicobacter pylori stool antigens in patients with upper gastrointestinal bleeding. Thirty-four patients with upper gastrointestinal bleeding because of peptic ulcer were included. The first stool sample during hospitalization was collected, and stool antigens were determined with: polyclonal enzyme-linked immunosorbent assay (Premier-Platinum-HpSA); monoclonal enzyme-linked immunosorbent assay (Amplified-IDEIA-HpStAR); and rapid monoclonal immunochromatographic test (ImmunoCard-STAT HpSA). A patient was considered infected when H. pylori was diagnosed with invasive tests (rapid urease test or histology) or with (13)C-urea breath test. When all tests were negative, a new breath test was repeated after stopping proton pump inhibitors. All patients were infected and, therefore, only sensitivity of the tests could be calculated: polyclonal enzyme-linked immunosorbent assay (74%), monoclonal enzyme-linked immunosorbent assay (94%), and rapid monoclonal immunochromatographic test (60%; concordance between the two observers was high, kappa = 0.9). Neither the presence of maelena nor the delay in obtaining stool samples explained false negatives. Neither the polyclonal enzyme-linked immunosorbent assay stool antigen test nor the rapid immunochromatographic stool antigen test can be recommended to diagnose H. pylori infection in patients with upper gastrointestinal bleeding. However, the monoclonal enzyme-linked immunosorbent assay stool antigen test is highly sensitive for detecting the infection in patients with this complication, although more studies are necessary to evaluate the specificity of the method.

Background: Gastrointestinal infections are among the leading causes of morbidity worldwide. In contrast to acute diarrhoea, long-lasting digestive disorders can be defined as persistent diarrhoea (≥14 days) and/or persistent abdominal pain (≥14 days). This clinical syndrome is frequently caused by intestinal infections, but its medical importance in the tropics, the range of causative pathogens and the contribution of neglected tropical diseases remain to be elucidated. Currently employed diagnostic tools for the detection of intestinal pathogens frequently lack sensitivity, and there are only few evidence-based recommendations to guide the clinical management of persistent digestive disorders in resource-constrained settings. Rapid diagnostic tests (RDTs) have become available for the diagnosis of various intestinal pathogens and hold promise to be used even in peripheral healthcare centres with only very limited laboratory infrastructure. More recently, multiplex polymerase chain reaction (PCR) assays targeting gastrointestinal pathogens have been developed, but these tests have yet to be systematically evaluated in the tropics. The current Ph.D. thesis was carried out as part of the NIDIAG project, an international research consortium that aims at developing evidence-based diagnosis-treatment algorithms for persistent digestive disorders and other common clinical syndromes in resource-constrained settings of Africa and Asia.
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\nMethods: A systematic review was performed to elucidate the aetiological spectrum of persistent digestive disorders. A study protocol, accompanied by a set of more than 30 standard operating procedures (SOPs), was developed to conduct a multi-country, prospective case-control study to investigate persistent diarrhoea (≥14 days; all individuals aged above 1 year) and persistent abdominal pain (≥14 days; all children and adolescents aged 1-18 years) in Côte d’Ivoire, Indonesia, Mali and Nepal. In the framework of a specific site assessment, a case-control study was performed in Dabou, south Côte d’Ivoire to determine the aetiology and clinical features of persistent diarrhoea. Stool samples were subjected to a host of microscopic techniques, RDTs for Clostridium difficile, Cryptosporidium spp. and Giardia intestinalis, as well as the Luminex® Gastrointestinal Pathogen Panel, a stool-based multiplex PCR. A subsequent study was conducted to assess the diagnostic accuracy of real-time PCR for detection of Strongyloides stercoralis and to compare it to a combination of microscopic methods (Baermann funnel concentration and Koga agar plate). For the first time, a previously validated, urine-based RDT for the diagnosis of Schistosoma mansoni was employed for individual management of patients presenting with digestive disorders to a hospital in Europe. 
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\nResults: The systematic review identified more than 40 bacterial, parasitic (helminths and intestinal protozoa) and viral pathogens that may potentially cause persistent diarrhoea and persistent abdominal pain. In a subsequent case-control study in southern Côte d’Ivoire, 20 different intestinal pathogens were detected and >50% of all participants had co-infections. Enterotoxigenic Escherichia coli (32%) and Shigella spp. (20%) were the most prevalent bacterial pathogens, while G. intestinalis (29%) and S. stercoralis (10%) were the predominant intestinal protozoon and helminth species, respectively. With regard to infection status, there were few differences between cases and controls. Most patients with persistent diarrhoea lived in rural areas, but clinical signs and symptoms could not distinguish between specific infections. The protocol for the multi-country NIDIAG study on persistent digestive disorders adopted a case-control approach and regular follow-up visits of symptomatic patients to monitor the clinical response to treatment.
\nA diagnostic study in south-central Côte d’Ivoire found that the application of a stool-based real-time PCR for S. stercoralis substantially improved the detection rate of this pathogen, leading to a total prevalence of 21.9%, compared to a prevalence of 10.9% according to stool microscopy. C. difficile could also be detected in stool samples from Côte d’Ivoire (5.4% prevalence according to RDT). Non-toxigenic C. difficile strains predominated and their molecular characteristics differed considerably from those observed in other settings. Prolonged storage without properly maintained cold chain only minimally affected the subsequent recovery of C. difficile and its toxins in stool culture.
\nA point-of-care (POC) test detecting a circulating cathodic antigen (CCA) in urine was successfully utilised to confirm intestinal S. mansoni infection in migrants from Eritrea who presented to a European hospital because of persistent abdominal pain.
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\nConclusions: Persistent digestive disorders are of considerable public health importance in Côte d’Ivoire and elsewhere, with the majority of cases being detected in rural areas. Many different causative agents may give rise to this syndrome and they can be accurately detected by the application of highly sensitive diagnostic techniques. The diversity of the potentially implicated pathogens underscores the need for a syndromic approach to persistent digestive disorders. RDTs are helpful tools for the detection of specific pathogens and may be implemented as part of diagnostic algorithms in endemic areas and in hospitals providing care for migrants and returning travellers. There is an urgent need to develop a stool-based RDT for S. stercoralis. The high asymptomatic carriage rates of intestinal pathogens call for the inclusion of healthy controls in epidemiological studies to define the specific contribution of each pathogen to the syndrome of persistent digestive disorders. Future studies employing metagenomic approaches will provide further insights into the intestinal microbiome of symptomatic patients and healthy controls.

