Bacterial Pneumonia Group Research Articles

Prediction of risk of in-hospital death in patients with chronic heart failure complicated by lung infections using interpretable machine learning

To predict the risk of in-hospital death in patients with chronic heart failure (CHF) complicated by lung infections using interpretable machine learning. The clinical data of 1415 patients diagnosed with CHF complicated by lung infections were obtained from the MIMIC-IV database. According to the pathogen type, the patients were categorized into bacterial pneumonia and non-bacterial pneumonia groups, and their risks of in-hospital death were compared using Kaplan-Meier survival curves. Univariate analysis and LASSO regression were used to select the features for constructing LR, AdaBoost, XGBoost, and LightGBM models, and their performance was compared in terms of accuracy, precision, F1 value, and AUC. External validation of the models was performed using the data from eICU-CRD database. SHAP algorithm was applied for interpretive analysis of XGBoost model. Among the 4 constructed models, the XGBoost model showed the highest accuracy and F1 value for predicting the risk of in-hospital death in CHF patients with lung infections in the training set. In the external test set, the XGBoost model had an AUC of 0.691 (95% CI: 0.654-0.720) in bacterial pneumonia group and an AUC of 0.725 (95% CI: 0.577-0.782) in non-bacterial pneumonia group, and showed better predictive ability and stability than the other models. The overall performance of the XGBoost model is superior to the other 3 models for predicting the risk of in-hospital death in CHF patients with lung infections. The SHAP algorithm provides a clear interpretation of the model to facilitate decision-making in clinical settings.

Electrolyte disturbances in patients hospitalized for COVID-19 infection: An observational study.

There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrolyte abnormalities, which may not be the case for bacterial causes of pneumonia. This study aimed to assess the differences in electrolyte levels between patients suffering from COVID-19 and bacterial pneumonia. This is an original, retrospective study. Two cohorts of hospitalized patients were included, 1 suffering from COVID-19 and the other from bacterial pneumonia. Their day 1 and day 3 levels of sodium, potassium, magnesium, and phosphorus, as well as their outcomes, were extracted from the charts. Statistical analysis was subsequently performed. Mean admission levels of sodium, potassium, phosphorus, and magnesium were 135.64 ± 6.13, 4.38 ± 0.69, 3.53 ± 0.69, and 2.03 ± 0.51, respectively. The mean day 3 levels of these electrolytes were 138.3 ± 5.06, 4.18 ± 0.59, 3.578 ± 0.59, and 2.11 ± 0.64, respectively. Patients suffering from bacterial pneumonia were significantly older (N = 219, mean = 64.88 ± 15.99) than patients with COVID-19 pneumonia (N = 240, mean = 57.63 ± 17.87). Bacterial pneumonia group had significantly higher serum potassium (N = 211, mean = 4.51 ± 0.76), and magnesium (N = 115, mean = 2.12 ± 0.60) levels compared to COVID-19 group (N = 227, mean = 4.254 ± 0.60 for potassium and N = 118, mean = 1.933 ± 0.38 for magnesium). Only magnesium was significantly higher among day 3 electrolytes in the bacterial pneumonia group. No significant association between electrolyte levels and outcomes was seen. We found that COVID-19 patients had lower potassium and magnesium levels on admission, possibly due to the effect of COVID-19 on the renin-angiotensin-aldosterone system as well as patient characteristics and management. We did not find enough evidence to recommend using electrolyte levels as a determinator of prognosis, but more research is needed.

Compare Clinical Characteristics of Psittacosis Pneumonia in 35 Patients and of Non Psittacosis Bacterial Pneumonia in 46 Patients.

