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Ruan J, Fu Z, Ying L. Clinical differences between Mycoplasma pneumoniae pneumonia and Streptococcus pneumoniae pneumonia: a case control study. Front Pediatr 2024; 12:1409687. [PMID: 39100649 PMCID: PMC11294199 DOI: 10.3389/fped.2024.1409687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction Mycoplasma pneumoniae pneumonia (MPP) and Streptococcus pneumoniae pneumonia (SPP) are frequent causes of respiratory tract infection, the aims of the study were to explore the differences in clinical features between children with MPP and those with SPP. Methods This retrospective study included admitted children who were diagnosed with MPP or SPP over 5 years from January 2015 to January 2020. Children with MPP were compared to children with SPP in terms of clinical features. Results 506 patients with MPP were compared to 311 patients with SPP in terms of clinical differences. The MPP group with a median age of 60 [29-89] months and the SPP group with a median age of 24 [10-40] months. Patients with MPP were older and had a higher occurrence of receiving antibiotics before admission, fever, dry cough, polypnea and diarrhea than patients with SPP (all p < 0.01). Patients with SPP were more likely to have wheezing, cyanosis and irritability (all p < 0.01). Laboratory findings in our study showed that there were significant differences between MPP and SPP patients in mean leucocyte count, neutrophil % (N%), lymphocyte % (L%), ALT levels, AST levels, LDH levels and incidence of accelerated procalcitonin (PCT) (all p < 0.01). Lower age, no dry cough, no polypnea, lower LDH levels, and higher PCT might lead to the diagnosis of SPP. Our study showed that age had a higher accuracy in predicting MPP than LDH levels, with an age >48.5 months shown to be an independent predictive factor for the early evaluation and identification of MPP. Discussion In conclusion, patients with MPP and SPP usually present with fever, cough and some nonspecific symptoms. Our study showed that age, dry cough, polypnea, LDH levels, and PCT levels were independent predictive factors associated with MPP and SPP.
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Affiliation(s)
- Jinping Ruan
- Department of Pediatrics, Chongqing Red Cross Hospital (People’s Hospital of Jiangbei District), Chongqing, China
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Linyan Ying
- Department of Pediatrics, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
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Li J, Zhang H, Guo J, Ma X. Clinical features of Mycoplasma pneumoniae pneumonia in children without fever. BMC Pediatr 2024; 24:52. [PMID: 38229052 DOI: 10.1186/s12887-023-04512-1] [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: 09/23/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children. Most children have fever. In 2021, we found that the proportion of children without fever increased. The aim of this study is to summarize the differences in the clinical characteristics of children with MP pneumonia who are febrile or not, and to raise awareness of children who are not febrile. METHOD Demographic information of the children was collected on admission. Clinical manifestations during the course of the disease and the first laboratory, imaging, and pulmonary function tests before discharge were recorded and compared. RESULTS From August to December, a total of 542 people were included in the study. We found that older children were more likely to have fever. Inflammatory indicators including procalcitonin (P = 0.030), C-reaction protein (P < 0.001), erythrocyte sedimentation rate (P < 0.001), ferritin (P = 0.040) and the rate of atelectasis (P = 0.049) of febrile children were higher in febrile children. However, the elevated lactate dehydrogenase and pulmonary function impairment (P all > 0.05), especially the small airway function impairment, are no lower in afebrile children than in febrile children. CONCLUSION The fever rate is lower in younger children, but wheezing is more common. In afebrile children, the impairment of organ and lung function was no less than in febrile children. Therefore, attention should also be paid to children who are not febrile.
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Affiliation(s)
- Jialin Li
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China
| | - Hua Zhang
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China
| | - Jing Guo
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China
| | - Xiang Ma
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China.
- Jinan Key Laboratory of Pediatric Respiratory diseases, Jinan Children's Hospital, Jinan, China.
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China.
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Liu M, Meng K, Jiang J, Zhang L, Sun S. Comparison of serodiagnosis methods for community-acquired Mycoplasma pneumoniae respiratory tract infections in children. Medicine (Baltimore) 2023; 102:e34133. [PMID: 37478238 PMCID: PMC10662900 DOI: 10.1097/md.0000000000034133] [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: 02/16/2023] [Accepted: 06/07/2023] [Indexed: 07/23/2023] Open
Abstract
This study aimed to evaluate the diagnostic value of chemiluminescence immunoassay (CLIA), passive particle agglutination (PPA), and indirect immunofluorescence assay (IFA) in detecting Mycoplasma pneumoniae infection in children. Serum samples from 165 children with acute community-acquired respiratory tract infections were examined using CLIA, PPA, and IFA, and consistency coefficient, specificity, and sensitivity were analyzed. Compared with the PPA (titer ≥ 1:160), the consistency coefficients of the immunoglobulin(Ig)M-CLIA, immunoglobulin(Ig)G-CLIA and IgM-IFA methods were 93.94%, 75.76%, and 83.64%, respectively. The positive likelihood ratio (PLR) and specificity of IgM-CLIA was 19.40 and 95.49%, respectively. The consistency coefficient of (IgM+IgG)-CLIA and PPA (titer ≥ 1:160) was 89.1%, and the sensitivity and negative predictive value of (IgM+IgG)-CLIA were 96.88% and 98.94%, respectively. CLIA MP-IgM has high concordance with PPA, and its specificity and sensitivity are higher than those of CLIA MP-IgG and IFA MP-IgM, suggesting its better diagnosis of early MP infection. The sensitivity and negative predictive value of CLIA MP (IgM+IgG) were higher than those of PPA or IFA, indicating that it should be considered as a priority in the diagnosis of MP infection.