BackgroundInfective diarrhea is a common problem. Multiplex Polymerase chain reaction (PCR) based pathogen diagnostics of diarrheal stool specimens are shown to be highly sensitive and rapid as opposed to conventional diagnostics.MethodsWe analyzed the performance of a multiplex PCR test, FilmArray (FA) gastrointestinal (GI) panel, on stool specimens in patients admitted with acute and chronic diarrhea to our hospital from December 2016 to December 2019 and compared the results with conventional diagnostic tests.ResultsA total of 98 patients were analyzed, 52 were males and 9 belonged to pediatric age. 92.9% patients presented with acute diarrhea. None were HIV positive. Among 98 tested, FA GI pathogen panel was positive for at least one pathogen in 39.8% patients. The yield was low for stool culture, 7.79%. In samples tested by FA GI pathogen panel, a single pathogen was identified in 27 patients (27.5%) while multiple targets were identified in 12 patients (12.2%). Majority (76.5%) had normal stool routine. Stool routine abnormality and positive GI pathogen panel did not correlate, as only 7 patients with abnormal stool routine had a positive result in FA GI pathogen panel, while 12 patients had negative result. Among the 39 patients with positive FA GI pathogen panel, only 6 had positive stool culture result. All stool culture positive sample also had GI pathogen panel positive result. Commonest organism in stool culture was Salmonella (5) while one patient had E. coli. Commonest organism in stool FA GI pathogen panel was also Salmonella, 12 isolates as a single pathogen and 5 as one among the multiple targets identified, making a total of 17 isolates. This is followed by Enteroaggregative E. coli (EAEC- 9) and Enteropathogenic E. coli (EPEC- 5). %). Only one had virus as pathogen (norovirus), no parasitic infection was identified. Multiple pathogens were identified in 12 patients. Clostridium difficile toxin was positive in 2 in whom multiple targets were identified. Among the chronic diarrhea syndrome, none had stool culture positivity while two had positive FA GI pathogen panel results and the organisms were Campylobacter and EAEC.FA GI pathogen panel results Multiple targets that are identified ConclusionFA GI panel detects a wide array of GI pathogens, better yield and has a quick turn-around-time compared to conventional tests like stool culture.Disclosures All Authors: No reported disclosures

