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Summary Background Limited research has been published on current Helicobacter pylori infection rate in asymptomatic children in China. Aim To assess current Helicobacter pylori infection rate, distribution characteristics and risk factors in Chinese asymptomatic children. Methods A prospective, cross‐sectional, population‐based study was performed from 2009 to 2011 in three cities of China. Helicobacter pylori infection was diagnosed by a stool antigen test. Multi‐stage cluster random sampling was used to select asymptomatic children including neonates. Socioeconomic details were obtained through a standardised questionnaire. Results Among total of 3491 children (0–18 years), the global infection rate was 6.8% and there were no significant differences between genders. Age specific infection rate between regions was significantly different (P < 0.05). The infection rate significantly increased with age (P for trend <0.01). It was low during the newborn (0.6%) to preschool period and was significantly increased in high school students (13.5%) (P < 0.01). Multivariable regression indicated that hand sanitisation, individually served meals, higher education level of mother, above average living space and residence in urban areas were significantly protective against infection (OR 0.749, 0.698, 0.720, 0.838 and 0.770 respectively). Conversely, consuming meals in unsanitised conditions, sharing towels, receiving pre‐chewed food from the mother, artificial feeding and family history of gastrointestinal disease were significantly associated with the risk of infection (OR 1.200, 1.965, 2.002, 1.071 and 2.093 respectively). Conclusions Helicobacter pylori infection rate increases with age in Chinese asymptomatic children and is common after 10 years of age. The rate of infection is related to socioeconomic status.

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Background: Early interactions between respiratory viruses and microbiota mightmodulate host immune responses and subsequently contribute to later development of recurrent wheezing and asthma in childhood. We aimed to study the possible association between respiratory microbiome, host immune response, and the development of recurrent wheezing in infants with severe respiratory syncytial virus (RSV) bronchiolitis.Methods: Seventy-four infants who were hospitalized at Beijing Children's Hospital during an initial episode of severe RSV bronchiolitis at 6 months of age or less were included and followed up until the age of 3 years. Sputum samples were collected, and their microbiota profiles, LPS, and cytokines were analyzed by 16S rRNA-based sequencing, ELISA, and multiplex immunoassay, respectively.Results: Twenty-six (35.1%) infants developed recurrent wheezing by the age of 3 years, and 48 (64.9%) did not. The relative abundance of Haemophilus, Moraxella, and Klebsiella was higher in infants who later developed recurrent wheezing than in those who did not (LDA score >3.5). Airway levels of LPS (P = .003), CXCL8 (P = .004), CCL5 (P = .029), IL-6 (P = .004), and IL-13 (P < .001) were significantly higher in infants who later developed recurrent wheezing than in those who did not. Moreover, high airway abundance of Haemophilus was associated with CXCL8 (r = 0.246, P = .037) level, and that of Moraxella was associated with IL-6 level (r = 0.236, P = .046) and IL-10 level (r = 0.266, P = .024). Conclusion:Our study suggests that higher abundance of Haemophilus and Moraxella in airway microbiome might modulate airway inflammation during severe RSV bronchiolitis in infancy, potentially contributing to the development of subsequent recurrent wheezing in later childhood. K E Y W O R D S airway inflammation, children, lipopolysaccharide, recurrent wheezing, respiratory microbiome, respiratory syncytial virus S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Zhang X, Zhang X, Zhang N, et al. Airway microbiome, host immune response and recurrent wheezing in infants with severe respiratory syncytial virus bronchiolitis. Pediatr Allergy Immunol. 2020;31:281-289.