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Affiliation(s)
- Mengyang Liu
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, P.R. China
| | - Ke Meng
- Department of Physical Examination of Qilu Hospital (Qingdao), Shandong University, Qingdao, P.R. China
| | - Jun Jiang
- Department of Physical Examination of Qilu Hospital (Qingdao), Shandong University, Qingdao, P.R. China
| | - Li Zhang
- Department of Immunology, School of Basic Medicine, Qingdao University, Qingdao, P.R. China
| | - Shiying Sun
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, P.R. China
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Sanyang B, de Silva TI, Kanteh A, Bojang A, Manneh J, de Steenhuijsen Piters WA, Peno C, Bogaert D, Sesay AK, Roca A. Effect of intra-partum azithromycin on the development of the infant nasopharyngeal microbiota: A post hoc analysis of a double-blind randomized trial. EBioMedicine 2022; 83:104227. [PMID: 35988464 PMCID: PMC9420482 DOI: 10.1016/j.ebiom.2022.104227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Sepsis is a leading cause of neonatal death. Intrapartum azithromycin reduces neonatal nasopharyngeal carriage of potentially pathogenic bacteria, a prerequisite for sepsis. Early antibiotic exposure has been associated with microbiota perturbations with varying effects. This study aims to understand the effect of intrapartum azithromycin intervention on the developing nasopharyngeal microbiota of the child. Methods Using 16S rRNA gene sequencing, we analysed the microbiota of 343 nasopharyngeal samples collected from birth to 12 months from 109 healthy infants selected from a double-blind randomized placebo-controlled clinical trial conducted in the Gambia (PregnAnZI-1). In the trial, 829 women were given 2g oral azithromycin or placebo (1:1) during labour with the objective of reducing bacterial carriage in mother and child during the neonatal period. The post-hoc analysis presented here assessed the effect of the intervention on the child nasopharyngeal microbiota development. Findings 55 children were from mothers given azithromycin and 54 from mothers given placebo. Comparing arms, we found an increase in alpha-diversity at day-6 (p = 0·018), and a significant effect on overall microbiota composition at days 6 and 28 (R2 = 4.4%, q = 0·007 and R2 = 2.3%, q = 0·018 respectively). At genus level, we found lower representation of Staphylococcus at day-6 (q = 0·0303) and higher representation of Moraxella at 12 months (q = 0·0443). Unsupervised clustering of samples by microbial community similarity showed different community dynamics between the intervention and placebo arms during the neonatal period. Interpretation These results indicate that intrapartum azithromycin caused short-term alterations in the nasopharyngeal microbiota with modest overall effect at 12 months of age. Further exploration of the effects of these variations on microbiome function will give more insight on the potential risks and benefits, for the child, associated with this intervention. Funding This work was jointly funded by the Medical Research Council (UK) (MC_EX_MR/J010391/1/MRC), Bill & Melinda Gates Foundation (OPP1196513), and MRCG@LSHTM Doctoral Training Program.
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Sun H, Li S, Wang T, Chen Z. Mycoplasma Pneumoniae Infection and Persistent Wheezing in Young Children: A Retrospective Case-Control Study. Front Pediatr 2022; 10:811086. [PMID: 35321015 PMCID: PMC8935056 DOI: 10.3389/fped.2022.811086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To investigate the clinical characteristics of children with persistent wheezing (PW) with Mycoplasma pneumoniae (MP) DNA in bronchoalveolar lavage fluid (BALF). METHODS This retrospective case-control study included consecutive admitted children under 3 years of age who were diagnosed with PW and had MP DNA detected in BALF. Patients with mycoplasma pneumoniae pneumonia (MPP) and foreign-body aspiration (FBA) were enrolled as controls. The clinical characteristics of the groups were compared. RESULTS During the study period, there were 89 patients diagnosed with PW without structural anomalies of the conductive airways, and 30 of these patients (33.7%, 30/89) with MP DNA detected in the BALF were selected as the study group. We included 44 patients with MPP and 44 patients with FBA as controls. Patients with MPP were older and had a higher occurrence of fever and C-reactive protein (CRP) than patients with PW (all P < 0.001). The median MP DNA copy number in patients with MPP was higher than that of patients with PW (P = 0.004). The median level of MP IgG in patients with PW was lower than that of patients with MPP and higher than that of patients with FBA (all P < 0.001). MP DNA copy number positively correlated with age (r = 0.392, P = 0.001) and CRP (r = 0.235, P = 0.048). CONCLUSIONS Our study reveals that MP was highly detected in the BALF of PW patients. In addition, young patients with a low load of MP infection showed lower amounts of antibody, and a weak inflammatory response might be associated with PW.
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Affiliation(s)
- Huiming Sun
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Shuxiang Li
- Department of Nuclear Medicine, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, China
| | - Ting Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Zhengrong Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
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Su M, Wang Q, Li D, Wang LL, Wang CY, Wang JL, Zhang Q, Du LY, Liu JY, Xie GC. Prevalence and clinical characteristics of hospitalized children with community-acquired Mycoplasma pneumoniae pneumonia during 2017/2018, Chengde, China. Medicine (Baltimore) 2021; 100:e23786. [PMID: 33592835 PMCID: PMC7870167 DOI: 10.1097/md.0000000000023786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
Community acquired-pneumonia (CAP) has varying causative pathogens and clinical characteristics. This study investigated the prevalence of Mycoplasma pneumoniae (M pneumoniae) and evaluated the clinical characteristics in infected hospitalized children by disease severity.From throat swabs of hospitalized children (5 months to 14 years) with CAP collected between November 2017 and May 2018, M pneumoniae and other CAP pathogens were identified using polymerase chain reaction (PCR). Differences in clinical and laboratory test data were compared between severe and mild case groups.Of 333 hospitalized children enrolled, 221/333 (66.4%) tested positive for M pneumoniae and 24/221 (10.9%) patients were (n = 9, aged <5 years vs n = 15, ≥5 years) single infection by PCR, however, only 170/333 (51.1%) patients were presented with M pneumoniae IgM-positive. M pneumoniae detection rate by PCR was higher than by immunoglobulin (IgM) serology. In 123/221 (55.7%) M pneumoniae infected patients, coinfection with bacterial pathogens (n = 61, <5 years vs n = 62, ≥5 years) occurred. Children (aged 3-8 years) had most M pneumoniae infection. Severe M pneumoniae pneumonia (MPP) in children occurred mostly in older age (7 [interquartile ranges {IQR}, 6-8] years; P < .0001), with longer cough days (14 [IQR, 10-19.5] days; P = .002) and hospitalization duration (9.5 [IQR, 7-12.3] days; P < .0001), lower lymphocyte ratio (24.1, [IQR, 20.0-31.1] %; P = .001), higher neutrophils ratio (66.0, [IQR, 60.2-70.3]%; P < .0001), and serum C-reactive protein (CRP) level (3.8, [IQR, 1.3-10.9] mg/L; P = .027).M pneumoniae is the most commonly detected pathogen in CAP. High coinfection prevalence increases diagnosis difficulty by clinically nonspecific characteristics. M pneumoniae detection by PCR with IgM may improve precise and reliable diagnosis of community-acquired MPP.
