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Zhang J, Ma HK, Li BW, Ma KK, Zhang YL, Li SJ. Changes in urinary renal injury markers in children with Mycoplasma pneumoniae pneumonia and a prediction model for related early renal injury. Ital J Pediatr 2024; 50:155. [PMID: 39180109 PMCID: PMC11342508 DOI: 10.1186/s13052-024-01709-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/20/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND This study aims to analyse changes in urinary kidney injury markers in children with Mycoplasma pneumoniae pneumonia (MPP), investigate the risk factors for MPP-related acute kidney injury (AKI) and establish a model to predict MPP-related AKI. METHODS Ninety-five children were enrolled based on the study's inclusion and exclusion criteria. They were divided into a severe MPP (SMPP) group and a non-SMPP group and then into an AKI group and a non-AKI group according to the presence of AKI. A univariate logistic regression analysis was performed to explore the early risk factors for AKI. Based on a multivariate logistic regression analysis and a least absolute shrinkage and selection operator regression analysis, appropriate variables were selected to establish a prediction model, and R 4.2.2 software was used to draw nomograms and generate a dynamic nomogram website. RESULTS Seven urinary kidney injury markers were abnormally elevated in the SMPP group and the non-SMPP group: urinary N-acetyl-β-D-glucosaminidase (NAG), β2-microglobulin, α1-microglobulin, retinol-binding protein, urinary immunoglobulin G, urinary transferrin and urinary microalbumin. Sixteen children were identified with AKI during hospitalisation. The AKI group had higher levels of urinary NAG, α1-microglobulin, β2-microglobulin, urinary microalbumin, urinary transferrin and retinol-binding protein than the non-AKI group (P < 0.05). The MPP-related AKI prediction model consists of four indicators (serum immunoglobulin M [IgM], C-reactive protein [CRP], urine NAG and sputum plug presence) and a dynamic nomogram. CONCLUSION Urinary kidney injury markers are often elevated in children with MPP; urinary NAG is the marker most likely to be elevated, and it is especially evident in severe cases. The nomogram of the prediction model, comprising serum IgM, CRP, urinary NAG and sputum plug presence, can predict the probability of AKI in children with MPP.
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Affiliation(s)
- Ju Zhang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University No. 88, Weihui Jianjian Road, Xinxiang, 453100, China
| | - He-Kai Ma
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University No. 88, Weihui Jianjian Road, Xinxiang, 453100, China
| | - Bao-Wen Li
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University No. 88, Weihui Jianjian Road, Xinxiang, 453100, China
| | - Ke-Ke Ma
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University No. 88, Weihui Jianjian Road, Xinxiang, 453100, China
| | - Yu-Ling Zhang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University No. 88, Weihui Jianjian Road, Xinxiang, 453100, China
| | - Shu-Jun Li
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University No. 88, Weihui Jianjian Road, Xinxiang, 453100, China.
