Background: Some children hospitalized for severe pertussis need intensive care; moreover, some children die because of deterioration alone or in combination with other complications. The purpose of this study was to identify the mortality risk factors among hospitalized children with severe pertussis. Methods: This study evaluated the medical records of 144 hospitalized children with severe pertussis at the Guangzhou Women and Children’s Medical Centre between January 2016 and December 2019. Results: The median age of patients was 2 months (IQR 1–4 months), with 90.3% of the patients aged < 6 months and 56.9% of the patients aged < 3 months. A total of 38 patients were admitted to intensive care unit (ICU), 13 patients died, and the mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for 76.9% of the deaths. On the multivariate analysis, the independent risk factors for death were WBC > 70.0 × 10⁹/L (odds ratio [OR], 230.66; 95% confidence interval [CI], 5.16–10,319.09 P = 0.005) and pulmonary hypertension (PH) (OR 323.29; 95% CI 16.01–6529.42; P < 0.001). Conclusion: Severe pertussis mainly occurred in children aged < 3 months. The mortality of severe pertussis was 34.2%, with patients younger than 6 weeks accounting for the majority of the deaths. We recommend the first dose of diphtheria-tetanus-pertussis (DTP) should be advanced to the age of 2 months or even 6 weeks. The presence of a WBC > 70.0 × 10⁹/L and PH were the prognostic independent variables associated with death.

Some children hospitalized due to severe community-acquired pneumonia (CAP) require to the pediatric intensive care unit (PICU) because of severe complications. The purpose of this study was to identify the risk factors for mortality in this patient population. This study evaluated the medical records of 113 hospitalized children with severe CAP, who were transferred to the PICU within 48 h of admission at the Guangzhou Women and Children's Medical Center between 2013 and 2017. The study group consisted of 87 boys (77%) and 26 girls (33%), aged between 1 month and 9 years; 72.6% (82/113) of patients were aged 3 on admission, not receiving corticosteroid therapy prior to admission, the need for mechanical ventilation, septic shock, multi-organ dysfunction (MODS), and acute renal failure (ARF) occurring prior to transfer to the PICU, increased alanine aminotransferase (ALT) and aspartate transaminase (AST) levels, and decreased hemoglobin and albumin (ALB) levels were associated with mortality (P < 0.05). Non-survivors were more likely to have an oxygen saturation <90% on admission and lower levels of ALB prior to transfer to the PICU than survivors (P < 0.05). Our results showed that hospitalized children with severe CAP who were transferred to the PICU within 48 h of hospital admission were mainly aged <1 year. Additionally, an oxygen saturation <90% and decreased ALB levels were early prognostic variables independently associated with death.

Introduction: Talaromyces marneffei (T. marneffei) infections in children can occur secondary to inborn errors of immunity (IEIs). We aimed to investigate the clinical and genetic features of T. marneffei infection in Chinese pediatric patients.Materials and methods: We retrospectively reviewed 18 pediatric patients with IEIs who were diagnosed with T. marneffei infections at five public hospitals in China from January 2015 to January 2023.Results: The common clinical features among the patients were fever, cough, and hepatomegaly. The most common severe complications included septic shock, hemophagocytic lymphohistiocytosis (HLH), and acute respiratory distress syndrome (ARDS). Three cases presented with pan-hypogammaglobulinemia, while three other cases showed heightened levels of IgM. Elevated levels of IgE were detected in five cases, and six cases exhibited decreased T lymphocyte absolute counts. Four children were diagnosed with hyperimmunoglobulin M syndrome (HIGM) due to CD40LG mutations, three cases had severe combined immunodeficiency (SCID), and five were diagnosed with hyper-IgE syndrome (HIES). Gain-of-function (GOF) mutations in STAT1 led to STAT1 GOF in four cases. One patient was diagnosed with caspase-recruitment domain (CARD9) deficiency due to a compound mutation in the CARD9 gene, while another patient was confirmed with adenosine deaminase (ADA) deficiency.Conclusion: T. marneffei infections in children with IEIs induced severe systemic complications. These children commonly exhibited abnormal immunoglobulin levels in peripheral blood, and underlying IEIs associated with T. marneffei infections have enhanced our understanding of the disease.

Objective: To investigate the epidemiological characteristics of pediatric respiratory pathogens in Guangzhou, China, from 2018 to 2023 in the context of the COVID-19 Pandemic and to evaluate the impact of non-pharmaceutical interventions (NPIs) on the transmission dynamics and seasonal patterns of respiratory pathogens. Methods: A retrospective analysis was conducted at Guangzhou Women and Children’s Medical Center between January 2018 and December 2023. Pediatric patients who underwent the respiratory pathogens tests were enrolled in the study and divided into four groups by age: Infant group, Toddler group, Preschool group, and School-age group. The nasopharyngeal swab or bronchoalveolar lavage fluid (BALF) samples were collected for real-time fluorescence quantitative polymerase chain reaction (qPCR) test of respiratory pathogens. Ten common respiratory pathogens, including respiratory syncytial virus (RSV), Mycoplasma pneumoniae (MP) and Influenza A virus (FluA), were detected. In addition, the study period was divided into three phases: Pre-COVID-19 (2018–2019), COVID-19 (2020–2022), and Post-COVID-19 (2023). Detection rates, distribution patterns, and seasonal variations of respiratory pathogens were analyzed between different phases and different age groups. Results: This study included 317,828 pediatric patients (median age: 3.4 years, IQR: 1.3-6.0), from whom 1,160,764 respiratory pathogen tests were conducted. The overall pathogen detection rate was 8.02% (93,108/1,160,764). The positive rate during the COVID-19 phase (18.44%, 95% CI 14.89-22.00%) was significantly lower than that of the Pre-COVID-19 (27.55%, 95% CI 23.95–31.16%) and Post-COVID-19 (27.15, 95% CI 21.47–32.84%) phases (P < 0.001). No significant difference was observed between Pre-COVID-19 and Post-COVID-19 phases (P = 0.948). Different pathogens exhibited varying levels of suppression and recovery patterns, with some demonstrating altered seasonal patterns. The primary affected age groups shifted from infants and toddlers during the Pre-COVID-19 and COVID-19 phases to preschool and school-age children in the Post-COVID-19 phase. Co-infections were identified in 2,515 cases, with the highest rate observed during the Pre-COVID-19 phase (3.40%), followed by the COVID-19 (2.26%) and Post-COVID-19 (2.46%) phases. Conclusions: NPIs implemented during the early COVID-19 pandemic effectively suppressed the transmission of respiratory pathogens and disrupted their seasonal patterns. However, some pathogens gradually resumed activity during the mid-to-late COVID-19 phase, leading to atypical outbreaks. Following NPI relaxation, multiple pathogens rebounded during the Post-COVID-19 phase, posing significant challenges for the healthcare system. These findings offer valuable insights for guiding public health strategies and optimizing the prevention and control of respiratory infections. Clinical trial number: Not applicable.