Volume 04 · Issue 03 · 2024

在冠状病毒疾病2019（新冠肺炎）爆发之前，临床环境中广泛使用的唯一抗病毒治疗是流感。然而，在全球疫情之后，人们对呼吸道病毒感染的药物重新产生了研究兴趣。由于人群间疾病严重程度的显著差异，抗病毒药物的临床试验往往需要考虑多个维度。例如，在呼吸道病毒流行季节，临床疾病谱通常很复杂，包括无症状感染、有症状感染（轻至中度无需住院）、重症病例（需要住院）和死亡病例。

乙型肝炎病毒（HBV）感染是一个主要的公共卫生问题，也是慢性肝病的原因，2019年估计有82万人死亡，主要是由于肝硬化和肝癌。2019年，世卫组织估计有2.96亿人慢性感染和患有乙型肝炎，中低收入国家的负担不成比例地高。世卫组织非洲区域、东南亚区域和西太平洋区域占全球负担的88%。慢性乙型肝炎（CHB）的大部分全球负担可归因于出生时或出生后不久的母婴传播，此类围产期感染导致高慢性率。通过普遍的婴儿HBV免疫，包括及时的乙型肝炎出生剂量，在消除HBV围产期传播方面取得了相当大的进展，这在减少儿童新感染方面非常有效。然而，2022年全球乙型肝炎出生剂量覆盖率仅为45%，世卫组织非洲地区覆盖率最低（18%）。对于CHB感染者，目前推荐的替诺福韦和恩替卡韦的核苷类似物治疗非常有效，可以延缓肝硬化的进展，降低肝细胞癌（HCC）的发生率，提高长期生存率。然而，仍然存在重大的检测和治疗差距。2019年，在估计的2.96亿慢性乙型肝炎患者中，只有10%被诊断出来，2%接受了治疗。扩大检测和治疗以实现消除目标将需要彻底简化治疗标准和护理途径，以克服获得乙型肝炎检测和治疗的障碍。

The aim of this consensus is to standardize the prevention, diagnosis, and treatment of chronic hepatitis B in children and to achieve the goal of "eliminating viral hepatitis as a major public health threat by 2030" issued by the World Health Organization. Formulated by organized experts of the Chinese Society of Infectious Diseases and Chinese Society of Hepatology, Chinese Medical Association; Group of Infectious Diseases, Chinese Pediatric Society, Chinese Medical Association; and the National Clinical Research Center for Infectious Diseases (Beijing), the consensus provides the latest evidence and recommendations for the prevention, diagnosis, and treatment of chronic hepatitis B in children.

Monkeypox (mpox) is a rare viral zoonotic disease, endemic to Central and West Africa, caused by the monkeypox virus, an orthopoxvirus similar to the variola virus (smallpox). Although sporadic travel-associated cases have historically occurred outside Africa, in May 2022, mpox began spreading globally in multiple nonendemic countries across several continents. In 2024, there has been an increase in globally reported confirmed cases of mpox and deaths from mpox, making it a public health emergency of international concern. The reasons for the unusual global spread are under investigation but likely relate to increased travel and waning population immunity to orthopoxviruses. Transmission now appears to be mainly through close, intimate contact, especially among men who have sex with men. Mpox is usually a self-limited disease. Although limited approved antiviral treatments are available, such as tecovirimat, which the European Medicines Agency approved in January 2022 for the treatment of mpox, their widespread availability and effectiveness in the current outbreak remain to be investigated. Public health control measures include surveillance, case identification/isolation, contact tracing, and targeted vaccination of contacts at high risk of exposure. However, challenges remain in curtailing the current unprecedented outbreak. Critical knowledge gaps include animal reservoir(s) responsible for initial spillover events, viral mutations that may enhance transmissibility, optimal diagnostics for noninvasive specimens, effective antiviral therapies, next-generation vaccines providing longer-term immunity, and building global capacity for outbreak response. This review summarizes the current literature on mpox virology, epidemiology, pathogenesis, clinical manifestations, diagnostics, treatment, prevention, and public health control measures. Ongoing investigation and research are needed to better understand mpox’s evolving epidemiology, pathogenicity, transmissibility, and ecology to guide strategies for containing the outbreak and preventing future global emergence.

