Current Issue

2024 Vol.9 No.3 Published:30 June 2024

Special Topic on Pertussis

The resurgence of pertussis has brought new challenges to clinical diagnosis and treatment Wu Wenyan, Guan Yuhong, Liu Jingzhe 2024, 9 (3):  1-4.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.001 Abstract ( 43)    PDF (1224KB) ( 22 )    Pertussis is a respiratory infectious disease caused by Bordetella pertussis infection, which is one of the Class B infectious diseases in the national notifiable infectious diseases., 60-70s of the 20th century,the incidence of whooping cough in China was very high, reaching 10-20/10 000, which brought a huge threat to people's health and life safety. Since 1978, when pertussis vaccine was widely administered nationwide, the incidence and mortality of pertussis have dropped significantly. However, according to the latest national epidemic data on notifiable infectious diseases released by the National Bureau of Disease Control and Prevention, whooping cough has made a comeback in recent years. The incidence of older children is increasing year by year, and the infection rate of young infants is also on the rise, and the infection symptoms of young infants are severe, and serious complications such as suffocation and cardiac arrest and even death may occur, which greatly affects the health and life safety of children. Based on clinical cases, this article systematically expounds the current situation of pertussis, the main clinical manifestations, diagnosis, the selection principles of treatment regimens, and vaccination and preventive measures, which has important guiding significance for clinical work.

Clinical characteristics and analysis of risk factors related to severe pertussis in 283 hospitalized children with pertussis Luo Jingjing, Li Yaowen, Tian Xiaoxu, Tan Kun, Lin Jieqiong, Zeng Hongwu 2024, 9 (3):  5-10.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.002 Abstract ( 35)    PDF (2941KB) ( 32 )    Objective To analyze the clinical and chest imaging characteristics of hospitalized patients with pertussis in Shenzhen Children's Hospital from January to March 2024, and explore the relevant risk factors for severe pertussis. Method Clinical and chest radiology data of 283 inpatients with pertussis hospitalized in Shenzhen Children's Hospital from January to March 2024 were collected. According to the severity of pertussis, they were divided into non-severe group (253 cases) and severe group (30 cases). The severe group patients were subdivided into survival group (25 cases) and death group (5 cases) according to clinical outcomes. Compare clinical indicators and radiology characteristics between these two groups, analyze risk factors for severe pertussis, and use ROC curves to analyze the predictive efficacy of different indicators and combined indicators. Result Toltaly 283 pediatric patients, among them 139 patients (49.1%)≤3 months old, 151 cases (53.4%) got a history of contact with cough patients, 117 cases (41.3%) had received the pertussis vaccine, Four cases (1.4%) had pertussis encephalopathy. Compared with the non-severe group, the severe group had higher index in percentage of onset age(≤3 months old),no vaccination, atelectasis, pulmonary arterial hypertension, respiratory failure, pertussis encephalopathy, invasive ventilation with respiratory machines, the use of blood exchange surgery and white blood cell count,neutrophil count, lymphocyte count, neutrophil ratio, CRP, lactate dehydrogenase, with statistically significant difference (P<0.05).Compared with the survival group, the death group had higher index in proportion with vomiting after coughing, neutrophil ratio, CRP and invasive ventilation with ventilators, with statistically significant difference (P<0.05). Age≤3 months, neutrophil ratio, CRP, atelectasis, and pulmonary arterial hypertension were related risk factors for severe pertussis. The ROC curve analysis results showed that the combined predictive sensitivity of age≤3 months, neutrophil ratio and CRP, atelectasis, and pulmonary arterial hypertension was 0.933, specificity was 0.762, and the area under the curve was 0.888 (95%CI 0.816-0.961) (P<0.001). Conclusion When the age of the patient was≤3 months, the proportion of neutrophils and CRP increased, and combined with atelectasis and/or pulmonary arterial hypertension, it is inclined to develop into severe illness. Monitoring blood routine and CRP can help evaluate the severity of the condition.

