Mycoplasma pneumoniae triggers pneumonia epidemic in autumn and winter in Beijing: a multicentre, population-based epidemiological study between 2015 and 2020

Detection of Mycoplasma pneumoniae in hospitalized pediatric patients presenting with acute lower respiratory tract infections utilizing targeted next-generation sequencing

BACKGROUND

Mycoplasma pneumoniae is a prevalent pathogen in pediatric community-acquired pneumonia. Currently, limited literature exists on the clinical utilization of pathogen-targeted sequencing technologies.

METHODS

Targeted next-generation sequencing (tNGS) technology was employed to analyze bronchoalveolar lavage fluid (BALF) from 1,070 hospitalized pediatric patients with acute lower respiratory tract infections. Subsequently, the clinical data of children diagnosed with Mycoplasma pneumoniae pneumonia were systematically evaluated.

RESULTS

tNGS identified pathogenic infections in 1,064 (99.4%) of these patients, with M. pneumoniae infections representing 56.9% of the cases. Of these with M. pneumoniae cases, 169 patients (27.75%, 169/609) had infections solely due to with M. pneumoniae, while 440 patients (72.25%, 440/609) presented with co-infections involving M. pneumoniae and additional microorganisms. Among the co-infections, Rhinovirus was the most frequent co-infecting pathogen (120/609), followed by Streptococcus pneumoniae (91/609), human respiratory syncytial virus (78/609) and human parainfluenza virus (74/609). Among the 609 children identified M. pneumoniae infection, 274 were found to harbor macrolide-resistant M. pneumoniae (MRMP), yielding a resistance rate of 45.0% (274/609). In children with M. pneumoniae infection, pleural effusion and respiratory failure emerged as the most prevalent respiratory complications, while hepatic impairment and myocardial impairment were the predominant complications of other systems. The median duration of hospitalization for the children diagnosed with M. pneumoniae infection was 7 days. Out of 609 children with M. pneumoniae infection, 10 cases required intensive care unit (ICU) admission, accounting for 1.64% of the total.

CONCLUSION

tNGS technology exhibits substantial clinical utility in identifying pathogens associated with respiratory tract infections. This study delineates the clinical manifestations and co-infection patterns of M. pneumoniae in Guangxi, China.

Comparison of the epidemiological characteristics of mycoplasma pneumoniae infections among children during two epidemics in Wuhan from 2018 to 2024

BACKGROUND

Mycoplasma pneumoniae (M pneumoniae, MP) is a common pathogen causing respiratory tract infections, particularly in children. In 2023, a resurgence of MP epidemics was observed in Wuhan, Hubei Province, China. This study aims to examine the epidemiological trends and clinical characteristics of MP infections among children in Wuhan from 2018 to 2024, providing valuable scientific evidence to guide local prevention strategies.

METHODS

From January 1, 2018, to June 30, 2024, samples were collected from children under 14 years with Acute Respiratory Tract Infections (ARTI) at Renmin Hospital of Wuhan University. MP infections were diagnosed through MP-IgM antibody detection and MP-DNA detection. Results were analyzed and compared across distinct epidemic periods.

RESULTS

Of the 183 626 ARTI children, 57 393 (31.26%) tested positive for MP, with an average age of 4.87 ± 2.99 years and a male-to-female ratio of 1.12:1. The annual positive rates from 2018 to 2024 were 45.92%, 32.23%, 22.84%, 16.22%, 16.26%, and 42.93%, respectively. Across the study period, the highest positive rate was recored in autumn (35.13%, P < 0.05). Two distinct MP outbreaks were identified, in 2018-2019 and 2023. Significant differences were observed between the two outbreaks. The 2018-2019 epidemic peaked in summer, while the 2023 epidemic peaked in November and persisted into February 2024. By age, the 2018-2019 outbreaks predominantly affected pre-school children, whereas the 2023 outbreaks mainly involved school-aged children. In boths outbreaks, girls had higher positive rates. Antibody and DNA testing results followed similar trends.

CONCLUSION

This study highlights the epidemiological trends and clinical characteristics of MP infections in Wuhan from 2018 to 2024, including two distinct outbreaks with differing seasonal patterns. The MP strain in 2023 appeared to predominantly affect older children.The trends observed suggest that MP infections may persist into the winter of 2024. Enhanced surveillance of respiratory pathogens and early diagnosis and prevention of MP infections in children remain critical in this region.

Effect of azithromycin combined with fluticasone propionate aerosol inhalation on immune function in children with chronic cough caused by Mycoplasma pneumoniae infection

This research aimed to describe the effect of azithromycin combined with fluticasone propionate aerosol inhalation on immune function in children with chronic cough caused by Mycoplasma pneumoniae (MP) infection. This study was a retrospective analysis in which 110 children with chronic cough caused by MP infection were divided into two groups based on different treatment methods: 58 cases in the control group treated with azithromycin dry suspension and 52 cases in the intervention group treated with azithromycin dry suspension and fluticasone propionate inhalation aerosol. Lung function, inflammatory factors, immune indicators, laboratory-related indicators, adverse reactions, and therapeutic effects were compared between the two groups. Compared with the pre-treatment period, levels of FEV1, FVC, and PEF increased post-treatment in both groups, with higher levels observed in the intervention group (all P < 0.05). IL-17, IL-6, and IL-10 levels decreased post-treatment in both groups, with the intervention group showing lower levels (all P < 0.05). The levels of IgG, IgA, IgM, CRP, ESR, and PCT decreased in both groups, with the intervention group showing lower levels (all P < 0.05). Higher treatment effectiveness rates were observed in the intervention group compared to the control group (P < 0.05). The incidence of adverse reactions did not differ significantly between the two groups (P > 0.05).

CONCLUSION

Azithromycin dry suspension combined with fluticasone propionate aerosol inhalation in children with chronic cough due to MP infection reduces inflammatory factors, improves immune function, and enhances treatment efficacy.

WHAT IS KNOWN

• The addition of oral azithromycin has demonstrated significant efficacy in treating cough caused by chronic respiratory disease, and inhaling fluticasone propionate has a more significant systemic impact than other corticosteroids.

WHAT IS NEW

• Azithromycin dry suspension combined with fluticasone propionate aerosol inhalation in children with chronic cough due to MP infection reduces inflammatory factors, improves immune function, and enhances treatment efficacy.

Mycoplasma pneumoniae detections in children with acute respiratory infection, 2010-2023: a large sample study in China

BACKGROUND

This study aimed to describe the epidemiological trends of Mycoplasma pneumoniae (MP) infection among children with acute respiratory tract infections (ARTIs) before, during and after the COVID-19 pandemic, and evaluating the impact of non-pharmaceutical interventions (NPIs) on the epidemiology of MP infection.

METHODS

Children with ARTIs admitted to the Children's Hospital of Soochow University (SCH) from January 2010 to December 2023 and underwent MP nucleic acid PCR assay were included. Clinical data on age, sex, onset time and detection result were collected and analyzed.

RESULTS

All of the 122,984 inpatients were enrolled, in which 20.8% (25659/122984) of the children with MP tested positive, including 19.4% (14139/72662) for male and 22.9% (11520/50322) for female. It was a statistically significant difference between the two genders (p < 0.05). In addition, the positive rate of MP was the highest in the age group > 6 years old each year (p < 0.05). During 14-year period, the detection rate of MP has experienced four peaks in 2012, 2013, 2019, and 2023. Before the NPIs the prevalence of MP showed seasonality, and the number and rate of MP positivity reached their peak in August. However, the rate of MP positivity remained at a low level during the NPIs. After the abolition of NPIs, the MP positivity rate obviously increased and remained at a high level.

CONCLUSIONS

The NPIs could reduce the spread of MP infection and change its epidemic season, but it has not changed the susceptible population of MP infection.