The characteristics of Mycoplasma pneumonia (M. pneumoniae)-associated bronchiolitis obliterans (BO) are not well known. We retrospectively reviewed 17 patients with M. pneumoniae–associated BO. All patients had M. pneumoniae–associated acute bronchiolitis prior to the development of BO. In the acute bronchiolitis stage, all patients had fever and cough; six patients also had wheezing and dyspnoea. BO was diagnosed approximately 1.5–8 months later based on clinical manifestations and chest high-resolution computed tomography (HRCT) findings. All patients presented with wheezing and/or dyspnoea at the time of diagnosis of BO. HRCT findings included mosaic attenuation, pronounced air trapping, central bronchiectasis and emphysema, according to disease severity. Lung function tests revealed mild to severe airway obstruction. Fourteen of 17 patients had a greater than 12% increase in forced expiratory volume in 1 second values after taking salbutamol. All patients had positive allergy test results and family or personal history of atopic disease. Four patients had a history of asthma before M. pneumonia bronchiolitis. Asthma was diagnosed before, at the time of or after the diagnosis of BO in 11 cases. M. pneumoniae–associated BO may therefore develop following M. pneumonia bronchiolitis and overlap with asthma.

BackgroundThis study aimed to analyze the risk factors and treatment efficacy of neurobrucellosis.Material/MethodsA cross-sectional epidemiologic survey was carried out in 557 patients with brucellosis by specially trained neurologic clinicians. Sixty-six patients with neurobrucellosis were treated with doxycycline, rifampicin, and ceftriaxone sodium as standard medication and evaluated for efficacy on a regular basis.Results(1) Symptoms improved in most patients after 6 weeks of treatment, which demonstrated a favorable efficacy. (2) Cross-sectional epidemiologic survey suggested that sex, nationality, and regional distribution were not related to nervous system damage in patients with brucellosis (P>0.05), whereas age and duration of disease were related factors. Increased age as well as a prolonged duration of disease were risk factors for nervous system damage in patients with brucellosis (P<0.05).Conclusions(1) Doxycycline, rifampicin, and third-generation cephalosporins should be considered both standard and first-choice medications for neurobrucellosis. Treatment should last for at least 6 weeks. Standardized, sufficient, and combined medication is recommended for better efficacy and prognosis. (2) Age and duration of disease are risk factors for neurobrucellosis, whereas sex, nationality, and regional distribution are not. Older patients with a prolonged duration of disease are more likely to develop neurobrucellosis.

Background With the increase of awareness of mycoplasma pneumoniae pneumonia (MPP), we found thrombosis in severe MPP (SMPP) was not rare. The aim of the study was to investigate the clinical characteristics, treatment, and long-term prognosis of MPP-associated thrombosis. Methods We retrospectively reviewed the medical records of 43 children with MPP-associated thrombosis between January 2013 and June 2019 at Beijing Children’s Hospital. The results of blood coagulation studies, autoimmune antibody, thrombophilia screening, contrast-enhanced lung computed tomography, echocardiography, and blood vessel ultrasonography were analyzed, as were treatment outcomes. Results Forty-two patients were diagnosed with SMPP. D-dimer was higher than 5.0 mg/L in 58.1% (25/43) of patients. The mean D-dimer level was 11.1 ± 12.4 mg/L. Anticardiolipin-IgM was positive in 60.0% of patients, β2-glycoprotein-IgM in 64.0%, and lupus anticoagulant in 42.1%. Chest imaging revealed pulmonary consolidation with lobe distribution in all patients (2/3–1 lobe in 10 patients, > 1 lobe in 29 patients). In our experience, thrombosis can occur in a vessel of any part of the body, and it can be initially detected as late as 31 days after disease onset. Thrombosis in the brain and abdomen can occur early, at 5 days after disease onset. Pulmonary vessels were the most commonly involved sites in the current study, and accordingly chest pain was the most common symptom (32.6%), followed by neurological symptoms (14.0%) and abdominal pain (9.3%). Thirty-five percent of patients were asymptomatic with regard to thrombosis. All patients underwent anticoagulant therapy, and thrombus absorption took > 3 months in most patients. All patients were followed until October 2019, at which time 41 were asymptomatic and 2 had mild recurrent cough. Conclusions SMPP with pulmonary consolidation (> 2/3 lobe) was the most strongly associated risk factor for thrombosis. Thrombosis-associated symptoms may be subtle, even absent. Elevated D-dimer, specifically > 11.1 mg/L (even > 5.0 mg/L), would assist in the early diagnosis of thrombosis. The long-term prognosis of thrombosis was good after timely administration of anticoagulant therapy.