BackgroundThe burden and characteristics of respiratory viral infections in children hospitalized for acute respiratory tract infections (ARTIs) during the post-COVID-19 pandemic era are unclear. We analyzed the epidemiological and clinical characteristics of pediatric patients hospitalized with common respiratory virus infections before and after relaxation of non-pharmaceutical interventions in Hangzhou, China and evaluated the diagnostic value of the six-panel respiratory pathogen detection system.MethodsSix types of respiratory viruses were detected in respiratory samples from children with suspected ARTIs by multiplex real-time quantitative polymerase chain reaction (RT-qPCR). Changes in virus detection rates and epidemiological and clinical characteristics, obtained from electronic health records, were analyzed. Binary logistic regression was used to identify respiratory tract infections risk factors. Multiplex RT-qPCR and targeted next-generation sequencing results were compared in random samples.ResultsAmong the 11,056 pediatric samples, 3228 tested positive for one or more of six common respiratory pathogens. RSV and PIV-3 detection rates differed significantly across age groups (both P < 0.001), and were more common in younger children. PIV-1 was more common in infants, toddlers, and preschoolers than in school-age children (P < 0.001). FluB was predominantly detected in school-age children (P < 0.001). RSV-, ADV-, and PIV-1-positivity rates were higher in 2022 than in 2023. Seasonal viral patterns differed across years. RSV (OR 9.156. 95% CI 5.905–14.195) and PIV-3 (OR 1.683, 95% CI 1.133–2.501) were risk factors for lower respiratory tract infections. RSV-positivity was associated with severe pneumonia (P = 0.044). PIV-3 (OR 0.391, 95% CI 0.170–0.899), summer season (OR 1.982, 95% CI 1.117–3.519), and younger age (OR 0.938, 95% CI 0.893–0.986) influenced pneumonia severity. Multiplex RT-qPCR showed good diagnostic performance.ConclusionAfter changes in COVID-19 prevention and control strategies, six common respiratory viruses in children were prevalent in 2022–2023, with different seasonal epidemic characteristics and age proclivities. RSV and PIV-3 cause lower, and FluA, FluB, and ADV more typically cause upper respiratory tract infections. Infancy and summer season influence severe pneumonia risk. Multiplex RT-qPCR is valuable for accurate and timely detection of respiratory viruses in children, which facilitates management, treatment, and prevention of ARTIs.

