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Copyright of Chinese Journal of Preventive Veterinary Medicine / Zhongguo Yufang Shouyi Xuebao is the property of Chinese Journal of Preventive Veterinary Medicine Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BackgroundInfluenza and Mycoplasma pneumonia (MP) infection are common winter diseases in northern China, both of which have similar clinical symptoms. There are few studies on the infection of MP in individuals with influenza-like illness (ILI) .ObjectiveTo study the presence and drug resistance of MP in throat swabs from ILI patients.MethodsThroat swab specimens of 915 outpatients with ILI were collected from 17 grade A tertiary healthcare institutions in 15 regions of China (Weifang, Kaifeng, Harbin, Inner Mongolia, Beijing, Tianjin, Tongchuan, Xianyang, Qinhuangdao, Dandong, Hanzhong, Taiyuan, Benxi, Luohe, Nanyang) during two winters (one was from December 2018 to February 2019, and the other from December 2019 to February 2020) . The Influenza A+B Antigen Test Kit (Colloidal Gold) was used to identify influenza viral antigens. PCR was used to detect the nucleic acid from pneumonia pathogens. DNA sequencing was used to detect the drug-resistant gene associated with MP.ResultsOf the specimens, 578 were from children (

Objective This paper reports a case of Plasmodium ovale and SARS-CoV-2 coinfection, which was successfully cured under the strategy of early diagnosis, timely antiviral and anti-malarial treatment, offering a reference for clinical diagnosis and treatment of this disease. Methods The epidemiological history, clinical manifestations, treatment status and laboratory results of the case were collected for case analysis. Results The patient had a history of travel to malaria and COVID-19 epidemic areas, and had repeated fever after admission, accompanied by headache, fatigue, throat discomfort and muscle soreness. Laboratory results showed abnormal liver function, decreased hemoglobin concentration, decreased lymphocyte and platelet counts. Blood Plasmodium tests showed negative by malaria rapid diagnostic test and the microscopic test showed Plasmodium, PCR was positive for Plasmodium ovale, the nasopharyngeal swab detected SARS-CoV-2, lung CT showed inflammatory foci in the lower lobe of the right lung. Plasmodium ovale malaria with COVID-19 coinfection was diagnosed. After antiviral and antimalarial treatment, he was cured. Conclusions The clinical manifestations of Plasmodium ovale co -infection with SARS-CoV-2 are complicated, and laboratory tests are easy to miss. Early diagnosis and timely targeted treatment can achieve good results. [ABSTRACT FROM AUTHOR]

Over the past two to three decades, the emergence and re-emergence of new infectious diseases, advances in molecular detection techniques of pathogens, antibiotic resistance, changes in population lifestyle and immune status (including vaccination), and other factors have led to new evolutions in the etiology of community-acquired pneumonia (CAP). (1) Although Streptococcus pneumoniae remains a common pathogen of CAP, it is no longer the leading cause in China and the United States. According to the results of 2 multicenter studies in China in the early 21st century, Streptococcus pneumoniae accounted for 10.3% and 12.0% of adult CAP pathogens, respectively, ranking second. A study on key pathogens of adult CAP in nine cities in mainland China from 2014 to 2019 using real-time quantitative PCR and conventional culture on respiratory and blood specimens showed an overall prevalence of Streptococcus pneumoniae of 7.43%, ranking sixth. However, its ranking varied from third to seventh among the nine cities. (2) Challenges and concerns about viruses have increased. National surveillance of acute respiratory tract infections and epidemiology in China from 2009 to 2019 indicated that the positivity rates for viral infections in adult pneumonia was 20.5%. These rates were similar to the results of the CDC's CAP pathogen study in the United States, although the rankings were different (viruses ranked second in China and first in the United States). Over the past 20 years, the emergence of new viral respiratory infections caused by mutant strains or zoonotic strains has significantly increased the challenges and threats posed by viral respiratory infections. (3) The role of Mycoplasma pneumoniae ( M pneumoniae ) in adult CAP and the need for routine empirical antibiotic coverage are controversial. In addition to the influence of epidemic cycles, the prevalence of M pneumoniae is influenced by factors such as age, season, study design, and detection methods, and geographical distribution is also an important influencing factor. Although M. pneumoniae ranks first among CAP pathogens in mainland China (11.05%), there are significant regional differences. In Beijing, Xi'an, and Changchun M. pneumoniae ranks first, while in Harbin, Nanjing, and Fuzhou it ranks second to sixth. In Wuhan, Shenzhen, and Chengdu M. pneumoniae ranks after the tenth position. Available evidence supports the notion that routine coverage of M. pneumoniae is not necessary for empirical treatment of CAP, except in severe cases. In regions with a high prevalence of M. pneumoniae , the decision to cover atypical pathogens in patients with mild to moderate CAP should be based on local data and individualized. (4) CAP caused by multidrug-resistant bacteria, especially multidrug-resistant Gram-negative bacilli (GNB), has become a concern. According to a systematic review of Chinese literature, Klebsiella pneumoniae accounted for 8.12% of adult CAP patients, ranking fifth, and Pseudomonas aeruginosa accounted for 4.7% (ninth). The China Antimicrobial Resistance Surveillance System (CARSS) reported an average resistance rate of 27.7% for Klebsiella pneumoniae to third-generation cephalosporins and a resistance rate of 10.0% to carbapenems in 2021. The average resistance rate of Pseudomonas aeruginosa to carbapenems was 16.6%. Early empirical treatment should consider predicting the resistance profile using a "locally validated risk factor" scoring system. (5) Co-infections are common but under-reported. The development of non-culture detection techniques over the past 40 years has significantly increased the detection rate of respiratory pathogens, especially viruses, leading to an increasing number of reports of bacterial-viral co-infections in CAP. It has been reported that co-infections account for 39% of severe CAP cases on ventilators in the ICU. Currently, there is inconsistency and confusion regarding the definition and concept of co-infection, the choice of detection techniques, and the differentiation between co-detection and co-infection. Many reports of co-infections in COVID-19 lacked pathogenic evidence, and some even listed "effective antibiotic treatment" as one of the diagnostic criteria for viral-bacterial co-infections, suggesting to some extent an overuse of antibiotics in COVID-19. Due to the diverse etiological spectrum of CAP between regions in the recent years, it is challenging to develop unified guidelines for the management of CAP in large countries. This article provides recommendations for the development of local guidelines for the diagnosis and treatment of CAP.

Objective: To compare the epidemiological and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection in Kunming among the pre-and post-COVID-19 era, and to establish a prediction model for severe RSV infection in children during the post-COVID-19 period. Methods: This was a retrospective study. Clinical and laboratory data were collected from 959 children hospitalized with RSV infection in the Department of Pulmonary and Critical Care Medicine at Kunming Children's Hospital during January to December 2019 and January to December 2023. Patients admitted in 2019 were defined as the pre-COVID-19 group, while those admitted in 2023 were classified as the post-COVID-19 group. Epidemiological and clinical characteristics were compared between the two groups. Subsequently, comparison of the clinical severity among the two groups was performed based on propensity score matching (PSM). Furthermore, the subjects in the post-COVID-19 group were divided into severe and non-severe groups based on clinical severity. Chi-square test and Mann-Whitney U test were used for pairwise comparison between groups, and multivariate Logistic regression was applied for the identification of independent risk factors and construction of the prediction model. The receiver operating characteristic (ROC) curve and calibration curve were employed to evaluate the predictive performance of this model. Results: Among the 959 children hospitalized with RSV infection, there were 555 males and 404 females, with an onset age of 15.4 (7.3, 28.5) months. Of which, there were 331 cases in the pre-COVID-19 group and 628 cases in the post-COVID-19 group. The peak period of RSV hospitalization in the post-COVID-19 group were from May to October 2023, and the monthly number of inpatients for each of these months were as follows: 72 cases (11.5%), 98 cases (15.6%), 128 cases (20.4%), 101 cases (16.1%), 65 cases (10.4%), and 61 cases (9.7%), respectively. After PSM for general data, 267 cases were matched in each group. The proportion of wheezing in the post-COVID-19 group was lower than that in the pre-COVID-19 group (109 cases (40.8%) vs. 161 cases (60.3%), χ 2 =20.26, P <0.001), while the incidences of fever, tachypnea, seizures, severe case, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein and interleukin-6 levels were all higher than those in the pre-COVID-19 group (146 cases (54.7%) vs. 119 cases (44.6%), 117 cases (43.8%) vs. 89 cases (33.3%), 37 cases (13.9%) vs . 14 cases (5.2%), 69 cases (25.8%) vs. 45 cases (16.9%), 3.6 (1.9, 6.4) vs. 2.3 (1.8, 4.6), 9.9 (7.1, 15.2) vs. 7.8 (4.5, 13.9) mg/L, 20.5 (15.7, 30.4) vs. 17.2 (11.0, 26.9) ng/L, χ 2 =5.46, 6.36, 11.47, 6.42, Z =4.13, 3.06, 2.96, all P <0.05). There were 252 cases and 107 cases with co-infection in the post-and pre-COVID-19 groups, respectively. The proportion of triple and quadruple infection in the post-COVID-19 group was higher than that in the pre-COVID-19 group (59 cases (23.4%) vs. 13 cases (12.1%), 30 cases (11.9%) vs. 5 cases (4.7%), χ 2 =5.94, 4.46, both P <0.05). Among the 252 cases with co-infection in post-COVID-19 group, the most prevalent pathogens involving in co-infections, in order, were Mycoplasma pneumoniae 56 cases (22.2%), Influenza A virus 53 cases (21.0%), Rhinovirus 48 cases (19.0%), Parainfluenza virus 35 cases (13.9%), and Adenovirus 28 cases (11.1%).The result of multivariate Logistic regression showed that age ( OR =0.70, 95% CI 0.62-0.78, P <0.001), underlying diseases ( OR =10.03, 95% CI 4.10-24.55, P <0.001), premature birth ( OR =6.78, 95% CI 3.53-13.04, P <0.001), NLR ( OR =1.85, 95% CI 1.09-3.15, P =0.023), and co-infection ( OR =1.28, 95% CI 1.18-1.38, P <0.001) were independently associated with the development of severe RSV infection in the post-COVID-19 group. The ROC curve of the prediction model integrating the above five factors indicated an area under the curve of 0.85 (95% CI 0.80-0.89, P <0.001), with an optimal cutoff of 0.21, a sensitivity of 0.83 and a specificity of 0.80. The calibration curve showed that the predicted probability in this model did not differ significantly from the actual probability ( P =0.319). Conclusions: In the post-COVID-19 era in Kunming, the peak in pediatric hospitalizations for RSV infection was from May to October, with declined incidence of wheezing and increased incidence of fever, tachypnea, seizures, severe cases, and rates of triple and quadruple co-infections. Age, underlying diseases, premature birth, NLR, and co-infection were identified as independent risk factors for severe RSV infection in the post-COVID-19 period. In this study, a risk prediction model for severe pediatric RSV infection was established, which had a good predictive performance.