We aimed to describe the difference between Chlamydia psittaci pneumonia group and non C. psittaci bacterial pneumonia group in community acquired pneumonia in this single-center clinical study. We collected the data of 35 patients with C. psittaci pneumonia cases and 46 patients with non C. psittaci bacterial pneumonia cases diagnosed with metagenomic next-generation sequencing assays from February 2019 to December 2021 in Huaihua First People's Hospital in China. In the C. psittaci pneumonia group, 35 patients (100%) had a chance of exposure to poultry or birds, and their body temperature was greaterthanorequalto 39.0°C. The other common symptoms were a slow pulse (68.6%), cough (65.7%), expectoration (54.3%), chills (51.4%) and a shortness of breath (37.1%). Laboratory tests showed that >90% of the cases had markedly elevated infection indicators, and 97.1% of the cases had markedly declined calcium.The most common imaging finding was patchyshadows (94.3%), pleuraleffusion (68.6%), bilateral in 54.3% (n = 19) and unilateral in 45.7% (n = 16) participants, and 51.4% (n = 18) of cases met the criteria for severe pneumonia. In the non C. psittaci bacterial pneumonia group, 18 patients (39.1%) had a chance of exposure to poultry or birds, and 11 patients (23.9%) body temperature was greaterthanorequal to 39.0°C. Laboratory tests showed that >67% of cases had a mildlyelevated infection indicators, and mildly declined serumalbumin. The following characteristics are more likely to help distinguish C. psittaci pneumonia from non C. psittaci bacterial pneumonia. Including had a chance of exposure to poultry or birds, high fever, exhibit chills, expectoration, relatively slow pulse, and progress into severe pneumonia. Percentage of neutrophils, C-reactive protein, procalcitonin, lactate dehydrogenase, and myoglobin levels are higher. Blood calcium and corrected calcium are lower. Chest CT showed pleural effusion, pericardial effusion, and mediastinal lymphadenopathy.

Bacterial Pneumonia and Stroke Risk: A Nationwide Longitudinal Followup Study.

Pneumonia causes significant morbidity and mortality and has been associated with cardiovascular complications. Our study aimed to investigate the incidence of ischemic and hemorrhagic strokes following bacterial pneumonia. Between 1997 and 2012, 10,931 subjects with bacterial pneumonia and 109,310 controls were enrolled from the Taiwan National Health Insurance Research Database, and were followed up to the end of 2013. The risk of stroke was estimated in Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs). When compared to the control group, subjects in the bacterial pneumonia group had a higher incidence of developing ischemic stroke (2.7% versus 0.4%, p <0.001) and hemorrhagic stroke (0.7% versus 0.1%, p <0.001). The risk of stroke increases with repeated hospitalizations due to bacterial pneumonia. Across bacterial etiologies, bacterial pneumonia was a significant risk factor among 775 subjects who developed ischemic stroke (HR, 5.72; 95% CI, 4.92-6.65) and 193 subjects who developed hemorrhagic stroke (HR, 5.33; 95% CI, 3.91-7.26). The risks of developing ischemic stroke and hemorrhagic stroke are significant following bacterial pneumonia infection. The risk factors, clinical outcomes, and the disease course should also be profiled to better inform the monitoring of stroke development and the clinical management of bacterial pneumonia patients.

Applying Artificial Intelligence to Pediatric Chest Imaging: Reliability of Leveraging Adult-Based Artificial Intelligence Models

ObjectiveThe scarcity of artificial intelligence (AI) applications designed for use in pediatric patients can cause a significant health disparity in this vulnerable population. We investigated the performance of an adult-trained algorithm in detecting pneumonia in a pediatric population to explore the viability of leveraging adult-trained algorithms to accelerate pediatric AI research. MethodsWe analyzed a publicly available pediatric chest x-ray dataset using an AI algorithm from TorchXRayVision. A 60% threshold was used to make binary predictions for pneumonia presence. Predictions were compared with dataset labels. Performance measures including true-positive rate, false-positive rate, true-negative rate, false-negative rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value, accuracy, and F1-score were calculated for the complete dataset and bacterial and viral pneumonia subsets. ResultsOverall (n = 5,856), the algorithm identified 3,923 cases with pneumonia (67.00%) and 1,933 (33.00%) normal cases. In comparison with the actual image labels, there were 3,411 (58.25%) true-positive cases, 512 (8.74%) false-positive cases, 1,071 (18.29%) true-negative cases, and 862 (14.72%) false-negative cases resulting in 79.83% sensitivity, 67.66% specificity, 86.95% PPV, 55.41% negative predictive value, and 76.54% accuracy and an F1-score of 0.83. Although the performance remained consistent in the bacterial pneumonia group, there was a significant decrease in PPV (69.9%) and F1-score (0.74) in the viral pneumonia group. ConclusionAn adult-trained model adequately detected pneumonia in pediatric patients aged 1 to 5 years. Though models trained exclusively on pediatric images performed better, leveraging adult-based algorithms and datasets can expedite pediatric AI research.