Background Sexually transmitted infections (STIs) refer to infections transmitted through sexual contact, including asymptomatic cases. Data on co-infections among STI pathogens based on different specimen types have been accumulating with the increasing use of multiplex PCR for STI diagnosis. This study retrospectively analyzed the epidemiological characteristics of STIs using multiplex PCR test results from South Korea(2018-2024), focusing on co-infections. Methods We analyzed multiplex PCR test results for 12 STI pathogens from January 2018 to September 2024 in individuals aged 10 to 90, conducted by Eone Laboratories. The pathogens included Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), Mycoplasma hominis (MH), Trichomonas vaginalis (TV), Ureaplasma urealyticum (UU), Mycoplasma genitalium (MG), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Gardnerella vaginalis (GV), Treponema pallidum (TP), Candida albicans (CA), and Ureaplasma parvum (UP). The dataset included information on gender, age, specimen type, and test date. Multiplex PCR reaction was performed using NextGene STI-12 Detection Kit (EONEBIOTECH, Republic of Korea) with an CFX 96 real-time PCR system(Bio-Rad, Republic of Korea). We analyzed the positivity rates by gender, age, and specimen type. Additionally, association rule mining was applied to evaluate co-infection patterns, and lift indices were calculated to assess the strength of associations between pathogens. Result From 2,694,547 specimens, 32,334,564 STI test results were obtained, with 3,093,258 positive cases (9.6%). Female specimens comprised 70.1%, and male 29.9%.. Among the specimens, 40.0% were negative for all pathogens, 25.8% were positive for a single pathogen, and 34.2% had co-infections with two or more pathogens. Pathogen positivity rates showed that in females, GV, UP, CA, UU, and MH had a positivity rate above 10%, while in males, UU, CT, and UP had a positivity rate exceeding 5%. NG and CT had higher positivity in males than females, peaking in individuals in their 10s and 20s, and declining with increasing age. Age-specific positivity rates revealed that, exception of TV and GV in males and HSV2 in females, all STI pathogens peaked in individuals in their 10s and 20s. In females, UU, MH, TV, GV, and UP exhibited a biphasic peak pattern, with the first peak occurring in individuals in their 10s and 20s, followed by a second peak in their 50s and 60s. A comparison of positivity rates by specimen type in female samples revealed that vaginal discharge specimens had 1.28 to 8.19 times higher positivity rates than urine specimens, indicating higher sensitivity for STI detection in female. Co-infection analysis revealed that CT-NG and TV-MH had a lift index of =3 in both males and females, indicating a strong co-occurrence. When lift indices were analyzed separately for individuals aged 10–30 and those over 30, the absolute values varied by age group; however, co-infection patterns were consistent within the same gender but differed between males and females. Conclusion This study assessed the associations among major STI pathogens based on multiplex PCR test results and analyzed their epidemiological characteristics. Further research is needed to incorporate clinical symptom data and elucidate the biological interactions of highly associated pathogens.

Sepsis-like illness with suspected meningitis or encephalitis is a common reason for using empiric antimicrobial therapy in infants and children. However, in cases of viral meningitis not covered by these antimicrobials, this management is ineffective and due to side effects potentially harmful. A retrospective analysis of cerebrospinal fluid (CSF) multiplex PCRs (Biofire FilmArray®) in children with clinical suspicion of meningitis, encephalitis or sepsis-like illness was performed over the period of 1year. Subsequently, a subgroup of children (age of 8-84days of life) diagnosed with viral meningitis (enterovirus, HHV-6, human parechovirus) was compared to an age-matched control group. During the study period, the multiplex PCR panel was performed on 187 individual CSF samples that met the inclusion criteria. About half of the patients (92/187) were less than 1year of age. In 27 cases (14.4%), the PCR yielded a positive result with the majority (12/27) being indicative of an enteroviral infection. In the age group of 8-84days of life, 36.4% of the patients had a positive result. When the patients with a PCR positive for a viral agent were compared to an age-matched group of patients, no differences were observed regarding symptoms and laboratory parameters. However, the duration of antimicrobial therapy could be significantly reduced through the use of multiplex PCR. The use of on-site diagnostic multiplex PCR was able to reduce the use of antimicrobials in selected cases. This test can guide clinical decisions earlier during the course of medical care compared to standard diagnostics.

