Mediterranean Journal of Hematology and Infectious Diseases最新文献

Background: Radiologic complications of pediatric Mycoplasma pneumoniae pneumonia (MPP), consolidation, and necrotizing pneumonia (NP) are difficult to anticipate early. We tested whether admission cytokines and short-term changes predict imaging outcomes.

Methods: A retrospective cohort (Oct 2022-Sep 2024) of hospitalized children with PCR-confirmed MPP. Multiplex cytokines (including IL-6, IL-10, CXCL10/IP-10) were assayed from residual samples at admission (T0) and days 3-5 (T1). NP analyses were conditional on undergoing computed tomography (CT). Primary outcomes were WHO end-point CXR consolidation ≤14 days and CT-defined NP ≤28 days. Full-cohort 14-day CXR-consolidation risk (admission), post-T1 consolidation risk among event-free children (day 3-5 landmark), and 28-day NP risk conditional on being scanned. Penalized logistic models evaluated T0 and Δ(T0-T1) predictors among children event-free at T1, with AUC (bootstrap-corrected) and BH-FDR control.

Results: Of 286 enrollments, 268 were analyzed; consolidation occurred in 96/268 (35.8%), CT was performed in 124/268 (46.3%), and identified NP in 28/124 (22.6%; 10.4% overall). In the Admission model, IL-6 (adjusted OR [aOR] 1.45, 95% CI 1.16-1.83; q=0.01), IP-10 (1.52, 1.21-1.93; q<0.01), and IL-10 (1.28, 1.03-1.60; q=0.04) predicted consolidation (AUC 0.78, 95% CI 0.73-0.83). In event-free children at T1 (n=180), ΔIL 6 (1.40, 1.12-1.76) and ΔIP 10 (1.48, 1.18-1.88) improved discrimination (AUC 0.84, 0.79-0.88). In CT-subset models, T0 IL-6 (1.67, 1.09-2.58) and ΔIL-6 (1.89, 1.22-3.00) were associated with NP (AUC 0.79). Findings were robust in prespecified sensitivity analyses.

Conclusions: Admission cytokines and early rises, especially IL-6 and IP-10, enable pragmatic early risk stratification for consolidation, with ΔIL-6 also signaling NP risk in the CT-scanned subset. These results support external validation of a cytokine-based tool to inform imaging and triage.

Background: Febrile neutropenia (FN) remains a frequent and potentially life-threatening complication in pediatric oncology, where prompt recognition of bacteremia is critical for risk-adapted therapy and antimicrobial stewardship. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) are widely used, yet their early predictive value is inconsistent across studies. Cellular activation markers measured by flow cytometry, particularly CD48, have been scarcely investigated in this setting. This study aimed to evaluate conventional, metabolic, and immune biomarkers for predicting bacteremia in children with FN and to assess the incremental diagnostic value of CD48.

Methods: This prospective single-center cohort enrolled 38 pediatric oncology patients presenting with 46 FN episodes over 9 months. Clinical data, blood cultures, and serial measurements of CRP, PCT, lactate, interleukin-6, interleukin-8, MCP-1, sTREM-1, CD48, and CD64 were obtained at 0, 24, 48, and 72 hours. Bacteremia was defined by positive culture for a recognized pathogen. Receiver operating characteristic (ROC) analyses were performed to determine the area under the curve (AUC), sensitivity, and specificity. A multivariable logistic regression model evaluated the combined performance of biomarkers.

Results: Bacteremia occurred in 12 (26.1%) FN episodes. Sepsis, tachycardia, and elevated lactate were more common among bacteremic patients. CRP showed limited early discrimination (AUC 0.62 on day 2) but improved by day 4 (AUC 0.74). PCT was consistently higher in bacteremia (AUC 0.89 at day 4), and lactate demonstrated strong early predictive value (AUC 0.81). CD48 was significantly elevated from 0-24 h (AUC 0.78), outperforming CD64 (AUC 0.60) and preceding the rise in CRP. In combined modeling, PCT + CD48 + lactate achieved the highest discrimination (AUC 0.92; sensitivity 92%, specificity 85%). Post-hoc power analysis showed 82% power to detect AUC differences ≥0.15.

Conclusion: Integration of CD4 with PCT and Lactate markedly improved diagnostic accuracy in this cohort; however, given the limited number of bacteremic episodes, these findings should be considered exploratory and require external validation in larger, multicenter studies before clinical implementation.

Background: Thalassemia is a common hereditary hemoglobin disorder in Vietnam. Elucidating the epidemiological and genetic patterns in children is essential for developing screening and prevention strategies.

Methods: A retrospective analysis of 1,240 children under 10 years of age with Thalassemia treated at the National Institute of Hematology and Blood Transfusion in Vietnam, between 2014 and 2023.

Results: The median age at treatment initiation was 1 year (range 0-9 years), with 94.5% of patients aged 0-5 years. Children born after 2020 were diagnosed and treated earlier than those born before 2020 (0 year (range 0-2 years) vs 1 year (range 0-9 years); p < 0.0001), concurrent with the implementation of the national prenatal screening program. β-thalassemia and β-thalassemia/HbE accounted for nearly 90% of cases, with subtype distribution varying by ethnicity and region. β-thalassemia/HbE predominated in the Northwest and North Central regions, particularly among the Thai and Muong populations. In contrast, β-thalassemia was more prevalent in the Northeast, notably among the Tay and Nung populations. Eight α-globin and thirteen β-globin mutated types were detected. The common β-globin variants (CD17, CD41/42, CD71/72, -28, and IVSI-1) and HbE (CD26) mirror patterns reported in neighboring Laos and Guangxi Province, China. For α-globin genotypes, --^SEA (49.83%), Hb CS (31.53%), and -α^3.7 (8.47%) were most frequent.

Conclusion: Geography, ethnicity, and genetic background strongly shape Thalassemia epidemiology in Northern Vietnam. Targeted genetic counseling, early carrier screening, and region-focused community programs are urgently needed to reduce disease burden in high-risk populations.