Original Articles

Investigation and analysis of persistent transmission of herpangina mixed with hand, foot and mouth disease Liu Wei, Wang Yanmei, Jiang Shiqing, Zheng Sijie, Chen Zhigao, Zhang Zhen, Kuang Cuiping 2024, 9 (3):  11-15.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.003 Abstract ( 45)    PDF (1158KB) ( 33 )    Objective To understand the epidemiological characteristics of an outbreak of herpangina (HA) combined hand, foot and mouth disease (HFMD) in a kindergarten in Luohu District, Shenzhen, and analyze the factors of sustained transmission and provide scientific basis for formulating effective prevention and control measures. Method Field epidemiological methods were used to collate and analyze the relevant data of the epidemic. Throat swabs, anal swabs and environmental samples were collected to detect the nucleic acid and genotype of enterovirus in the stages of reporting and continuous transmission of the epidemic. Result The epidemic lasted for 42 days, 115 cases were reported, no severe cases, no hospitalization cases, no death cases. There were 86 cases of HA, 11 cases of HFMD and 18 others. The overall incidence was 20.7% (115/555), and the incidence of children on the second floor of the teaching building was 27.5% (57/207), the difference was statistically significant (RR=1.824, 95%CI:1.187-2.804). The pathogens in the two samples were different, and the sustained spread of the epidemic may be related to factors such as close community contact, misdiagnosis of the first diagnosis, irregular morning examination, and park activities. Conclusion This is an outbreak of HA mixed HFMD caused by multiple transmission sources. There is not only communication from community to kindergarten, but also communication between kindergarten classes. It is recommended to add the observation period of home isolation for the prevention and control of campus infectious diseases to prevent the continued spread of the epidemic.

Evaluation the application value of whole-genome sequencing technology to diagnosic the drug-resistant tuberculosis Mei Jinzhou, Wang Yunxia, Zhang Meijuan, Gui Jing, Zheng Juanjuan, Huang Peipei, Chen Wensheng, Guo Yanfang 2024, 9 (3):  16-20.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.004 Abstract ( 29)    PDF (919KB) ( 18 )    Objective To evaluate the application value of whole-genome sequencing technology to diagnostic the drug-resistant tuberculosis, and provide reference for the early diagnosis of drug-resistant tuberculosis. Method The phenotypic susceptibility results of 8 kinds of anti-tuberculosis drugs with sputum culture positive strains were regard as gold standard, which patients were confirmed and registered in the designated medical institution of Bao'an District from January 1, 2019 to December 31,2021. And the strains were inactivated before DNA was extracted for whole template sequence. The sequence results were uploaded to the platform to obtain the mutation sites of each strain. With reference to the drug resistance gene loci reported in previous literature, the sequence results were compared with the phenotypic drug susceptibility results, and the sensitivity, specificity,coincidence rate and Kappa value were used to evaluate the application value of whole-genome sequencing technology. Result The total drug resistance rate of 1327 culture-positive strains was 20.35%(270/1327). 86.30%(233/270) of the resistant strains were resistant to at least one of the four first-line anti-tuberculosis drugs, including isoniazid, rifampicin, ethambutol and streptomycin. The highest resistance rates of first and second-line anti-tuberculosis drugs were streptomycin(10.63%) and ofloxacin(3.01%). katG, fabG1,inhA and ahpC mutated genes were found in isoniazid-resistant strains. Three genetic mutations were found in resistant strains to streptomycin and para-aminosailcylic acid. Two genetic mutations were found in resistant strains to ethambutol, capreomycin and ofloxacin. There were only one genetic mutation in resistant strains to rifampicin and kanamycin.The sensitivity and specificity of whole-genome sequencing for predicting resistance to isoniazid and rifampicin were above 93.44%(95%CI 84.05-98.18), 97.55%(95%CI 96.54-98.33), respectively. The sensitivity and specificity of the whole-genome sequencing technology for predicting resistance to ethambutol and streptomycin was 80.77%(95%CI 60.65-93.45) and 70.18%(95%CI 62.72-70.92), 99.08%(95%CI 98.39-99.52) and 98.18%(95%CI 97.24-98.87), respectively. For the four second-line anti-tuberculosis drugs, the sensitivity of the whole-genome sequencing technology was from 50%(95%CI 6.76-93.24) to 100%(95%CI 88.42-100.00), the specificity was 98.86%(95%CI 98.13-99.36) or above. Conclusion The whole-genome sequencing technology has high application value in the diagnosis of drug-resistant tuberculosis for isoniazid, rifampicin, and ofloxacin, with the higher sensitivity and specificity. But more studies are needed to confirm it's diagnosis value to drug-resistant pulmonary tuberculosis for capreomycin, streptomycinand para-aminosailcylic acid.