Objective: To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF). Methods: 220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ (2) test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results: There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group ( P  < 0.05). Among the 220 ACLF cases, 158 (71.82%) were infected with the hepatitis B virus (HBV). The incidence rate of infection during hospitalization was 69.09% (152/220). The common sites of infection were intraabdominal (57.07%) and pulmonary infection (29.29%). Pearson correlation analysis showed that PNI and MELD-Na were negatively correlated ( r  = -0.150, P  < 0.05). Multivariate logistic analysis results showed that low PNI score ( OR =0.916, 95% CI : 0.865~0.970), ascites ( OR =4.243, 95% CI : 2.237~8.047), and hepatorenal syndrome ( OR =4.082, 95% CI : 1.106~15.067) were risk factors for ACLF co-infection ( P  < 0.05). The ROC results showed that the PNI curve area (0.648) was higher than the MELD-Na score curve area (0.610, P  < 0.05). The effectiveness of predicting infection risk when PNI was combined with ascites and hepatorenal syndrome complications was raised. Patients with co-infections had a good predictive effect when PNI ≤ 40.625. The sensitivity and specificity were 84.2% and 41.2%, respectively. Conclusion: Low PNI score and ACLF co-infection have a close correlation. Therefore, PNI has a certain appraisal value for ACLF co-infection.

The peak of COVID-19 infections in China has just passed, and symptomatic manifestations in patients vary widely, with a minority experiencing severe morbidity and mortality. Early detection of adverse outcomes remains critical for clinical governance and prognosis in COVID-19. This review synthesized both national and international studies relevant to the prognostic evaluation of COVID-19 and summarized the prognostic implications of demographics (age and gender), specific laboratory parameters, adjunctive examination results, complications, and comorbidities in COVID-19 patients. Pertinent laboratory parameters chiefly included markers of inflammation, coagulation function, and electrolytic balance. Adjunctive examinations included thoracic CT and electrocardiographic evaluations. Major complications and comorbid conditions included thrombotic episodes, co-infections, secondary infections, chronic pulmonary disorders, cardiovascular diseases, acute and chronic renal diseases, diabetes mellitus, and cerebrovascular accidents. Moreover, this article discussed how these elements affected the prognosis of patients with COVID-19. By summarizing the information, it aimed to inform preventive and therapeutic strategies against COVID-19 infections in the forthcoming period.

Nocardia is a rarely encountered opportunistic gram-positive bacterium that exhibits marked invasiveness and dissemination. Typically, acquired through trauma or inhalation, this pathogen primarily affects immunocompromised individuals and is a potentially life-threatening risk in severe cases. Nocardia otitidiscaviarum is a particularly rare subtype of Nocardia infection, and the occurrence of concurrent Aspergillus infection is extremely rare. In cases where both infections manifest concomitantly, rapid and accurate diagnosis is essential to facilitate the subsequent selection of appropriate anti-infective interventions. This paper reported the diagnostic and therapeutic experience in managing a case of pulmonary co-infection with Nocardia otitidiscaviarum and Aspergillus . The patient presented with an acute onset, rapid progression, and early manifestation of respiratory failure. The diagnostic process included respiratory pathogen culture and bronchoscopy, which was supplemented with targeted next-generation sequencing (tNGS). These comprehensive diagnostic modalities led to the identification of pulmonary co-infection with Nocardia otitidiscaviarum and Aspergillus . After adjustment of the antibiotic regimen, the patient's condition improved rapidly, culminating in a timely discharge.

Objective: To analyze the incidence of co-infection of HIV and HBV and death in HIV/AIDS cases who newly received antiretroviral therapy (ART) from 2005-2020 in Jiangsu Province. Methods: According to the baseline and follow-up data of HIV/AIDS cases on ART enrolled between January 2005 and December 2020, the last follow-up clinical visit was up until December 31, 2022, the national information system was retrospectively collected for HIV/AIDS cases from Chinese System Disease for Control and Prevention. Excel database was established, and statistical analysis was performed using the SPSS 16.0 software. Kaplan-Meier method was used to draw the survival curves, the log rank test was used to compare the survival curves, and Cox proportional hazards modeling was used to assess the mortality and potential risk factors. Results: There were 33 322 HIV/AIDS cases that newly received ART during 2005-2020.The rate of HBsAg test was 57.3%(19 098/33 322). Among HIV/AIDS cases tested HBsAg, the ratio of male to female was 7.1∶1 (16 745∶2 353), the average age was (39.4±14.0) years old, 49.5% (9 446/19 098) of the HIV/AIDS cases were married, 57.8% (11 048/19 098) were infected with HIV through homosexual contact and 36.6% (6 990/19 098) were through heterosexual contact. The M ( Q 1 , Q 3 ) of CD4 + T lymphocytes (CD4) counts at ART initiation was 297 (166, 445) cells/μl. A total of 8.2% (1 566/19 098, 95% CI :7.8%-8.6%) were HBsAg positive. There were 1 062 HIV/AIDS died by December 31, 2022. The log rank test showed that there were differences in survival curves between HIV/AIDS co-infected with HBV or not ( χ 2 Effective treatment for coinfection with HBV and HBV vaccination for HBV-negative people with HIV should be integrated into HIV treatment programs to reduce HIV-related mortality in Jiangsu Province, 2005-2020.P <0.001). Multivariate analysis of the Cox proportional risk regression model showed that enrollment year, age, marital status, route of HIV infection, baseline CD4 counts before ART, and co-HBV infection were the influencing factors for HIV/AIDS death (all P <0.05), compared with those enrolled in 2015 and before, age ≥45 years, and those who were unmarried. Those enrolled in treatment from 2016 to 2020, those younger than 45 years, and married/cohabitation had a lower risk of death. Compared with baseline CD4 counts ≥201 cells/μl, other routes of infection, and HIV infection alone, baseline CD4 counts ≤200 cells/μl, injecting drug use, and co-HBV infection were associated with a higher risk of death. Conclusion: Effective treatment for coinfection with HBV and HBV vaccination for HBV-negative people with HIV should be integrated into HIV treatment programs to reduce HIV-related mortality in Jiangsu Province, 2005-2020.

Objective: To construct a nomogram prediction model for predicting the risk of death in patients with sepsis-associated thrombocytopenia (SAT) in intensive care unit (ICU) for early indentification and active intervention., Methods: Clinical data of SAT patients admitted to ICU of the First Affiliated Hospital of Nanjing Medical University from December 2019 to August 2021 were retrospectively collected, including demographic data, laboratory indicators, etc. According to the prognosis at 28 days, the patients were divided into the death group and the survival group, and the differences of clinical variables between the two groups were compared. Multivariate Logistic regression analysis was performed to analyze the independent risk factors influencing mortality of patients within 28 days, then a nomogram predictive model was constructed and its performance was verified with internal data. Receiver operator characteristic curve (ROC curve) was used to evaluate the diagnostic effectiveness of the nomogram model, and the clinical applicability of this model was evaluated by clinical decision curve analysis (DCA)., Results: A total of 275 patients were included, with 95 deaths at 28 days and a 28-day mortality of 34.5%. Compared with the survival group, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), lactic acid (Lac), platelet distribution width (PDW) on day 5 of ICU admission, blood urea nitrogen (BUN), total bilirubin (TBIL), aspartate aminotransferase (AST), C-reactive protein (CRP) of patients in the death group were higher, activated partial thromboplastin time (APTT) and prothrombin time (PT) were longer, platelet count (PLT) on day 3 and day 5 of ICU admission, direct bilirubin (DBIL), fibrinogen (FIB) were lower, the history of chronic lung disease, mixed site infection, lung infection, bloodstream infection, Gram-negative bacterial infection and fungal infection accounted for a higher proportion, the history of diabetes mellitus, urinary tract infection and no pathogenic microorganisms cultured accounted for a lower proportion, and the proportion of the use of vasoactive drugs, mechanical ventilation (MV), continuous renal replacement therapy (CRRT), bleeding events and platelet transfusion were higher. Multivariate Logistic regression analysis showed that APACHE II score at the day of ICU admission [odds ratio (OR) = 1.417, 95% confidence interval (95%CI) was 1.153-1.743, P = 0.001], chronic lung disease (OR = 72.271, 95%CI was 4.475-1 167.126, P = 0.003), PLT on day 5 of ICU admission (OR = 0.954, 95%CI was 0.922-0.987, P = 0.007), vasoactive drug (OR = 622.943, 95%CI was 10.060-38 575.340, P = 0.002), MV (OR = 91.818, 95%CI was 3.973-2 121.966, P = 0.005) were independent risk factors of mortality in SAT patients. The above independent risk factors were used to build a nomogram prediction model, and the area under the curve (AUC), sensitivity and specificity were 0.979, 94.7% and 91.7%, respectively, suggesting that the model had good discrimination. The Hosmer-Lemeshow goodness of fit test showed a good calibration with P > 0.05. At the same time, DCA showed that the nomogram model had good clinical applicability., Conclusions: Patients with SAT has a higher risk of death. The nomogram model based on APACHE II score at the day of ICU admission, chronic lung disease, PLT on day 5 of ICU admission, the use of vasoactive drug and MV has good clinical significance for the prediction of 28-day mortality, and the discrimination and calibration are good, however, further verification is needed.