Trends in Mycoplasma pneumoniae infections in pediatric patient preceding, during, and following the COVID-19 pandemic: a comprehensive longitudinal analysis

This study investigated the impact of the coronavirus disease 2019 (COVID-19) pandemic and its associated restrictive measures on Mycoplasma pneumoniae infections in children with acute respiratory tract infection. The study aimed to elucidate the epidemiological characteristics of M. pneumoniae infections before and during the pandemic and following the easing of restrictive measures. Pharyngeal secretions were collected from 1,0174 pediatric patients with acute respiratory infection (ARI) who were admitted to Shaoxing Maternity and Child Health Care Hospital (Shaoxing, China) between May 2018 and December 2023. The analysis concentrated on M. pneumoniae detection rates, epidemiological features, and clinical characteristics. Among 10,174 samples collected from 2018 to 2023, 1,060 strains of M. pneumoniae were detected, resulting in an overall positive rate of 10.42% (n = 1,060 out of 1,0176). Further breakdown revealed positive rates of 8.25% (n = 279 out of 3,381) in phase I (May 2018-December 2019), 2.40% (n = 87 out of 3,623) in phase II (January 2020-November 2022), and 21.89% (n = 694 out of 3,170) in phase III (December 2022-December 2023). In comparison to phase I, a noteworthy decline in the positive rate of M. pneumoniae was found during phase II, followed by a substantial increase during phase III (P < 0.05). Furthermore, the positive rate of M. pneumoniae exhibited a significantly greater surge during the summer-autumn period in contrast to the winter-spring (P < 0.05). Additionally, the risk of M. pneumoniae infection in children who aged 7 years surpassed that of the age group of 0-3 years. Throughout the phases preceding, during, and after the COVID-19 pandemic, discernible fluctuations in both age distribution and seasonality of M. pneumoniae infections were identified among hospitalized children with ARI in the East China.

IMPORTANCE

The resemblance between the transmission pathways of M. pneumoniae and those of COVID-19 suggests that non-pharmaceutical interventions may have comparable effects on both. This study aimed to analyze the epidemiological characteristics of children with M. pneumoniae infections in Shaoxing, China, from 2018 to 2023. This study explored how the COVID-19 pandemic has influenced the prevalence of M. pneumoniae and provided guidance for disease treatment and infection prevention.

Epidemiological and clinical characteristics of hospitalized pediatric patients with Mycoplasma pneumoniae pneumonia before and after the COVID-19 pandemic in China: a retrospective multicenter study

BACKGROUND

In China many respiratory pathogens stayed low activities amid the COVID-19 pandemic due to strict measures and controls. We here aimed to study the epidemiological and clinical characteristics of pediatric inpatients with Mycoplasma pneumoniae pneumonia (MPP) after the mandatory COVID-19 restrictions were lifted, in comparison to those before the COVID-19 pandemic.

METHODS

We here included 4,296 pediatric patients with MPP, hospitalized by two medical centers in Jiangsu Province, China, from January 2015 to March 2024. Patients were divided into the pre-COVID (n = 1,662) and post-COVID (n = 2,634) groups. Their baseline characteristics, laboratory test results and radiological patterns were separately assessed and compared between the two groups to determine the substantial changes in the disease profile of MPP after the COVID-19 pandemic.

RESULTS

Epidemiological results suggested a higher annual incidence of MPP after the COVID-19 pandemic when the outbreak reached a peak in October, two months delayed in seasonality compared to that in the pre-COVID era. For pediatric patients with MPP, there was no difference in their median ages, gender ratios, and severe case percentages between the two groups, where most patients were younger than 14 years old. With significance, the post-COVID group had more occurrences of cough and expectoration and higher incidences of influenza A/B virus (IAV/IBV) co-infection than the pre-COVID group. Many hematological parameters and radiological features between the two groups displayed alteration, but comparatively there demonstrated no worsened severity in hospitalized children with MPP after COVID-19 pandemic. Concurrently, the post-COVID group was administered with fewer antibiotics but more corticosteroids for effective treatment than the pre-COVID group.

CONCLUSION

Through the COVID-19 pandemic, the epidemiological and clinical characteristics of pediatric patients with MPP differed, but there was no evident change in the disease severity. After the COVID-19 pandemic, the increased incidence of IAV/IBV co-infection may contribute to the differences in clinical symptoms and hematological profiles, while the adding usage of corticosteroids might treat more effectively.

Risk factors and prescription patterns analysis for macrolide-resistant Mycoplasma pneumoniae pneumonia in children

First-line macrolide therapy is encountering challenges due to the escalating incidence of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP). This study aimed to illustrate prescription patterns among children diagnosed with either macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMPP) or MRMPP and to further analyze the risk factors associated with MRMPP. This research encompassed 825 children who were diagnosed with Mycoplasma pneumoniae pneumonia (MPP) at a tertiary hospital located in central China in 2023. Notably, the MRMPP group had a longer fever duration compared to the MSMPP group. A combination of doxycycline and piperacillin-tazobactam was the most frequently used treatment for hospitalized MRMPP children, whereas azithromycin was the primary choice for the MSMPP group. More children in the MRMPP group required discharge medications, primarily doxycycline, whereas the MSMPP group primarily received azithromycin. Furthermore, a history of allergy emerged as an increased risk factor for MRMPP, alongside age, fever, pulmonary imaging changes, and co-detections of bacteria or fungi.

Clinical characteristics and predictive indictors of macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a retrospective study

Introduction

Macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) cases have been rapidly increasing. The primary reason for this increased incidence is the pathogen's acquisition of resistance through mutations in 23S rRNA genes. Due to the unfeasibility of testing for macrolide susceptibility at the time of admission, this study aimed to assess the clinical features of pediatric MUMPP, using insights from laboratory tests and patterns of chest radiographic resolution.

Material and methods

We conducted a retrospective review of 161 patients with M. pneumoniae pneumonia (MPP) between January 2023 and December 2023. These patients were categorized into two groups based on their responsiveness to macrolides: 72 patients were in the MUMPP group, and 89 patients were in the macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP) group.

Results

MUMPP patients experienced a longer duration of fever and hospital stay. A higher proportion of MUMPP patients had shortness of breath, transcutaneous blood oxygen saturation (SpO2) lower than 94%, bilateral lobar infiltrates, lobar pneumonia and pleural effusion. The serum level of serum ferritin (SF), interleukin-6(IL-6), D-dimer, lactate dehydrogenase to albumin rate (LAR), and neutrophil to lymphocyte rate (NLR) were higher in MUMPP group.

Conclusions

Our findings revealed that patients with MUMPP exhibit more severe initial radiographic indicators and clinical course compared to those with MSMP. Therefore, it is crucial to promptly administer alternative therapeutic agents besides macrolides for the management of MUMPP.

Etiological analysis of acute respiratory infections in hospitalized children after the relaxation of COVID-19 non-pharmacological interventions in Quzhou, China

BACKGROUND

Acute respiratory infections (ARIs) can cause morbidity and mortality in children. This study was to determine the characteristics of pathogens in hospitalized children with ARIs after the relaxation of COVID-19 non-pharmacological interventions (NPIs) in Quzhou, China.

METHODS

Hospitalized children with ARIs were enrolled between May and October 2023, and thirteen common respiratory pathogens were tested by fluorescent quantitative polymerase chain reaction. Mono- and co-infections were assessed, and the association between pathogens and age was explored using restricted cubic spline analysis.

RESULTS

A total of 1225 children were included, 820 of them detected one pathogen and 238 of them detected two or more pathogens. The dominant pathogen varies monthly. Mycoplasma pneumoniae (Mp) was the most common pathogen in monoinfection, followed by respiratory syncytial virus (RSV) and human rhinovirus (HRV), while influenza virus was detected at a lower rate. Mp + HRV was the most common combination of coinfections. The detection rates of Mp and HRV were higher in coinfections than in monoinfection, but there was no difference in the detection rate of RSV. Children aged 1-3 years had the highest positive detection rates and were more likely to be infected with multiple pathogens, with 40% of respiratory pathogen monoinfection and 47.48% of coinfections (χ2 = 4.245, P = 0.039). In the restricted cubic spline models, a J-shaped association was consistently observed between age and Mp infection, the risk of HRV first increased and then decreased, the risk of RSV was relatively flat until 1.5 years and then decreased rapidly.

CONCLUSION

Our study revealed the epidemiological characteristics of ARIs pathogens after the relaxation of NPIs. The positivity rates of Mp, RSV, and HRV are the highest, while those of influenza virus are still low. Additionally, age and season affect the distribution of respiratory pathogens. These findings underscore the importance of ongoing regional pathogen surveillance to guide local public health responses.