The establishment and significance of clinical score prediction model for septic shock in patients with sepsis Wu Senquan, Mo Weiliang, Li Shaomei 2024, 9 (3):  21-25.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.005 Abstract ( 39)    PDF (1277KB) ( 18 )    Objective To develop a predictive model for differentiating septic shock from sepsis. Thus, treating potential septic shock patients as soon as possible. Method A retrospective analysis was performed on 82 patients with sepsis hospitalized in Dongguan People's Hospital from 1 January 2018 to 31 December 2020, and they were divided into sepsis group and septic shock group according to whether they developed into septic shock. Single factor analysis was performed on the general clinical data of the patients. The receiver operating characteristic (ROC) curve was used to determine the cut-off value of continuous variables with statistical significance between the two groups. Binary data conversion was performed on the continuous variables according to the cut-off value. Multivariate binary logistic regression analysis was used to further screen the indexes with predictive value for septic shock, and the corresponding score was set up according to the β regression coefficient of each variable to establish the septic shock prediction model. Finally, 64 patients admitted with sepsis from 1 January 2022 to 31 December 2023 will be used to validate the model. Result Univariate analysis showed that age and gender had no statistical significance between the two groups, while the other observation indexes had statistical significance. However, only procalcitonin (PCT) ≥12μg/L,C-reactive protein (CRP) ≥181mg/L and neutrophil to lymphocyte ratio (NLR) ≥17 were included in the multivariate logistic regression model finally. The prediction model equation was as follows: Y=2.471×PCT+1.76×CRP+1.009×NLR, and the cut-off value was 2.62, that is, when Y value ≥2.62, sepsis was highly likely to develop into septic shock. The sensitivity, specificity and accuracy of the model were 89.5%, 63.6% and 85.9%, respectively. The validation results showed a sensitivity of 88.2%, a specificity of 83.3% and an accuracy of 85.9%．Conclusion The scoring model provides a simple and feasible way of facilitating a differential diagnosis of septic shock and sepsis, thus, providing evidence for the timely treatment of high-risk patients with septic shock.

Analysis of risk factors and early predicting value of dialysis for hemorrhagic fever with renal syndrome Tang Qingrong, Xu Yizhou, Xu Chunhua, Lu Jin, Li Xiangjun 2024, 9 (3):  26-29.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.006 Abstract ( 35)    PDF (1704KB) ( 12 )    Objective Screening the dialysis risk factors of hemorrhagic fever with renal syndrome (HFRS) from the commonly used clinical indicators and constructing an early warning model, so as to guide the clinic. Method The clinical data of 112 HFRS patients in the first hospital of Changsha from December 2013 to April 2023 were retrospectively analyzed, divided into dialysis group (38 cases) and non dialysis group (74 cases) based on whether hemodialysis is performed or not. To compare and analyze the differences between the basic data of patients in dialysis group and those in non-dialysis group and the indexes of routine laboratory examination. Logstic regression was used to build an early prediction model, and receiver operating characteristic curve (ROC) was used to warn the dialysis ability of each index. Result In 112 HFRS patients, 38 in dialysis group (33.928%) with (24±8.95) days average hospitalization time and 74 in non-dialysis group (66.07%), and the average hospitalization time was (16±6.10) days. Sex and underlying diseases were no difference in two groups (P>0.05). Blood transfusion, shock, pulmonary infection and proteinuria incidence rates in dialysis group was higher than non-dialysis group, and the differences have significant (P<0.05). Age in dialysis group was less than non-dialysis group(P=0.015） and hospitalization time was longer than non-dialysis group(P<0.001）, and ALB in two groups were no differences (P=0.393). WBC、PCT、CR and CK-MB were higher in dialysis group and PLT was lower in dialysis group. ALT, AST, CRP and LDH were no differences in two groups. The AUC of Age, WBC, PLT, PCT, CR and CKMB is 0.650, 0.712, 0.801, 0.671, 0.700 and 0.712, respectively, and the optimal thresholds for prediction are 48.50 years old, 11.92×109/L, 22.50×109/L,1.63μg/L,181.75μmol/L and 25.15U/L, using Logstic regression model, P=1(1+e-γ), γ=1.745-0.084×PLT+0.006×CR (P is the probability value for predicting patient requiring dialysis, γ is the prediction index), and it is concluded that the AUC of the combined detection of PLT and CR is 0.888, the sensitivity is 81.10%, and the specificity is 86.80%. Conclusion sAge, WBC, PLT, PCT, CR, CKMB can be used as early predictors of whether hemorrhagic fever with renal syndrome needs hemodialysis, and combined indicators (PLT and CR) detection is more helpful to find out whether hemorrhagic fever with renal syndrome needs dialysis than single indicators detection.