Coronavirus disease 2019(COVID-19) is prevalent around the world, and pre-existing ILD is associated with increased severity and mortality of COVID-19. However, the current knowledge on the management strategy for COVID-19 patients with pre-existing interstitial lung disease (ILD) is very limited. There is still a need for consensus on treatments for these patients. In addition, ILD that occurs after the acute phase of COVID-19 (Post-acute Covid-19 ILD, PC-ILD) is also very common, and how to manage PC-ILD is also under debate. Therefore, a consensus was established by experts from the related disciplines in the field of ILD based on available scientific evidence and experience of the expert working group. This consensus elucidated 22 practical questions for practicing physicians, such as clinical characteristics, risk factors and treatment of COVID-19 patients with pre-existing ILD and PC-ILD patients. Finally, 15 recommendations were made regarding the diagnosis and management of COVID-19 patients with pre-existing ILD and PC-ILD patients. We hope to assist physicians in making appropriate decisions, thereby improving the management of COVID-19 with pre-existing ILD and PC-ILD. Recommendation 1: It is recommended to differentiate COVID-19 from ILD with acute/subacute onset based on duration, exposure history, symptoms and signs, chest high-resolution CT (HRCT) features, and laboratory tests. Recommendation 2: According to the guidelines on the diagnosis and treatment of new coronavirus pneumonia (version 10) issued by the National Health Commission of China on January 6 th , 2023, we recommended the following disease severity definition and management for the COVID-19 patients with pre-existing ILD. Recommendation 3: ILD is an independent risk factor for severe/critical COVID-19. We recommend antiviral treatment for COVID-19 patients with pre-existing ILD as early as possible after symptoms onset, ideally within 5 days. Recommendation 4: We recommend that the use of systemic corticosteroids in COVID-19 patients with pre-existing ILD who had no indications for corticosteroids therapy should follow the guidelines of COVID-19 for the general population. Those with pre-existing ILD who need to start or are already on systemic corticosteroids are recommended to start or continue corticosteroids if they develop COVID-19. The dose adjustment is based on the severity of COVID-19 with pre-existing ILD: For the patients with severe/critical COVID-19 with pre-existing ILD but no AE-ILD, the use of corticosteroids should follow the guidelines of COVID-19 in the general population; the patients with AE-ILD are recommended to follow the use of corticosteroids in AE-ILD. Recommendation 5: There is no evidence available for the use of interleukin-6 receptor blockers in COVID-19 patients with pre-existing ILD. Recommendations regarding interleukin-6 receptor blockers in COVID-19 patients with pre-existing ILD may follow the guideline of COVID-19 in the general population. Recommendation 6: There is no evidence to support the use of Janus kinase inhibitors in COVID-19 patients with pre-existing ILD. The use of Janus kinase inhibitors in COVID-19 patients with pre-existing ILD is recommended to follow the guideline of COVID-19 in the general population. Recommendation 7: For patients who have not started immunosuppressants/biological agents for pre-existing ILD at the time of COVID-19, delayed initiation of immunosuppressants/biological agents is recommended, if the risk of ILD progression in the short term is low. For patients who are already on immunosuppressants/biological agents, a multidisciplinary discussion with rheumatologists is recommended to weigh the benefits and risks of discontinuing immunosuppressants/biological agents. It is recommended to discontinue immunosuppressants/biological agents for pre-existing ILD in acute phase of COVID-19 unless short-term discontinuation affects control of underlying ILD or connective tissue disease. Recommendation 8: It is recommended that the COVID-19 patients with pre-existing ILD who are on anti-fibrotic medication should continue to take anti-fibrotic medication. For COVID-19 patients with newly diagnosed fibrotic ILD who need to start anti-fibrotic therapy, it is recommended to start anti-fibrotic treatment as early as possible. Recommendation 9: It is recommended to investigate and monitor co-infections and secondary infections in COVID-19 patients with pre-existing ILD, and to promptly prevent and treat co-infections and secondary infections such as bacteria, fungi, Pneumocystis jirovecii , and cytomegalovirus. Recommendation 10: Anticoagulation therapy for the COVID-19 patients with pre-existing ILD is recommended to be used in accordance with guideline of COVID-19 in general population. Recommendation 11: For COVID-19 patients with pre-existing ILD, we recommend follow-up at 4 weeks after recovery (non-hospitalized patients) or 4 weeks after discharge (hospitalized patients), and then the routine monitoring frequency for ILD once stable, i.e . every 3 to 6 months. Pulmonary function testing is a routine investigation. Chest HRCT is suggested when clinically indicated. Arterial blood gas analysis, echocardiography, CT pulmonary angiography, and blood examinations can be selected when necessary. Recommendation 12: Severe/critical COVID-19 survivors are the main target population for rehabilitation intervention. Rehabilitation therapy should be administered individualized. Recommendation 13: Healthcare providers should fully inform patients with pre-existing ILD about the benefits and risks of vaccination, and involve patients in a shared decision-making process to discuss whether or not to receive a COVID-19 vaccine. Recommendation 14: For PC-ILD patients with persistent or progressive respiratory symptoms, persistent interstitial lung abnormalities and lung function impairment following acute COVID-19 pneumonia, may be treated with glucocorticoids after exclusion of other causes such as infection. Recommendation 15: For PC-ILD patients who have recovered from severe/critical COVID-19, anti-fibrotic medications may be administered after discussing disease-and treatment-related factors with patients. The optimal timing and duration of anti-fibrotic treatment are still uncertain. We conditionally recommend against anti-fibrotic medications in patients who have recovered from mild or moderate COVID-19. This recommendation does not apply to patients with pre-existing fibrotic ILD.

Objective: To analyze the immunological characteristics and antibody changes of patients infected with the Omicron BA.1 and evaluate the possibility of secondary infection. Methods: A total of 104 patients infected with Omicron BA.1 in the Jinnan District of Tianjin from January 8 to February 2, 2022, were included in the study. The control group and case group were matched 1∶1 based on age, sex and vaccination status. Serum was collected from the case group and control group at 3, 6 and 9 months after infection. The serum levels of interleukin4 (IL-4), IL-5 and interferon-gamma (IFN-γ), as well as the positive rates of IgG, IgG1 and IgG2, were detected by ELISA. Results: The highest concentration of IFN-γ in the case group at 6 months after infection was 145.4 pg/ml, followed by a decrease in concentration. The concentrations of IL-4 and IL-5 began to decrease at 6 months after infection (all P <0.001). There was no significant difference in the IgG2 positive rate between the case group and the control group at 6 months after BA.1 infection. However, at 9 months, there was a significant decrease compared to the control group ( P =0.003). The ratio of IFN-γ/IL4 at 3 months after infection in the case group was lower than that in the control group ( P <0.001). There was no significant difference in the ratio between the case group and the control group at 9 months after infection. Conclusion: The cellular immune function has been impaired at 3 months after infection with BA.1, and the specific cellular immune and humoral immune functions decrease significantly after 6 months, and the risk of secondary infection increases.

A 69-year-old female patient was admitted to the Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University due to a "cough and fever for eight days". On admission, a coronavirus disease (COVID-19) nucleic acid test was positive, and a chest CT scan showed progressive patchy shadows and consolidation shadows in both lungs. Arterial blood gas analysis showed type Ⅰ respiratory failure. The primary diagnosis was severe community-acquired pneumonia in an older adult without underlying disease. However, oxygen inhalation, steroid, anti-inflammatory, and antibacterial empirical treatment with piperacillin/tazobactam was ineffective. Metagenomic next-generation sequencing of bronchoscopy alveolar lavage fluid showed Chlamydia psittaci ( C. psittaci ). Severe pneumonia was confirmed, caused by coinfection with severe acute respiratory syndrome coronavirus 2 and C. psittaci . A combination of doxycycline and moxifloxacin significantly improved the targeted and symptomatic treatment of the underlying cause. After discharge, the patient recovered within four weeks of follow-up. Therefore, clinicians should be alert to the possibility of coinfection of C. psittaci in patients already diagnosed with COVID-19.

Objective: To study the infection status and epidemiological characteristics of parainfluenza virus (PIV) in acute respiratory tract infection adult cases in Shanghai from 2015 to 2021, and to provide a scientific basis for preventing and controlling PIV. Methods: Acute respiratory tract infections were collected from 13 hospitals in Shanghai from 2015 to 2021. Relevant information was registered, and respiratory specimens were sampled to detect respiratory pathogens by multiplex PCR. Results: A total of 5 104 adult acute respiratory tract infection cases were included; the overall positive rate of the respiratory pathogens was 29.37% (1 499/5 104). The positive rate of PIV was 2.61% (133/5 104), compared with 2.32% (55/2 369) and 2.85% (78/2 735) in influenza-like cases (ILI) and severe acute respiratory infection (SARI) cases, respectively. Among them, PIV3 accounted for the highest proportion (62.41%, 83/133), followed by PIV1 (18.80%, 25/133), PIV2 (9.77%, 13/133), and PIV4 (9.02%, 12/133). The incidence of PIV-positive cases was mainly distributed in the first and second quarters, accounting for 62.41% (83/133). The difference in the incidence in each quarter was significant ( χ 2 =24.78, P <0.001). Mixed infection accounted for 18.80% (25/133) of 133 PIV-positive cases, the mixed infection rates of ILI and SARI were 18.18% (10/55) and 19.23% (15/78), respectively, and the main mixed pathogen of PIV was coronavirus 229E. Conclusions: There are a certain proportion of PIV-positive acute respiratory tract infection cases in Shanghai. It is necessary to strengthen the etiological surveillance in acute respiratory tract infection cases, especially the mixed infection of PIV and other pathogens.

Objective To study the correlation between coinfection of Epstein⁃Barr virus (EBV) and Porphyromon⁃ as gingivalis(Pg) and severity of maternal chronic periodontitis in pregnant women. Methods Saliva samples were collected from 36 pregnant women with chronic periodontitis and 36 pregnant women with healthy periodontal status. EBV was detected using nested polymerase chain reaction (PCR), Pg was detected using 16S rRNA based PCR. Clini⁃ cal periodontal indices were recorded through periodontal examination. Correlation between the coinfection and severity of maternal chronic periodontitis were analyzed. Results The results showed no significant differences in prevalence of infection of EBV or Pg between pregnant women with chronic periodontitis and with healthy periodontal status (P＞ 0.05). Contemporaneously, coinfection prevalence of EBV and Pg showed significant differences between two groups (P = 0.028). Coinfection of EBV and Pg showed significant association with bleeding on probing index (BOP) (P = 0.003). No significant associations were found between the coinfection and periodontal depth(PD) or clinical attachment loss (CAL) (P＞0.05). Conclusion Relationship between coinfection of EBV and Pg and maternal chronic periodonti⁃ tis needs further investigation.