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Sun X, Wang Y, Wang L, Xu Z, Tang F, Zeng X, Zhang F. Case report of legionnaire's disease mimicking idiopathic inflammatory myopathy. Int J Rheum Dis 2024; 27:e15213. [PMID: 38881296 DOI: 10.1111/1756-185x.15213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/08/2024] [Accepted: 05/21/2024] [Indexed: 06/18/2024]
Affiliation(s)
- Xiaochuan Sun
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Yutie Wang
- Department of Rheumatology and Immunology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Li Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Zuojun Xu
- Department of Pulmonary and Critical Care, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Fulin Tang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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Almutairi A, Alenezi F, Tamim H, Sadat M, Humaid FB, AlMatrood A, Syed Y, Arabi Y. The prevalence of acute kidney injury in patients with community-acquired pneumonia who required mechanical ventilation. Ann Saudi Med 2024; 44:104-110. [PMID: 38615183 PMCID: PMC11016152 DOI: 10.5144/0256-4947.2024.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 12/08/2023] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a common reason for intensive care unit (ICU) admission and sepsis. Acute kidney injury (AKI) is a frequent complication of community-acquired pneumonia and is associated with increased short- and long-term morbidity and mortality and healthcare costs. OBJECTIVE Describe the prevalence of AKI in patients with CAP requiring mechanical ventilation and evaluate its association with inhospital mortality. DESIGN Retrospective cohort. SETTING Intensive care unit. PATIENTS AND METHODS We included patients with CAP on mechanical ventilation. Patients were categorized according to the development of AKI in the first 24 hours of ICU admission using the Kidney Disease Improving Global Outcomes (KDIGO) classification from no AKI, stage 1 AKI, stage 2 AKI, and stage 3 AKI. MAIN OUTCOME MEASURES The primary outcome was hospital mortality. Secondary outcomes were ICU mortality, hospital and ICU length of stay, ventilation duration, tracheostomy, and renal replacement therapy requirement. RESULTS Of 1536 patients included in the study, 829 patients (54%) had no AKI while 707 (46%) developed AKI. In-hospital mortality was 288/829 (34.8%) for patients with no AKI, 43/111 (38.7%) for stage 1 AKI, 86/216 (40%) for stage 2 AKI, and 196/380 (51.7%) for stage 3 AKI (P<.0001). Multivariate analysis revealed that stages 1, 2, or 3 AKI compared to no AKI were not independently associated with in-hospital mortality. Older age, vasopressor use; decreased Glasgow coma scale, PaO2/Fio2 ratio and platelet count, increased bilirubin, lactic acid and INR were associated with increased mortality while female sex was associated with reduced mortality. CONCLUSION Among mechanically ventilated patients with CAP, AKI was common and was associated with higher crude mortality. The higher mortality could not be attributed alone to AKI, but rather appeared to be related to multi-organ dysfunction. LIMITATIONS Single-center retrospective study with no data on baseline serum creatinine and the use of estimated baseline creatinine distributions based on the MDRD (Modification of Diet in Renal Disease)equation which may lead to an overestimation of AKI. Second, we did not have data on the microbiology of pneumonia, appropriateness of antibiotic therapy or the administration of other medications that have been demonstrated to be associated with AKI.
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Affiliation(s)
- Abdulmajed Almutairi
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Farhan Alenezi
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Musharaf Sadat
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Felwa Bin Humaid
- Intensive Care Unit, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Amal AlMatrood
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yadullah Syed
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- From the Intensive Care Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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A Case of Legionnaires’ Disease with Severe Rhabdomyolysis Misdiagnosed as COVID-19. Heliyon 2022; 8:e12341. [PMCID: PMC9734067 DOI: 10.1016/j.heliyon.2022.e12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/29/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background COVID-19 case numbers have begun to rise with the recently reported Omicron variant. In the last two years, COVID-19 is the first diagnosis that comes to mind when a patient is admitted with respiratory symptoms and pulmonary ground-glass opacities. However, other causes should be kept in mind as well. Here we present a case of Legionnaires’ disease misdiagnosed as COVID-19. Case Presentation A 48-year-old male was admitted with complaints of dry cough and dyspnea. Chest computed-tomography revealed bilateral ground-glass opacities; therefore, a preliminary diagnosis of COVID-19 was made. However, two consecutive COVID PCR tests were negative and the patient deteriorated rapidly. As severe rhabdomyolysis and acute renal failure were present, Legionnaires’ disease was suspected. Urine antigen test for Legionella and Legionella pneumophila PCR turned out to be positive. The patient responded dramatically to intravenous levofloxacin and was discharged successfully. Discussion Legionnaires’ disease and COVID-19 may present with similar signs and symptoms. They also share common risk factors and radiological findings. Conclusions Shared clinical and radiological features between COVID-19 and other causes of acute respiratory failure pose a challenge in diagnosis. Other causes such as Legionnaires’ disease must be kept in mind and appropriate diagnostic tests should be performed accordingly.