Heparin-Binding Protein in Bronchoalveolar Lavage Fluid as a Biomarker for Discriminating Severe Bacterial and Viral Pneumonia in Critically Ill Children.

This study is aimed at exploring the ability to use heparin-binding protein (HBP) in bronchoalveolar lavage fluid (BALF) to differentially diagnose bacterial infection from viral infection for severe community-acquired pneumonia (CAP) in critically ill children. A total of 181 children with severe CAP admitted to the intensive care unit (ICU) were included in this study. BALF and blood samples were collected within the first 24 hours of admission. BALF HBP and interleukin-6 (IL-6) concentrations and neutrophil percentage (N%) as well as blood HBP, IL-6, procalcitonin (PCT), C-reactive protein, white blood cell concentrations and N% were measured. Of the enrolled children, 126 were confirmed to have bacterial pneumonia, and 55 were confirmed to have viral pneumonia. Blood HBP and PCT concentrations and N% and BALF HBP and IL-6 concentrations and N% were significantly higher in bacterial pneumonia than in viral pneumonia (P < 0.05). In the bacterial pneumonia group, HBP and IL-6 concentrations and N% in BALF samples were all significantly higher than those in blood samples (P < 0.001), and BALF HBP and IL-6 concentrations and N% were correlated with blood HBP and IL-6 concentrations and N%, respectively (r = 0.439, 0.250, and 0.235, P < 0.01). BALF N% and blood N% were both correlated with BALF HBP concentrations and blood HBP concentrations, respectively (r = 0.622 and 0.346, P < 0.001). ROC analysis revealed that BALF HBP showed the best ability to predict bacterial pneumonia, with an area under the curve of 0.994, a sensitivity of 95.24%, and a specificity of 100.00% at its optimal cutoff value of 74.05 ng/mL. BALF HBP might be a promising biomarker for the early discrimination of bacterial infection from viral infection in critically ill children with severe CAP.

Could we use digital infrared medical thermography to distinguish SARS-СоV-2 viral from community acquired pneumonia?

Objectives: This study set out to determine the possibility to differ SARS-СоV-2 viral pneumonia from community acquired pneumonia (CAP) by mean of digital infrared medical thermography. Material, methods: Totally 380 patients were evaluated: with diagnosis 'U07.1COVID-19, virus identified. SARS-CoV-2 pneumonia' (group 1) — 208 pts, with community acquired viral or bacterial pneumonia (group 2) — 172 pts. Thermographic assessment was performed using TBC300-med infrared camera (manufactured by LLC 'STC SILAR', Saint Petersburg, Russia, image format 384 x 288, thermal resolution 30 mK). To store and analyze thermographic images cloud application 'TVision' (LLC 'Dignosys', Russia) was used. Quadrangle in shape regions of interest (ROI) were automatically created on the front and back of the thorax roughly in the projection of the upper lobe (ULP) and the lower lobe (LLP) of the lungs. Mean temperature was measured and thermal gradients- ΔТ° (side-to-side temperature difference) - were calculated between symmetric ROI both on front and back of the thorax. Values obtained were taken as modulus, the greatest value used for analysis. Results: Mean ΔТ° value were significantly higher in SARS-CoV-2 pneumonia compared with CAP group (0,56 ± 0,35 ºC and 0,32 ± 0,14ºC respectively; P &lt; 0,05). The ΔТ° value &gt; 0,51 °C is associated with SARS-CoV-2 pneumonia with sensitivity 71 % and specificity 62,8 %, area under the ROC curve 0.739; P &lt; 0,05). Conclusions. Infrared thermography proved to be a sensitive method for detection of temperature differences between both types of pneumonia and may contribute to preliminary diagnosis.