Objective: To understand the infection status and epidemiological characteristics of hepatitis C in people aged 1-69 years in Henan Province in 2020. Methods: The estimated sample size was 5 827. From August to December 2020, multistage sampling was used to select 8 counties (districts) in Henan, and two survey sites were selected in each county (district), and a questionnaire survey was conducted in local people aged 1-69 years, blood samples were collected from them for anti-HCV, HCV RNA and genotype detections. Results: A total of 5 165 people aged 1-69 years completed the questionnaire survey. Men accounted for 44.76% (2 312/5 165), women accounted for 55.24% (2 853/5 165). In the people aged 1-69 years, the overall prevalence rates of anti-HCV and HCV RNA were 0.69% (95% CI: 0.68%-0.70%) and 0.20% (95% CI: 0.19%-0.21%) respectively. The prevalence rates of anti-HCV and HCV RNA were 0.48% (95% CI: 0.46%-0.50%), 0.09% (95% CI: 0.08%-0.10%) in men and 0.86% (95% CI: 0.85%-0.87%), 0.30% (95% CI: 0.28%-0.32%) in women. The prevalence rates of anti-HCV and HCV RNA increased with age. The prevalence rates of anti-HCV and HCV RNA were 0.87% (95% CI: 0.86%-0.88%), 0.28% (95% CI: 0.26%-0.30%) in urban residents and 0.53% (95% CI: 0.51%-0.55%), 0.14% (95% CI: 0.13%-0.15%) in rural residents. The genotyping results of 10 HCV RNA positive samples ware genotype 1b (4/10), genotype 2 (3/10), genotype 1b/3 (1/10), genotype 1b/3/6 (1/10) and genotype 2/6 (1/10). Conclusions: The prevalence of hepatitis C was low in Henan in 2020. It is necessary to strengthen hepatitis C surveillance in people aged 40 years and above. The major HCV genotypes were 1b and 2, and mixed genotype infection existed.

Human bocavirus is a novel pathogen first detected in respiratory tract samples in 2005. People of different ages can be infected by human bocavirus. Children are the susceptible population, especially the infants aged from 6-24 months old. The epidemic season varies in different regions due to the differences in climate and geographical location, and it mainly occurs in autumn and winter. It's demonstrated that human bocavirus-1 is closely related to respiratory system diseases and even causes life-threatening critical illness. Also, the severity of symptom is positively correlated with viral load. Co-infections between human bocavirus-1 and other viruses often present high frequency occurrence. Human bocavirus-1 interferes immune function of host by inhibiting interferon secrete pathway. Currently, it remains limited knowledge and understanding of the roles of human bocavirus 2-4 in diseases, but the gastrointestinal diseases should be paid more attention. Detection of human bocavirus DNA by traditional polymerase chain reaction (PCR) assay shouldn't be regarded as conclusive diagnostic basis. Instead, combined with mRNA and specific antigen detection, it is beneficial to improve the accuracy of diagnosis. Till now, the knowledge of human bocavirus remains poorly studied, which is deserved to further progress.

Strongyloides stercoralis is an opportunistic pathogenic parasite that can cause severe strongyloidiasis and even death among immunocompromised individuals. Previous clinical studies have reported cases co-infected with S. stercoralis and other pathogens, such as parasites, viruses, bacteria and fungi. This review summarizes strongyloidiasis patients co-infected with pathogens, and analyzes the impact of co-infection on strongyloidiasis, so as to provide insights into the reduction of the morbidity and mortality of disorders associated with S. stercoralis infections.

Objective: We analyze the characteristics of Clostridioides difficile ( C. difficile ) infection among diarrhea patients in Kunming from 2018 to 2020 and provide evidence for follow-up surveillance and prevention. Methods: A total of 388 fecal samples of diarrhea patients from four sentinel hospitals in Yunnan Province from 2018 to 2020 were collected. Real-time quantitative PCR was used to detect the fecal toxin genes of C. difficile . The positive fecal samples isolated the bacteria, and isolates were identified by mass spectrometry. The genomic DNA of the strains was extracted for multi-locus sequence typing (MLST). The fecal toxin, strain isolation, and clinical patient characteristics, including co-infection with other pathogens, were analyzed. Results: Among the 388 fecal samples, 47 samples with positive reference genes of C. difficile were positive, with a total positive rate of 12.11%. There were 4 (8.51%) non-toxigenic and 43 (91.49%) toxigenic ones. A total of 18 strains C. difficile were isolated from 47 positive specimens, and the isolation rate of positive specimens was 38.30%. Among them, 14 strains were positive for tcdA , tcdB , tcdC , tcdR, and tcdE . All 18 strains of C. difficile were negative for binary toxins. The MLST results showed 10 sequence types (ST), including 5 strains of ST37, accounting for 27.78%; 2 strains of ST129, ST3, ST54, and ST2, respectively; and 1 strain of ST35, ST532, ST48, ST27, and ST39, respectively. Fecal toxin gene positive ( tcdB +) results were statistically associated with the patient's age group and with or without fever before the visit; positive isolates were only statistically associated with the patient's age group. In addition, some C. difficile patients have co-infection with other diarrhea-related viruses. Conclusions: The infection of C. difficile in diarrhea patients in Kunming is mostly toxigenic strains, and the high diversity of strains was identified using the MLST method. Therefore, the surveillance and prevention of C. difficile should be strengthened.

Objective: To analyze the phenotypic and genotypic characteristics of Escherichia coli causing bloodstream and abdominal co-infection (CoECO), and provide clues for empirical antibiotics treatment. Methods: The strains of Escherichia coli isolated from blood and abdominal samples in the Department of Laboratory Medicine of the First Medical Center of the PLA General Hospital from 2010 to 2020 were retrospectively analyzed. Mass spectrometer was used to identify all of the strains and the minimum inhibitory concentration (MIC) were detected by VITEK 2 Compact. All isolates were sequenced by 2×150 bp double terminal sequencing strategy on the HiSeq X Ten sequencer (Illumina). After the genome sequence was spliced, the single nucleotide polymorphism (SNP) analysis of the strain sequence was performed using kSNP3 software to clarify the homologous relationship between strains. If the strains isolated from two different parts had high homology, they were regarded as the same strain and the case was with CoECO infection. Meanwhile, the multilocus sequence type (MLST) was determined using PubMLST website and resistant genes were screened by CARD website. Results: A total of 70 cases of CoECO infection were screened, including 45 males and 25 females, and aged (59.2±16.3) years old. The 70 CoECO isolates belonged to 35 sequence types (STs). The most prevalent STs included ST38 ( n =6), ST 405 ( n =6), ST 1193 ( n =6) and ST131 ( n =5), and other ST types contained less than 5 strains. The homologous relationship among strains was relatively scattered, presenting a sporadic trend as a whole, and only a few strains had a small-scale outbreak. The CoECO isolates showed significantly resistance to ampicillin (91.4%, 64/70), ampicillin/sulbactam (74.3%, 5 2/70), ceftriaxone (72.9%, 51/70), ciprofloxacin (71.4%, 50/70) and levofloxacin (71.4%, 50/70), and high-sensitivity to piperacillin/tazobactam, carbapenems and amikacin. The most prevalent resistant gene was tet (A/B) (70%, 49/70), followed by bla TEM (58.6%, 41/70), sul1 (55.7%, 40/70), sul2 (54.3%, 38/70), bla CTX-M-14 (25.7%, 18/70), bla CTX-M-15 (17.1%, 13/70), bla CTX-M-55 (15.7%, 11/70), bla CTX-M-64/65 (5.7%, 4/70), bla CTX-M-27 (4.3%, 3/70), mcr-1 (4.3%, 3/70), bla NDM-5 (2.9%, 2/70). Conclusions: CoECO is distributed dispersedly and has no obvious advantage clone. No genotype with obvious advantages was found. Although the strain has a high resistance rate to some antibacterial drugs, the proportion of carrying resistant genes is low, and it has a high sensitivity to some first-line antibacterial drugs.

Objective: To investigate the clinical characteristics and the risk factors of severe human metapneumovirus (hMPV)-associated community acquired pneumonia (CAP) in children. Methods: A retrospective case summary was conducted. From December 2020 to March 2022, 721 children who were diagnosed with CAP and tested positive for hMPV nucleic acid by PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at the Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects. The clinical characteristics, epidemiological characteristics and mixed pathogens of the two groups were analyzed. According to CAP diagnostic criteria, the children were divided into the severe group and the mild group. Chi-square test or Mann-Whitney rank and contrast analysis was used for comparison between groups, while multivariate Logistic regression was applied to analyze the risk factors of the severe hMPV-associated CAP. Results: A total of 721 children who were diagnosed with hMPV-associated CAP were included in this study, with 397 males and 324 females. There were 154 cases in the severe group. The age of onset was 1.0 (0.9, 3.0) years, <3 years old 104 cases (67.5%), and the length of hospital stay was 7 (6, 9) days. In the severe group, 67 children (43.5%) were complicated with underlying diseases. In the severe group, 154 cases (100.0%) had cough, 148 cases (96.1%) had shortness of breath and pulmonary moist rales, and 132 cases (85.7%) had fever, 23 cases (14.9%) were complicated with respiratory failure. C-reactive protein (CRP) was elevated in 86 children (55.8%), including CRP≥50 mg/L in 33 children (21.4%). Co-infection was detected in 77 cases (50.0%) and 102 strains of pathogen were detected, 25 strains of rhinovirus, 17 strains of Mycoplasma pneumoniae , 15 strains of Streptococcus pneumoniae, 12 strains of Haemophilus influenzae and 10 strains of respiratory syncytial virus were detected. Six cases (3.9%) received heated and humidified high flow nasal cannula oxygen therapy, 15 cases (9.7%) were admitted to intensive care unit, and 2 cases (1.3%) received mechanical ventilation. In the severe group, 108 children were cured, 42 children were improved, 4 chlidren were discharged automatically without recovery and no death occurred. There were 567 cases in the mild group. The age of onset was 2.7 (1.0, 4.0) years, and the length of hospital stay was 4 (4, 6) days.Compared with the mild group, the proportion of children who age of disease onset <6 months, CRP≥50 mg/L, the proportions of preterm birth, congenital heart disease, malnutrition, congenital airway malformation, neuromuscular disease, mixed respiratory syncytial viruses infection were higher (20 cases (13.0%) vs. 31 cases (5.5%), 32 cases (20.8%) vs. 64 cases (11.3%), 23 cases (14.9%) vs. 44 cases (7.8%), 11 cases (7.1%) vs . 18 cases (3.2%), 9 cases (5.8%) vs . 6 cases (1.1%), 11 cases (7.1%) vs. 12 cases (2.1%), 8 cases (5.2%) vs. 4 cases (0.7%), 10 cases (6.5%) vs. 13 cases (2.3%), χ 2 =0.42, 9.45, 7.40, 4.94, 11.40, 8.35, 3.52, 6.92, all P< 0.05). Multivariate Logistic regression analysis showed that age<6 months ( OR =2.51, 95% CI 1.29-4.89), CRP≥50 mg/L ( OR =2.20, 95% CI 1.36-3.57), prematurity ( OR =2.19, 95% CI 1.26-3.81), malnutrition ( OR =6.05, 95% CI 1.89-19.39) were the independent risk factors for severe hMPV-associated CAP. Conclusions: Severe hMPV-associated CAP is most likely to occur in infants under 3 years old and has a higher proportion of underlying diseases and co-infection. The main clinical manifestations are cough, shortness of breath and pulmonary moist rales, fever. The overall prognosis is good. Age<6 months, CRP≥50 mg/L, preterm birth, malnutrition are the independent risk factors for severe hMPV-associated CAP.