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Affiliation(s)
- Meng Su
- Department of Pathogenic Biology
| | - Qian Wang
- Department of Respiratory, Children′s Hospital of Hebei Province, Shijiazhuang
| | - Dan Li
- Department of Pathogenic Biology
| | - Ling-Ling Wang
- Department of Preventive Medicine, Chengde Medical University
| | - Chun-Yang Wang
- Clinical Medical College, Xi’an Medical University, Xi’an
| | - Jiang-Li Wang
- Chengde Center for Disease Control and Prevention, Department of Microbiology Laboratory
| | - Qing Zhang
- Chinese Center for Viral Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, Beijing
| | | | - Jian-Ying Liu
- Department of Pediatrics, NO.2 Clinical Teaching Hospital Affiliated to Chengde Medical University, Chengde, China
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Sun H, Xu H, Wang T, Yan Y, Ji W, Zhu C, Wang Y, Hao C, Chen Z. The implications of platelet count changes during hospitalization in the disease management of paediatric patients with bronchiolitis. Infect Dis (Lond) 2020; 52:786-792. [PMID: 32609033 DOI: 10.1080/23744235.2020.1787504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate the significance of the platelet count on admission and platelet count changes during hospitalization in paediatric patients with bronchiolitis. METHODS Clinical data from 404 consecutive patients hospitalized for bronchiolitis were collected and compared after grouping according to the platelet count on admission and the delta platelet count during hospitalization (the platelet count 3-5 days after admission minus the platelet count on admission; Group A, delta platelet count < -50 × 109/L; Group B, -50 × 109/L ≤ delta platelet count ≤ 50 × 109/L; Group C, delta platelet count > 50 × 109/L). RESULTS Thrombocytosis was found in 79 (19.6%) patients, while 325 (80.4%) patients had a normal platelet count on admission. There was no difference in disease severity between these two groups. Groups A, B and C comprised 57 (14.1%), 133 (32.9%) and 214 (53.0%) patients, respectively. The patients from Group A had longer periods of oxygen therapy and stay in the paediatric intensive care unit, and a greater frequency of mechanical ventilation than the patients from Group B or Group C (all p < .05). Notably, among all the patients, the delta platelet count negatively correlated with the numbers of days of oxygen therapy (r = -0.385, p < .001) and stay in the paediatric intensive care unit (r = -0.603, p < .001). CONCLUSIONS A decrease in the platelet count during hospitalization in paediatric patients with bronchiolitis may provide useful information for disease management.
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Affiliation(s)
- Huiming Sun
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Hua Xu
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ting Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Yongdong Yan
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Wei Ji
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Canhong Zhu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Zhengrong Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
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Lee KL, Lee CM, Yang TL, Yen TY, Chang LY, Chen JM, Lee PI, Huang LM, Lu CY. Severe Mycoplasma pneumoniae pneumonia requiring intensive care in children, 2010-2019. J Formos Med Assoc 2020; 120:281-291. [PMID: 32948415 DOI: 10.1016/j.jfma.2020.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/30/2020] [Accepted: 08/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/PURPOSE Despite the high prevalence of Mycoplasma pneumoniae infections, reports on severe life-threatening M. pneumoniae pneumonia (MPP) in children are limited. METHODS We retrospectively enrolled pediatric patients with PCR-positive MPP requiring ICU admission in a children's hospital in Taipei, Taiwan from Jun 2010 to October 2019. Clinical manifestations and laboratory data of severe MPP were analyzed. Macrolide susceptibility was determined by genotyping, and its relationship with clinical manifestations was also analyzed. RESULTS Approximately 5% (34/658) children hospitalized for MPP required ICU admission. Compared with non-ICU cases (n = 291), ICU cases (n = 34) were associated with more underlying conditions, more pleural effusion, longer fever duration, longer hospital stay, the requirement of second-line antibiotic treatment, and delayed effective and second-line antibiotic treatment. Macrolide resistance was similar in ICU and non-ICU groups (53% vs 53%; p = 0.986). In severe MPP, patients requiring endotracheal intubation were associated with more septic shock, empyema, ARDS, prolonged fever after effective antibiotic treatment, delayed second-line and effective antibiotic treatment. In 18 of the 22 patients with pleural fluid analysis, the pleural effusion was alkaline (pH > 7.7) and lymphocyte-predominant. CONCLUSION M. pneumoniae infection can cause severe life-threatening pneumonia in children. Delayed effective and second-line antibiotic treatments are associated with severe life-threatening MPP.
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Affiliation(s)
- Kuan-Lin Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Ming Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Te-Liang Yang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-Yu Yen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jong-Min Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Cai X, Xu Q, Zhou C, Zhou L, Yong Q, Mu Q, Cheng Y, Wang J, Xie J. Distribution characteristics of serum β2-microglobulin between viral and bacterial lower respiratory tract infections: a retrospective study. PeerJ 2020; 8:e9814. [PMID: 32904447 PMCID: PMC7453919 DOI: 10.7717/peerj.9814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/04/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is one of the leading cause of death in children under 5 years old around the world between 1980 and 2016. Distinguishing between viral and bacterial infection is challenging when children suffered from LRTI in the absence of pathogen detection. The aim of our study is to analyze the difference of serum β2-microglobulin (β2-MG) between viral LRTI and bacterial LRTI in children. METHODS This retrospective study included children with LRTI caused by a single pathogen from Yancheng Third People's Hospital, Yancheng, China, between January 1, 2016 and December 31, 2019. Participants were divided into the younger group (1 year old ≤ age < 3 years old) and the older group (3 years old ≤ age < 5 years old) for subgroup analysis. RESULTS A total of 475 children with LRTI caused by common respiratory pathogens were identified. In the younger group as well as the older group, the serum level of β2-MG in respiratory syncytial virus, influenza A virus and influenza B virus groups were significantly increased compared to that in the Mycoplasma pneumoniae group. Compared with Streptococcus pneumoniae infection group, the serum β2-MG level of respiratory syncytial virus, influenza A virus and influenza B virus groups were significantly higher in children between 1 and 3 years old. CONCLUSIONS The serum β2-MG may distinguish viral infection from bacterial infection in children with LRTI.