Differential diagnosis of community-acquired bacterial pneumonia and viral lung injury in hospitalized adults

Objective. Identification of clinical, laboratory, and instrumental factors more common in bacterial pneumonia compared to viral pneumonia, including COVID-19. Materials and Methods. This retrospective case-control study included hospitalized adults with communityacquired bacterial pneumonia and viral lung injury, including COVID-19. Patients were included taking into account age, gender, hospitalization department (general ward or ICU), and Charlson comorbidity index. Clinical, demographic, laboratory, and instrumental data on admission were studied. Unadjusted odds ratios (OR) were calculated using univariate logistic regression (for quantitative indicators) and contingency table analysis (for categorical indicators); adjusted OR were calculated using multivariate logistic regression. Results. The community-acquired bacterial pneumonia group included 100 patients, and the viral lung injury group included 300 patients. Among the causative agents of bacterial pneumonia, Streptococcus pneumoniae was the most common; in the group of viral lung injury, SARS-CoV-2 predominated. In multivariate analysis, the presence of chills (OR and 95% CI: 22.1 [6.8–72.6], p &lt; 0.001), unilateral infiltration according to X-ray or computer tomography (OR and 95% CI: 17.9 [ 7.3–44.1], p &lt; 0.001), altered level of consciousness (OR and 95% CI: 3.2 [1.2–8.5], p = 0.019), use of vasopressors in the first 24 hours of hospitalization ( OR and 95% CI: 11.8 [2.5–55.9], p = 0.002), higher heart rate (OR and 95% CI: 9.1 [2.2–38.6], p = 0.003) and neutrophil/lymphocyte index (OR and 95% CI: 1.4 [1.1–1.9], p = 0.021), as well as the absence of fatigue (OR and 95% CI: 0.2 [0.08–0.40], p &lt; 0.001) and lower total protein (OR and 95% CI: 0.2 [0.02–1.00], p = 0.049) are more typical for bacterial pneumonia compared to viral lung injury. Conclusions. Differential diagnosis between community-acquired bacterial pneumonia and viral lung injury, including COVID-19, requires a comprehensive analysis of clinical, laboratory, and instrumental data.

Determining the Relationship Between Fever of Without focus and Latent Pneumonia in Feverish Children in Bandar Abbas, Iran

Background: Fever is one of the most common causes of children’s referral to the emergency department, for which in 20% of cases no clear source is found. Latent pneumonia is not easily differentiable as one of the differential diagnoses of fever of unknown origin (FUO). This study aimed to determine the relationship between FUO and latent pneumonia in feverish children referring to pediatric emergency department. Materials and Methods: The present analytical research was carried out on 220 children with FUO aged 3-36 months referred to pediatric hospital of Bandar Abbas, Iran in 2019. To find the signs and symptoms, demographic information, history, and physical examination results were recorded by a physician using a predetermined checklist. Chest x-ray and blood sample were prepared for white blood cell (WBC) count, C-reactive protein (CRP), and absolute neutrophil count (ANC). Results: The mean age of the patients was 18.38±8.6 months. There was no significant difference between the mean fever, pulse rate, respiratory rate, WBC count, erythrocyte sedimentation rate (ESR), and ANC among the three groups differentiated by their diagnosis. The mean CRP in the bacterial pneumonia group was 68.17±24.13, while it was 35.00±20.43 in the viral infection group and 35.71±26.20 in the group of other diseases; the difference was statistically significant (P=0.004). Conclusion: Although there was no significant difference between WBC, ANC, and ESR and latent pneumonia, there was a significant difference between CRP and latent pneumonia, whose value was larger in these patients.

Metagenomics analysis of the gut microbiome in healthy and bacterial pneumonia forest musk deer.

The forest musk deer (FMD, Moschus berezovskii) is an threatened species in China. Bacterial pneumonia was found to seriously restrict the development of FMD captive breeding. Historical evidence has demonstrated the relationship between immune system and intestinal Lactobacillus in FMD. We sought to elucidate the differences in the gut microbiota of healthy and bacterial pneumonia FMD. The bacterial pneumonia FMD was demonstrated by bacterial and pathological diagnosis, and the gut microbiome of healthy and bacterial pneumonia FMD was sequenced and analysed. There are three pathogens (Pseudomonas aeruginosa, Streptococcus equinus and Trueperella pyogenes) isolated from the bacterial pneumonia FMD individuals. Compared with the healthy group, the abundance of Firmicutes and Proteobacteria in the pneumonia group was changed, and a high level of Proteobacteria was found in the pneumonia group. In addition, a higher abundance of Acinetobacter (p = 0.01) was observed in the population of the pneumonia group compared with the healthy group. Several potentially harmful bacteria and disease-related KEGG subsystems were only found in the gut of the bacterial pneumonia group. Analysis of KEGG revealed that many genes related to type IV secretion system, type IV pilus, lipopolysaccharide export system, HTH-type transcriptional regulator/antitoxin MqsA, and ArsR family transcriptional regulator were significantly enriched in the metagenome of the bacterial pneumonia FMD. Our results demonstrated that the gut microbiome was significantly altered in the bacterial pneumonia group. Overall, our research improves the understanding of the potential role of the gut microbiota in the FMD bacterial pneumonia.