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Acute Pancreatitis Associated with Atypical Bacterial Pneumonia: Systematic Literature Review. J Clin Med 2022; 11:jcm11237248. [PMID: 36498822 PMCID: PMC9736890 DOI: 10.3390/jcm11237248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extra-pulmonary features sometimes occur in association with atypical bacterial pneumonia and include neurologic manifestations, diarrhea, rashes, altered liver enzymes, or kidney injury, among other conditions. Acute pancreatitis has been associated with atypical pneumonias since 1973. METHODS We performed a systematic review of the literature in the Excerpta Medica, National Library of Medicine, and Web of Science databases. We retained 27 reports published between 1973 and 2022 describing subjects with an otherwise unexplained pancreatitis temporally associated with an atypical pneumonia. RESULTS The reports included 33 subjects (19 males, and 14 females; 8 children and 25 adults) with acute pancreatitis temporally associated with atypical pneumonia caused by Mycoplasma pneumoniae (n = 18), Legionella species (n = 14), or Coxiella burnetii (n = 1). Approximately 90% of patients (n = 29) concurrently presented with respiratory and pancreatic diseases. No cases associated with Chlamydophila pneumoniae, Chlamydophila psittaci, or Francisella species were found. CONCLUSIONS Acute pancreatitis has been associated with various infectious agents. The present review documents the association with atypical pneumonia induced by Mycoplasma pneumoniae, Legionella species, and Coxiella burnetii.
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Branstetter A, Wyler B. Legionnaires' Disease Causing Severe Rhabdomyolysis and Acute Renal Failure: A Case Report. Clin Pract Cases Emerg Med 2022; 6:288-291. [PMID: 36427031 PMCID: PMC9697879 DOI: 10.5811/cpcem.2022.8.57155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Legionnaires' disease is a multisystem disease involving respiratory, gastrointestinal, and neurologic systems. This is a case of a previously healthy 44-year-old man who was diagnosed with Legionella pneumonia causing acute kidney failure and rhabdomyolysis. CASE REPORT The patient presented with four days of chills, shortness of breath, chest discomfort, diarrhea, and myalgias. Laboratory testing revealed hyponatremia, leukocytosis, elevated inflammatory markers, renal failure, and rhabdomyolysis. He was admitted to the intensive care unit for acute hypoxemic respiratory failure, received a course of antibiotics, and more than two weeks of intermittent hemodialysis with full recovery of renal function. The pathophysiologic mechanisms by which Legionella causes rhabdomyolysis and acute kidney failure are not fully understood, although numerous mechanisms have been proposed including direct invasion of myocytes and renal tubular cells. CONCLUSION Legionnaires' disease is one of several infections that can cause rhabdomyolysis and kidney failure. Although rarely described in the literature, it is important for emergency physicians to be aware of this clinical entity in order to implement early diagnostic testing and empiric treatment.
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Affiliation(s)
- Andrew Branstetter
- Mount Sinai Morningside-West, Department of Emergency Medicine, New York, New York
| | - Benjamin Wyler
- Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York, New York
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Hill J, Li J, Li Y. Incidence and influence of hyperCKemia in Legionella infection. J Neurol Sci 2022; 436:120252. [DOI: 10.1016/j.jns.2022.120252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/08/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
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Cai F, Shou X, Ye Q. Epidemiological Study on Mycoplasma pneumoniae and Chlamydia pneumoniae Infection of Hospitalized Children in a Single Center During the COVID-19 Pandemic. Front Cell Infect Microbiol 2022; 12:843463. [PMID: 35386684 PMCID: PMC8977740 DOI: 10.3389/fcimb.2022.843463] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Since the outbreak of COVID-19, a series of preventive and control measures in China have been used to effectively curb the spread of COVID-19. This study aimed to analyze the epidemiological characteristics of Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) in hospitalized children with acute respiratory tract infection during the COVID-19 pandemic. Methods MP IgM antibody and CP IgM antibody were detected in all hospitalized children due to acute respiratory tract infection in the Children’s Hospital Affiliated to Zhejiang University from January 2019 to December 2020. These data were compared