Bronchiolitis associated with Mycoplasma pneumoniae in infants in Suzhou China between 2010 and 2012

Clinical characteristics and etiology of children with bronchiolitis before and during the COVID-19 pandemic in Suzhou, China

OBJECTIVE

We sought to compare the clinical characteristics and etiology of children with bronchiolitis in Suzhou before the pandemic of coronavirus disease 2019 (COVID-19) with those during the pandemic.

METHODS

Children who were hospitalized with bronchiolitis in the Department of Respiratory Disease, Children's Hospital of Soochow University were retrospectively enrolled over 3 consecutive years (2019, 2020, and 2021) from February 1 to January 31. Medical records were reviewed for etiology, clinical manifestations, and laboratory examination results.

RESULTS

The pathogen detection rate and the positive respiratory syncytial virus (RSV) detection rate were lowest in 2020 and highest in 2021. The rate of human rhinovirus detection in 2021 was higher than that in 2019 but similar to that in 2020. The RSV-positive rate differences among the 3 years varied by age group. Regarding the monthly distribution of RSV-positive cases over the 3-year study, all age groups showed a significant increase in the number of cases during the winter of 2021, and this increase started as early as October. With regard to clinical manifestations, the proportion of children presenting with stuffy nose rhinorrhea in 2021 [73.33% (165/225)] was greater than that in 2019 [48.61% (122/251)] and 2020 [57.06% (97/170)], while the proportion of children with gastrointestinal symptoms in 2021 [11.56% (26/225)] was smaller than that in 2019 [25.50% (64/251)] but similar to that in 2020 [17.06% (29/170)].

CONCLUSIONS

After the implementation of COVID-19 pandemic-related interventions, significantly lower pathogen detection and RSV-positive rates were observed in children with bronchiolitis in 2020. An upward trend in these rates was observed in 2021, coinciding with the relaxation of COVID-19 prevention measures. Strengthening infection control and surveillance systems is extremely important for future work.

Mycoplasma Pneumoniae Infection and Persistent Wheezing in Young Children: A Retrospective Case-Control Study

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.

Identifying and managing bronchiolitis

Bronchiolitis is a common viral illness that affects the lower respiratory tract of infants and young children. The disease is characterized by wheezing and increased mucus production and can range from mild to severe in terms of respiratory distress. This article reviews the epidemiology, clinical presentation, and treatment of bronchiolitis.

Effects of bronchoalveolar lavage on pediatric refractory mycoplasma pneumoniae pneumonia complicated with atelectasis: a prospective case-control study

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.

Clinical characteristics of pneumonia caused by Mycoplasma pneumoniae in children of different ages

To study clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) in children of different ages. We investigated the medical records of MPP patients admitted at Children's Hospital of Soochow University from January 2006 and December 2013. The presence of MP was confirmed by real-time PCR and ELISA. There were overall 3358 children with MPP. 412 (12.3%) were <6 months old. Six months to 1 year, 1-3 years, 3-5 years and ≥5 years old children constituted 423 (12.6%), 1033 (30.8%), 733 (21.8%) and 757 (22.5%) respectively. Fever was less frequent in <6 months old infants, with frequency increasing in older patients. The proportion of patients with wheeze was highest (57.9%) in patients aged 6 months to 1-year-old. Tachypnea, cyanosis and hypoxemia were more prevalent in <6 months old infants (P=0.00). Radiologically, bronchopneumonia was frequent among infants, while segmental/lobar pneumonia was frequent in ≥5 years old patients. White blood cell and platelet counts of infants were significantly higher than other children. Neutrophil count, c-reaction protein levels was significantly different amongst age groups. Our study revealed MPP patients of different ages presented with different clinical findings especially <6 months old and ≥5 years of age, which may indicate different pathological findings in age groups of patients with MPP.

Kawasaki disease associated with Mycoplasma pneumoniae

BACKGROUND

Kawasaki disease (KD) is an illness of unknown etiology that mostly occurs in children under 5 years of age and is the leading cause of acquired heart disease all over the world. Mycoplasma pneumoniae (MP) was one of the likely causative agents of KD. However, the etiologic effect of MP in KD has not been fully recognized.

METHODS

We prospectively analyzed the clinical records of 450 patients with KD hospitalized in Children's Hospital of Soochow University from 2012 to 2014. Using medical records, we retrospectively identified patients with low respiratory tract infection (non-KD group).

RESULTS

Of the 450 KD patients, MP was positive in 62 (13.8 %). The median age of the MP + KD+ group was significantly older than the MP-KD+ group (25 vs 14.5 months, P < 0.01). MP + KD+ group had higher levels of ESR, N% and CRP than the MP-KD+ group. MP + KD+ group were more frequent in respiratory disorders than MP-KD+ group with a P < 0.05. No statistical difference of non-responders or coronary artery lesion was found between the groups.

CONCLUSIONS

MP infections are found in an important proportion of the KD patients (13.8 % in our series). MP infection tended to occur in older populations and with a higher rate of respiratory tract involvement in patients with KD. No statistical difference of non-responders or coronary artery lesion was found between the MP+ and MP- KD patients.

The epidemiology and clinical features of Mycoplasma pneumoniae infection in neonates

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.

Increased concentrations of soluble B7-H3 and interleukin 36 in bronchoalveolar lavage fluid of Children with Mycoplasma pneumoniae pneumonia

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.

Epidemiological and clinical profiles of respiratory syncytial virus infection in hospitalized neonates in Suzhou, China

BACKGROUND

This study was designed to explore the epidemiological and clinical profiles of respiratory syncytial virus (RSV) infection in neonates from the Suzhou area of China, taking into consideration how climate factors influence disease.

METHODS

From 2010 to 2014, nasopharyngeal aspirates (NPA) collected from hospitalized neonates with lower respiratory tract infections (LRIs) were screened for seven common respiratory viruses including RSV by direct immunofluorescence assay. Human bocavirus, human metapneumovirus, and mycoplasma pneumoniae were detected by polymerase chain reaction.

RESULTS

Of the 1803 hospitalized neonates analyzed, 20.74 % were found to be infected with RSV. Interestingly, 30 subjects were identified as being coinfected with other viruses. The rate of RSV infection was highestduring thewinter and early spring seasons; however, infection was negatively associated with monthly mean temperature (rs = -0.821, P < 0.0001), total rainfall (rs = -0.406, P = 0.002), and sum of sunshine (rs = -0.386, P = 0.001). Monthly mean temperature was the only independent factor associated with RSV activity, as determined using multivariate regression analysis. Compared with non-RSV neonates, neonates with RSV infection presented more frequently with tachypnea,moist rales, and abnormal chest X-rays requiring supplemental oxygen and extended hospitalization postpartum. Neonatal admittance into the NICU was determined based on prematurity and coinfection with other viruses; two independent risk factors for RSV disease, as determined by multivariate logistic analysis.

CONCLUSIONS

Important as a major cause of LRIs in hospitalized neonate, we found that the subtropical climate of the Suzhou area was associated with RSV activity. The identified risk factors ofsevere disease in neonates with RSV infection should be taken into consideration when implementing disease health interventions.