Comparison of Epidemiologic and Clinical Features between Respiratory Syncytial Virus and Human Metapneumovirus in Korean Children

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified pathogen which mainly spreads by droplets. Most published studies focused on adult patients with coronavirus disease 2019 (COVID-19), but data concerning pediatric patients is limited. This study aimed to determine epidemiological characteristics and clinical features of pediatric patients with COVID-19. Methods: We reviewed and analyzed data on pediatric patients with laboratory-confirmed COVID-19, including basic information, epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome and follow-up results. Findings: From January 20 th to February 27 th of 2020, a total of 74 pediatric patients with COVID-19 were included in this study. Of the 68 cases whose epidemiological data were complete, 65 (65/68, 95.59%) cases were household contacts of adults whose symptoms developed earlier. Forty (59.46%) of the infected children were male, and the median age and body weight are 6 (0.10-15.08) years and 24 (4.20-87.00) kg, respectively. Except for one critically ill case, 20 (27.03%) patients did not show any symptoms of infection, 24 (32.43%) patients had acute upper respiratory tract infection and 29 (39.19%) patients were diagnosed with mild pneumonia. Cough (24/74, 32.43%) and fever (20, 27.03%) were the predominant symptoms of 44 (59.46%) symptomatic patients at onset of the illness. Abnormalities in leukocyte count were found in 23 (31.08%) children and 10 (13.51%) children presented with abnormal lymphocyte count. Of the 34 (45.95%) patients who had nucleic acid testing results for common respiratory pathogens, 19 (19 / 34, 51.35%) showed co-infection with other pathogens other than SARS-CoV-2. Ten (13.51%) children had RT-PCR analysis of SARS-CoV-2 for fecal specimens and 8 of them showed prolonged existence of SARS-CoV-2 RNA 11 (5-23) days after nasopharynx swabs turning negative. Abnormalities in chest imaging were observed in 37 (50.00%) patients and 28 (37.84%) of them only presented with nontypical changes. All children had good prognosis with a median hospitalization duration of 11 days and follow-up period of 16.5 days. During the follow-up period, all the patients remained in quarantine at designated site and home for two 14-day observation periods and showed no clinical manifestation, but 3 of the 8 cases with prolonged fecal shedding of SARS-CoV-2 still showed positive result of feces test. Interpretation: Pediatric patients with COVID-19 presented with distinct epidemiological, clinical, and radiological characteristics from adult patients. Nearly half of the infected children had co-infection with other common respiratory pathogens. It is not uncommon for pediatric patients to have prolonged fecal shedding of SARS-CoV-2 RNA during the convalescent phase. More investigations would be warranted to facilitate the diagnosis, prevention and control of COVID-19 in children. Funding Statement: This work is supported by The National Natural Science Foundation of China (NSFC) [Grant number 81770315]; Distinguished Taishan Scholars (2019); Qingdao Outstanding Young Health Professional Development Fund (2020) and Qingdao People's Livelihood Science and Technology Program(17-3-3-6-nsh). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study was approved by the institutional review board of the ethics committee in our hospital (QFELL-KY-2020-11) and written informed consent was obtained from patients’ legal guardians prior to enrollment.

BackgroundThe pandemic of Coronavirus Disease 2019 (COVID-19) brings new challenges for pediatricians, especially in the differentiation with non-COVID-19 pneumonia in the peak season of pneumonia. We aimed to compare the clinical characteristics of pediatric patients with COVID-19 and other respiratory pathogens infected pneumonias.MethodsWe conducted a multi-center, cross-sectional study of pediatric inpatients in China. Based on pathogenic test results, pediatric patients were divided into three groups, including COVID-19 pneumonia group, Non-COVID-19 viral (NCV) pneumonia group and Non-viral (NV) pneumonia group. Their clinical characteristics were compared by Kruskal-Wallis H test or chi-square test.ResultsA total of 636 pediatric pneumonia inpatients, among which 87 in COVID-19 group, 194 in NCV group, and 355 in NV group, were included in analysis. Compared with NCV and NV patients, COVID-19 patients were older (median age 6.33, IQR 2.00-12.00 years), and relatively fewer COVID-19 patients presented fever (63.2%), cough (60.9%), shortness of breath (1.1%), and abnormal pulmonary auscultation (18.4%). The results were verified by the comparison of COVID-19, respiratory syncytial virus (RSV) and influenza A (IFA) pneumonia patients. Approximately 42.5%, 44.8%, and 12.6% of the COVID-19 patients presented simply ground-glass opacity (GGO), simply consolidation, and the both changes on computed tomography (CT) scans, respectively; the proportions were similar as those in NCV and NV group (p>0.05). Only 47.1% of COVID-19 patients had both lungs pneumonia, which was significantly lower than that proportion of nearly 80% in the other two groups. COVID-19 patients presented lower proportions of increased white blood cell count (16.5%) and abnormal procalcitonin (PCT) (10.7%), and a higher proportion of decreased lymphocyte count (44.0%) compared with the other two groups.ConclusionMajority clinical characteristics of pediatric COVID-19 pneumonia patients were milder than non-COVID-19 patients. However, lymphocytopenia remained a prominent feature of COVID-19 pediatric pneumonia.

