| PurposeTo discuss the pathogenic types of children with lobar pneumonia and the clinical characteristics of various pathogens in order to provide reference for diagnosis and treatment by the pathogenic detection of Bronchoalveolar lavage fluid(BALF)in children.MethodsBALF of children were collected and detected by direct immunofluorescence detection,PCR fluorescence probe The method of bacterial culture was used for pathogen detection,and SPSS20.0 software package was used for statistical analysis of data.Statistically analyze the differences of BALF etiology in children of different ages,genders and seasons;Statistically analyzing the differences of clinical manifestations and laboratory tests of different pathogenic infections in children with lobar pneumonia of different ages and genders;Statistically analyzing the outcome of lobar pneumonia in children.Results179 children with lobar pneumonia who were hospitalized in the pediatric department of Shenzhen Maternity and Child Health Hospital from January 1,2014 to December 31,2021 and treated with bronchoscopic alveolar lavage(BAL)within 1-10 days of the course of disease were selected.Among 179 children with BALF,160 were positive(89.38%).There were 83 cases(46.37%)with MP infection;29 cases(16.20%)were infected by bacteria,including 15 cases(51.72%)of Streptococcus pneumoniae,3 cases(10.34%)of Group B streptococcus,3 cases(10.34%)of Staphylococcus aureus,3 cases(10.34%)of Klebsiella pneumoniae,2 cases(6.9%)of Streptococcus hemolyticus,1 case(3.45%)of Staphylococcus epidermidis,1 case(3.45%)of Escherichia coli,and 1 case(3.45%)of Pseudomonas aeruginosa;There were 47 cases of viral infection(26.26%),including 22 cases of RSV infection(46.80%),8 cases of ADV infection(17.02%),4cases of EB infection(8.51%),3 cases of IV B infection(6.38%),3 cases of cytomegalovirus infection(6.38%),2 cases of IV A infection(4.26%),2 cases of PIV 1infection(4.26%),2 cases of PIV 3 infection(4.26%),1 case of PIV 2 infection(2.13%),and 1 case of fungal infection(0.56%).The results showed that the detection rate of MP infection was the highest.Pathogenic distribution of children in different age groups: The detection rates of RSV,MP and group B streptococci were different among different age groups(P<0.05).The detection rate of RSV in the 28 day to 3 year old group(6.88%)was significantly higher than that in the 4-7 year old group(2.50%)and the 8-14 year old group(4.37%);The detection rate of MP in the 8-year-old to 14-year-old group(36.25%)was significantly higher than that in the 28 day to 3-year-old group(6.25%)and4-year-old to 7-year-old group(9.37%);The detection rate of group B streptococcus was higher in the 28 day to 3 year old group(1.25%)than in the 4-7 year old group(0.63%)and the 8-14 year old group(0.00%);There was no significant difference in the detection rate of other pathogens(P>0.05).Gender difference in pathogen detection rate: MP detection rate of male children was higher than that of female children(P<0.05),and there was no statistical difference in the gender difference in pathogen detection rate,both P>0.054.Compared with different seasons,the detection rate of MP in spring and winter was significantly higher than that in summer and autumn(P<0.05).Although the detection rate of other pathogenic microorganisms in spring and winter was higher than that in summer and autumn,there was no statistical difference(P>0.05).Comparison of different seasons: The detection rate of RSV and MP had seasonal difference(P<0.05),and the detection rate of RSV in spring and winter(12.50%)was higher than that in summer and autumn(1.25%),P<0.05;The detection rate of MP in spring and winter(37.50%)was higher than that in summer and autumn(14.38%),P<0.05;Although the detection rate of other pathogens in spring and winter was higher than that in summer and autumn,there was no statistical difference(P>0.05).Among 160 children with positive etiological test results,40 children had mixed infection,accounting for 25.00%.Among them,15 cases(37.50%)were associated with MP virus infection,including 5 cases(12.50%)associated with RSV,3 cases(7.50%)associated with ADV,IVA1(2.50%),IVB1(2.50%),PIV1(2.50%),PIV2(2.50%),PIV3(2.50%),EB1(2.50%),and cytomegalovirus(2.50%);MP was associated with bacterial infection in 20 cases(50.00%),including 1 case of group B streptococcus(2.50%),10 cases of pneumonia streptococcus(25.00%),3 cases of staphylococcus aureus(7.50%),1 case of hemolytic streptococcus(2.50%),1 case of staphylococcus epidermidis(2.50%),1 case of escherichia coli(2.50%),1 case of pseudomonas aeruginosa(2.50%),and 1 case of fungi(2.50%);MP complicated with RSV and Streptococcus pneumoniae infection in 2 cases(5.00%);RSV complicated with Streptococcus pneumoniae in 3 cases(7.50%).Comparing the age,course of disease,laboratory examination indicators and complications of single infection and mixed infection of MP and RSV: Compared with single infection children,MP children with mixed infection had statistical differences in course of disease,WBC,CRP,PCT and complications(P<0.05),MP children with mixed infection had longer course of disease than single infection children,WBC,CRP,PCT were significantly higher than single infection children,and the incidence of complications was significantly higher than single infection children,Although the age of mixed infection was older than that of single infection,there was no statistical significance(P>0.05);Compared with children with single infection,children with mixed RSV infection had significant differences in age,WBC,CRP,PCT,and complications(P<0.05).Children with mixed RSV infection were older than children with single infection,WBC,CRP,PCT were significantly higher than children with single infection,and the incidence of complications was higher.Although the course of mixed RSV infection was longer than that of children with single infection,P>0.05 was not statistically significant.In children infected by other pathogens,the course of mixed infection,WBC,CRP,PCT and complication rate were higher than those of single infection,but there was no statistical difference.179 children were all cured and discharged,of which 86 patients had 5-7 days of treatment,accounting for 48.04%,and 93 patients had 8-15 days of treatment,accounting for 51.96%ConclusionChildren with lobar pneumonia can be caused by a variety of pathogens,common pathogens include MP,RSV,ADV,influenza virus,parainfluenza virus,group B streptococcus,cytomegalovirus,Epstein-Barr virus,etc.The detection rate of MP was the highest in 179 children by BALF pathogen detection,and male children were higher than female children;The older children(4-14 years old)are higher than the younger children(28 days to 3 years old);Winter and spring are higher than summer and autumn.The clinical symptoms,laboratory tests and imaging examinations of children with lobar pneumonia mixed infection are more serious than those with single infection,and they are prone to complications,such as atelectasis,consolidation of the lung,pleural effusion,etc.,which should be paid great attention by clinicians. |
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