Exploration of the application of online and offline mixed teaching mode in the teaching of infectious diseases Li Xiaopeng, Zhong Lianghui, Zhong Yuanbin, Chen Jiali 2024, 9 (3):  30-33.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.007 Abstract ( 32)    PDF (1608KB) ( 15 )    Objective To analyze and explore the role and effectiveness of a blended online and offline teaching model in infectious disease education. Method From March 2022 to March 2023, a random number table method was used to select 160 students majoring in clinical medicine from the Medical College of Nanchang University in 2020 as the research subjects. They were divided into an experimental group and a control group, with 80 students in each group. The control group received conventional offline teaching mode, while the experimental group adopted a mixed teaching mode of online and offline concepts. Through theoretical exams, questionnaire surveys, Comparedthe excellent rate of final exam scores and the evaluation of teaching mode of the two groups of students. Result The excellent rate of the final exam scores of the experimental group students was significantly higher than that of the control group, and the difference was statistically significant (P<0.05); The evaluation of the experimental group students on the blended online and offline teaching mode was significantly better than that of the control group students on the traditional teaching mode, with a statistically significant difference (P<0.05). Conclusion The blended teaching model of online and offline concepts applied in infectious disease teaching enriches teaching forms, enhances students learning interest and grades, and significantly improves their teaching satisfaction.

Epidemiological trend characteristics and quantitative prediction of newly discovered HIV/AIDS cases aged ≥50 years in Longgang District Shenzhen Sun Chunyun, Li Gang, Chen Xiaoyan, Wei Weiquan 2024, 9 (3):  34-39.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.008 Abstract ( 31)    PDF (1113KB) ( 12 )    Objective To explore the epidemic trend characteristics of HIV/AIDS patients ≥50 years old, and to make quantitative predictions to provide scientific reference data for prevention and control,as well as for risk assessment. Method Descriptive epidemiological methods were used to analyze the epidemic trend of newly discovered HIV/AIDS cases aged ≥50 years in Longgang District of Shenzhen from 2018 to 2023, and the grey mean GM(1,1) model was established by buffer operator sequence to determine trend and quantitatively predict. Result From 2018 to 2023, 271 new HIV/ADIS cases aged ≥50 years were found in Longgang District, with an average annual rate of (45±11) cases. The male/female sex ratio was 3.44:1, 62.37% were aged 50 to 59, and the occupations were widely distributed, including housework and unemployment (37.27%) and commercial services (15.87%), 53.51% were married or with spouses, 62.36% had a junior high school education or less, and 81.18% were registered outside the city. Heterosexual transmission (71.22%) was the main route of infection in elderly patients, and non-marital heterosexual contact history was high (63.10%). The main way of detection was found in medical institutions (76.38%). There was no trend in the distribution of HIV/ADIS cases aged ≥50 years in terms of population characteristics, infection routes and sample sources (P>0.05). The proportion of newly discovered cases showed an increasing trend (P<0.005). The established weakening operator GM(1,1) gray model is excellent, with an average relative error of < 2.0%, accuracy >98.0% and development coefficient of 0.05. The number of cases shows an increasing trend, and it is predicted that the annual number of cases aged ≥50 years old may increase from 62 to 75 in 2024-2028. Conclusion The proportion and number of HIV/ADIS cases aged ≥50 in Longgang District showed an increasing trend. Attention should be paid to the epidemic of HIV/ADIS cases aged ≥50 years, and publicity and education should be strengthened to formulate and improve the AIDS prevention and treatment system for the elderly population. The grey GM(1,1) prediction model can be used to determine the epidemic trend and quantitatively predict of HIV/AIDS aged ≥50 years, and has a good guiding significance for the quantitative risk assessment and prevention and control of HIV/AIDS epidemic.