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Affiliation(s)
- Xulong Cai
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Qiaolan Xu
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Chenrong Zhou
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Li Zhou
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Qijun Yong
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Qing Mu
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Yan Cheng
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Jiena Wang
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
| | - Jingjing Xie
- Department of Pediatrics, Yancheng Third People’s Hospital, Yancheng, Jiangsu, China
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Aguilera-Alonso D, López Ruiz R, Centeno Rubiano J, Morell García M, Valero García I, Ocete Mochón MD, Montesinos Sanchis E. Epidemiological and clinical analysis of community-acquired Mycoplasma pneumonia in children from a Spanish population, 2010-2015. An Pediatr (Barc) 2020; 91:21-29. [PMID: 32289046 PMCID: PMC7146767 DOI: 10.1016/j.anpede.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction and objectives Mycoplasma pneumoniae (MP) is one of the most common etiological agents of community-acquired pneumonia (CAP) in children. We aimed to describe the clinical and epidemiological characteristics, treatment and outcome of children diagnosed with community-acquired MP pneumonia (CAMP) in a tertiary hospital in Valencia, Spain. Material and methods Medical records of children <14 years with CAMP were retrospectively reviewed from January 2010 to December 2015. Patients with radiological evidence of pneumonia and microbiological confirmation of MP (PCR from nasopharyngeal swab and/or serum specific IgM) were considered CAMP. Results One hundred and sixty two children were diagnosed with CAMP; median age 6 years (IQR: 4-9). The positive MP test rate among children with CAP progressively increased with age as did the empirical use of macrolides. There were two peaks of cases in 2011 and in 2015, being July, August, November and December the seasons with the higher number of cases. The most frequent radiological pattern was segmental infiltrate (62.3%) and 22 (13.6%) children had pleural effusion. It was noteworthy the mild symptomatology and low levels of inflammatory parameters that children with CAMP had. A macrolide was empirically initiated in 68.5% of cases. Hospital admission rate was inversely proportional to patient's age. Conclusions According to this study, older, less symptomatic patients and with lower inflammatory parameters had the greatest rate of MP infection among children with CAP and thus they could benefit of empiric macrolide therapy. Therefore, knowing the epidemiology of a geographical area may be important for the management of CAP in children.
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Affiliation(s)
- David Aguilera-Alonso
- Servicio de Pediatría, Hospital General Universitario, Valencia, Spain
- Corresponding author.
| | - Rocío López Ruiz
- Servicio de Pediatría, Hospital General Universitario, Valencia, Spain
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Li F, Zhu B, Xie G, Wang Y, Geng J. Effects of bronchoalveolar lavage on pediatric refractory mycoplasma pneumoniae pneumonia complicated with atelectasis: a prospective case-control study. Minerva Pediatr (Torino) 2020; 73:340-347. [PMID: 32241100 DOI: 10.23736/s2724-5276.20.05538-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There has been a paucity of data about the therapeutic efficacy of bronchoalveolar lavage (BAL) for pediatric refractory mycoplasma pneumonia pneumonia (RMPP) complicated with atelectasis. This study aimed to evaluate the clinical effectiveness and safety of BAL in pediatric RMPP inpatients complicated with atelectasis. METHODS Totally 225 children diagnosed as having RMPP with radiological proven irreversible atelectasis completed this study. According to whether they received BAL treatment, they were divided into BAL-intervention group (N.=125) and the control group (N.=100). Clinical, laboratory and radiological effects were compared between these two groups. Bronchoscopic imaging features were also comprehensively investigated. RESULTS Compared with control group, the febrile days after enrollment was significantly shorter in BAL-intervention group (3.0±1.6 d) compared with that in control group (4.1±1.7 d) (P<0.01). The duration of coughing was 3.1±1.7 d in BAL-intervention group and 4.6±1.8 days in the control group (P<0.01). The duration of abnormal lung auscultation was 3.8±1.8 d in intervention group and 5.8±1.6 d in the control group (P<0.01). The length of hospital stays was 5.8±1.6 days and 7.8±1.9 days (P<0.01), respectively. We also found that WBC count (P<0.01) and CRP value (P<0.01) recovered more quickly in BAL-intervention group compared with that in the control group. Seven days after admission, 85.6% of patients in BAL-intervention group showed atelectasis resolution versus 39.0% in control group (P<0.01), and for pleural effusion disappearance 78.4% versus 43.0% (P<0.01). CONCLUSIONS Our data suggested that BAL intervention combined with regular drug usage and prednisolone is a better treatment for RMPP children complicated with atelectasis than conventional drug therapy alone.
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Affiliation(s)
- Fang Li
- Department of Pediatrics, Taizhou Jiangyan Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Baihui Zhu
- Department of Pediatrics, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China -
| | - Guihui Xie
- Department of Pediatrics, Taizhou Jiangyan Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Yan Wang
- Department of Pediatrics, Taizhou Jiangyan Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Jianmei Geng
- Department of Pediatrics, Taizhou Jiangyan Hospital of Traditional Chinese Medicine, Taizhou, China
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Li QL, Dong HT, Sun HM, Zhang XX, Gu WJ, Huang L, Wang YQ, Yan YD, Ji W, Hao CL, Zhu CH, Chen ZR. The diagnostic value of serological tests and real-time polymerase chain reaction in children with acute Mycoplasma pneumoniae infection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:386. [PMID: 32355830 PMCID: PMC7186703 DOI: 10.21037/atm.2020.03.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study set out to evaluate the clinical significance and diagnostic effectiveness of serological tests and real-time polymerase chain reactions (RT-PCR) in children of different age groups and disease durations infected with Mycoplasma pneumoniae (MP). Methods Pediatric patients with lower respiratory tract infection (LRTI) confirmed by polymerase chain reaction (PCR) were enrolled and subjected to bronchoalveolar lavage fluid PCR (BALF-PCR) for MP infection. The diagnostic values of the serum immunoglobulin M (IgM) test, paired sera immunoglobulin G (IgG) test, RT PCR applied to nasopharyngeal aspirates (NPA-PCR), and combined IgM and NPA-PCR test were evaluated. Results When BALF PCR was used as the gold standard, the MP positivity rate of combined IgM and NPA PCR was 78.85%in children aged 3–5 years. The positivity rates of IgM, NPA PCR, and combined IgM and NPA PCR in children older than 5 years were 71.21%, 72.72%, and 84.85%, respectively. The detection rate of combined IgM and NPA PCR was consistent with BALF PCR (Kappa =0.727). The MP positivity rates of combined IgM and NPA PCR at 1–2 weeks was as high as 91.11%, and was consistent with the BALF PCR (Kappa =0.756). Moreover, the positivity rates of IgM or NPA PCR at 2-3 weeks were 63.16%, and were consistent with each other (Kappa =0.771). Conclusions Combined IgM and NPA PCR is the optimal test to confirm MP infection among children aged 3–5 years in cases with a disease duration of less than2 weeks, and either NPA PCR or IgM is recommended for children older than 5 years with a disease duration of 2–3 weeks. Keywords Mycoplasma pneumoniae pneumonia (MPP); diagnosis; children; age; disease duration