BackgroundGlobally, the epidemiology of non‐SARS‐CoV‐2 respiratory viruses like respiratory syncytial virus (RSV) and influenza virus was remarkably influenced by the implementation of non‐pharmacological interventions (NPIs) during the COVID‐19 pandemic. Our study explored the epidemiological and clinical characteristics of pediatric patients hospitalized with RSV or influenza infection before and during the pandemic after relaxation of NPIs in central China.MethodsThis hospital‐based prospective case‐series study screened pediatric inpatients (age ≤ 14 years) enrolled with acute respiratory infections (ARI) for RSV or influenza infection from 2018 to 2021. The changes in positivity rates of viral detection, epidemiological, and clinical characteristics were analyzed and compared.ResultsMedian ages of all eligible ARI patients from 2018–2019 were younger than those from 2020–2021, so were ages of cases infected with RSV or influenza (RSV: 4.2 months vs. 7.2 months; influenza: 27.3 months vs. 37.0 months). Where the positivity rate for influenza was considerably decreased in 2020–2021 (1.4%, 27/1964) as compared with 2018–2019 (2.9%, 94/3275, P < 0.05), it was increased for RSV (11.4% [372/3275] vs. 13.3% [262/1964], P < 0.05) in the same period. The number of severe cases for both RSV and influenza infection were also decreased in 2020–2021 compared with 2018–2019.ConclusionsThe implemented NPIs have had varied impacts on common respiratory viruses. A more effective prevention strategy for RSV infections in childhood is needed.

Objective: Gastroenteritis is the most important cause of morbidity and mortality in all age groups all over the world. Multiplex PCR tests give sensitive and specific results in the investigation of bacterial, viral, parasitic agents. In this study, it was aimed to determine the agents of the stool specimens of patients with acute diarrhea by multiplex PCR. Materials and Methods: Stool sample taken from 471 patients sent to Istanbul Gelişim Laboratories between January 1, 2015 and September 30, 2016 was included in the study. All stool samples were processed according to manufacturer’s instructions with GastroFinder SMART 18 FAST multiplex PCR test (Pathofinder, Holland). 18 different gastrointestinal pathogens were diagnosed in one study. Results: Of the 471 patients stool sample included in the study. The agent was negative in 241 (51.2%), while the agent was isolated in 230 (48.8%). 190 (82%) had a single pathogen, 40 had two or more pathogens. Of the 190 samples detected with single agent, 149 (31.6%) were bacterial, 26 (5.5%) were parasitic and 15 (3.1%) were viral agents. Of the 149 bacterial agents, 108 (23%) was detected as Salmonella spp, 14 (6%) as EHEC, 8 (3.5%) as Clostridium difficile toxin A / B, 8 (3.5%) as Campylobacter spp., 7 (3%) Aeromonas spp., 2 (0.8%) Yersinia enterocolitica, 2 (0.8%) Enterotoxigenic E. coli (ETEC). Of 26 parasitic agents, 18 (7.8%) was detected as Giardia lamblia, 6 (2.6%) as Dientamoeba fragilis and 2 (0.8%) as Cryptosporidium spp. Conclusion: Identification of enteric pathogens by multiplex PCR will avoids the use of unnecessary antibiotic treatments