Alterations in Gut Microbiota and Serum Metabolites in Children with Mycoplasma pneumoniae Pneumonia

Background

Over the past years, there has been a significant increase in the incidence of Mycoplasma pneumoniae (MP) infections, particularly among pediatric patients, nationwide. An emerging body of research has established a link between dysbiosis of the host microbiome and the metabolic functioning of the host, which contributes to the development of respiratory diseases.

Methods

A total of 25 children were included in the study, comprising 15 pneumonia patients and 10 healthy children. Stool samples were collected from all participants to analyze the 16S ribosomal RNA (16S rRNA) gene, while serum samples were prepared for untargeted metabolomics to qualitatively and quantitatively assess short-chain fatty acids.

Results

The gut microbial composition of individuals with Mycoplasma pneumoniae pneumonia (MPP) exhibited significant differences compared to healthy children. Notably, diseased children demonstrated higher microbial diversity and an enrichment of opportunistic pathogens, such as Erysipelatoclostridium and Eggerthella. Analysis revealed elevated levels of two specific short-chain fatty acids, namely acetic acid and isobutyric acid, in the MPP group, suggesting their potential as biomarkers for predicting MP infection. Metabolomic signature analysis identified a significant increase in major classes of glycerophospholipids in the MPP group. Moreover, we identified a total of 750 significant correlations between gut microbiota and circulating serum metabolites. MPP enriched genera Erysipelatoclostridium and Eggerthella, exhibited negative associations with indole-3-butyric acid. Additionally, Eggerthella showed a positive correlation with inflammatory metabolites LPC (18:0).

Discussion

Collectively, these findings provide novel insights into the selection of potential biomarkers and the pathogenesis of MPP in children based on the gut microbiota and systemic circulating metabolites.

[Analysis of multidrug resistance gene locus mutations and clinical significance in children with Mycoplasma pneumoniae pneumonia]

OBJECTIVES

To detect multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia through targeted high-throughput sequencing and to explore its clinical significance.

METHODS

A retrospective analysis was conducted on the clinical data of 2 899 children with Mycoplasma pneumoniae pneumonia, who underwent respiratory pathogen-targeted high-throughput sequencing, treated at Hubei Maternal and Child Health Care Hospital between January and December 2023. The patients were divided into a mutation group (n=885) and a non-mutation group (n=2 014) based on whether there was a mutation in the 23SrRNA macrolide-resistant gene of Mycoplasma pneumoniae. Multivariate logistic regression analysis was used to investigate the risk factors for multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia.

RESULTS

Among the 2 899 children, 885 cases (30.53%) had mutations in the 23SrRNA resistance gene, including 884 cases with the A2063G mutation and 1 case with the A2064G mutation. In children with 23SrRNA resistance gene mutations, treatment with doxycycline or ofloxacin was more effective than with azithromycin or clarithromycin, and doxycycline was more effective than ofloxacin (P<0.05). The mutation rate of resistance genes in children with Mycoplasma pneumoniae pneumonia increased with age (P<0.001). Multivariate logistic regression analysis showed that increased age, extrapulmonary infection, lung consolidation, prolonged fever, prolonged hospitalization, and elevated CRP levels were risk factors for 23SrRNA gene locus mutations (P<0.05).

CONCLUSIONS

Age, extrapulmonary infections, lung consolidation, duration of fever, length of hospitalization, and CRP levels are closely related to 23SrRNA resistance gene locus mutations. Detecting multidrug resistance gene locus mutations in children with Mycoplasma pneumoniae pneumonia can aid in early diagnosis and prediction of treatment efficacy, promoting rational clinical treatment.

Tigecycline combined with bronchoscopic interventions in the treatment of macrolide-unresponsive Mycoplasma penumoniae pneumonia: A case report

Mycoplasma penumoniae (MP) is a common etiological agent of community-acquired pneumonia. However, there has been an increasing incidence of macrolide-unresponsive Mycoplasma penumoniae pneumonia (MUMPP) in recent years. The treatment of MUMPP requires further investigation. In this report, we describe a case of MUMPP complicated by secondary spontaneous pneumothorax. The patient was unresponsive to initial macrolide treatment and his pneumonia worsened with increasing hypoxemic respiratory failure. However, after receiving a novel tetracycline and a carbapenem antibiotic as anti-infective agents, glucocorticoid for anti-inflammatory and bronchoscopic interventions to clear the bronchial casts, his fever and hypoxia resolved, and his lung lesions had significantly improved. Symptomatic supportive measures, including supplemental oxygen, was provided for the management of spontaneous pneumothorax developed twenty days after discharge. At follow-up, he did not experience any more initial symptoms. All indexes remained normal for half a year. This study represents the initial investigation into the utilization of tigecycline in conjunction with bronchoscopic interventions including bronchoalveolar lavage (BAL) and bronchoscopic cryotherapy (BC) in the treatment of MUMPP, glucocorticoid can be considered for anti-inflammatory purposes, especially for patients with severe pneumonia. The findings from this case offer valuable insights into a potential therapeutic approach for individuals afflicted with MUMPP.

Epidemiological characteristics of severe community-acquired pneumonia in children admitted to two tertiary hospitals in Shihezi, Xinjiang Region, China in 2023: a cross-sectional analysis

Background

Severe community-acquired pneumonia (SCAP) in children is associated with high morbidity and mortality, and the data of epidemiological characteristics of SCAP in Shihezi area were inadequate. The main pathogens responsible for SCAP may vary dramatically according to the geographical area. We identified two tertiary hospitals with better medical level and the largest number of hospitalized children in Shihezi as sentinel hospitals. The primary purpose of the study is to cross-sectionally summarize the epidemiological characteristics of SCAP in children admitted to hospitals in Shihezi, Xinjiang, China in 2023.

Methods

SCAP was defined as involving the respiratory and other systems, accompanied by significant systemic toxic symptoms. We prospectively included all patients <15 years old who diagnosed with SCAP according to the SCAP diagnostic criteria. We enrolled all patients <15 years who were diagnosed with SCAP during the study period (January to December 2023), a total of 309 cases were included from two sentinel hospitals in Shihezi, Xinjiang, from January to December 2023. Basic information and clinical data were collected on a standardized questionnaire, and respiratory samples were obtained for the detection of 27 respiratory pathogens using a panel, targeted next-generation sequencing (t-NGS), and metagenomic next-generation sequencing (mNGS).

Results

We enrolled 309 patients aged 1-14 years: 157 males (50.8%) and 152 females (49.2%). There were 45 infants (1 month to 1 year, 14.6%), 33 toddlers (>1-3 years, 10.7%), 121 preschool children (>3-7 years, 39.2%), and 110 school-age children (>7-14 years, 35.6%). Overall, the number of SCAP cases in spring was 39 (12.6%), in summer was 44 (14.2%), in autumn was 137 (44.3%), and in winter was 89 (28.8%). A total of 572 pathogens were detected in this study, primarily Mycoplasma pneumoniae (MP) (n=120, 21.0%), respiratory syncytial virus (RSV) (n=82 strains, 14.3%), and Streptococcus pneumoniae (SP) (n=67, 11.7%). MP was prevalent mainly during the cold season of autumn, with its detection starting from July and reaching a peak detection rate in November. By studying the interaction among 22 common respiratory pathogens, we found a strong negative correlation between MP and SP, yet the highest number of co-infected cases involved MP and SP. Seventy-six (63.3% of all MP) SCAP were identified as macrolide-resistant (all with mutations at the A2063G site). MP SCAP was associated with prolonged illness duration and fever spikes. We observed incidence of pediatric SCAP showed an inverse trend with PM2.5 level changes.

Conclusions

The most common pathogens responsible for SCAP in the Shihezi region in 2023 were MP, RSV, and SP. MP was the primary cause of SCAP in children, and increased risk of co-infections, and high prevalence of macrolides resistance-all related to mutations at the A2063G site. Early identification of SCAP pathogen epidemiological characteristics can reduce severe case occurrence.

Distinct lower respiratory tract microbiota profiles linked to airway mucus hypersecretion in children with Mycoplasma pneumoniae pneumonia

Background

Airway mucus hypersecretion (AMH) can occur in children with acute respiratory diseases, but its underlying mechanisms and relationship with the lower respiratory tract microbiota (LRTM) are not yet fully understood. This study investigates the characteristics of LRTM in children with Mycoplasma pneumoniae pneumonia (MPP) and its impact on AMH.