Objective: To investigate the epidemiological data of maternal sepsis in intensive care unit (ICU), analyze the common causes, outcomes of maternal sepsis, and the risk factors of multi-drug resistant (MDR) bacteria., Methods: A retrospective cohort study. Maternal sepsis cases admitted to ICUs of Peking University Third Hospital, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2008 to September 2022 were enrolled. The following data were recorded: demographic characteristics, sequential organ failure assessment (SOFA) during infection, infection time, infection sites, invasive intervention measures before infection, microbial culture results, blood routine test during infection, body temperature, and clinical outcomes caused by infection. According to the time of sepsis occurrence, the patients were divided into pre-ICU sepsis group and ICU sepsis group, and the causes of sepsis in the two groups were analyzed. According to whether MDR occurred, the patients were divided into MDR group and non-MDR group, and clinical outcomes were analyzed. Multivariate Logistic regression was used to analyze the risk factors of MDR bacteria infection in obstetrics with sepsis., Results: 160 patients were enrolled, among which 104 cases of sepsis happened before ICU and 56 cases of sepsis happened during ICU, 53 cases were with MDR bacteria and 107 cases were without MDR bacteria. The median age of the patients was 30.5 (28.0, 34.0) years old, the median temperature was 38.8 (38.2, 39.5) centigrade, and the median white blood cell count (WBC) was 17.2 (13.2, 21.3)×10 9 /L, the median SOFA score was 5.0 (3.0, 8.0), and 130 cases (81.2%) were referred from other hospitals. The main infection sites were uterine cavity in 64 cases (40.0%), lung in 48 cases (30.0%), abdominal and pelvic cavity in 30 cases (18.8%), urinary system in 27 cases (16.9%). Sepsis led to hysterectomy in 6 cases (3.8%), stillbirth in 8 cases (5.0%), and neonatal death in 2 cases (1.3%). The main surgical intervention measures were cesarean section (44 cases, accounting for 27.5%), followed by exploratory laparotomy (19 cases, 11.9%). The median length of ICU stay was 5.0 (3.0, 10.0) days, and the median hospital length was 14.0 (10.0, 20.8) days. Intrauterine infection was the primary cause of sepsis happened during ICU, accounting for 50.0% (28/56), of which postpartum hemorrhage accounted for 85.7% (24/28). The proportion of diabetes [28.3% (15/53) vs. 14.0% (15/107)], intrauterine operation [41.5% (22/53) vs. 23.4% (25/107)], intrauterine infection [50.9% (27/53) vs. 34.6% (37/107)] and bacteremia [18.9% (10/53) vs. 2.8% (3/107)] in the MDR group were significantly higher than those in the non-MDR group (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes [odds ratio (OR) = 2.348, 95% confidence interval (95%CI) was 1.006-5.480, P = 0.048] and intrauterine operation (OR = 2.541, 95%CI was 1.137-5.678, P = 0.023) were independent risk factors for MDR bacterial infection in obstetrics with sepsis., Conclusions: Intrauterine infection is the common cause of maternal sepsis in ICU, and postpartum hemorrhage is the common cause of secondary intrauterine infection in ICU. MDR bacteria can lead to serious clinical outcomes. Diabetes and intrauterine operation are independent risk factors for MDR bacteria' infection.

Objective: To investigate the distribution characteristics of respiratory non-bacterial pathogens in children in Ningbo from 2019 to 2021. Methods: A retrospective analysis was performed on 23 733 children with respiratory tract infection who visited the department of pediatrics of Ningbo Women and Children's Hospital from July 2019 to December 2021. There were 13 509 males (56.92%) and 10 224 females (43.08%), with an age range of 1 day to 18 years old. There were 981 cases in the neonatal group (younger than 1 month old), 5 880 cases in the infant group (1 month to younger than 1 year old), 6 552 cases in the toddler group (1 to younger than 3 years old), 7 638 cases in the preschool group (3 to younger than 7 years old), and 2 682 cases in the school-age group (7 to 18 years old). Thirteen respiratory pathogens were detected by multiple polymerase chain reaction (PCR) based on capillary electrophoresis, and SPSS 23.0 software was used for statistical analysis of the results, the count data were expressed as percentages, and the χ 2 test was used for comparison between groups. Results: Of the 23 733 specimens, 13 330 were positive for respiratory pathogens, with a total positive rate of 56.17%. The positive rates of human rhinovirus (HRV) 24.05% (5 707/23 733), human respiratory syncytial virus (HRSV) 10.45% (2 480/2 3733) and mycoplasma pneumoniae (Mp) 7.03% (1 668/23 733) were in the first three. The positive rates of pathogens in the male and female children were 57.47% (7 763/13 509) and 54.45% (5 567/10 224), respectively, and the difference was statistically significant (χ 2 =21.488, P <0.001). The positive rates in the neonatal group, infant group, toddler group, preschool group, and school-age group were 31.80% (312/981), 54.71% (3 217/5 880), 63.23% (4 143/6 552), 59.83% (4 570/7 638), 40.57% (1 088/2 682), respectively, and the difference among the groups was statistically significant (χ 2 =681.225, P <0.001). The single infection rate was 47.43% (11 256/23 733), the mixed infection rate of two or more pathogens was 8.74% (2 074/23 733), most of which were mixed infections of two pathogens. HRV, HADV, HCOV, Ch disseminated in the whole year. HRSV, HMPV, Boca, HPIV occurred mostly in fall and winter. The positive rates of FluA, FluB, Mp were at a low level after the corona virus disease 2019 (COVID-19) epidemic (2020 and 2021). The positive rates of FluA, H1N1, H3N2, FluB, HADV, Mp in 2020 were significantly lower than in 2019 ( P <0.05). The positive rates of HPIV, HRV, HCOV, Ch in 2020 were significantly higher than in 2019 ( P <0.05). The positive rates of FluA, H1N1, H3N2, HPIV, HCOV, Mp, Ch in 2021 were significantly lower than in 2020 ( P <0.05). The positive rates of Boca, HMPV, HRSV in 2021 were significantly higher than in 2020 ( P <0.05). Conclusion: From 2019 to 2021, the main non-bacterial respiratory pathogens of children in Ningbo City were Mp and HRV, and the detection rates of respiratory pathogens varied among different ages, seasons and genders.

Hepatitis D virus (HDV) is a defective RNA virus with 8 genotypes, which requires hepatitis B virus (HBV) for its replication both in co-infection (HDV infection occurs when people become infected with both hepatitis B and D simultaneously) and super-infection (HDV infection after infected with hepatitis B). Due to persistency of anti-HDV in the superinfected patient, the most epidemiology data of HDV infection suggests HBV/HDV super-infection. Because of inadequate awareness and effective HBV vaccination programme, HDV infection screen was not specific recommended, except for risk population recommended by AASLD. However, the disease burden of HDV infection was not fully understood and might be underestimated. This review summarized the anti-HDV and HDV genotype epidemiology and the screening of HDV infection.

Globally, the number of patients with post-tuberculosis lung disease (PTLD) is huge, with high morbidity and mortality. PTLD is defined as chronic respiratory abnormality that affects large and small airways (bronchiectasis and obstructive lung disease), lung parenchyma, pulmonary vasculature, and pleura and may be complicated, with or without symptoms, attributable at least in part to previous pulmonary tuberculosis. The aforementioned chronic respiratory abnormality may be complicated due to coinfection such as fungi and nontuberculosis mycobacteria . Risk factors for PTLD include multiple episodes of tuberculosis, drug-resistant tuberculosis, delays in diagnosis, smoking, and possible diabetes. Empirical expert opinion advocates preventive anti-tuberculosis treatment for high-risk groups of tuberculosis, early diagnosis and treatment of tuberculosis, surgical treatment for specific groups, pulmonary rehabilitation for patients after tuberculosis treatment, early identification and treatment of co-infection. It is effective to prevent the occurrence of PTLD, improve the treatment effect, and prevent the deterioration of the disease. As a high TB burden country, PTLD has been seriously neglected in China. Internationally, there is currently a lack of epidemiological survey data on post-TB pulmonary disease, and there are few studies on its clinical characteristics, risk factors, prevention, and treatment. With an emerging literature on PTLD, collaborative research is urgently needed to inform our understanding of the natural history, prevention, and treatment of PTLD, and to allow for the development of much needed evidence-based guidelines.