PRS65 EFFECT AND COST OF TRADITIONAL CHINESE MEDICINE XIYANPING INJECTION FOR TREATING COMMUNITY ACQUIRED PNEUMONIA AMONG ADULTS IN CHINA

To evaluate the effect and cost of Xiyanping injection (herb-derived compound, andrographolide sulfonate) on the treatment of community acquired pneumonia among adults using real world data in China. Data about patients diagnosed with community acquired pneumonia identified with ICD-10 diagnosis code dated between 2013 and 2014 was extracted from the Hospital Information System Database of 2 hospitals in Jiangxi Province. Patients were divided into 4 groups according to the age and causative agent: young patients (15-64 years) with viral pneumonia (group 1) or bacterial pneumonia (group 2), and elderly patients (over 65 years) with viral pneumonia (group 3) or bacterial pneumonia (group 4). Cure rate, improvement rate, uncured rate, death rate, average hospitalization days and total hospitalization costs were compared between patients treated with Xiyanping injection and those treated with conventional treatment. 114 patients treated with Xiyanping injection (60, 21, 18 and 15 patients in group 1-4, respectively) and 3,107 patients with conventional treatment (893, 376, 1,322 and 516 patients in group 1-4, respectively) were included. After prosperity score matching, no significant differences in the cure rate, improvement rate, uncured rate, and death rate when comparing patients treated with Xiyanping injection and those treated with conventional treatment. Patients treated with Xiyanping injection had significantly shorter hospital stay for Group 1 patients (5.142±2.54 vs. 6.98±3.86 days), Group 2 patients (5.00±2.61 vs. 7.92±3.75 days) and Group 4 patients (5.58±2.97 vs. 9.25±3.19 days). The total cost of hospitalization was lower for patients treated with Xiyanping injection than those treated with conventional treatment in Group 1, 2 and 4 although there were no significant statistics differences. Comparing with conventional treatment, Xiyanping injection provided the same clinical outcome but with shorter hospital stay resulting in reduced hospitalization cost for adults with community acquired pneumonia in China.

The Use of Procalcitonin for Prediction of Pulmonary Bacterial Coinfection in Children With Respiratory Failure Associated With Viral Bronchiolitis.

Objectives. Viral bronchiolitis is a frequent cause of pediatric hospitalization and respiratory failure. Procalcitonin (PCT) is a biomarker used to identify serious bacterial infection and can distinguish bacterial and viral infections. Concomitant bacterial pneumonia is not rare in viral bronchiolitis and can lead to a worse clinical course. This study examined the use of PCT in pediatric patients with respiratory failure attributed to viral bronchiolitis to predict concomitant bacterial pneumonia. Methods. This prospective descriptive study evaluated children less than 4 years of age who underwent endotracheal intubation for respiratory failure due to viral bronchiolitis. PCT levels and endotracheal aspirate cultures were obtained at admission. Bacterial pneumonia was defined as at least moderate growth of a single pathogenic organism from endotracheal culture. PCT levels were evaluated in groups with and without concomitant bacterial pneumonia. Results. Thirty-five patients were enrolled between February 2013 and May 2015. All subjects tested positive for at least 1 viral pathogen by nasal wash polymerase chain reaction or enzyme immunoassay. The top viruses obtained were respiratory syncytial virus (n = 15, 42.8%) and rhinovirus (n = 8, 22.9%). The incidence of bacterial pneumonia was 60% (21/35). The PCT median was 0.93 ng/mL (interquartile range = 0.25-6.64) in the bacterial pneumonia group and 1.85 ng/mL (interquartile range = 0.28-7.94) in the nonbacterial pneumonia group. No correlation was found between PCT and bronchiolitis with bacterial coinfection (P = .74). Conclusion. Incidence of bacterial coinfection in patients with respiratory failure and viral bronchiolitis was high. PCT did not predict concomitant bacterial pneumonia in children with viral bronchiolitis.