The expression of serum TGF-β and IL-23 in infants with respiratory syncytial virus pneumonia and their correlation with the severity of the disease Tang Huizhuo, Wu Honghua, Li Xiaomei 2024, 9 (3):  40-44.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.009 Abstract ( 22)    PDF (1515KB) ( 11 )    Objective To observe the expression of serum transforming growth factor-β （Transforming growth factor-β, TGF-β) and interleukin 23 (Interleukin 23, IL-23) in infants with respiratory syncytial virus (RSV) pneumonia, and to analyze the possible relationship between TGF-β, IL-23 and the severity of the disease. Method The data of 100 infants with RSV pneumonia admitted to Chenzhou First People's Hospital from January 2021 to December 2023 were collected and included in the observation group. The data of 100 infants who underwent physical examination in the hospital during the same period were collected and included in the control group. The disease data and physical examination data of children and healthy infants were preserved intact. The observation group were divided into mild group (n=37) and severe group (n=63) according to the severity of the disease after admission. The levels of TGF-β and IL-23 in the control group and children with different severity of disease, the baseline data of children with different severity of disease, and the levels of TGF-β and IL-23 were compared. The correlation between serum TGF-β and IL-23 and the severity of respiratory syncytial virus pneumonia in infants was analyzed. Result Compared with the control group, the mild group and the severe group had lower TGF-β and higher IL-23; compared with the mild group, the TGF-β in the severe group was lower and the IL-23 was higher (P<0.05). Through Logistic regression analysis, the severity of RSV pneumonia in infants and young children may be related to TGF-β, and IL-23 levels (P<0.05). The ROC curve results showed that TGF-β and IL-23 at the time of admission had a certain efficacy in assessing severe illness, with AUC greater than 0.70 and evaluation value. Moreover, the combined evaluation AUC of the two was 0.937, indicating better evaluation value (P<0.05). Conclusion The serum levels of TGF-β and IL-23 in infants with RSV pneumonia are generally low and high, and the two are related to the severity of the disease. The more severe the disease, the lower the TGF-β and the higher the IL-23. The combined determination of TGF-β and IL-23 levels in infants with RSV pneumonia may be used to evaluate the severity of the disease in early stage.

Correlation between Treg/Th17 immune imbalance and EBV-DNA positivity after treatment in children with infectious mononucleosis Zhou Guijuan, Jia Yuee, Sun Youjia, Li Haixia, Fang Xue 2024, 9 (3):  45-50.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.010 Abstract ( 25)    PDF (943KB) ( 10 )    Objective To explore the relationship between Treg/Th17 immune imbalance and EBV-DNA positivity in children with infectious mononucleosis, and to provide important markers for treatment and prognosis evaluation of such children. Method 88 children with infectious mononucleosis who were treated in our hospital from January 2021 to June 2023 were studied. Children received standardized treatment based on acyclovir or ganciclovir and continued follow-up. According to whether the EBV-DNA load was positive or not at 14 days after treatment, they were divided into EBV-DNA negative group (n=70) and EBV-DNA positive group (n=18). The general clinical data, treatment-related characteristics, T cell subsets, inflammatory cytokines, immunoglobulin before treatment of the two groups were compared. Spearman correlation analysis and multiple Logistic regression analysis were used to evaluate the correlation between different indicators and EBV-DNA positive in children with infectious mononucleosis after 14 days of treatment, and screen for risk factors. Result The average hospitalization time, average temperature recovery time and lymph node enlargement recovery time in EBV-DNA positive group were significantly higher than those in EBV-DNA negative group (P<0.05). The average CD4+T cell ratio, CD4+/CD8+ ratio, Treg cell ratio, Treg/Th17 ratio and serum IL-4 level in the EBV-DNA positive group were significantly lower than those in the EBV-DNA negative group, while the average Th17 cell proportion and serum IFN-γ level in the EBV-DNA negative group were significantly higher (P<0.05). Spearman correlation analysis and multivariate Logistic regression analysis showed that lower proportion of CD4+T cells, lower proportion of Treg cells, higher proportion of Th17 cells and lower Treg/Th17 ratio were risk factors for EBV-DNA positive after 14 days of standardized treatment in children with infectious mononucleosis (P<0.05). Conclusion The proportion of T cell subsets, the severity of Treg/Th17 immune imbalance, Th1/Th2 cytokine levels and immunoglobulin levels in children with infectious mononucleosis before treatment were significantly correlated with EBV-DNA positive after 14 days of treatment. Close monitoring and promoting the recovery of immune-inflammatory balance in children with infectious mononucleosis has important clinical significance for improving the prognosis of infectious mononucleosis treatment.