Objective To analyze the effect of hepatitis C virus (HCV) on disease progression in patients with human immunodeficiency virus (HIV)/HCV coinfection. Methods Twenty-nine patients with HIV/HCV coinfection and 20 patients with HIV infection alone, who visited Beijing YouAn hospital for follow-up in August 2012, were enrolled. The two groups of patients were matched for age, sex, time and route of HIV infection, and HIV subtypes. The liver function and fibrosis were evaluated by biochemical testing of peripheral blood and FibroScan. CD4+ and CD8+ T cell counts were determined by flow cytometry. Results The levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin for the HIV/HCV coinfection group were 76.16±81.25 U/L, 87.66±71.32 U/L, and 14.21±9.56 μmol/L, respectively, significantly higher than those for the HIV infection group (27.74±20.63 U/L, 45.65±16.95 U/L, and 10.26±3.22 μmol/L) (P=0.004, 0.005, and 0.046). Compared with the HIV infection group, the HIV/HCV coinfection group had a nonsignificantly increased liver stiffness (t=1.889, P=0.080), a significantly higher viral load (3.66±0.97 lg copies/ml vs 3.02±0.90 lg copies/ml, t=2.251, P=0.030), significantly lower CD4+ T cell count and CD4+/CD8+ ratio (374.25±185.48 cells/μl vs 496.45±230.98 cells/μl, P=0.048; 0.33±0.17 vs 0.46±0.27, P=0.043), and a nonsignificantly higher incidence of AIDS (27.59% vs 5.00%, P=0.063). Conclusion HCV exacerbates liver damage, enhances HIV replication, increases the impairment of immune function in patients with HIV/HCV coinfection, so it can accelerate the disease progression in these patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether anisodamine can regulate the ratio of helper T helper cells/regulatory T cells (Th17/Treg) and its protective effect on animals after resuscitation., Methods: Twenty-four Beijing white minipigs were randomly divided into sham operation group (Sham group), resuscitation and normal saline group (SA group), and resuscitation and anisodamine hydrobromide group (AH group), with 8 pigs in each group. In SA group and AH group, ventricular fibrillation was induced by continuous stimulation with intraventricular electrodes for 8 minutes and then resuscitated to establish ischemia/reperfusion (I/R) model. In SA group, after cardiopulmonary resuscitation (CPR), only normal saline was intravenously infused, while in AH group, normal saline and anisodamine hydrobromide were given intravenously at the same time point. Hemodynamic indexes, arterial blood gas analysis indexes, interleukins (IL-17, IL-10) levels in venous blood and IL-17/IL-10 ratio were recorded at 6 different time points: baseline, immediately after return of spontaneous circulation (ROSC), 1 hour, 2 hours, 4 hours and 6 hours after ROSC. The animals were sacrificed at 6 hours after ROSC, and intestinal lymphatic tissues were taken to observe pathological changes under light microscope. At the same time, the levels of IL-17 and IL-10 in intestinal lymphatic tissue were measured (the ratio of IL-17/IL-10 represents the ratio of Th17/Treg cytokines) to evaluate the immune status of the resuscitated animals. The bacterial translocations of different groups were evaluated by culturing intestinal lymphoid tissue., Results: With the extension of ROSC time, the levels of IL-17 in venous blood and the IL-17/IL-10 ratio in pig blood samples continued to decrease, while the levels of IL-10 continued to increase. From 2 hours after ROSC, the IL-17/IL-10 ratio in AH group was significantly higher than that in SA group continued until at 6 hours after ROSC (0.79±0.05 vs. 0.49±0.08, P < 0.05). Light microscopy showed that the number and size of lymph nodules in the cortex of intestinal lymphatic tissue were less in AH group, compared with SA group. Compared with Sham group, the levels of IL-17 and IL-17/IL-10 ratio also decreased in intestinal lymphatic tissue at 6 hours after ROSC [IL-17 (ng/L): 155.23±0.92, 178.76±7.25 vs. 209.21±19.82, IL-17/IL-10 ratio: 1.43±0.13, 1.92±0.18 vs. 3.30±0.31, all P < 0.05], and IL-10 increased significantly (ng/L: 109.85±11.60, 93.55±81.83 vs. 63.45±0.62, all P < 0.05); IL-17/IL-10 ratio in AH group was significantly higher than that in SA group (1.92±0.18 vs. 1.43±0.13, P < 0.05). Tissue culture indicated the intestinal bacterial translocation after resuscitation, suggesting that the animals had immunosuppression and the increased risk of intestinal secondary infection after resuscitation. Compared with SA group, the risk of bacterial translocation was lower than that in AH group [62.5% (5/8) vs. 87.5% (7/8), P < 0.05]., Conclusions: Anisodamine plays an immunomodulatory role by affecting the balance of Th17/Treg cytokines in resuscitated animals, so as to reduce the risk of intestinal secondary infection and has an organ protective effect.

A 59-year-old male patient with local sinus tract formation due to residual foreign body was admitted to the Second Affiliated Hospital of Zhejiang University College of Medicine on December 17, 2018. The examination showed that the residual foreign body was the component of a sticky cloth implanted when the patient underwent appendectomy 27 years ago. Hypertrophic scar developed at the right-lower abdominal incision for appendectomy 23 years ago and the secondary infection after cicatrectomy resulted in non-healing of the wound. The chronic refractory wound healed completely after surgical treatment in our hospital after this admission. The postoperative pathological examination revealed local inflammatory granuloma. This case suggests that chronic refractory wound is likely to form when secondary infection occurs following the surgical procedure near the implant, and aggressive surgery is an effective way to solve this problem.

Objective: To improve the awareness of hyper-IgE syndrome (HIES) characterized by disseminated infection. Methods: We retrospectively analyzed a patient with HIES characterized by Talaromyces marneffei and Staphylococcus aureus mixed disseminated infection in Shenzhen People's Hospital. The clinical manifestations, results of laboratory tests/genetic examinations, therapeutic strategies and prognosis were summarized. The keywords "hyper-lgE syndrome" were used to search and review the literature in Wanfang databases and Pubmed database. Results: In February 2021, an 18-year-old male patient was admitted to our hospital with backache for over 3 weeks and fever for 4 days. Physical examination revealed deciduous teeth in the oral cavity, bilateral renal pain on percussion, and interphalangeal joint hyperextension. Laboratory studies demonstrated increased blood eosinophils and serum level of total IgE. Bacterial culture from bronchoscopic secretions, bronchial mucosa, and necrotic tissue from the left upper arm showed Talaromyces marneffei . Bacterial culture from alveolar lavage fluid, left upper arm necrotic tissue, puncture fluid of right retroauricular abscess and renal drainage fluid suggested methicillin-sensitive Staphylococcus aureus . The chest and abdominal CT revealed diffuse patchy and nodular lesions in bilateral lungs, cavitary lesions in the upper lobe of the left lung, multiple enlarged lymph nodes in the mediastinum, and infectious lesions within both kidneys and perirenal space. Furthermore, the patients was identified with STAT3 mutations by whole exome sequencing, which confirmed the diagnosis of HIES. Nineteen literature articles were retrieved, involving 27 adult patients with a median age of diagnosis of 23 years. The most common manifestations included: skin infection (16/27), eczema (15/27), elevated IgE (26/27) and eosinophils (17/27), as well as positive STAT3 mutation (11/27). Conclusion: Clinicians should be alert to the possibility of hyper-IgE syndrome in patients with severe or disseminated intracellular bacterial infections.

Coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has spread all over the world. Streptococcus pneumoniae as a common pathogen of community-acquired pneumonia shares similar high-risk susceptible populations with COVID-19. Streptococcus pneumoniae co-infection is a key risk factor for severe COVID-19 and death. Pneumococcal vaccination has a beneficial impact on reducing the incidence and mortality of COVID-19. The vaccination rate of streptococcus pneumoniae is still low in China. Streptococcus pneumoniae vaccination may be one of effective strategies in the management of COVID-19 for high-risk population such as the elderly and those who have underlying chronic diseases.

The article presents a study regarding the outcome of porcine reproductive and respiratory syndrome virus on piglets' blood mononuclear cells.

Acquired immune deficiency syndrome caused by human immunodeficiency virus (HIV) infection is a fatal disease involving multiple systems. Syphilis is a systemic chronic infection disease caused by treponema pallidum infection. In recent years, the incidence of the two infectious diseases in China has been on the rise. Both of them have the same high-risk population and similar transmission routes, and co-infection is increasing day by day. They can influence each other. Syphilis significantly increases the risk of HIV infection, and HIV is able to change the natural course of syphilis. HIV and syphilis co-infection leads to diverse ocular manifestations which are not typical or specific. This condition results in not only a high rate of missed diagnosis and misdiagnosis, but also a high rate of treatment failure and recurrence. There is a high correlation between ocular syphilis and neurosyphilis in HIV-positive patients. Many patients with HIV/syphilis co-infection visit eye clinics for the initial symptom. In order to provide reference for clinical diagnosis, treatment and research, this article reviews the recent advances on the studies of the co-infection of HIV and syphilis, including epidemiological characteristics, ocular manifestations and treatments. (Chin J Ophthalmol, 2021, 57: 865-870) .

Objective: To investigate the epidemiological characteristics of human coronavirus (HCoV) in hospitalized children with respiratory tract infection in Hebei region, providing evidence for the diagnosis and prevention of children with respiratory tract infection. Methods: A retrospective study was conducted on 1 062 HCoV positive children hospitalized for respiratory tract infection in Children's Hospital of Hebei Province from January 2015 to December 2020, aged from 33 days to 14 years, with a median age of 2 years. 27 932 (60.9%) were males and 17 944(39.1%) were females. And the gender, ages, seasonal distribution, HCoV-positive rates, co-detection distribution and clinical diagnosis of HCoV positive cases were analyzed by SPSS 25.0. Enumeration data were expressed by frequency and percentage; categorical variable were compared by the Pearson χ 2 test. Results: The overall HCoV-positive rate was 2.31% (1 062/45 876), which was 2.37% (662/27 932) in male children and 2.23% (400/17 944) in female children. There was no statistically significant difference between genders (χ²=0.916, P =0.339). Children at age groups<1 years (2.44%) and 1-<3 years (2.63%) had higher HCoV-positive rates than those at age groups 3-<5 years (1.97%) and ≥5 years (1.38%) (χ²=27.332, P <0.01). The HCoV-positive rates from 2015 to 2018 were 2.13%, 2.45%, 2.28% and 2.23%. The HCoV-positive rate of 2019 (1.71%) was significantly lower than in 2016 (χ²=12.05, P <0.01), 2017 (χ²=7.34, P =0.01) and 2018 (χ²=6.78, P =0.01), but there was no significant difference compared with 2015 (χ²=2.84, P =0.09). The HCoV-positive rate of 2020 (3.37%) was significantly higher than in 2015 (χ²=13.636, P <0.01), 2016 (χ²=11.099, P <0.01), 2017 (χ²=15.482, P <0.01), 2018(χ²=18.601, P <0.01) and 2019(χ²=45.580, P <0.01). The positive rate was highest in spring (March to May) in 2015 and 2017 to 2018. February to April and July to September of 2016 were the peak periods of positive detection. No obvious seasonal change was observed in 2019 and the HCoV-positive rate of 2020 was extremely low from January to July, following significantly increased from August to December. 26.37% (280/1 062) of HCoV were co-detected with other respiratory pathogens and the most frequently identified mixed detection was RSV. Three or more pathogens were detected in 7.34% (78/1 062) of the HCoV-positive samples. Bronchopneumonia and bronchiolitis were more frequently observed in the single HCoV positive (61.89% and 16.75%) children compared to co-detected children(34.29% and 9.64%)(χ²=63.394 and 8.228, P <0.01). However, compared to those with HCoV mono-detection, co-detected children were more likely to have severe pneumonia (4.6% and 47.14%) (χ²=280.171, P <0.01). Conclusions: HCoV is one of the respiratory pathogens in children in Hebei region and more prevalent in spring. The susceptible population of HCoV is mainly children under the age of 3 years old. HCoV often co-detects with other respiratory pathogens, and the co-infection is one of the risk factors of severe pneumonia in children with respiratory infection.