Methods

We collected bronchoalveolar lavage fluid and related clinical indicators from 202 children with MPP. 16S rRNA gene amplicon sequencing was used for detection and identification. Microbial diversity and characteristic genera were compared, and their abundance was analyzed for correlations with clinical factors.

Results

As the disease course (days from onset to bronchoscopy, grouped into T1, T2, T3) extended, α-diversity of the LRTM gradually increased, particularly in the T3 hypersecretion group. Moreover, significant differences were observed in the incidence of AMH, co-infection rates, peripheral white blood cell (WBC) count, and C-reactive protein levels. In AMH, Mycoplasmoides and Veillonella abundance and peripheral neutrophils were risk factors for increased secretions. In addition, in the T3 co-infection group, Streptococcus and Prevotella increased, replacing Stenotrophomonas as the dominant genus, possibly due to β-lactam antibiotic use. Prevotella abundance was strongly correlated with WBC.

Conclusion

The composition and structure of LRTM in children with MPP played a crucial role in AMH and disease progression.

Respiratory pathogen analysis in pediatric inpatients unraveled the infection pattern of Mycoplasma pneumoniae post the COVID-19 pandemic

Background

To counteract the COVID-19 pandemic, nonpharmaceutical interventions (NPIs) were implemented globally, exerting a profound influence on a wide spectrum of infectious diseases, encompassing respiratory tract infections (RTIs). Subsequent to the easing of NPIs, China experienced a significant outbreak of Mycoplasma pneumoniae (MP).

Methods

Over a decade from 2015 to 2024, our study scrutinized 12 common infectious diseases among pediatric children. Etiologically diagnostic data and clinical outcome metrics of children with RTIs, tested for 13 pathogens, were analyzed to evaluate changes during and after the pandemic compared to pre-pandemic periods, with a notable emphasis on age profile and coinfection patterns of MP.

Results

Among 57,471 hospitalized children, 23,178 were diagnosed with infectious diseases. Under NPIs, most respiratory infections declined compared to pre-pandemic levels, rebounding by 69.64% in 2023. While the infection rate of common respiratory pathogens decreased, cases of respiratory syncytial virus increased during the period of extensive NPI implementation. In 2023, pediatric intensive care unit durations for these pathogens increased, suggesting greater severity of illness compared to 2019. MP exhibited the highest infection rate (31.38% average), with a notable outbreak post-pandemic due to severity increase in <3 year olds and rise among older children. NPIs reduced MP coinfections and mitigated their severity, while exerting a significant influence on bacterial coinfections with MP over the span of 5 years, in contrast to their impact on viral pathogens.

Conclusion

NPIs effectively curb transmission of respiratory infections by most pathogens, resulting in increased average age of MP infections and altered patterns of coinfection post-pandemic.

New Insights into the Epidemiological Characteristics of Mycoplasma pneumoniae Infection before and after the COVID-19 Pandemic

Mycoplasma pneumoniae (M. pneumoniae), a prevalent respiratory pathogen affecting children and adolescents, is known to trigger periodic global epidemics. The most recent significant outbreak commenced in the first half of 2023 and reached its peak globally during the autumn and winter months. Considering the worldwide repercussions of the COVID-19 pandemic, it has become increasingly essential to delve into the epidemiological characteristics of M. pneumoniae both before and after the pandemic. This review aims to provide a comprehensive analysis of the key features of M. pneumoniae epidemics in the pre-and post-COVID-19 contexts, including but not limited to shifts in the susceptible population, the molecular genotypes of the pathogen, the clinical manifestations, and potential new trends in drug resistance. Additionally, we will introduce the latest advancements in the diagnosis of M. pneumoniae.

The epidemic characteristics of Mycoplasma pneumoniae infection among children in Anhui, China, 2015-2023

The number of pediatric respiratory tract infection cases in China has significantly increased this year, and Mycoplasma pneumoniae is one of the main pathogens. This study aimed to investigate the epidemiological characteristics of M. pneumoniae in children in the Anhui region and to provide evidence for the prevention and control strategies of M. pneumoniae in children in this region. A total of 66,488 pediatric patients with respiratory tract infection were enrolled from January 2015 to November 2023 in this study. The results of this study exhibited that M. pneumoniae infection in the Anhui region was characterized by a high positive rate during 2021-2023, especially this year is considered a year of pandemic for M. pneumoniae infection. Moreover, the positive rate of M. pneumoniae in female children is significantly higher than in male children, and the infection rate of M. pneumoniae in children increases significantly with age, particularly in school-aged children.

IMPORTANCE

The number of pediatric respiratory tract infection cases in China has significantly increased this year, and Mycoplasma pneumoniae is one of the main pathogens. This study aimed to investigate the epidemiological characteristics of M. pneumoniae in children in the Anhui region and provide evidence for the prevention and control strategies of M. pneumoniae in children in this region.

Using random forest and biomarkers for differentiating COVID-19 and Mycoplasma pneumoniae infections

The COVID-19 pandemic has underscored the critical need for precise diagnostic methods to distinguish between similar respiratory infections, such as COVID-19 and Mycoplasma pneumoniae (MP). Identifying key biomarkers and utilizing machine learning techniques, such as random forest analysis, can significantly improve diagnostic accuracy. We conducted a retrospective analysis of clinical and laboratory data from 214 patients with acute respiratory infections, collected between October 2022 and October 2023 at the Second Hospital of Nanping. The study population was categorized into three groups: COVID-19 positive (n = 52), MP positive (n = 140), and co-infected (n = 22). Key biomarkers, including C-reactive protein (CRP), procalcitonin (PCT), interleukin- 6 (IL-6), and white blood cell (WBC) counts, were evaluated. Correlation analyses were conducted to assess relationships between biomarkers within each group. The random forest analysis was applied to evaluate the discriminative power of these biomarkers. The random forest model demonstrated high classification performance, with area under the ROC curve (AUC) scores of 0.86 (95% CI: 0.70-0.97) for COVID-19, 0.79 (95% CI: 0.64-0.92) for MP, 0.69 (95% CI: 0.50-0.87) for co-infections, and 0.90 (95% CI: 0.83-0.95) for the micro-average ROC. Additionally, the precision-recall curve for the random forest classifier showed a micro-average AUC of 0.80 (95% CI: 0.69-0.91). Confusion matrices highlighted the model's accuracy (0.77) and biomarker relationships. The SHAP feature importance analysis indicated that age (0.27), CRP (0.25), IL6 (0.14), and PCT (0.14) were the most significant predictors. The integration of computational methods, particularly random forest analysis, in evaluating clinical and biomarker data presents a promising approach for enhancing diagnostic processes for infectious diseases. Our findings support the use of specific biomarkers in differentiating between COVID-19 and MP, potentially leading to more targeted and effective diagnostic strategies. This study underscores the potential of machine learning techniques in improving disease classification in the era of precision medicine.

CHAMP: A Centrifugal Microfluidics-Based CRISPR/Cas12b-Combined Real-Time LAMP One-Pot Method for Mycoplasma pneumoniae Infection Diagnosis

The Mycoplasma pneumoniae outbreak poses health risks to community residents. However, it still has limitations for current clinical diagnostic methods (qPCR nucleic acid assay or IgM immunoassay), including specialized handling, expensive equipment, prolonged turnaround time, and false positives and negatives, highlighting the need to improve clinical diagnostic methods. Herein, we present a novel centrifugal microfluidics-based method for rapidly diagnosing M. pneumoniae infections (CHAMP system). This user-friendly method combines CRISPR/Cas12b and real-time loop-mediated isothermal amplification (LAMP) in a one-pot reaction, offering high sensitivity, specificity, and simplicity for methodology. By adding fully automated nucleic acid magnetic bead-extracted samples to a prepackaged centrifugal microfluidics chip, 48 samples can be automated tested simultaneously within 15 to 60 min at 60 °C. 427 clinical nasopharyngeal swab specimens were used for validation, demonstrating good positive and negative predictive values and good diagnostic sensitivity, specificity, and significant time savings. This method is particularly suitable for detecting low nucleic acid copies of M. pneumoniae samples.