Infection and vaccination can provide protective immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the emergence of SARS-CoV-2 variants has persisted, leading to breakthrough infections. Owing to the original antigenic sin (OAS), variant breakthrough infection or vaccination potentially induces a stronger antibody response against the ancestral strain than to subsequent variants, as in the case of influenza. Thus, overcoming OAS is important for the development of future vaccine designs. This review summarizes the recent findings on OAS in the antibody response to SARS-CoV-2 and its variants, with an emphasis on future vaccine designs.

结核病(TB)，由结核分枝杆菌，仍然是全球传染病中死亡的主要原因。潜伏性结核病感染（LTBI）导致结核病疾病的全球负担。结核病预防性治疗（TPT）是实现最终结核病战略目标的关键干预措施。世界卫生组织推荐LTBI治疗方案，包括6个月或9个月的每日一次异烟肼(INH，H)，4个月的每日一次利福平(RIF，R)，3个月的每周一次利福喷丁(RPT，P)加INH(3HP)，3个月的每日一次RIF加INH，或1个月的每日一次RPT加INH(1HP)。临床医生和LTBI患者可能不愿意实施TPT，部分原因是担心当前推荐的LTBI治疗方案的长治疗持续时间和药物毒性。非常需要更短、耐受性更好且具有成本效益的TPT方案。利福喷丁是一种长效利福霉素，以利福霉素为基础的方案现在是首选的LTBI治疗，因为它们具有相似或更好的疗效，并且由于持续时间较短而具有更高的完成率。根据我们在中国矽肺患者中进行TPT实践的经验，我们发现3HP方案的耐受性不佳，因为不良事件（AE）（70.4%）和3级或4级AE（7.9%）的频率出乎意料地高，尤其是流感样全身药物反应（SDR）的发生率高（10.8%）。^[1]该结果与同期在中国老年人中进行的临床试验结果一致。^[2]AE的高发生率导致3HP方案的低完成率。我们试验中的药代动力学分析显示，从时间零到无穷大的曲线下几何平均面积（AUC_0-inf）的利福喷丁及其代谢物分别比TBTC和预防结核病研究中观察到的高2倍和1.6倍以上。^[1]此外，给药后24小时的几何平均浓度也是预防结核病研究中的两倍。同时，流感样SDR通常发生在接受间歇性利福平治疗的个体中，通常是在高剂量之后。^[3]因此，我们设计了一种新的为期一个月、每周三次的方案，由INH加RPT组成，称为1H₃P₃养生法。目的是通过减少药物的单次剂量和增加给药频率来降低峰值浓度，从而避免与间歇给药相关的SDR。

Mycoplasma hominis is an opportunistic microorganism that colonizes the genitourinary tract and causes genitourinary infections. However, pulmonary infections caused by M. hominis have rarely been reported in immunocompetent individuals. Herein, we report a rare case of an immunocompetent adult male with M. hominis pneumonia who presented with multiple pulmonary nodules that progressed to a cavitary mass with a halo sign. The presence of M. hominis infection was confirmed using multiplex polymerase chain reaction (mPCR) of the bronchoalveolar lavage fluid. The patient demonstrated no response to the initial levofloxacin therapy; however, the symptoms subsequently improved after the administration of moxifloxacin. M. hominis may be an underestimated causative agent of community-acquired pneumonia of unknown etiology in immunocompetent adults, and the involvement of the organism should be especially suspected in sexually active patients. Molecular diagnostic methods, such as mPCR, can be used to identify the etiology of atypical pneumonia. Appropriate antibiotics are crucial for effective treatment.

The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans. Although Citrobacter infections are infrequently diagnosed in environmental contexts, the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections. We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis. On hospital day 1, joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri, a pathogen not commonly associated with septic arthritis, and ceftriaxone was administered to target it. On hospital day 7, antibiotic was transitioned to levofloxacin, every other day for 4 weeks. The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay. This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling, especially in a postoperative setting.