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Affiliation(s)
- Qing-Ling Li
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China.,The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi 445000, China
| | - He-Ting Dong
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Hui-Ming Sun
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Xin-Xing Zhang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Wen-Jing Gu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Li Huang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Yu-Qing Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Yong-Dong Yan
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Wei Ji
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Chuang-Li Hao
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Can-Hong Zhu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Zheng-Rong Chen
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou 215003, China
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Zhang D, Li Y, Chen Q, Jiang Y, Chu C, Ding Y, Yu Y, Fan Y, Shi J, Luo Y, Zhou W. The relationship between air quality and respiratory pathogens among children in Suzhou City. Ital J Pediatr 2019; 45:123. [PMID: 31547841 PMCID: PMC6757402 DOI: 10.1186/s13052-019-0702-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/06/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE We studied the short-term effects of air pollutant concentrations in Suzhou City on respiratory infections in children of different age groups. METHODS We employed clinical data from children hospitalized with respiratory infections at the Children's Hospital of Soochow University during 2014-2016, and air quality for Suzhou City covering the same period.We investigated the relationships between the air pollutant concentrations and respiratory tract infections in children by causative pathogen using time series models with lagged effects. RESULTS The results of single-pollutant models showed that PM2.5, PM10, NO2, SO2 and CO had statistically significant associations with respiratory tract infections in children under 3 years, with the largest effect sizes at a lag of 3 weeks. Notably, the multi-pollutant model found PM2.5 was significantly associated with viral respiratory in children under 7 months, and bacterial respiratory infections in other age groups, while PM10 concentrations were associated with viral infections in preschool children. CONCLUSION PM2.5, PM10 and NO2 are the main atmospheric pollutants in Suzhou. The associations between pollutant concentrations and viral and bacterial respiratory infections were stronger among children under 3 years than for older age group.s PM2.5 had the strongest influence on viral and Mycoplasma pneumoniae respiratory infections when multiple pollutants were tested together.
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Affiliation(s)
- Dandan Zhang
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yuqin Li
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Qiu Chen
- School of Radiation Medicine and Protection, Soochow University, Suzhou, 215123 China
| | - Yanqun Jiang
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Chu Chu
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Ying Ding
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yixue Yu
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yujie Fan
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Jinjin Shi
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Yali Luo
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
| | - Weifang Zhou
- Department of Infectious Disease, Children’s Hospital of Soochow University, Suzhou, 215003 China
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Guo DX, Hu WJ, Wei R, Wang H, Xu BP, Zhou W, Ma SJ, Huang H, Qin XG, Jiang Y, Dong XP, Fu XY, Shi DW, Wang LY, Shen AD, Xin DL. Epidemiology and mechanism of drug resistance of Mycoplasma pneumoniae in Beijing, China: A multicenter study. Bosn J Basic Med Sci 2019; 19:288-296. [PMID: 30878034 DOI: 10.17305/bjbms.2019.4053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 01/30/2023] Open
Abstract
Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired respiratory tract infections (RTIs). We aimed to investigate the prevalence of M. pneumoniae infection, antibiotic resistance and genetic diversity of M. pneumoniae isolates across multiple centers in Beijing, China. P1 protein was detected by Nested PCR to analyze the occurrence of M. pneumoniae in pediatric patients with RTI. M. pneumoniae isolates were cultured and analyzed by Nested-PCR to determine their genotypes. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of antibiotics. Out of 822 children with RTI admitted to 11 hospitals in Beijing, 341 (41.48%) were positive for M. pneumoniae by Nested PCR and 236 (69.21%) samples had mutations in 23S rRNA domain V. The highest proportion of M. pneumoniae positive samples was observed in school-age children (118/190; 62.11%) and in pediatric patients with pneumonia (220/389; 56.56%). Out of 341 M. pneumoniae positive samples, 99 (12.04%) isolates were successfully cultured and the MIC values were determined for 65 M. pneumoniae strains. Out of these, 57 (87.69%) strains were resistant to macrolides, and all 65 strains were sensitive to tetracyclines or quinolones. M. pneumoniae P1 type I and P1 type II strains were found in 57/65 (87.69%) and 8/65 (12.31%) of cultured isolates, respectively. Overall, we demonstrated a high prevalence of M. pneumoniae infection and high macrolide resistance of M. pneumoniae strains in Beijing. School-age children were more susceptible to M. pneumoniae, particularly the children with pneumonia. Thus, establishment of a systematic surveillance program to fully understand the epidemiology of M. pneumoniae is critical for the standardized use of antibiotics in China.
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Affiliation(s)
- Dong-Xing Guo
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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15
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Abstract
BACKGROUND Mycoplasma pneumoniae (MP) is a major cause of community-acquired upper and lower respiratory infections in school-age children; however, there is increasing recognition that younger children are also affected. Clinical manifestations vary from asymptomatic, to severe complicated pneumonia sometimes with extrapulmonary manifestations. METHODS We reviewed the medical records of all MP positive pediatric patients admitted to the Hadassah-Hebrew University Medical Center. MP positive case was defined if MP polymerase chain reaction was positive from an oropharyngeal swab sent from 2007 to 2017. RESULTS During the study period, we identified 353 MP positive pediatric cases, of which 51.3% (181 of 353) were younger than 6 years old. Full clinical data were available for 332 of 353 (94%). The median age was 5.7 years (range, 3 weeks to 18 years). Disease presentation differed between younger and older children. Children older than 6 years were more likely to have chest radiograph confirmed pneumonia (66% vs. 52%; P = 0.009), while younger children were more likely to have other respiratory manifestations (37% vs. 25%; P = 0.017). The duration of hospitalization and pediatric intensive care unit admission rate, however, did not differ between age groups. The rate of extrapulmonary manifestations were also similar. CONCLUSIONS MP-associated infection is a significant cause of hospitalization in the pediatric population including younger children (<6 years old). However, the clinical presentation in younger age is less typical than is thought. These findings should prompt clinicians to consider MP infections also in children younger than 6 admitted with fever even without pneumonia.