Lectin Microarray Combined with Mass Spectrometry Identifies Haptoglobin-Related Protein (HPR) as a Potential Serologic Biomarker for Separating Nonbacterial Pneumonia from Bacterial Pneumonia in Childhood.

Etiological diagnosis of pediatric patients with community-acquired pneumonia is difficult. For therapy, one of the major problems is the difficulty in separating bacterial pneumonia which would benefit from antibiotics from nonbacterial pneumonia. Therefore, to identify potential biomarkers for distinguishing nonbacterial pneumonia from bacterial pneumonia are sought . Lectin microarray containing 91 lectins is used to screen serums from pediatric patients with pneumonia. Lectin-based pull-down assay combined with LC-MS/MS is used to identify the potential biomarkers. SNA-I, a lectin binding preferentially to α2-6 linked sialic acid residues, shows higher binding signals (near 42kDa) in the mycoplasma pneumonia group, when compared with the other groups. A total of 18 proteins are identified with LC-MS/MS. By western blot analysis, the authors confirm that the expression of haptoglobin-related protein (HPR) is elevated in pediatric patients with pneumonia compared with normal children (p<0.001). Furthermore, HPR is higher in the mycoplasma pneumonia group (p<0.01) and the viral pneumonia group (p<0.05), when compared with the bacterial pneumonia group. These results indicate that HPR is a potential serologic biomarker which can differentiate between bacterial pneumonia and nonbacterial pneumonia. Detection of serum HPR might be useful for clinical diagnosis.

Clinical value of serum iron in the diagnosis and treatment of children with pulmonary infectious diseases

Objective To observe the changes of serum iron in patients with bronchopneumonia (bacterial pneumonia, mycoplasmal pneumonia) before and after treatment, and to discuss whether it can be used as an indicator of infection. Methods Forty cases with bacterial pneumonia and 41 cases with mycoplasmal pneumonia were recruited.The serum iron levels before and after treatment in bacterial pneumonia group and mycoplasmal pneumonia group were compared and analyzed.The correlation between white blood cell count, percentage of neutrophils, serum C-reactive protein (CRP) levels and the serum iron levels before treatment, and changes of the serum iron before and after treatment were analyzed. Results The level of serum iron after treatment in the bacterial pneumonia group [(16.28±5.81) μmol/L] was significantly higher than that before treatment [(4.83±2.12)μmol/L] (t=-11.19, P 0.05). Conclusion The serum iron level is significantly decreased in children with pulmonary infectious diseases and increased to normal level after anti-infection treatment.Serum iron can not be used as an indicator of infection in children. Key words: Bronchopneumonia; Children; Serum iron

The role of D-dimer in detection and diagnosis of mycoplasma pneumonia

Objective To investigate the role of D-dimer in the diagnosis and evaluation of mycoplasma pneumonia. Methods The positive rate and concentration of D-dimer in mycoplasma pneumonia, bacterial pneumonia, viral pneumonia and healthy controls were detected and compared.The positive rate and concentration of D-dimer in patients with systemic inflammatory response syndrome (SIRS) and without SIRS were observed.Changes of D-dimer concentration in patients with mycoplasma pneumonia before and 2 weeks after treatment were observed. Results Compared with bacterial pneumonia group (16.7%), the viral pneumonia group (20.0%) and healthy control group (0.0%), the positive rate of D-dimer in mycoplasma pneumonia group (41.6%) was significantly higher (χ2=5.625, 4.158, 17.308, all P<0.05). The positive rate of mycoplasma pneumonia group with SIRS (64.0%) was significantly higher than that in other groups (χ2=17.308, P<0.05). The D-dimer levels of the mycoplasma pneumonia group [(324.4±125.3)μg/L], bacterial pneumonia group[(282.3±95.4)μg/L ] and viral pneumonia group[(293.1±92.3)μg/L ]were significantly higher than that in the healthy controls[(72.9±22.4)μg/L ](t=10.878, 11.704, 12.698, all P<0.05). The concentration of D-dimer[(381.4±129.4)μg/L] in the mycoplasma pneumonia group with SIRS was significantly higher than that in the other groups(t=2.668, P<0.05). Compared with before treatment, the concentration of D-dimer after treatment in the two groups was significantly lower[(129.3±65.3)μg/L, (89.7±28.6)μg/L](t=2.582, P<0.05). Conclusion The level of D-dimer in children with mycoplasma pneumonia was significantly increased, and the severity of the disease could be reflected. Key words: Mycoplasma pneumonia; Diagnosis