Objective: To investigate the long-term characteristic changes of virus, immune status, and liver fibrosis markers in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients after receiving direct-antiviral agents (DAAs). Methods: HIV/HCV co-infected patients who visited the Guangzhou Eighth People's Hospital, Guangzhou Medical University from May 2014 to December 2019 were selected as the research subjects. The changes of virological response rate, peripheral blood CD4(+)T lymphocyte level and serological markers of liver fibrosis (APRI score and FIB-4 index) were observed during 144 weeks of follow-up course after the end of DAAs treatment. Kruskal-Wallis test was used for statistical approach. Results: A total of 103 cases were included in the study. There were 87 males (87.5%), with a median age of 44 years. Sustained virological response rate at 12 weeks (SVR12) after DAAs treatment was 97.6%, and the SVR during the entire follow-up period was at least 95.9%. Compared with baseline, CD4(+)T lymphocyte count were significantly increased equally at 12 weeks ( Z = -2.283, P = 0.022), 24 weeks (Z = -3.538, P < 0.001), 48 weeks ( Z = -3.297, P = 0.001), 96 weeks ( Z = -3.562, P < 0.001), and 144 weeks ( Z = -2.842, P = 0.004). APRI score ( Z = -6.394, P < 0.001) and FIB-4 index ( Z = -2.528, P = 0.011) were significantly lower than baseline at week 4 of DAAs treatment, and thereafter remained at a low level, without further declination. Conclusion: HIV/HCV co-infected patients can maintain high SVR for a long time, acquire good immune reconstitution, and significantly improve liver fibrosis after DAAs treatment.

The incidence of endophthalmitis after vitrectomy is extremely low,especially lower in silicone oil-filled eyes.Silicone oil exerts a toxic effect on the cell membranes of microorganisms and leads to the lack of nutrients.It is thus believed to inhibit the growth of bacteria and fungi.Endophthalmitis induced by mixed bacteria in silicone oil-filled eye has been rarely reported.We reviewed the clinical manifestations,diagnosis,and treatment of a patient with endophthalmitis caused by mixed infection of Morganella morganii and Staphylococcus epidermidis in the silicone oil-filled eye,aiming to improve the understanding and diagnosis of mixed infections.

The primary and secondary tuberculosis features two completely different pathogenesis.At present,the pathogenesis of primary tuberculosis has been clear,whereas that of secondary tuberculosis remains unclear.In order to decipher the mechanism of secondary infection of Mycobacterium tuberculosis and provide insights into vaccine research and drug development,this paper reviews the problems of the widely accepted mechanism of secondary infection,the new findings of the research on the mechanism,as well as the role of cord factors.

Objective: To investigate the sensitivity of adult worms of filial generations from praziquantel-resistant and -sensitive Schistosoma japonicum mixed infections to praziquantel., Methods: Mice were infected with the cercariae of an experimentally generated praziquantel-resistant S. japonicum isolate [median effective dose (ED 50 ) = 277.4 mg/kg] and a laboratory-maintained praziquantel-sensitive S. japonicum isolate (ED 50 = 99.6 mg/kg) at a mixture ratio of 1:1 and 2:1, which was maintained in the laboratory via the mouse-snail cycle for 8 generations. Then, mice were infected with the cercariae of the 8th filial-generation parasite, and grouped 35 days post-infection. Mice in the 5 treatment groups were given praziquantel treatment by gavage at a single oral dose of 37.5, 75, 150, 300 mg/kg and 600 mg/kg, while animals in the control group was administered orally with 2.5% cremophor EL. All mice were sacrificed 14 days post-treatment and adult worms were collected by perfusion of the portal vein. The worm burden reductions and praziquantel ED 50 values were calculated. The praziquantel-resistant S. japonicum isolate generated from experimental induction with 12 rounds of praziquantel treatment with sub-curative doses was maintained in the laboratory via the mouse-snail cycle, and mice were infected with the cercariae of the 8th filial-generation parasite. The praziquantel ED 50 value against the 8th filial-generation adults was measured., Results: After mice were infected with the mixture of cercariae of PZQ-resistant and -sensitive S. japonicum isolates at a ratio of 1:1, the praziquantel ED 50 was 135.2 mg/kg against the adults of the 8th filial-generation parasite. After mice were infected with the mixture of cercariae of PZQ-resistant and -sensitive S. japonicum isolates at a ratio of 2:1, the praziquantel ED 50 was 129.2 mg/kg against the adults of the 8th filial-generation parasite. In addition, the praziquantel ED 50 was 208.4 mg/kg against the adults of the 8th filial-generation S. japonicum without the selection pressure of praziquantel., Conclusions: Compared with the experimentally induced praziquantel-resistant S. japonicum isolate, the adult worms of the filial-generation S. japonicum show a reduced sensitivity to praziquantel in the same host following infection with the mixture of cercariae of praziquantel-resistant and -sensitive S. japonicum isolates. The adult worms of the filial generation of the praziquantel-resistant S. japonicum isolate without the selection pressure of praziquantel may still maintain the resistance to praziquantel.

Objective: To study the clinical and etiological characteristics of viral pneumonia in patients with chronic obstructive pulmonary disease(VP-COPD), and to identify the risk factors associated with poor prognosis. Methods: From August 1, 2017 to August 1, 2019, totally 235 patients in a general hospital in Beijing were prospectively enrolled in this research, and all patients were diagnosed with viral pneumonia by imaging and etiology. The patients were divided into VP-COPD group( n =60) and VP-nCOPD(viral pneumonia in non-COPD patients) group( n =175). Pathogen detection and clinical characteristics were compared between the two groups.Finally, the binomial logistic regression was used to explore the risk factors associated with severe VP-COPD. Results: Compared with the VP-nCOPD group, the VP-COPD group was older(76.5 vs 66.0 years, P =0.001), and the CURB-65 score(2 vs 1, P = 0.001) and the PSI score(111 vs 85, P <0.001) were higher at admission. Pseudomonas aeruginosa ( χ²= 10.308, P = 0.001) and Staphylococcus aureus(χ²= 5.953, P =0.028) were the most common co-infection bacteria. In the VP-COPD group type Ⅱ respiratory failure was more common(23.3% vs 6.8%, P <0.001), the number of severely ill patients was larger(48.3% vs 30.3%, P =0.011), the length of hospital stay was longer(13 vs 8, P <0.001), and the mortality rate during hospitalization was higher(18.3% vs 7.4%, P =0.016) in the VP-nCOPD group. Multivariate analysis showed that the level of blood glucose( OR : 1.73, 95% CI : 1.22-2.44, P = 0.002) and pleural effusion( OR : 133.12, 95% CI : 7.57-2 340.36, P =0.001) were risk factors for severe VP-COPD patients. Conclusion: Viral pneumonia in patients with COPD tended to develop into severe cases and had a poor prognosis.

Objective: To investigate the diagnosis and surgical treatment of co-infection with hepatic cystic and alveolar echinococcosis, so as to provide insights into the diagnosis and treatment of these patients., Methods: The clinical data of patients with co-infections of hepatic cystic and alveolar echinococcosis in Qinghai Provincial People's Hospital between 2017 and 2018 were retrospectively analyzed., Results: Three patients were diagnosed with co-infection of hepatic cystic and alveolar echinococcosis. One patient was diagnosed by preoperative CT scan, and confirmed intraoperatively. The other two cases were diagnosed as cystic echinococcosis by preoperative color ultrasonography and imaging examinations, and were definitively diagnosed as co-infection of hepatic cystic and alveolar echinococcosis by intraoperative examination of the lesion morphology and postoperative pathology. Two patients were given radical surgery, and another case was given removal of the internal capsule and subtotal excision of the outer capsule of Echinococcus granulous in the liver following exploration., Conclusions: Co-infection with hepatic cystic and alveolar echinococcosis is easy for missed diagnosis and misdiagnosis prior to operation, and the definitive diagnosis may be made by means of imaging examinations combined with postoperative pathology. The surgery is relatively complicated and difficult for patients with co-infection of hepatic cystic and alveolar echinococcosis, and individualized surgical treatment regimen should be employed for patients with various types of infections.

Hepatitis B virus (HBV)/hepatitis C virus (HCV) co-infection shares the same transmission routes, and thereby it is not rare in regions where the prevalence of HBV and HCV is high. However, the co-infection rates of HBV/HCV reported in different regions of the world are relatively dissimilar, and the co-infection rates of HBV/HCV in the population are unidentified due to the presence of silent HBV infection. Thus, the phenomenon of underestimation exists. HCV may have an inhibitory effect on HBV replication when HBV/HCV is co-infected, and the effect of HBV on HCV replication remains to be certain by more studies. Furthermore, the mechanism of interaction may include the direct effect of viral proteins and the indirect effect of immune mediated host response. HBV/HCV co-infection can cause more serious chronic liver diseases and cirrhosis, and can increase the risk of liver cancer. The efficacy of peginterferon plus ribavirin in patients with HBV/HCV co-infection is same as HCV monotherapy. There are few studies on the efficacy of direct-acting antiviral drugs. Patients with HBV/HCV co-infection have the risk of HBV reactivation regardless of anti-HCV treatment with peginterferon plus ribavirin or direct-acting antiviral drugs, but the probability of HBV reactivation and how to assess and prevent it needs more studies to interpret.