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Xu Y, Yu L, Hao C, Wang Y, Zhu C, Ji W, Li Y, Li G, Chen Z, Yan Y. Plasma soluble B7-H3 levels for severity evaluation in pediatric patients with Mycoplasma pneumoniae pneumonia. Int Immunopharmacol 2019; 73:163-171. [PMID: 31100711 DOI: 10.1016/j.intimp.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
Seeking for the novel biomarkers for Mycoplasma pneumoniae pneumonia (MPP) could be not only helpful for disease diagnosis but also useful for treatment efficacy monitoring. The aim of present study was to evaluate the role of plasma soluble B7-H3 (sB7-H3) in MPP diagnosis and treatment efficacy prediction, and involvement of B7-H3 in MPP disease course. A total of 108 MPP patients and 40 control subjects were recruited into this study for changes of sB7-H3 levels in MPP. In addition, a mouse model of MPP was also established for confirmation of the involvement of sB7-H3 in MPP in vivo. Significantly increased levels of sB7-H3 were found in both mild and severe MPP patients compared to control patients. Moreover, significantly increased level of sB7-H3 was also found in severe MPP patients compared to mild subjects. The ROC curve showed sB7-H3 had severity prediction capacity in mild and severe MPP. Plasma sB7-H3 correlated positively with IFN-r and GM-CSF in mild or severe MPP patients. Moreover, significantly increased level of plasma sB7-H3 level were found in acute phase MPP patients compared to control subjects, whereas significantly decreased level of plasma sB7-H3 was found in recovery phase MPP patients compared to acute phase patients. In addition, decreased levels of sB7-H3 were found in mice from Dexamethasone group compared to LAMP group. Plasma sB7-H3 level might serve as biomarker for severity MPP prediction and treatment efficacy evaluation. Furthermore, direct involvement of B7-H3 was confirmed in vivo during the MPP disease course.
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Affiliation(s)
- Yunyun Xu
- Institute of Pediatrics, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Lexiang Yu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Chuangli Hao
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Yuqing Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Canhong Zhu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Wei Ji
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Yiping Li
- Institute of Pediatrics, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Gang Li
- Institute of Pediatrics, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China
| | - Zhengrong Chen
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China.
| | - Yongdong Yan
- Department of Respiratory Disease, Children's Hospital of Soochow University, Suzhou, Jiangsu 215025, China.
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Li QL, Wu YY, Sun HM, Gu WJ, Zhang XX, Wang MJ, Yan YD, Hao CL, Ji W, Chen ZR. The role of miR-29c/B7-H3/Th17 axis in children with Mycoplasma pneumoniae pneumonia. Ital J Pediatr 2019; 45:61. [PMID: 31088519 PMCID: PMC6518711 DOI: 10.1186/s13052-019-0655-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. Recent studies demonstrated that the incidence of severe or fatal M. pneumoniae was gradually increasing, which may be related to the excessive inflammation. However, the exact pathogenesis of excessive inflammation in Mycoplasma pneumoniae pneumonia(MPP) is still unclear. This study aimed to reveal the role of miR-29c/B7-H3/Th17 axis in children with MPP. Methods Children hospitalized in Respiratory Department during Jan. 2014 to Dec. 2015 were enrolled. All children enrolled was confirmed with MP infection using real-time PCR and ELISA. Children were excluded if they were co-infected with other pathogens. A total of 52 children with MPP and 26 controls were enrolled. miR-29c expression in monocytes of children with MPP was determined by real-time PCR and soluble B7-H3 (sB7-H3) and IL-17 were determined by ELISA, and explore their clinical significance. miR-29c overexpression and silencing technology and luciferase reporter assay were performed to confirm whether B7-H3 is the direct target of miR-29c. The levels of transcription factor ROR-γt in CD4+ T cells and cytokine IL-17A in supernatant were detected after stimulated by different concentrations of B7-H3 fusion protein in vitro. Results Of all 52 children with MPP, the mean age of the children were 77 ± 33 months, and 23 cases were male accounting for 44.2%. Nineteen cases had pleural effusion accounting for 36.5%. Children with MPP had significantly lower level of miR-29c and higher level of sB7-H3 and IL-17 compared to controls (both P < 0.05). The level of miR-29c significantly increased during convalescent phase compared to that of acute phase while sB7-H3 and IL-17 significantly decreased during convalescent phase (both P < 0.05). There was a positive correlation between the level of sB7-H3 and IL-17 in children with MPP during acute-stage (r = 0.361,P = 0.009). Children with MPP combined with pleural effusion had significantly higher level of sB7-H3 compared to those without pleural effusion (9952.3 ± 3065.3 vs. 7449.7 ± 2231.5, pg/ml), and the levels of sB7-H3 was positively correlated with the number of days of fever. The level of miR-29c was negatively correlated with M. pneumoniae specific IgG, IgM level. High concentrations of B7-H3(15μg/ml) could enhance ROR-γt expression and increase IL-17A. Functional studies based on luciferase reporter assay and immunofluorescence staining suggested that B7-H3 is the direct target of miR-29c, and miR-29c silencing or overexpression could up- or down-regulate the expression of B7-H3 in THP-1 cells. Conclusions The axis of miR-29c/B7-H3/Th17 plays a vital role in children with MPP through excessive inflammation. miR-29c and B7-H3 may be the new target for the prevention and treatment of MPP, and may be the novel and potential biomarkers for the assessment of prognosis.
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Affiliation(s)
- Qing-Ling Li
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Yin-Yin Wu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Hui-Ming Sun
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Wen-Jing Gu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Xin-Xing Zhang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Mei-Juan Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Yong-Dong Yan
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Chuang-Li Hao
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Wei Ji
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China
| | - Zheng-Rong Chen
- Department of Respiratory Disease, Children's Hospital of Soochow University, Jingde Road NO.303, Jiangsu Province, Suzhou, 215003, China.