Observation of detection of serum calcitonin original (PCT) in the diagnosis of pediatric infectious pneumonia

Objective To observe the serum calcitonin original (PCT) detection in the diagnosis of children with infectious pneumonia. Methods From March 2014 to April 2015, 96 children with infectious pneumonia were selected, including bacterial pneumonia in 43 cases, 26 cases of viral pneumonia, 27 cases of Mycoplasma pneumonia.50 healthy children were selected as control group.All children received serum calcitonin original test, PCT test was applied in the diagnosis of children with infectious pneumonia. Results The PCT level in children with bacterial pneumonia group was(3.84±3.57)μg/L, which was obviously higher than (0.12±0.03)μg/L of healthy children, (0.74±0.13)μg/L of children with viral pneumonia and (1.07±0.08)μg/L of pure chlamydia pneumonia patients(F=6.120, P=0.013). Before treatment, the level of serum PCT in children with bacterial pneumonia was significantly higher than that in normal children[(3.84±3.57)μg/L vs.(0.12±0.03)μg/L, t=6.987, P=0.000]. After treatment, the results of PCT detection in serum of children with bacterial pneumonia was significantly lower[(3.84±3.57)μg/L vs.(0.16±0.03)μg/L, t=6.978, P=0.000)]. Conclusion Serum calcitonin original detection can effectively help the differential diagnosis of pediatric infectious pneumonia, has clinical application value. Key words: Serum calcitonin original; Pediatric infectious pneumonia; Diagnosis; Application effect

The value of peripheral blood neutrophil CD64 expression in early differential diagnosis of etiology in children with community-acquired pneumonia

Objective To evaluate the application value of peripheral blood neutrophil CD64 expression in early differential diagnosis of etiology in children with community-acquired pneumonia. Methods From June 2014 to June 2015 in our hospital, total of 99 cases of different pathogen infection were divided into three groups, bacterial pneumonia group(n=41), non-bacterial pneumonia group(n=38), healthy children group(n=20); and the non-bacterial pneumonia group was divided into two subgroups, viral pneumonia group(n=22) and mycoplasma pneumoniae pneumonia group(n=16). Flow cytometry was used to test the median fluorescence intensity(MFI) of peripheral blood neutrophil CD64.The levels of peripheral blood CRP, WBC and neutrophil percentage were detected. Results The levels of CD64 expression, CRP and WBC in bacterial pneumonia group were statistically higher than those of non-bacterial pneumonia group and healthy children group respectively(both P<0.01). The optimal cutoff value of CD64 was 6 519 MFI when using ROC curve, and the sensitivity and specificity of the diagnosis of bacterial pneumonia were 87.8% and 89.7% respectively.The levels of CD64 expression in bacterial pneumonia group were significantly higher than those in viral pneumonia group, mycoplasma pneumoniae pneumonia group and healthy children group(all P<0.01). Conclusion The expression of peripheral blood neutrophil CD64 increases in children with community-acquired pneumonia of bacteria infection.It can be used to guide early diagnosis of children with bacterial pneumonia and the using of antibiotics. Key words: CD64; Child; Community-acquired pneumonia; C-reactive protein

