Background: The incidence of asthma in Chinese children has rapidly increased as a result of inadequate management. This is mainly due to the failure of many primary-level pediatricians to distinguish asthma from common respiratory diseases, such as bronchitis and pneumonia. Such misdiagnoses often lead to the abuse of antibiotics and systemic glucocorticoids. Additionally, if asthma is not diagnosed early, chronic airway inflammation results in lesions that not only hamper children’s athletic abilities, but serve as the primary cause for adult chronic airway diseases, such as chronic obstructive pulmonary disease (COPD). Methods: A number of machine learning–based models including CatBoost, Logistic Regression, Naïve Bayes, and Support Vector Machines (SVM) have been developed to identify asthma via utilizing retrospective electronic medical records (EMRs) of patients. These models were evaluated independently using EMRs from both the Pulmonology Department and other departments of the Children’s Hospital, Zhejiang University School of Medicine, China. Results: Two independent test sets were applied for performance evaluation. TestSet-1 consisted of 325 positive asthma cases and 428 negative cases from the Pulmonology Department. TestSet-2 was composed of 2,123 cases from non-pulmonology departments, and included 337 positive and 1,786 negative cases. Experimental results showed that the CatBoost model outperformed other models on both test sets with an accuracy of 84.7% and an area under the curve (AUC) of 90.9% on TestSet-1, and an accuracy of 96.7% and an AUC of 98.1% on TestSet-2. Conclusions: The artificial intelligence (AI) model could rapidly and accurately identify asthma in general medical wards of children, and may aid primary pediatricians in the correct diagnoses of asthma. It possesses great clinical value and practical significance in improving the control rate of asthma in children, optimizing medical resources, and limiting the abuse of antibiotics and systemic glucocorticoids.

Background: Pulmonary cryptococcosis (PC) rarely occurs in immunocompetent children. Case presentation: A 13-year-old boy was admitted to the First Affiliated Hospital of Ningbo University in February 2023 with complaints of cough and chest pain. Physical examination showed slightly moist rales in the right lung. Chest computed tomography (CT) suggested a lung lesion and cavitation. Blood routine test, lymphocyte subsets, immunoglobulin, and complement tests indicated that the immune system was normal. However, the serum cryptococcal antigen test was positive. Next-generation sequencing revealed Cryptococcus infection. The child was diagnosed with PC and was discharged after treating with fluconazole 400 mg. Four months later, chest CT showed that the lung lesion diminished, and reexamination of serum cryptococcal antigen test turned positive. Conclusion: PC should be considered in an immunocompetent child with pulmonary cavities with nonspecific symptoms.

Introduction: Streptococcus intermedius is an opportunistic pathogen associated with prolonged hospital stays and high mortality rates in adults. However, little is currently known about the clinical features of Streptococcus intermedius infection in children.Methods: This retrospective case series study included 40 children diagnosed with Streptococcus intermedius, confirmed through bacterial cultures or high-throughput sequencing. Antibiotic resistance was assessed through susceptibility testing. The site and clinical manifestations were evaluated for all patients.Results: The common infection sites were the abdominal cavity, skin and soft tissue, intracranial, and invasive pulmonary, with the abdominal cavity being the most frequently affected. The drug susceptibility test showed 100% sensitivity to ceftriaxone, levofloxacin, chloramphenicol, vancomycin, and linezolid, 92.6% sensitivity to penicillin, 73.3% resistance to erythromycin, and 76.7% resistance to clindamycin. Besides antibiotic therapy, surgical intervention or pus drainage was often necessary. Lung imaging of four patients revealed pulmonary abscesses, nodules, or encapsulated pleura. Two cases yielded positive culture results, while three were identified as positive through high-throughput nucleotide sequencing of pleural effusion.Discussion: In children with Streptococcus intermedius infection, emphasis should be placed on the risk of pus or abscess formation. In cases of pulmonary abscess and pleural effusion, especially in male children, Streptococcus intermedius should be suspected even if the culture is negative. Improvements in high-throughput nucleotide sequencing are required to reduce misdiagnosis rates.

This study aims to describe the epidemiology and genotypic diversity of human metapneumovirus (HMPV) in hospitalized children with pneumonia in Hangzhou, Zhejiang, China. From February 2022 to January 2023, nasopharyngeal swabs from hospitalized children with acute respiratory tract infections (ARTIs) in the Children’s Hospital, Zhejiang University School of Medicine (Zhejiang, Hangzhou) were collected and tested for HMPV. Clinical characteristics and genotypes were analyzed on HMPV-positive samples. 3.43% (357/12993) of pediatric patients were HMPV-positive, and 287 of them were hospitalized with HMPV-induced pneumonia. 185 were classified as non-severe pneumonia group, and 102 as severe pneumonia group. Neutrophil to lymphocyte ratio (NLR), C-reactive protein to prealbumin ratio (CPAR) and C-reactive protein (CRP) were substantially higher in severe groups compared to non-severe groups across all patient categories (P < 0.05). There were 14 cases of B1 lineage infection, 7 cases of B2 lineage infection and 105 cases of A2.2.2 lineage infection in hospitalized patients. Under the prevention and control of the COVID-19 pandemic, the HMPV infection rate in pediatric patients with ARTIs has decreased, and the main lineage of HMPV infection in Hangzhou was A2.2.2. NLR and CPAR have higher predictive potential in severe patients.

Background: Brucellosis is the most common zoonotic infection worldwide, and is caused by bacterial genus Brucella. The disease is rarely transmitted through human-to-human transmission. Few cases have been reported about vertical transmission of human brucellosis. Herein, we reported a case of congenital brucellosis, with clear evidence of pathogen detected in mother's placental specimen. Case Presentation: A 34-day-old girl was admitted to the department of pulmonology with fever for 8 days. Three blood samples and one sample of cerebrospinal fluid were positive for Brucella melitensis . The diagnosis of brucellosis and B. melitensis meningitis were established, along with hyperbilirubinemia and liver dysfunction. Treatment of rifampicin (for 6 weeks) and meropenem (for 2 weeks) was administered. However, the disease relapsed within 18 days. Thereafter, a combination therapy of rifampicin and sulfamethoxazole/trimethiprim (SMZ/TMP) was administered for 8 weeks. The disease relapsed again in 42 days. For chronic brucellosis, three courses of combination therapy of rifampicin and SMZ/TMP was administered. The mother had fatigue and arthralgia for 2 weeks, fever and membrane rupture 1 day before the baby was born. B. melitensis DNA was detected in the mother's placental specimen by next-generation sequencing and bacterial identification under microscope proved chorioamnionitis. Conclusions: We reported a confirmed case of congenital brucellosis. This disease should be closely monitored even in nonepidemic areas. The treatment of brucellosis in infancy faces challenges of drug choice and disease relapse.

Plastic bronchitis is a relatively uncommon illness that has been reported in all age groups. This case report describes a specific manifestation of plastic bronchitis in two pediatric brothers influenced by both smoke inhalation and influenza A virus infection. The therapeutic approach mainly involved symptomatic supportive care, antiviral therapy, repeated bronchoscopic alveolar lavage, and bronchial cast removal. Eventually, both patients went into remission. Bronchoscopy proved to be helpful in diagnosing and treating these cases.