Routine blood parameters as auxiliary diagnostic tools for Mycoplasma pneumoniae infection in children

Introduction. Recently, the incidence of Mycoplasma pneumoniae (M. pneumoniae) infection in children has been increasing annually. Early differential diagnosis of M. pneumoniae infection can not only avoid the abuse of antibiotics, but also is essential for early treatment and reduction of transmission.Gap statement. The change of routine blood parameters may have important clinical significance for the diagnosis of M. pneumoniae infection, but it has not been reported so far.Aim. This study aims to establish a predictive model for M. pneumoniae infection and explore the changes and clinical value of routine blood parameters in children with M. pneumoniae infection, serving as auxiliary indicators for the diagnosis and differentiation of clinical M. pneumoniae infection.Methodology. A total of 770 paediatric patients with respiratory tract infections were enrolled in this study, including 360 in the M. pneumoniae group, 40 in the SARS-CoV-2 group, 200 in the influenza A virus group, and 170 in the control group. The differences of routine blood parameters among all groups were compared, and risk factors were analysed using multivariate logistics analysis, and the diagnostic efficacy of differential indicators using ROC curves.Results. This study revealed that Mono% (OR: 3.411; 95% CI: 1.638-7.102; P=0.001) was independent risk factor associated with M. pneumoniae infection, and Mono% (AUC=0.786, the optimal cutoff at 7.8%) had a good discriminative ability between patients with M. pneumoniae infection and healthy individuals. Additionally, Mono% (OR: 0.424; 95% CI: 0.231-0.781; P=0.006) and Lymp% (OR: 0.430; 95% CI: 0.246-0.753; P=0.003) were independent risk factors for distinguishing M. pneumoniae infection from influenza A virus infection, and the Lymp% (AUC=0.786, the optimal cutoff at 22.1%) and Net% (AUC=0.761, the optimal cutoff at 65.2%) had good discriminative abilities between M. pneumoniae infection and influenza A infection. Furthermore, platelet distribution width (OR: 0.680; 95% CI: 0.538-0.858; P=0.001) was independent risk factor for distinguishing M. pneumoniae infection from SARS-CoV-2 infection. Meanwhile, the ROC curve demonstrated that PDW (AUC=0.786, the optimal cutoff at 15%) has a good ability to differentiate between M. pneumoniae infection and SARS-CoV-2 infection.Conclusion. This study demonstrates that routine blood parameters can be used as auxiliary diagnostic indicators for M. pneumoniae infection and provide reference for the diagnosis and differentiation of clinical M. pneumoniae infection.

Clinical characteristics and logistic regression analysis of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

PURPOSE

To investigate macrolide-resistant Mycobacterium pneumoniae (MRMP) pneumonia in children and construct a logistic regression model for mutations in the Mycoplasma pneumoniae drug-resistant gene.

METHODS

Clinical data of 281 children were analyzed. Sequencing confirmed a mutation at the A2063G locus of the 23 S rRNA gene in 227 children (A2063G group); 54 children showed no mutations (non-MRMP [NMRMP] group). We compared clinical features, laboratory tests, imaging, and bronchoscopy results and constructed a multifactorial logistic regression model to analyze risk and protective factors.

RESULTS

The A2063G group had longer durations of fever and hospitalization before admission, a higher proportion of treatment with sodium methylprednisolone succinate (MPS)/dexamethasone, longer time to discontinue hormones, and higher probability of combined infections. Monocyte percentage was significantly higher in the A2063G group. Imaging suggested a higher incidence of infections in the right lung compared to both lungs. Univariate analysis revealed fever duration before admission, hormone dose and duration, monocyte percentage, and mixed infections as risk factors for Mycoplasma pneumoniae infection with the A2063G mutation. The logistic regression model showed that mixed infections were an independent risk factor for the A2063G locus mutation, whereas hormone dose was a protective factor.

CONCLUSION

A prevalence of macrolide resistance of 80.8% among children was observed in the region. Logistic regression analysis revealed that co-infection with other respiratory pathogens is an independent risk factor for the development of resistance genes, while the use of hormone dosage acts as a protective factor.

Epidemiological characteristics of mycoplasma pneumoniae in hospitalized children before, during, and after COVID-19 pandemic restrictions in Chongqing, China

Background

Mycoplasma pneumoniae (MP) is a significant cause of community-acquired pneumonia with high macrolide resistance rates. Various COVID-19 pandemic restrictions have impacted the prevalence of MP.

Objective

To assess the changes in the pattern of MP infections among children before, during, and after the COVID-19 pandemic.

Methods

A total of 36685 enrolled patients, aged 0-18 years, diagnosed with pneumonia and admitted to Children's Hospital of Chongqing Medical University from January 2019 to December 2023, were retrospectively reviewed in this study. The epidemiological characteristics of pediatric MP infection were analyzed.

Results

Among 36685 patients, 7610 (20.74%) tested positive for MP. The highest positive rate was observed among children aged over 6 years (55.06%). There was no gender disparity in MP infection across the three phases of the COVID-19 pandemic. Hospital stays were longest for children during the COVID-19 pandemic (P <0.001). MP infection was most prevalent in the summer (29.64%). The lowest positive rate was observed during the pandemic, with the highest rate found after easing the measures across all age groups (P <0.001). There was a surge in the positive rate of MP in the third year after the COVID-19 pandemic. Regression analyses demonstrated a shift in the age range susceptible to MP infection, with children aged 3.8 to 13.5 years post-pandemic compared to the pre-pandemic range of 5.3 to 15.5 years old. Additionally, the average macrolide resistance rate was 79.84%. We observed a higher resistance rate during the pandemic than in the pre- and post-pandemic phases (P <0.001).

Conclusion

The restrictive measures implemented during the COVID-19 pandemic have influenced the spread of MP to some extent and altered demographic and clinical characteristics, such as age, age group, season, length of stay, and macrolide resistance. We recommend continuous surveillance of the evolving epidemiological characteristics of MP infection in the post-pandemic period when restrictions are no longer necessary.

An outbreak of Mycoplasma pneumoniae in children after the COVID-19 pandemic, Shanghai, China, 2023

Background

During the coronavirus disease 2019 (COVID-19) pandemic, the infection of Mycoplasma pneumoniae (MP) decreased significantly. At the beginning of the summer of 2023, there was an increasing trend of MP infection in China and the MP pneumonia (MPP) is surging when it comes to the school season and lasts for several months which has attracted widespread attention.

Objective

This study aims to investigate the prevalent characteristics of the MP and the difference between the COVID-19 pandemic and the post in Shanghai, China.

Methods

The demographic information and the results of laboratory pathogen detection from July 2021 to May 2024 were collected and analyzed to find out the prevalent characteristics of MP. Two periods, during the COVID-19 pandemic and the post-pandemic, were divided and compared. The P1 genotyping and macrolide resistance-associated gene of 23 s rRNA were detected using the remaining MP-positive samples.

Results

During the COVID-19 pandemic, the prevalence of the MP has significantly decreased. Female children are more susceptible to MP infection than the male. The school-aged group (>6 years) had the highest infection rate. The rate of MP P1 genotype during post panel is higher than that during COVID-19 pandemic, which is dominant from July 2021 to May 2024, while the macrolide-resistant associated mutations (A2063G) keep high percentage during or post pandemic.

Conclusion

After the COVID-19 pandemic, an outbreak of MP infection occurred from summer onwards in 2023 with children in Shanghai, China. Immunity debt and high rate of macrolide-resistance may take effects in this MP epidemic. Continuous surveillance of MP is necessary to help to alert the prevalence of MPP.

Mycoplasma pneumoniae infection outbreak in Guangzhou, China after COVID-19 pandemic

BACKGROUNDS

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen causing respiratory diseases in children. This study aimed to characterize epidemiological and disease severity shifts of M. pneumoniae: infections in Guangzhou, China during and after the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Throat swab samples were obtained from 5405 hospitalized patients with symptoms of acute respiratory infections to detect M. pneumoniae. Differences in epidemiological and clinical characteristics of M. pneumoniae: infections were investigated during 2020-2022 and after COVID-19 pandemic (2023).