Diagnostic values of plasma CD64 and sTREM-1 for pediatric pneumonia

To determine the diagnostic values of plasma CD64 and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in children with pneumonia. Sixty children with pneumonia between August 2014 and October 2015 were classified into bacterial pneumonia group (25 cases), viral pneumonia group (17 cases), and Mycoplasma pneumonia group (18 cases) according to their clinical manifestations, pathogen cultures, and X-ray findings. Another 30 healthy children who underwent physical examination during the same period were selected as the control group. The concentrations of CD64 and sTREM-1 in blood samples were determined using ELISA. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic sensitivity and specificity of plasma CD64 and/or sTREM-1 for bacterial pneumonia. The expression of CD64 and sTREM-1 in the bacterial pneumonia group was significantly higher than that in the viral pneumonia, Mycoplasma pneumonia, and control groups (P<0.05). The areas under the ROC curves of CD64, sTREM-1, and a combination of the two markers for diagnosing bacterial pneumonia were 0.878, 0.805, and 0.956, respectively. The sensitivity and specificity of CD64 for diagnosing bacterial pneumonia were 81.30% and 92.32%, respectively, when the cut-off value was 641 pg/mL. The sensitivity and specificity of sTREM-1 for diagnosing bacterial pneumonia were 78.65% and 84.67%, respectively, when the cut-off value was 1 479 pg/mL. The sensitivity and specificity of a combination of the two markers for diagnosing bacterial pneumonia were 93.15% and 91.54%, respectively. Plasma CD64 and sTREM-1 can be used as markers for diagnosing pediatric bacterial pneumonia, and a combination of the two markers results in better diagnosis.

Serum Procalcitonin for Differential Diagnosis of Acute Exacerbation and Bacterial Pneumonia in Patients With Interstitial Lung Disease

BackgroundAcute exacerbation and bacterial pneumonia are major life-threatening conditions in patients with interstitial lung disease (ILD). The rapid recognition of these 2 different conditions is important for their proper treatment. An elevated procalcitonin (PCT) level is commonly detected in patients with bacterial infections. This study assessed the usefulness of the serum PCT level as a biomarker for the differential diagnosis of acute exacerbation and bacterial pneumonia in patients with ILD. Materials and MethodsIn this prospective observational study, we enrolled patients with ILD who had experienced recently progressive dyspnea and exhibited new infiltrations on chest radiographs. We classified these patients into an acute exacerbation group and a bacterial pneumonia group and compared their baseline characteristics and laboratory parameters, including the PCT level. ResultsOf 21 patients with ILD, 9 patients had bacterial pneumonia. Both the groups showed similar baseline characteristics. The bacterial pneumonia group demonstrated a high PCT level. The PCT level in the acute exacerbation group was significantly lower than that in the bacterial pneumonia group (0.05 versus 0.91ng/mL, respectively; P < 0.001). Other parameters, such as the C-reactive protein level, leukocyte count and body temperature, were also lower in the acute exacerbation group. At a cutoff value of 0.1ng/mL, the sensitivity, specificity and negative predictive values of the serum PCT level were 88.9%, 100.0% and 92.3%, respectively. ConclusionsThese findings suggest that the serum PCT level is useful in the differential diagnosis of acute exacerbation and bacterial pneumonia in patients with ILD.

Can Serum Surfactant Protein D Levels be used as an Effective Factor Instead of Clinical Severity Scores of Pneumonia in Pediatric Emergency Departments?

Aim: To investigate whether serum surfactant protein D (SP-D) level is an applicable indicator in differentiating bacterial and viral pneumonia and determining clinical severity in cases with community-acquired pneumonia (CAP). Materials and Methods: A total of 67 subjects were analyzed prospectively; of these, 32 were patients (aged 1 month–18 years) with a diagnosis of CAP and 35 were healthy control subjects. Results: The median age of the patients was 17.5 months (1.5–156 months). The serum SP-D levels of the patient group were significantly higher than those of the control group (p<0.001). Based on the pneumonia clinical severity index, serum SP-D levels in patients with mild (n=7), moderate (n=19), and severe (n=6) pneumonia were significantly higher than those in the control group (p<0.001, respectively). The serum SP-D levels in patients with severe pneumonia were much higher than in those with mild and moderate grades based the clinical severity index (p<0.001 and p<0.001, respectively). Although the serum SP-D levels in the bacterial pneumonia group were higher than those in the viral pneumonia group, the difference was not statistically significant. Conclusion: Although serum SP-D has limited efficacy in differentiating bacterial and viral pneumonia with respect to CAP in children, it can be used as an effective bioindicator for determining the clinical severity of the disease in emergency services. (Eurasian J Emerg Med 2016; 15: 1-6)