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Aguilera-Alonso D, López Ruiz R, Centeno Rubiano J, Morell García M, Valero García I, Ocete Mochón MD, Montesinos Sanchis E. [Epidemiological and clinical analysis of community-acquired Mycoplasma pneumonia in children from a Spanish population, 2010-2015]. An Pediatr (Barc) 2019; 91:21-29. [PMID: 30679135 PMCID: PMC7185449 DOI: 10.1016/j.anpedi.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/27/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022] Open
Abstract
Introducción y objetivos Mycoplasma pneumoniae (MP) es uno de los agentes etiológicos más comunes de las neumonías adquiridas en la comunidad (NAC) en niños. Objetivo: describir las características clínicas y epidemiológicas, tratamiento y evolución de los pacientes con NAC por MP (NACM) en un hospital terciario de Valencia, España. Material y métodos Se revisaron retrospectivamente las historias clínicas de los niños < 14 años con NACM entre enero de 2010 y diciembre de 2015. Los pacientes con evidencia radiológica de neumonía y confirmación microbiológica de MP (PCR de exudado nasofaríngeo y/o anticuerpos IgM específicos frente a MP) se consideraron NACM. Resultados Un total de 162 pacientes se diagnosticaron de NACM; mediana de edad de 6 años (rango intercuartílico: 4-9 años). La proporción de pruebas positivas para MP en pacientes con NAC, así como el uso empírico de macrólidos, aumentó progresivamente con la edad. Hubo un pico de casos en 2011 y en 2015, con un máximo de casos en julio, agosto, noviembre y diciembre. El patrón radiológico más frecuente fue el infiltrado segmentario (62,3%), mientras que 22 (13,6%) presentaron derrame pleural. Los niños con NACM desarrollaron una clínica leve, con poca elevación de parámetros inflamatorios. Se inició tratamiento empírico con un macrólido en el 68,5% de los casos. La necesidad de ingreso hospitalario fue inversamente proporcional a la edad del paciente. Conclusiones Según este estudio, los niños con NAC de mayor edad tuvieron la mayor proporción de infección por MP, siendo poco sintomáticos y con escasa elevación de parámetros inflamatorios, pudiéndose beneficiar del tratamiento empírico con macrólidos. Por consiguiente, conocer la epidemiología de un área geográfica podría ser importante para el abordaje de las NAC en niños.
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Affiliation(s)
| | - Rocío López Ruiz
- Servicio de Pediatría, Hospital General Universitario, Valencia, España
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Contribution of Co-detected Respiratory Viruses and Patient Age to the Clinical Manifestations of Mycoplasma Pneumoniae Pneumonia in Children. Pediatr Infect Dis J 2018; 37:531-536. [PMID: 29095244 DOI: 10.1097/inf.0000000000001819] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The clinical spectrum of Mycoplasma pneumoniae pneumonia is widely variable. This study evaluated the clinical manifestations of M. pneumoniae pneumonia in children of different age groups and by the presence of co-detected respiratory virus. METHODS This study included children hospitalized with M. pneumoniae pneumonia between 2010 and 2015. At the time of pneumonia diagnosis, a nasopharyngeal aspirate was analyzed for respiratory viruses by reverse transcription-polymerase chain reaction (RT-PCR). The clinical manifestations and laboratory findings were reviewed from medical records. RESULTS Of the 286 children with M. pneumoniae pneumonia, 84 (29.4%) had a co-detected respiratory virus, with the highest co-detection rate in young children (51.9% of children <2 years; P = 0.002). In children <2 years, with and without co-detected virus, wheezing occurred in 35.7% and 15.4%, respectively. Among the 202 children without any virus detected, only 6.4% were <2 years. These young children showed fewer median days of fever than the children ≥2 years (8 vs. 11 days; P = 0.022). Children ≥2 years tended to have accompanying skin rashes (21.7% vs.7.7%; P = 0.310) and elevated liver enzymes (21.7% vs. 0%; P = 0.075) more frequently than children <2 years. Only 53.8% of the patients <2 years were treated with macrolide compared with 94.1% of the patients ≥2 years (P < 0.001). CONCLUSIONS The clinical manifestations of M. pneumoniae pneumonia in young children are milder than those in older children. A high prevalence of co-detected respiratory virus in young children suggests that virus might play a role in making pneumonia clinically apparent in this age group.
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Shi S, Liu X, Li H. Downregulation of caspase‑3 alleviates Mycoplasma pneumoniae‑induced apoptosis in alveolar epithelial cells. Mol Med Rep 2017; 16:9601-9606. [PMID: 29039549 DOI: 10.3892/mmr.2017.7782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022] Open
Abstract
Mycoplasma pneumoniae (M. pneumoniae) infection is closely associated with pneumonia in children. Apoptosis of alveolar epithelial cells is involved in the development of pneumonia in children. The present study aimed to examine how caspase‑3 influences apoptosis rates in M. pneumoniae‑infected alveolar epithelial cells. A549 alveolar epithelial cells were treated with M. pneumoniae, and cells and culture supernatant were collected at different time points. Alterations in apoptosis rates and caspase‑3 mRNA and protein levels were measured for each treatment group. Cell apoptosis was detected using flow cytometry and TUNEL assay, and cell proliferation was detected using Cell Counting Kit‑8 assay. Caspase‑3 expression in A549 cells was inhibited via small interfering RNA (siRNA) knockdown and relative alterations in mRNA and protein levels and apoptosis rates were measured. Cytokine levels were measured using ELISA assay. Apoptosis rates of alveolar epithelial cells increased with prolonged exposure to M. pneumoniae (P<0.05). M. pneumoniae infection increased interleukin (IL)‑4, IL‑6 and IL‑13 levels and reduced IL‑10 levels. Caspase‑3 was upregulated, whereas B cell lymphoma (Bcl)‑2 was downregulated upon M. pneumoniae exposure for 24 h (P<0.05). Following 12 and 24 h of treatment, caspase‑3 levels in the siRNA‑treated cells were decreased compared with control group (P<0.05). M. pneumoniae also significantly altered caspase‑3 and Bcl‑2 protein expression. M. pneumoniae promoted apoptosis in alveolar epithelial cells via activation of the external death receptor pathway. Therefore, M. pneumoniae infection may affect the development of pneumonia in children by regulating caspase‑3 expression and promoting apoptosis.