RESULTS

M. pneumoniae were detected in 849 (15.6%, 849/5405) patients. The highest annual positive rate was 29.4% (754/2570) in 2023, followed by 5.3% (72/1367) in 2022, 1.2% (12/1015) in 2021, and 2.0% (11/553) in 2020, with significantly increasing annual prevalence from 2020 to 2023. M. pneumoniae incidence peaked between July and December post-COVID-19 pandemic in 2023, with the highest monthly positive rate (56.4%, 165/293). Clinical characteristics and outcomes of patients with M. pneumoniae did not vary between periods during and after COVID-19 pandemic except that patients with M. pneumoniae post-COVID-19 pandemic were more likely to develop fever. Patients with severe M. pneumoniae pneumonia (SMPP) were more likely to develop respiratory complications, myocardial damage, and gastrointestinal dysfunction than those with non-SMPP. Patients with SMPP had lower lymphocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and higher IL-4, IL-6, IL-10 levels than those with non-SMPP. Bronchoalveolar lavage fluid specimens from infected patients were obtained to identify macrolide resistance mutations. Macrolide-resistant M. pneumoniae (MRMP) proportion in 2023 was 91.1% (215/236).

CONCLUSION

Outbreaks of M. pneumoniae: occurred in Guangzhou, China in 2023 upon Non-pharmaceutical interventions easing. Despite the increasing incidence of M. pneumoniae, the disease severity remained similar during and after the COVID-19 pandemic.

Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023

We collected respiratory specimens from 128 pediatric patients diagnosed with pneumonia in Beijing in late 2023. Mycoplasma pneumoniae was detected in 77.3% (99/128) patients, with 36.4% (4/11), 82.9% (34/41), 80.3% (61/76) in children aged less than 3 years, 3-6 years, over 7 years, respectively. Mycoplasma pneumoniae (M. pneumoniae) was characterized using P1 gene typing, MLVA typing and sequencing of domain V of the 23S rRNA gene. P1 gene type 1 (P1-1; 76.1%, 54/71) and MLVA type 4-5-7-2 (73.7%, 73/99) were predominant. MLVA identified a new genotype: 3-4-6-2. Macrolide resistance-associated mutations were detected in 100% of samples, with A2063G accounting for 99% and A2064G for 1%. The positive rate of M. pneumoniae was higher compared to previous reports, especially in children less than 3 years, suggesting a M. pneumoniae epidemic showing a younger age trend occurred in late 2023 in Beijing, China. Higher proportions of macrolide-resistant M. pneumoniae, P1-1 and 4-5-7-2 genotype M. pneumoniae indicated increased macrolide resistance rate and genotyping shift phenomenon, which might be attributable to this epidemic. Additionally, complete clinical information from 73 M. pneumoniae pneumonia inpatients were analyzed. The incidence of severe M. pneumoniae pneumonia was 56.2% (41/73). Mycoplasma pneumoniae pneumonia patients exhibited longer duration of fever, with a median value of 10.0 days (IQR, 8.0-13.0), and higher incidence of complications (74.0%, 54/73). However, in this cohort, we found that the severity of M. pneumoniae pneumonia, co-infection, or complications were not associated with M. pneumoniae P1 gene or MLVA types. Clinicians should be aware that patients infected with macrolide-resistant M. pneumoniae exhibited more severe clinical presentations.

Clinical efficacy of macrolide antibiotics in mycoplasma pneumoniae pneumonia carrying a macrolide-resistant mutation in the 23 S rRNA gene in pediatric patients

BACKGROUND

The global prospective surveillance data showed the re-emergence of mycoplasma pneumoniae pneumonia (MPP) in Europe and Asia after the coronavirus disease 2019 pandemic. We sought to observe the effect of macrolide antibiotics in the treatment of MPP carrying a macrolide-resistant mutation gene and the potential of targeted next-generation sequencing (tNGS) as a front-line diagnostic in MPP patients.

METHODS

The baseline characteristics of 91 children with MPP hospitalized from January to October 2023 were retrospectively analyzed. They were divided into two groups according to whether carrying the macrolide-resistant mutation or not. The logistic and linear regression analyses were used to determine whether the mutation was a standalone predictive predictor of the duration of fever and hospital length of stay.

RESULTS

First, no patients had a fever for ≥ 7 days after macrolide treatment. But length of stay and hormone concentration were significantly different between the two groups (P < 0.05). There were also no statistical association between the mutation and the duration of fever and hospital length of stay.

CONCLUSION

Macrolides can be administered to MPP children carrying a macrolide-resistant mutation. tNGS can be seen as a front-line diagnostic in MPP.

Changing epidemic patterns of infectious diseases during and after COVID-19 pandemic in Taiwan

Mitigation measures aimed at curbing the transmission of the severe acute respiratory syndrome coronavirus 2 effectively suppressed the occurrence of many respiratory infections other than coronavirus disease 2019. Several infections experienced a resurgence following the relaxation of non-pharmaceutical interventions, surpassing pre-pandemic levels in Taiwan. This phenomenon, known as immune debt, primarily affected respiratory infections in young children, including respiratory syncytial virus (RSV) infection. Infections transmitted by means other than droplets or contact did not exhibit significant changes in their epidemic patterns, such as varicella and Japanese encephalitis. Alterations in seasonality were noted for RSV infection and influenza, and these changes are also linked to immune debt. The recent emergence of severe pediatric pneumonia in northern China may be associated with immune debt and the rise of macrolide-resistant Mycoplasma pneumoniae associated with severe illness.

Influence of non-pharmaceutical interventions on epidemiological characteristics of Mycoplasma pneumoniae infection in children during and after the COVID-19 epidemic in Ningbo, China

Background

Since the outbreak of COVID-19, China has implemented a series of non-pharmaceutical interventions (NPIs), effectively containing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as well as various respiratory pathogens. With the continuous relaxation of restrictions, China has entered a new phase of the post-pandemic era. However, the epidemiological differences of Mycoplasma pneumoniae (MP) between the two phases in Ningbo and even in China remain unclear.

Methods

Data of children aged 0-14 years who visited the Ningbo Medical Center LiHuiLi Hospital due to acute respiratory tract infections from January 2020 to December 2023 were collected. PCR was used to detect 13 respiratory pathogens and the macrolide-resistance of Mycoplasma pneumoniae.

Results

Among 10,206 children, 2,360 were infected with MP (23.12%). Among the total, the MP positive rate during the NPI phase (6.35%) was significantly lower than that during the non-NPI phase (34.28%), while the macrolide resistance rate increased from 62.5% (NPI phase) to 81.1% (non-NPI phase). The rate of MP co-infection increased from 11.2% (NPI phase) to 30.3% (non-NPI phase). MP infection exhibited obvious seasonality, with the highest prevalence in autumn (30.0%) followed by summer (23.6%). There were differences in MP positivity rates among different age groups, with the highest among school-age children at 39.5%. During the NPI phase, all age groups were less susceptible to MP, while during the non-NPI phase, the susceptible age for MP was 4-12 years, with 8 years being the most susceptible. The susceptible age for MP co-infection was 0-6 years. MP exhibited antagonistic effects against numerous pathogens. Compared to MP single infection, the proportion of pneumonia was higher in MP co-infection cases.

Conclusion

The removal of NPIs significantly impacted the spread of MP, altering population characteristics including age, seasonality, macrolide resistance, and MP co-infection rates.

Azithromycin Effectiveness in Children with Mutated Mycoplasma Pneumoniae Pneumonia

Objective

Mycoplasma pneumoniae (MP) is highly resistant to macrolides in China. However, macrolides still exhibit clinical effectiveness in some macrolide-resistant patients. We tend to explore azithromycin effectiveness in Mycoplasma pneumoniae pneumonia (MPP) children with A2063/2064G mutation.

Methods

This retrospective observational cohort study was conducted at the Children's Hospital of the Chongqing Medical University. Children with macrolide-resistant mutations (A2063/2064G) diagnosed as MPP were retrospectively enrolled. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to evaluate and identify independent risk factors for treatment failure (progress to refractory Mycoplasma pneumoniae pneumonia [RMPP]) in macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) children with the A2063/2064G mutation.

Results

One hundred fifty-five children were retrospectively enrolled. More than 20% (36/155, 23.23%) of patients experienced defervescence within 3 days of azithromycin treatment. RMPP was diagnosed in 54 patients (54/155, 34.84%) and the incidence of RMPP during hospitalization was 22.72 per 1000 person-days. Logistic regression analysis showed that lactate dehydrogenase (LDH) ≥ 399 (U/L) was an independent risk factor for RMPP (odds ratio [OR] 4.66, 95% confidence interval [CI] 1.31-17.10, P=0.017). During the year followed, RMPP patients had a significantly higher incidence of bronchiolitis obliterans and bronchiectasis than non-RMPP patients (16.67% vs 1.98%, P=0.001; 9.26% vs 0.00%, P=0.005, respectively).