Objective: To investigate the ocular manifestations of human immunodeficiency virus (HIV) and syphilis coinfection. Methods: A retrospective analysis of the ocular manifestations was carried out in 27 patients (54 eyes) diagnosed as syphilis and HIV coinfection by the Department of Infectious Medicine in Peking Union Medical College Hospital during the years of 2006-2017. The research included 26 males and 1 female, aging from 24 to 76 years old, with a mean age of 40.40±12.94 years old. Ocular anterior segments were examined with slit-lamp microscope. Fundus examinations were conducted with papillary dilation, fundus photography. Results: At the first visit, there were 2 eyes without light perception, 4 eyes with light perception, 1 eye with hand movement, 1 eye with finger counting, 2 eyes with 0.01-0.09 eyesight, 8 eyes with 0.1-0.2 eyesight, 12 eyes with 0.25-0.4 eyesight, 15 eyes with 0.5-0.9 eyesight, 9 eyes with 1.0-1.5 eyesight. Among the 27 patients (54 eyes) coinfected with HIV and syphilis, keratic precipitates were identified in 20 eyes, aqueous flare positive in 20 eyes, float positive in 15 eyes, and iris posterior synechias in 7 eyes. Nineteen eyes were diagnosed as syphilis uveitis, including 2 eyes with syphilis anterior uveitis and 17 eyes with syphilis panuveitis, among which, vitreous inflammatory opacity was observed in all 19 eyes, disk atrophy in 2 eyes, optic edema in 1 eye, vitreous hemorrhage in 1 eye, retinal detachment in 2 eyes, retinal hemorrhage and white vein in 1 eye. In addition, 8 eyes were diagnosed as HIV retinopathy, all manifested as cotton-wool spot. Among the 8 eyes, 4 were diagnosed as cytomegalovirus retinitis, 3 showed retinal yellow-white lesions, and 1 was in late phase which showed retinal pigmentation. The incidence of both HIV and syphilis coinfection patients and male homosexuality population increased. The most common ocular manifestation of HIV and syphilis coinfection was syphilis panuveitis. Six patients first visited the Department of Ophthalmology, and were then diagnosed as HIV and syphilis coinfection. Conclusions: The ocular manifestations of HIV and syphilis coinfection are diversified, which can be manifested as fundus necrotic lesions as well as anterior and posterior inflammatory. For HIV positive patients, syphilis serologic test should be routinely performed. The same, syphilis positive patients should be tested for HIV serum antibodies, in order to improve the diagnosis level of HIV/syphilis coinfection and give timely etiological treatment, which is of vital importance for saving visual acuity. (Chin J Ophthalmol, 2019, 55:267-272) .

Objective: To understand the characteristics on major strain subtypes of hepatitis C virus among HIV/HCV co-infected patients, so as to explore the molecular transmission clusters and related risk factors of HCV strains. Methods: A total of 336 newly reported HIV-infected patients were diagnosed as HIV/HCV co-infection in Dehong Dai and Jingpo autonomous prefecture (Dehong) in 2016. We used Nested PCR to amplify CE1 and NS5B genes among 318 samples with plasma levels above 200 μl, before using the combining phylogenetic tree and constructing molecular propagation network method to analyze the related data. Results: A total of 267 HIV/HCV co-infection patients who had met the HCV genotyping requirements were screened the gene subtypes were diversified. Among these genotypes, proportions of 3b, 6n, 6u, 1a, 3a and other subtypes appeared as 32.6% (87/267), 18.4% (49/267), 15.7%(42/267), 13.1%(35/267), 11.2%(30/267) and 9.0%(24/267) respectively. Molecular transmission network of five major HCV genotypes was constructed with a clustering rate of 39.1% (95/243). The clustering rate of subtype 1a was the highest, as 71.4% (25/35). Results from the multivariate logistic regression showed that ethnic minorities other than the Yi and Jingpo ( vs . the Han, OR =0.17, 95 %CI : 0.04-0.71), the married spouses ( vs . the unmarried, OR =0.42, 95 %CI : 0.18-0.94), the 6n and 3a subtype ( vs . the 3b subtype, OR =0.34, 95 %CI : 0.12-0.95; OR =0.22, 95 %CI : 0.05-0.93) were more difficult to form transmission clusters. However, the 6u and 1a subtype ( vs . the 3b subtype, OR =3.10, 95 %CI : 1.21-7.94; OR =4.00, 95 %CI : 1.32-12.11) seemed more likely to form the transmission clusters. Conclusion: Ethnicity, marital status and genetic subtypes were factors significantly associated with the formation of transmission clusters related to the major HCV gene subtypes among newly reported HIV/HCV co-infection in Dehong.

End-stage liver disease (ESLD) is a life threaten clinical syndrome with significantly increasing mortality when patients complicated with infections. For patients with ESLD, infections can induce or aggravate the occurrence of liver decompensation. In turn, infections are among the most common complications under, disease progression. There is lacking of working procedures for early diagnosis and appropriate management for patients of ESLD complicated with infections, neither guidelines nor consensus at home and abroad. This consensus assembled up-to-date knowledge and experience across Chinese colleagues, providing principles as well as working procedures for clinicians to diagnose and treat an ESLD patient complicated with infections.

Objective: To reveal the prevalence and the related factors of hepatitis B (HepB) virus infection among HIV/AIDS patients. Methods: We conducted a cross-sectional study in two HIV clinics, affiliated to local Centers of Disease Control and Prevention in Guangxi Zhuang Autonomous Regional. A face-to-face interview, with questionnaire was conducted to collect information on socio-demographic characteristics, drug use, and sexual behavior. Blood samples were used to test HBsAg. χ (2) test or Fisher's exact test and unconditional logistic regression models were used to identify the influencing factors. Results: The prevalence of HBV and HIV co-infection was 13.85% (113/816). Results from multivariate logistic regression analyses showed that age (25-45), family history of HBV and history of HepB vaccination were independent influencing factors for HBV and HIV coinfection, with OR (95% CI ) as 1.738 (1.031-2.931), 2.898 (1.678-5.005) and 1.744 (1.052-2.892), respectively. Conclusion: The prevalence of HBV among HIV/AIDS patients was significantly higher than that in general population. HIV/AIDS patients aged between 25 and 45 and with family history of HBV were more likely to be infected with HBV, while HepB vaccination was associated with the reduction of HIV/HBV coinfection. Specific comprehensive prevention and treatment programs on HIV/AIDS patients need to be set up.

Objective: To investigate the factors associated with syphilis/HIV infection among men who have sex with men (MSM) maintaining a single sexual partner in Shenzhen. Methods: Respondent driven sampling and snowball sampling method were used to recruit MSM receiving voluntary counseling and testing in Shenzhen Rainbow clinic from 2011 to 2016., Inclusion Criteria: aged 18 years and above; reported having one or more anal sexual partners in the recent 6 months. A total of 3 109 men who have sex with men (MSM) were involved in the study. Questionnaire-based interviews were conducted on a one-on-one basis. Data were collected including socio-demographic information, human immunodeficiency virus (HIV) testing history, history of blood donation and drug abuse in the recent two years, self-identified sexual orientation, role in homosexual behavior, ever being money boys (MB) and clients of MB, female sexual partners in the recent 6 months. 5 ml blood samples were taken after questionnaires. Syphilis was screened using toluidine red unheated serum test for the antibody of treponema pallidum and then confirmed by treponema pallidum particle assay. The enzyme-linked immunosorbent assay (ELISA) was used for screening HIV and western blot was used to confirm the HIV screening results. The difference of condom use among MSM between female sexual partners and male sexual partners were compared. Multivariate unconditional stepwise logistic regression model was used to analyze factors associated with syphilis infection and HIV positive among MSM. Results: A total of 3 109 eligible participants with mean (SD) age of 31.49 (8.64) years were enrolled in this study. Among them, 565 cases were infected with syphilis (18.17%), 330 cases were infected with HIV (10.61%), and 165 cases (5.31%) were syphilis co-infected with HIV. 791 (25.44%) reported maintaining a single sexual partners in the recent 6 months. Compared to MSM with multiple sexual partners, the prevalence of syphilis and HIV infection among MSM with a single sexual partner were lower, and the OR (95% CI ) were 0.64 (0.51-0.81) and 0.66 (0.49-0.90), respectively. Conclusion: The proportion of fixed single sexual partner was much lower among MSM in Shenzhen. Maintaining a single sexual partners can reduce the risk of syphilis/HIV infection among MSM.

Objective: To identify the clinical features of mononucleosis caused by co-infection of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in adult patients. Methods: A total of 103 inpatients with mononucleosis in Peking University Third Hospital from May 2013 to May 2016 were collected as the study subjects.The patients were divided into three groups according to the responsible pathogens: 33 patients infected with EBV and CMV, 53 infected with EBV alone and 17 infected with CMV alone.Furthermore, a case-control study was employed to retrospectively compare the clinical characteristics and prognosis with χ(2,) t or rank tests. Results: The incidences of sore throat, pharynx congestion, tonsil enlargement, tonsil membrane, lymphadenectasis in co-infected patients were statistically lower than those in EBV-infected patients(χ(2)=19.202-25.492, all P <0.05), and were equivalent to those in CMV-infected patients(χ(2)=0.078-4.381, all P >0.05). The levels of alkaline phosphatase, glutamyl transferase, lactic dehydrogenase, white blood cell count and atypical lymphocyte in co-infected patients were statistically lower than those in EBV-infected patients( t / U =3.471-104.629, all P <0.05), and were similar to those in CMV-infected patients( t / U =0.447-24.330, all P >0.05). The levels of alanine aminotransferase and total bilirubin in co-infected patients were equivalent to those in the other two groups( U =1.695, 6.371, both P >0.05). The duration of fever in co-infected patients[(18±9) d] was between EBV alone [(15±7) d] and CMV alone [(21±7) d]infected patients. Conclusions: Co-infection of EBV and CMV is not uncommon.The clinic manifestation of co-infection is more like CMV infection. Liver injury and duration of fever shows no aggravation.