Analysis of factors influencing the risk of nosocomial and MDRO infections in elderly patients with malignant tumours Wang Di, Zhang Meng, Wang Rui, Tan Chiyu, Hu Xingwei, Wang Zhe 2024, 9 (3):  51-55.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.011 Abstract ( 29)    PDF (995KB) ( 11 )    Objective To analyse the influencing factors of nosocomial infections and Multi-drug-resistantbacteria (MDRO) infections in elderly patients with malignant tumours, and to provide a scientific basis for the development of effective preventive and control measures. Method 782 malignant tumour patients aged 60 years and above admitted to Shengjing Hospital of China Medical University between June 2016 and January 2023 were selected and divided into no nosocomial infection group(529 cases) and nosocomial infection group(253 cases), of which nosocomial infection included MDRO infection group(156 cases) and non-MDRO infection group(97 cases), and the patients' medical records were reviewed and collected. Multivariate Logistic regression analysis was applied to analyze the indexes with significant differences in the univariate analysis, to assess the impact of nosocomial infection and MDRO infection on the elderly patients. The risk factors of nosocomial infection and MDRO infection in elderly patients with malignant tumours were studied using multifactorial logistic regression analysis. Result The proportions of nosocomial infections and MDRO infections among nosocomial infections in elderly patients with malignant tumours were 32.35% and 61.66%, respectively. The results of univariate analysis showed that there was a statistically significant difference between the two groups of patients in terms of chronic disease, physical weakness, invasive procedures, malignant tumors, hospital stay ≥ 14 days, intensive care unit stay ≥ 1 week, long-term bed rest, and low protein levels (P<0.05)the results of logistic regression showed that: debilitating conditions, invasive operations, malignant tumours, hospital stay ≥14d, intensive care unit stay ≥1 week, and prolonged bed rest were the main risk factors of nosocomial infections and MDRO infections in elderly patients with malignant tumours; chronic diseases, low protein level and low blood pressure were the main risk factors of nosocomial infections in elderly patients with malignant tumours. risk factors; chronic diseases and low protein level were independent risk factors for nosocomial infections; use of ≥3 antimicrobial drugs and antimicrobial application time ≥14d were independent risk factors for MDRO infections. Conclusion The incidence of nosocomial infections and MDRO infections in elderly patients with malignant tumours is high, and their influencing factors are diverse, which must be analysed scientifically and effectively to provide scientific basis for reducing the incidence of infections and improving the therapeutic efficacy and quality of life of patients.

The clinical value of dual-energy CT enhancement and magnetic resonance elastography in the diagnosis of hepatitis B liver fibrosis Gu Xiaoli, Pan Qiuhe, Chen Jianbo, Guo Qing 2024, 9 (3):  56-60.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.012 Abstract ( 25)    PDF (1743KB) ( 10 )    Objective To explore the value of dual energy CT (DECT) enhanced scanning and magnetic resonance elastography (MRE) in the diagnosis of hepatitis B liver fibrosis,and provide reference for clinical application. Method From July 2022 to July 2023, a retrospective study was carried out on the clinical diagnosis and treatment data of 85 patients with chronic hepatitis B diagnosed and treated in Department of Radiography of Luohu Hospital of Traditional Chinese Medicine, Guangdong Shenzhen. All patients in this group underwent DECT scans and MRE examinations. Based on the pathological biopsy results as the gold standard, they were divided into S0 group, S1-S2 group, and S3-S4 group according to the severity of liver fibrosis. The MRE elasticity values, arterial hepatic parenchymal iodine concentration (Ia), portal venous hepatic parenchymal iodine concentration (Ip), and hepatic arterial iodine fraction (AIF) were compared among the three groups; Analyze the correlation between liver fibrosis grading and the above indicators through Spearman correlation coefficient, and analyze the efficacy of clinical diagnosis. Result Pathological biopsies of 105 patients in this group showed that there were 28 cases in group S0, 35 cases in group S1-S2, and 22 cases in group S3-S4. There was no significant difference in the basic clinical data of the three groups (P>0.05). The MRE elastic value, Ia, Ip and AIF of S0 group, S1-S2 group and S3-S4 group were significantly different (P<0.05). Spearman correlation analysis showed that the severity of hepatitis B fibrosis was positively correlated with MRE elasticity score, Ia and AIF (r=0.705, 0.543, 0.685, P<0.05), and negatively correlated with Ip (r=-0.607, P<0.05). The sensitivity, specificity and accuracy of MRE and DECT enhanced scanning in the diagnosis of hepatitis B fibrosis were significant (P<0.05). According to ROC curve analysis, the AUC of DECT enhanced scan, MRE and combined diagnosis of HBV fibrosis were 0.769、0.833、0.926, respectively. Conclusion In the diagnosis of hepatitis B liver fibrosis,DECT enhanced scanning and MRE examination have good results,and the combined diagnosis of both can improve the diagnostic efficiency and has important clinical value.