Conclusion

Azithromycin was effective in children with MPP with the A2063/2064G mutation. For MUMPP children with A2063/2064G mutation, children with LDH ≥ 399 (U/L) had significant higher risk for progression to RMPP, and should consider to be treated with alternative antibiotics (eg tetracyclines, and fluoroquinolones).

Alterations of pathogen transmission patterns and attenuated immune stimulation might be the cause of increased adult respiratory infections cases in 2023, results from a multi-center study in mainland China

Background

Several respiratory infections outbreaks have been observed in mainland China after reduction of non-pharmaceutical interventions. Other countries have seen increases in respiratory infections outside typical seasons post-COVID-19, warranting investigation into underlying causes.

Methods

We established monitoring networks for suspected respiratory infection in 14 tertiary hospitals nationwide. PCR for SARS-CoV-2, influenza A and B were performed on 3708 respiratory specimens and deep sequencing were conducted to identify co-infections or newly emerging microbes in 2023. Viral evolutionary analysis was completed. We retrospectively detected serum antibody level for various respiratory pathogens from 4324 adults without respiratory infections over 7 years to observe its dynamic curves.

Findings

SARS-CoV-2 and influenza A were the main pathogens during outbreaks in 2023, bacterial-virus and bacterial-bacterial co-infections were most detected, but community co-infections didn't significantly increase pneumonia incidence. Different SARS-CoV-2 and influenza variants were present in different outbreaks, and no novel pathogens were found. The epidemiological patterns of influenza A, COVID-19 and etc. were altered, exhibiting characteristics of being "staggered" compared to most global regions, and potentially led to "overlapping prevalence". Binding antibody testing showed regular fluctuation, without significant decrease against common respiratory pathogens in adults. Influenza A antibody stimulation was attenuated during the 2023 outbreak.

Conclusions

"Misaligned" alteration in seasonal respiratory disease patterns possibly caused combined epidemics, leading to cases spike in China, 2023. In adults, antibody levels didn't show significant decline, but reduced immune response to influenza during 2020-2023 emphasizes the need for consistent vaccination during pandemics.

Comparison of Mycoplasma pneumoniae infection in children admitted with community acquired pneumonia before and during the COVID-19 pandemic: a retrospective study at a tertiary hospital of southwest China

PURPOSE

The COVID-19 pandemic has notably altered the infection dynamics of various pathogens. This study aimed to evaluate the pandemic's impact on the infection spectrum of Mycoplasma pneumoniae (M. pneumoniae) among children with community acquired pneumonia (CAP).

METHODS

We enrolled pediatric CAP patients admitted to a tertiary hospital in southwest China to compare the prevalence and characteristics of M. pneumoniae infections before (2018-2019) and during (2020-2022) the COVID-19 pandemic. Detection of M. pneumoniae IgM antibodies in serum were conducted using either indirect immunofluorescence or passive agglutination methods.

RESULTS

The study included 1505 M. pneumoniae-positive and 3160 M. pneumoniae-negative CAP patients. Notable findings were the higher age and frequency of pneumonia-associated symptoms in M. pneumoniae-positive patients, alongside a lower male proportion and fewer respiratory co-infections. The year 2019 saw a notable increase in M. pneumoniae infections compared to 2018, followed by a decline from 2020 to 2022. The COVID-19 pandemic period witnessed significant alterations in age distribution, male proportion, and co-infections with specific pathogens in both M. pneumoniae-positive and negative patients. The M. pneumoniae infections were predominantly seasonal, peaking in autumn and winter during 2018 and 2019. Although there was a sharp drop in February 2020, the infection still peaked in cold months of 2020 and 2021. However, the typical seasonal pattern was nearly absent in 2022.

CONCLUSIONS

The COVID-19 pandemic has markedly changed the infection landscape of M. pneumoniae in pediatric CAP patients, with shifts observed in infection rates, demographic profiles, co-infections, and seasonal patterns.

Marine-Derived Sulfated Glycans Inhibit the Interaction of Heparin with Adhesion Proteins of Mycoplasma pneumoniae

Mycoplasma pneumoniae, a notable pathogen behind respiratory infections, employs specialized proteins to adhere to the respiratory epithelium, an essential process for initiating infection. The role of glycosaminoglycans, especially heparan sulfate, is critical in facilitating pathogen-host interactions, presenting a strategic target for therapeutic intervention. In this study, we assembled a glycan library comprising heparin, its oligosaccharide derivatives, and a variety of marine-derived sulfated glycans to screen the potential inhibitors for the pathogen-host interactions. By using Surface Plasmon Resonance spectroscopy, we evaluated the library's efficacy in inhibiting the interaction between M. pneumoniae adhesion proteins and heparin. Our findings offer a promising avenue for developing novel therapeutic strategies against M. pneumoniae infections.

Significant differences in usage of antibiotics in three Chinese cities measured by wastewater-based epidemiology

Antibiotic use, particularly inappropriate use by irrational prescribing or over-the-counter purchases, is of great concern for China as it facilitates the spread of antibiotic resistances. In this study, we applied wastewater-based epidemiology (WBE) to monitor the total consumption of eight common antibiotics in three cities in northern, eastern and southern China. Wastewater samples were successively collected from 17 wastewater treatment plants including weekdays and weekends spanning four seasons between 2019 and 2021. The concentration of antibiotics and their corresponding metabolites showed a significant correlation, confirming the measured antibiotics were actually consumed. Different seasonal trends in antibiotic use were found among the cities. It was more prevalent in the winter in the northern city Beijing, with the high antibiotic consumption attributed to peak influenza occurrence in the city. This is clear evidence of irrational prescription of antibiotics since it's known that antibiotics do little to treat influenza. In terms of overall consumption, Foshan is significantly lower, thanks to warmer climate and higher use of herbal tea as a prevention measure. WBE estimates of antibiotic consumption were relatively comparable with other data sources, with azithromycin as the top antibiotic measured here. The studied cities had higher WBE estimated antibiotics consumption than results of previous studies in the literature. Monitoring antibiotic use in different areas and periods through WBE in combination with complementary information, can better inform appropriate antibiotic guideline policies in various regions and nations.

A Case Report of Mycoplasma pneumoniae-induced fulminant myocarditis in a 15-year-old male leading to cardiogenic shock and electrical storm

Mycoplasma pneumoniae (M. pneumoniae) is a well-recognized pathogen primarily associated with respiratory tract infections. However, in rare instances, it can lead to extrapulmonary manifestations, including myocarditis. We present a case of a 15-year-old male who developed fulminant myocarditis, cardiogenic shock, and cardiac electrical storm attributed to M. pneumoniae infection. He underwent a combination of intra-aortic balloon pump (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac support, ultimately surviving despite the intracardiac thrombus formation and embolic stroke. Following comprehensive treatment and rehabilitation, he was discharged in stable condition. This case underscores the importance of considering atypical pathogens as potential etiological factors in patients presenting with cardiac complications, especially in the adolescents. It also emphasizes the need for clinical vigilance and effective support for potential cardiac complications arising from M. pneumoniae infection.

The Impact of Respiratory Function Training and Rehabilitation Nursing on the Recovery of Patients With Mycoplasma Pneumoniae Pneumonia

Introduction The goal of this study was to see how people who had been diagnosed with Mycoplasma pneumoniae pneumonia (MPP) responded to respiratory function training and rehabilitation (RFTR) nursing. Methodology A total of 122 patients (five to 12 years of age) diagnosed with Mycoplasma pneumoniae pneumonia (MPP) and refractory Mycoplasma pneumoniae pneumonia (RMPP) using enzyme-linked immunoassay and PCR were included in this study. These patients were hospitalized at a tertiary care hospital from February 2022 to December 2022. Upon admission, they were assigned a numerical identifier based on the order of admission. Subsequently, they were randomly allocated into two equal groups: the observation (OG) and the control (CG), with each group consisting of 61 patients. Nano-acupoint sticking (NAS) therapy along with respiratory function training and rehabilitation (RFTR) nursing interventions were implemented for patients in the OG. Results The observed disparities in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the ratio of FEV1 to FVC among the patients did not exhibit significant disparity prior to the commencement of treatment (p values of 0.700, 0.105, and 0.829, respectively). There was no significant difference observed in the range of inflammation in the right lung (p=0.523). Inflammation in the left lung and fluid volume in both lungs are statistically different in both groups (p values of 0.001 and 0.000, respectively). The patients in the observation group exhibited a shorter duration of cough and sputum, disappearance of lung sounds, and length of hospital stays (LOS) compared to the other groups, with statistical significance (p<0.05). Conclusion Nano-acupoint sticking (NAS) therapy with respiratory function training and rehabilitation (RFTR) in nursing practice has shown enhanced rehabilitation outcomes for individuals diagnosed with Mycoplasma pneumoniae pneumonia (MPP). The present study focuses on the application of NAS therapy in the context of RFTR for individuals diagnosed with MPP.