between 2019 and 2020 based on age and month. Results The overall detection rate of MP and CP in 2020 was significantly lower than that in 2019 (MP: 21.5% vs 32.9%, P<0.001; CP: 0.3% vs 0.9%, P<0.001). This study found a 4-fold reduction in the number of children positive for MP and a 7.5-fold reduction in the number of children positive for CP from 2019 to 2020. The positive cases were concentrated in children aged >1 year old. In 2019, the positive rate of MP was detected more commonly in children 3 years of age or older than in younger children. In 2020, the higher positive rate of MP reached a peak in the 3- to 6-year age group (35.3%). CP was detected predominantly in children aged 6 years older in 2019 and 2020, with positive rates of 4.8% and 2.6%, respectively. Meanwhile, the positive rates of MP in 2019 were detected more commonly in July, August and September, with 47.2%, 46.7% and 46.3%, respectively. Nevertheless, the positive rates of MP from February to December 2020 apparently decreased compared to those in 2019. The positive rates of CP were evenly distributed throughout the year, with 0.5%-1.6% in 2019 and 0.0%-2.1% in 2020. Conclusions A series of preventive and control measures for SARS-CoV-2 during the COVID-19 pandemic can not only contain the spread of SARS-CoV-2 but also sharply improve the infection of other atypical pathogens, including MP and CP.
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Zhang A, Xia X, Yuan X, Liu Y, Niu H, Zhang Y, Liang J. Severe Chlamydia psittaci Pneumonia Complicated by Rhabdomyolysis: A Case Series. Infect Drug Resist 2022; 15:873-881. [PMID: 35281577 PMCID: PMC8910519 DOI: 10.2147/idr.s355024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Anbing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Xiuqiong Xia
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Xiaoling Yuan
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Yuxia Liu
- Department of Intensive Care Unit, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Haiming Niu
- Department of Intensive Care Unit, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Yinying Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Jianping Liang
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
- Correspondence: Jianping Liang, Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, No. 2, Sunwen East Road, Zhongshan, 528400, People’s Republic of China, Tel +86-1587-602-6693, Fax +86-760-8988-0256, Email
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Han HY, Park KC, Yang EA, Lee KY. Macrolide-Resistant and Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia in Children Treated Using Early Corticosteroids. J Clin Med 2021; 10:jcm10061309. [PMID: 33810090 PMCID: PMC8004593 DOI: 10.3390/jcm10061309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
We have found that early corticosteroid therapy was effective for reducing morbidity during five Korea-wide epidemics. We evaluated the clinical and laboratory parameters of 56 children who received early corticosteroid treatment for pneumonia that was caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae) or macrolide-sensitive M. pneumoniae between July 2019 and February 2020. All subjects had dual positive results from a PCR assay and serological test, and received corticosteroids within 24–36 h after admission. Point mutation of residues 2063, 2064, and 2067 was identified in domain V of 23S rRNA. The mean age was 6.8 years and the male:female ratio was 1.2:1 (31:25 patients). Most of the subjects had macrolide-resistant M. pneumoniae (73%), and all mutated strains had the A2063G transition. No significant differences in clinical and laboratory parameters were observed between macrolide-resistant and macrolide-sensitive M. pneumoniae groups that were treated with early dose-adjusted corticosteroids. Higher-dose steroid treatment may be needed for patients who have fever that persists for >48 h or increased biomarkers such as lactate dehydrogenase concentration at follow-up despite a usual dose of steroid therapy.
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Affiliation(s)
- Hye Young Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.Y.H.); (K.-Y.L.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea
| | - Ki Cheol Park
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea;
| | - Eun-Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.Y.H.); (K.-Y.L.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea
- Correspondence: ; Tel.: +82-42-220-9540; Fax: +82-42-221-2925
| | - Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.Y.H.); (K.-Y.L.)
- Junglock Biomedical Institute, 127, Yuchun-ro, Jung-gu, Deajeon 34886, Korea
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