Case Report

Acquired immune deficiency syndrome combined with Norwegian scabies complicating sepsis: a case report Lyu Liang, Zhang Ying, Zeng Qin 2024, 9 (3):  61-64.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.013 Abstract ( 25)    PDF (3454KB) ( 14 )    Scabies is a contact infectious skin disease caused by scabies mites. Norwegian scabies is a special type of scabies, also known as scabies. It is mainly characterized by extensive skin dryness, desquamation, scabs, cracks, etc. As the symptoms are similar to other skin diseases, it is easy to be confused and misdiagnosed, resulting in patients not receiving timely treatment or receiving unnecessary treatment. HIV infection impairs cell-mediated immunity, increases the risk of Norwegian scabies and makes more aggressive, leading to a poor prognosis. In this paper, we retrospectively analyzed the data of a patient with acquired immunodeficiency syndrome infected with Norwegian scabies complicated with sepsis admitted to Chongqing Public Health Medical Treatment Center. This patient was initially misdiagnosed with psoriasis, after symptomatic treatment failed, the Norwegian scabies was clearly diagnosed by skin pathological biopsy, and sepsis was considered combined with auxiliary examination. Suggests that when AIDS patients have extensive skin inflammatory changes, it is necessary to be alert to the possibility of Norwegian scabies, and pathologic examination should be performed as soon as possible to make a clear diagnosis and timely treatment.

Sporadic Creutzfeldt-Jakob disease: a case report and review of literatures Cai Chuan, Xiong Xunbo, Yang Hongjun 2024, 9 (3):  65-68.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.014 Abstract ( 33)    PDF (1330KB) ( 20 )    Being considered among the most fatal neurological conditions, Creutzfeldt-Jakob disease is a transmissible spongiform encephalopathy characterized by its unknown etiology and rapidly progressive neurodegenerative symptoms that often lead to a mean survival of 6 to 12 months. The accumulation of the prion protein causes brain matter degeneration, which leads to a set of clinical findings that include rapidly progressive dementia, myoclonus, tremors, cerebellar ataxia, and extrapyramidal signs. This clinical presentation is non-specific, which makes CJD a very difficult condition to diagnose, due to the low level of clinical suspicion. We present the case of a 48-year-old male presenting to the Neurology department with complaint of limbs clumsiness and cognitive decline. The patient's physical exam was significant for Severely declining in advanced cortical function, muscular hypertonia of extremities, bilateral positive Babinski's sign. Magnetic resonance imaging of his brain showed symmetric bilateral diffusion signal abnormality involving the cortex, bilateral caudate heads and putamina. Electroencephalogram revealed periodic sharp-slow compound wave emission in bilateral cerebral hemispheres. Lumbar puncture was significant for presence of 14-3-3 protein in cerebrospinal fluid. The multiple examinations performed in conjunction with the previous findings supported the diagnosis of sporadic CJD.

Penicillium caused peritoneal dialysis-associated peritonitis: a case report and literature review Wang Yuqi, Hu Mingliang, Wang Li, Liang Caixing, Wang Xiaoshuang 2024, 9 (3):  69-72.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.015 Abstract ( 30)    PDF (2824KB) ( 11 )    Peritoneal dialysis-associated peritonitis is a serious complication of peritoneal dialysis treatment, which can lead to a variety of adverse clinical outcomes.Therefore, the prevention and treatment of peritoneal dialysis-associated peritonitis is an important step to improve the prognosis of patients. Most peritoneal dialysis-associated peritonitis is caused by gram-positive bacteria, of which penicillium is rare. In this paper, a 45-year-old female patient with peritoneal dialysis-associated peritonitis was reported, who had previously received electronic colonoscopy indicating coliti.The patient treated with anti-infective therapy such as levofloxacin, imipenemenciastatin, fluconazole, etc. Subsequent peritoneal dialysis tube microbial culture results indicated penicillium infection, and peritonitis was cured after the peritoneal dialysis tube was extracted and replaced with voriconazole antifungal therapy. The diagnosis and treatment of this patient indicated that the clinical manifestations of the disease and routine laboratory examination were non-specific, and the possibility of penicillium infection should be vigilant for patients with poor treatment effect or negative culture of peritonitis. While timely and standardized treatment of peritonitis, attention should be paid to identifying and treating the predisposing factors of peritonitis associated with peritoneal dialysis.