Molecular epidemiology of Mycoplasma pneumoniae pneumonia in children, Wuhan, 2020-2022

BACKGROUND

Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of community-acquired pneumonia in children. The factors contributing to the severity of illness caused by M. pneumoniae infection are still under investigation. We aimed to evaluate the sensitivity of common M. pneumoniae detection methods, as well as to analyze the clinical manifestations, genotypes, macrolide resistance, respiratory microenvironment, and their relationship with the severity of illness in children with M. pneumoniae pneumonia in Wuhan.

RESULTS

Among 1,259 clinical samples, 461 samples were positive for M. pneumoniae via quantitative polymerase chain reaction (qPCR). Furthermore, we found that while serological testing is not highly sensitive in detecting M. pneumoniae infection, but it may serve as an indicator for predicting severe cases. We successfully identified the adhesin P1 (P1) genotypes of 127 samples based on metagenomic and Sanger sequencing, with P1-type 1 (113/127, 88.98%) being the dominant genotype. No significant difference in pathogenicity was observed among different genotypes. The macrolide resistance rate of M. pneumoniae isolates was 96% (48/50) and all mutations were A2063G in domain V of 23S rRNA gene. There was no significant difference between the upper respiratory microbiome of patients with mild and severe symptoms.

CONCLUSIONS

During the period of this study, the main circulating M. pneumoniae was P1-type 1, with a resistance rate of 96%. Key findings include the efficacy of qPCR in detecting M. pneumoniae, the potential of IgM titers exceeding 1:160 as indicators for illness severity, and the lack of a direct correlation between disease severity and genotypic characteristics or respiratory microenvironment. This study is the first to characterize the epidemic and genomic features of M. pneumoniae in Wuhan after the COVID-19 outbreak in 2020, which provides a scientific data basis for monitoring and infection prevention and control of M. pneumoniae in the post-pandemic era.

Increase of respiratory illnesses among children in Beijing, China, during the autumn and winter of 2023

In 2023, through an ongoing respiratory pathogen surveillance system, we observed from mid-September onwards, an increase of respiratory illness among children aged ≤ 15 years presenting at hospital outpatient clinics in Beijing, China. Data indicated that illness was caused by multiple pathogens, predominantly Mycoplasma pneumoniae. Seasonality, periodicity and high prevalence of resistance to macrolide (30 of 30 strains sequenced with the A2063G mutation) were important characteristics of the M. pneumoniae epidemic, which resulted in a rise in consultations at specialised paediatric hospitals.

Clinical Value of Metagenomics Next-Generation Sequencing in Antibiotic Resistance of a Patient with Severe Refractory Mycoplasma pneumoniae Pneumonia: A Case Report

Background

Mycoplasma pneumoniae is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant M. pneumoniae (MRMP) has become increasingly prevalent, and identifying pathogen resistance genes is crucial for treatment.

Case Presentation

We report a patient with severe refractory M. pneumoniae pneumonia (MPP). The failure of initial clinical treatment prompted the re-analysis of metagenomic next-generation sequencing (mNGS) data for macrolide-resistant gene. Macrolide-resistance 23S ribosomal RNA gene was confirmed with read depth of 64 X for the A2063G mutation, which can decrease the affinity of macrolide with M. pneumoniae ribosome resulting in macrolide resistance. Furthermore, antimicrobial susceptibility testing demonstrated that M. pneumoniae was resistant to macrolide. PCR confirmatory test about M. pneumoniae resistance A2063G mutation, clinical treatment course and prognosis with altered treatment strategy, and M. pneumoniae antimicrobial susceptibility confirmed that the severe refractory MPP was due to macrolide resistant M. pneumoniae.

Conclusion

As a new molecular level detection, mNGS is an effective method for detecting M. pneumoniae resistance genes. Early recognition of macrolide resistance and suitable antibiotics strategy is of vital importance for the prognosis of severe refractory MPP.

Genotyping of Mycoplasma pneumoniae strains isolated in Japan during 2019 and 2020: spread of p1 gene type 2c and 2j variant strains

We characterized 118 Mycoplasma pneumoniae strains isolated from three areas of Japan (Saitama, Kanagawa, and Osaka) during the period of 2019 and 2020. Genotyping of the p1 gene in these strains revealed that 29 of them were type 1 lineage (29/118, 24.6%), while 89 were type 2 lineage (89/118, 75.4%), thereby indicating that type 2 lineage was dominant in this period. The most prevalent variant of type 2 lineage was type 2c (57/89, 64%), while the second-most was type 2j, a novel variant identified in this study (30/89, 33.7%). Type 2j p1 is similar to type 2 g p1, but cannot be distinguished from reference type 2 (classical type 2) using the standard polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) with HaeIII digestion. Thus, we used MboI digestion in the PCR-RFLP analysis and re-examined the data from previous genotyping studies as well. This revealed that most strains reported as classical type 2 after 2010 in our studies were actually type 2j. The revised genotyping data showed that the type 2c and 2j strains have been spreading in recent years and were the most prevalent variants in Japan during the time-period of 2019 and 2020. We also analyzed the macrolide-resistance (MR) mutations in the 118 strains. MR mutations in the 23S rRNA gene were detected in 29 of these strains (29/118, 24.6%). The MR rate of type 1 lineage (14/29, 48.3%) was still higher than that of type 2 lineage (15/89, 16.9%); however, the MR rate of type 1 lineage was lower than that found in previous reports published in the 2010s, while that of type 2 lineage strains was slightly higher. Thus, there is a need for continuous surveillance of the p1 genotype and MR rate of M. pneumoniae clinical strains, to better understand the epidemiology and variant evolution of this pathogen, although M. pneumoniae pneumonia cases have decreased significantly since the COVID-19 pandemic.

The clinical significance of macrolide resistance in pediatric Mycoplasma pneumoniae infection during COVID-19 pandemic

Background

Mycoplasma pneumoniae (MP) is a commonly occurring pathogen causing community-acquired pneumonia (CAP) in children. The global prevalence of macrolide-resistant MP (MRMP) infection, especially in Asian regions, is increasing rapidly. However, the prevalence of MRMP and its clinical significance during the COVID-19 pandemic is not clear.

Methods

This study enrolled children with molecularly confirmed macrolide-susceptible MP (MSMP) and MRMP CAP from Beijing Children's Hospital Baoding Hospital, Capital Medical University between August 2021 and July 2022. The clinical characteristics, laboratory findings, chest imaging presentations, and strain genotypes were compared between patients with MSMP and MRMP CAP.

Results

A total of 520 hospitalized children with MP-CAP were enrolled in the study, with a macrolide resistance rate of 92.7%. Patients with MRMP infection exhibited more severe clinical manifestations (such as dyspnea and pleural effusion) and had a longer hospital stay than the MSMP group. Furthermore, abnormal blood test results (including increased LDH and D-dimer) were more common in the MRMP group (P<0.05). Multilocus variable-number tandem-repeat analysis (MLVA) was performed on 304 samples based on four loci (Mpn13-16), and M3562 and M4572 were the major types, accounting for 74.0% and 16.8% of the strains, respectively. The macrolide resistance rate of M3562 strains was up to 95.1%.

Conclusion

The prevalence of MRMP strains in hospitalized CAP patients was extremely high in the Baoding area, and patients infected with MRMP strains exhibited more severe clinical features and increased LDH and D-dimer. M3562 was the predominant resistant clone.