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Affiliation(s)
- Shan Shi
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaolei Liu
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Haibo Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Lee E, Cho HJ, Hong SJ, Lee J, Sung H, Yu J. Prevalence and clinical manifestations of macrolide resistant Mycoplasma pneumoniae pneumonia in Korean children. KOREAN JOURNAL OF PEDIATRICS 2017; 60:151-157. [PMID: 28592978 PMCID: PMC5461279 DOI: 10.3345/kjp.2017.60.5.151] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/01/2016] [Accepted: 12/21/2016] [Indexed: 11/27/2022]
Abstract
Purpose Macrolide resistance rate of Mycoplasma pneumoniae has rapidly increased in children. Studies on the clinical features between macrolide susceptible-M. pneumoniae (MSMP) and macrolide resistant-M. pneumoniae (MRMP) are lacking. The aim of this study was to identify the macrolide resistance rate of M. pneumoniae in Korean children with M. pneumoniae penupmonia in 2015 and compare manifestations between MSMP and MRMP. Methods Among 122 children (0–18 years old) diagnosed with M. pneumoniae pneumonia, 95 children with the results of macrolide sensitivity test were included in this study. Clinical manifestations were acquired using retrospective medical records. Results The macrolide resistant rate of M. pneumoniae was 87.2% (82 of 94 patients) in children with M. pneumoniae pneumonia. One patient showed a mixed type of wild type and A2063G mutation in 23S rRNA of M. pneumoniae. There were no significant differences in clinical, laboratory, and radiologic findings between the MSMP and MRMP groups at the first visit to our hospital. The time interval between initiation of macrolide and defervescence was significantly longer in the MRMP group (4.9±3.3 vs. 2.8±3.1 days, P=0.039). Conclusion The macrolide resistant rate of M. pneumoniae is very high in children with M. pneumoniae pneumonia in Korea. The clinical manifestations of MRMP are similar to MSMP except for the defervescence period after administration of macrolide. Continuous monitoring of the occurrence and antimicrobial susceptibility of MRMP is required to control its spread and establish strategies for treating second-line antibiotic resistant M. pneumoniae infection.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Huang F, Lu L, Jiang W, Yan Y, Ji W, Yang B, Yu S. The epidemiology and clinical features of Mycoplasma pneumoniae infection in neonates. Braz J Infect Dis 2016; 20:374-8. [PMID: 27320858 PMCID: PMC9427572 DOI: 10.1016/j.bjid.2016.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/22/2016] [Accepted: 04/05/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This retrospective study was aimed to explore the epidemiological and clinical profiles of Mycoplasma pneumoniae infection in neonates. METHODS From 2011 to 2014, 1322 hospitalized neonates with lower respiratory tract infections were screened for Mycoplasma pneumoniae by detection of Mycoplasma pneumoniae antibodies using Serion ELISA classic Mycoplasma pneumoniae kits. RESULTS Mycoplasma pneumoniae was identified in 89 (6.7%) patients. The age ranged from 1 day to 28 days with a median of 22 days. The male to female ratio was 1.15:1. Mycoplasma pneumoniae infection peaked in spring (from March through May) and winter (from December through February). Compared with non-Mycoplasma pneumoniae infected neonates, those with Mycoplasma pneumoniae infection were older, presented fever more frequently, and had less tachypnea. CONCLUSIONS Mycoplasma pneumoniae could be an important etiologic agent for respiratory tract infection in neonates. In neonates Mycoplasma pneumoniae infection was usually associated with older age, presence of fever, and less tachypnea. Mycoplasma pneumoniae infection in neonates tends to be a mild process.
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Affiliation(s)
- Feng Huang
- Children's Hospital of Soochow University, Department of Respiratory Medicine, Suzhou, China
| | - Lianghua Lu
- Children's Hospital of Soochow University, Department of Neonatology, Suzhou, China
| | - Wujun Jiang
- Children's Hospital of Soochow University, Department of Respiratory Medicine, Suzhou, China
| | - Yongdong Yan
- Children's Hospital of Soochow University, Department of Respiratory Medicine, Suzhou, China.
| | - Wei Ji
- Children's Hospital of Soochow University, Department of Respiratory Medicine, Suzhou, China
| | - Bin Yang
- Children's Hospital of Soochow University, Department of Clinical Lab, Suzhou, China
| | - Shenglin Yu
- Children's Hospital of Soochow University, Department of Neonatology, Suzhou, China
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Chen Z, Zhao X, Zhang X, Zhang G, Sun H, Jiang W, Wang Y, Zhu C, Ji W, Yan Y. Increased concentrations of soluble B7-H3 and interleukin 36 in bronchoalveolar lavage fluid of Children with Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2016; 16:212. [PMID: 27188891 PMCID: PMC4869194 DOI: 10.1186/s12879-016-1555-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 05/10/2016] [Indexed: 03/03/2023] Open
Abstract
Background The purpose of this study is to explore the correlations of interleukin 36 (IL-36) and Soluble B7-H3 (sB7-H3) levels in bronchoalveolar lavage fluid (BALF) with clinical characteristics and laboratory findings. Methods A total of 35 children with M. pneumnoiae pneumonia (MPP) and 15 control subjects were enrolled. BALF concentrations of sB7-H3 and IL-36 were detected using enzyme-linked immunosorbent assays and clinical profiles of children with MPP were obtained. Results Children with MPP had significantly higher levels of sB7-H3 and IL-36 compared to control subjects (both P < 0.05). Meanwhile, children with pleural effusion had significantly higher levels of sB7-H3 and IL-36 compared to children without pleural effusion (both P < 0.05). BALF concentration of sB7-H3 was strongly associated with concentration of IL-36 (r = 0.796, P < 0.0001) and sB7-H3 was correlated with duration of fever (r = 0.427, P = 0.11) and length of stay (r = 0.345, P = 0.043). Both concentrations of sB7-H3 and IL-36 were significantly decreased in convalescent phase after treatment (both P < 0.05). Conclusion Both soluble B7-H3 and IL-36 may play an important role in pathogenesis of M. pneumoniae infection and sB7-H3 could be useful as a prognostic predictor or biomarker of MPP. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1555-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhengrong Chen
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Xin Zhao
- General surgery department, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Xinxing Zhang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Guangbo Zhang
- Clinical Immunology Laboratory, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
| | - Huiming Sun
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Wujun Jiang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yuqing Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Canhong Zhu
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China
| | - Wei Ji
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China.
| | - Yongdong Yan
- Department of Respiratory Disease, Children's Hospital of Soochow University, Soochow University, Suzhou, China.
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Abstract
Community-acquired pneumonia (CAP) is the most common acute infectious cause of death in children worldwide. Consequently, research into the epidemiology, diagnosis, treatment, and prevention of pediatric CAP spans the translational research spectrum. Herein, we aim to review the most significant findings reported by investigators focused on pediatric CAP research that has been reported in 2014 and 2015. Our review focuses on several key areas relevant to the clinical management of CAP. First, we will review recent advances in the understanding of CAP epidemiology worldwide, including the role of vaccination in the prevention of pediatric CAP. We also report on the expanding role of existing and emerging diagnostic technologies in CAP classification and management, as well as advances in optimizing antimicrobial use. Finally, we will review CAP management from the policy and future endeavors standpoint, including the influence of clinical practice guidelines on clinician management and patient outcomes, and future potential research directions that are in the early stages of investigation.
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