A case of comprehensive analysis and diagnosis of mycobacterium tuberculosis complicated with multi-pathogen pneumonia by pathogens targeted next-generation sequencing Liu Tengyingzi, Liu Nanxi, Zhang Xiaomin, Niu Dandan, Guo Yongchao, Wang Dan, Lin Dachuan, Li Tong, Huang Manyu, Zhang Yingluan, Zhang Zhen, Shi Xiaolu, Feng Tiejian 2024, 9 (3):  73-77.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.016 Abstract ( 28)    PDF (1442KB) ( 25 )    Mycobacterium tuberculosis is the primary causative agent of human tuberculosis. Conventional detection methods for Mycobacterium tuberculosis, such as acid-fast staining and Roche culture method and Interferon gamma release assay (IGRA) , are time-consuming and have low sensitivity in diagnosing tuberculosis, often leading to clinical misdiagnosis, missed diagnosis, and treatment delays. In recent years, the integration of targeted Next-generation sequencing (tNGS) technology with Multiplex polymerase chain reaction (MPCR) amplification and high-throughput sequencing has gained increasing attention in the field of clinical testing due to its advantages of rapidity,ultra-broad spectrum, high sensitivity and high detection rate. It has gradually emerged as an important complementary approach for identifying Mycobacterium tuberculosis .This paper reported a 93-year-old male patient with severe pneumonia in the Longhua District People's Hospital of Shenzhen. The clinical manifestation, imaging examination, pathogen detection and treatment process were analyzed. The patient was finally diagnosed as Mycobacterium tuberculosis complicated with multi-pathogen infection by tNGS. tNGS showed potential value in earlier diagnosis, mixed infection identification, surveillance and therapeutic efficacy evaluation. This not only enhances the clinical differential diagnosis of Mycobacterium tuberculosis but also advances the understanding among healthcare professionals regarding the application of tNGS in pathogen identification for infectious diseases.

Review

Advances in the detection of carbapenemase among Enterobacterales Hua Shaowei, Zhao Zijin, Zhao Meng, Shen Xinxin, Feng Zhishan 2024, 9 (3):  78-85.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.017 Abstract ( 32)    PDF (2804KB) ( 19 )    In recent years, bacterial drug resistance has become a major challenge to public health, with carbapenem-resistant Enterobacteriaceae (CRE) being particularly resistant to antibiotics. The main resistance mechanism of CRE is the production of carbapenemases, which are carried differently by different strains and encode different resistance genes; therefore, early detection of carbapenemases and resistance genes plays an important role in controlling the spread of drug-resistant bacteria. The current phenotypic assays for carbapenemases are the modified Hodge assay, the carbapenem inactivation assay, the Carba NP assay, the immunological assay, and mass spectrometry. For the detection of genotypes, there are real-time fluorescence quantitative PCR assay microarray technology, isothermal amplification assay and sequencing technology, all of which are widely used in the detection of carbapenemases. Understanding the advantages and disadvantages of each detection technology is very important for the selection of the most appropriate detection method in practical applications, this paper focuses on the research progress of CRE carbapenemase detection methods and the advantages and disadvantages of each method are reviewed, to provide data support for the detection and prevention of CRE as well as the control of nosocomial infections.

Standards/Guidelines/Consensus

Expert consensus on the prevention and control of blood borne pathogen infections related to artificial liver support Hu Lingli, Mo Dan, Li Kanghua, Zhang Lihui, Wang Mingming, Luo Mengting, Chen Chong, Zhang Zhiyun, Yuan Su'e 2024, 9 (3):  98-104.  DOI: 10.19871/j.cnki.xfcrbzz.2024.03.020 Abstract ( 35)    PDF (1339KB) ( 21 )    Artificial liver support is currently an important means of treating liver failure. As some patients are carriers or infected with blood borne pathogens, both patients and medical staff are at risk of blood borne pathogen infection during the process of extracorporeal circulation. The research on prevention and control strategies for blood borne pathogens related to artificial liver support in China is still in its early stages, lacking standardized and consistent understanding. Hence, this consensus is formed with the effort of nursing experts who were organized by the Infectious Disease Nursing Professional Committee of Chinese Nursing Association organized domestic experts, based on the relevant laws and regulations of national hospital infection prevention and control. Which is also be guided by domestic and foreign literatures related to the current situation of artificial liver support treatment and blood borne pathogen infection prevention and control, and combined with China's clinical diagnosis and treatment guidelines and best clinical practice evidence requirements. Consensus provides clinical guidance for the prevention and control of blood borne pathogen infections related to artificial liver support through risk assessment of various stages of artificial liver support treatment, and the development of safe operation procedures to avoid risks, including the setting of artificial liver rooms, institutional management requirements, prevention and control rules based on patients and medical staff during the treatment process, exposure handling procedures and other 25 expert consensus content. It aims to avoid occupational exposure to blood borne pathogens and hospital acquired infection risks, and ensure the safety of patients and medical staff.