BackgroundThe development of the polymerase chain reaction (PCR) test promoted the evaluation of the epidemiological and clinical characteristics of human parainfluenza virus (HPIV) type 4, which has been rarely studied using conventional diagnostic methods. This study aimed to determine the seasonal epidemiological and clinical characteristics of all four HPIV serotypes (HPIV-1, HPIV-2, HPIV-3, and HPIV-4) during the era of PCR testing.MethodsThe medical records of hospitalized pediatric patients diagnosed with HPIV infections by a multiplex PCR test between 2015 and 2021 were retrospectively reviewed to determine the seasonal distributions of each HPIV serotype. For patients with a single HPIV infection, the clinical characteristics of each HPIV serotype were evaluated and compared with one another.ResultsAmong the 514 cases of HPIV infection, HPIV-1, HPIV-2, HPIV-3, and HPIV-4 were identified in 27.2%, 11.9%, 42.6%, and 18.3% of cases, respectively. HPIV-3 was most prevalent in spring, and the other three serotypes were most prevalent in autumn. For patients with a single HPIV infection, those infected by HPIV-1 and HPIV-3 were younger than those infected by HPIV-2 and HPIV-4 (P < 0.001). Croup and lower respiratory tract infection (LRI) were most frequently diagnosed in patients infected by HPIV-1 (P < 0.001) and HPIV-4 (P = 0.002), respectively. During 2020–2021, HPIV-3 was most prevalent in autumn and caused fewer LRIs (P = 0.009) and more seizures (P < 0.001) than during 2015–2019.ConclusionsEach HPIV serotype exhibited a distinct seasonal predominance, and some differences in the clinical characteristics of the HPIV serotypes were observed. HPIV-4 acted as an important cause of LRI. Considering the recent changes in the epidemiological and clinical characteristics of HPIV-3, more time-series analyses should be conducted.

Background. This case-control study aims to investigate the clinical characteristics in pediatric patients with pneumonia infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A, and human adenoviruses (HAdVs). Methods. Hospitalized pediatric patients with pneumonia infected with SARS-CoV-2 at Wuhan Children's Hospital and pneumonia infected with influenza A, and HAdVs at Qilu Children's Hospital were compared. Clinical manifestations, laboratory examinations, and imaging characteristics were analyzed. Results. The proportions of hyperpyrexia (54.3%, 33.9%), cough (100%, 99.2%), wheezing (45.7%, 53.7%), diarrhea (31.4%, 14.9%), and fever (100%, 75.2%) in patients with influenza A and HAdVs were higher than those of patients with SARS-CoV-2 (9.4%, P < .001; 48.5%, P < .001; 0%, P < .001; 8.8%, P = .002; 41.5%, P < .001; respectively). Laboratory examinations revealed the proportions of leukocytosis (37.1%, 52.9%), abnormal rates of neutrophils (40%, 40.5%), and lymphocytosis (42.9%, 65.3%) in influenza A and HAdV pneumonia groups were significantly higher than coronavirus disease 2019 (COVID-19) group (0%, P < .001; 0%, P < .001; 0%, P < .001; respectively). The proportion of elevated procalcitonin (5.7%, 14%) in patients with influenza A and HAdVs was significantly lower than those in patients with SARS-CoV-2 (64%, P < .001). In chest computed tomography, ground-glass opacities near the pleura were more common in patients with COVID-19 than those in patients with influenza A and HAdVs (32.7% vs 0% vs 0%, P < .001). Conclusion. Fever, cough, and wheezing are more common in the influenza A and HAdVs groups, whereas procalcitonin and computed tomography findings are likely to be pronounced in COVID-19 pneumonia. It provides a variety of methods except polymerase chain reaction for differentiating COVID-19 pneumonia from influenza A and HAdVs pneumonia.

Analysis of the relation between cerebrospinal fluid antibody titers and clinical characteristics in pediatric patients with anti-N-methyl-D-aspartate receptor encephalitis

Real-Time Multiplex Polymerase Chain Reaction with High-Resolution Melting-Curve Analysis for the Diagnosis of Enteric Infections Associated with Diarrheagenic Escherichia coli