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Guo ZQ, Gu SY, Tian ZH, Du BY. A comprehensive review of Mycoplasma pneumoniae infection in chronic lung diseases: recent advances in understanding asthma, COPD, and bronchiectasis. Front Med (Lausanne) 2024; 11:1437731. [PMID: 39386750 PMCID: PMC11461384 DOI: 10.3389/fmed.2024.1437731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/02/2024] [Indexed: 10/12/2024] Open
Abstract
This review summarizes the research progress over the past 30 years on the relationship between Mycoplasma pneumoniae infection and chronic respiratory diseases such as asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, particularly in children and young adults. Key findings from recent studies indicate that M. pneumoniae infection is associated with a higher risk of asthma exacerbations and may contribute to the development of bronchiectasis in susceptible individuals. Additionally, emerging evidence suggests that M. pneumoniae-induced immune dysregulation plays a crucial role in the pathogenesis of chronic lung diseases. This review aims to summarize the current understanding of the potential links between M. pneumoniae pneumonia and various chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis. We discuss the epidemiological data, pathogenic mechanisms, clinical manifestations, and long-term consequences of M. pneumoniae-related respiratory illnesses. Additionally, we highlight the challenges in diagnosis and treatment, as well as future research directions in this field.
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Affiliation(s)
- Zai-qiang Guo
- Department of Science and Education, Beijing Fengtai Hospital of Integrated Traditional Chinese and Modern Medicine, Beijing, China
| | - Shun-yi Gu
- Department of Internal Medicine, Beijing Tongzhou District Integrated Traditional Chinese and Modern Medicine, Beijing, China
| | - Zhi-hua Tian
- Department of Science and Education, Beijing Daxing District Hospital of Integrated Traditional Chinese and Modern Medicine, Beijing, China
| | - Bo-ying Du
- Pediatrics, Shijiazhuang Second Hospital, Shijiazhuang, China
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Ha EK, Jin JO, Kim JH, Shin J, Lee GC, Cha HR, Choi SH, Han MY. Age-related effects of Mycoplasma pneumoniae infection and subsequent asthma exacerbation in children. Pediatr Pulmonol 2024; 59:1569-1577. [PMID: 38708969 DOI: 10.1002/ppul.26907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Mycoplasma pneumoniae causes community-acquired pneumonia in children and increases asthma risk, but large studies are lacking. OBJECTIVE To assess the link between M. pneumoniae infection and to asthma exacerbation, in children with allergies, and age of infection impact. METHODS This retrospective cohort study analyzed medical records of South Korean children between January 2002 and December 2017. The study's exposure was hospitalization with an M. pneumoniae-related diagnosis, and the outcome was defined as asthma exacerbation, confirmed by hospitalization at least 6 months after M. pneumoniae infection, with alternative validation using asthma diagnosis and systemic steroid prescription records. Hazard ratios (HRs) for asthma exacerbation risk were estimated for the matched cohort using a Cox proportional hazards model stratified by allergic comorbidities. Time-dependent covariates and age-stratified exposure groups were used to calculate odds ratios. RESULTS The study included 84,074 children with M. pneumoniae infection and 336,296 unexposed children. Follow-up for 12.2 ± 2.3 years found the exposed group had a significant risk of asthma exacerbation (HR 2.86, 95% confidence interval [CI] 2.67-3.06) regardless of allergic comorbidities. The risk was highest (over threefold) in children infected between 24 and 71 months. Sensitivity analysis using an alternative definition of the outcome showed an HR of 1.38 (95% CI 1.35-1.42), further supporting the association between M. pneumoniae infection and asthma exacerbation. CONCLUSION M. pneumoniae infection was significantly associated with an increased risk of subsequent asthma exacerbation regardless of allergic comorbidities. Further research needed for understanding and confirmation.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Joo Ok Jin
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea, Seoul, Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jeewon Shin
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Gi Chun Lee
- School of Computer Science and Engineering, Konkuk University, Seoul, Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sungkyunkwan University, Suwon, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
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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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Ha EK, Kim JH, Cha HR, Han BE, Shin YH, Baek HS, Choi SH, Han MY. Investigating the occurrence of autoimmune diseases among children and adolescents hospitalized for Mycoplasma pneumoniae infections. Front Immunol 2023; 14:1165586. [PMID: 38124736 PMCID: PMC10732509 DOI: 10.3389/fimmu.2023.1165586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
Background Mycoplasma pneumoniae infection is common in the general population and may be followed by immune dysfunction, but links with subsequent autoimmune disease remain inconclusive. Objective To estimate the association of M. pneumoniae infection with the risk of subsequent autoimmune disease. Methods This retrospective cohort study examined the medical records of South Korean children from 01/01/2002 to 31/12/2017. The exposed cohort was identified as patients hospitalized for M. pneumoniae infection. Each exposed patient was matched with unexposed controls based on birth year and sex at a 1:10 ratio using incidence density sampling calculations. The outcome was subsequent diagnosis of autoimmune disease, and hazard ratios (HRs) were estimated with control for confounders. Further estimation was performed using hospital-based databases which were converted to a common data model (CDM) to allow comparisons of the different databases. Results The exposed cohort consisted of 49,937 children and the matched unexposed of 499,370 children. The median age at diagnosis of M. pneumoniae infection was 4 years (interquartile range, 2.5-6.5 years). During a mean follow-up time of 9.0 ± 3.8 years, the incidence rate of autoimmune diseases was 66.5 per 10,000 person-years (95% CI: 64.3-68.8) in the exposed cohort and 52.3 per 10,000 person-years (95% CI: 51.7-52.9) in the unexposed cohort, corresponding to an absolute rate of difference of 14.3 per 10,000 person-years (95% CI: 11.9-16.6). Children in the exposed cohort had an increased risk of autoimmune disease (HR: 1.26; 95% CI: 1.21-1.31), and this association was similar in the separate analysis of hospital databases (HR: 1.25; 95% CI 1.06-1.49). Conclusion M. pneumoniae infection requiring hospitalization may be associated with an increase in subsequent diagnoses of autoimmune diseases.
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Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Ju Hee Kim
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hye Ryeong Cha
- Department of Computer Science and Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Bo Eun Han
- Department of Software, Sejong University, Seoul, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hey-Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Song Z, Jia G, Luo G, Han C, Zhang B, Wang X. Global research trends of Mycoplasma pneumoniae pneumonia in children: a bibliometric analysis. Front Pediatr 2023; 11:1306234. [PMID: 38078315 PMCID: PMC10704248 DOI: 10.3389/fped.2023.1306234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP), attributable to Mycoplasma pneumoniae (MP), represents a predominant form of community-acquired pneumonia in pediatric populations, thereby posing a significant threat to pediatric health. Given the burgeoning volume of research literature associated with pediatric MPP in recent years, it becomes imperative to undertake a bibliometric analysis aimed at delineating the current research landscape and emerging trends, thereby furnishing a framework for subsequent investigations. METHODS A comprehensive literature search targeting pediatric MPP was conducted in the Web of Science Core Collection. After the removal of duplicate entries through Endnote software, the remaining articles were subject to scientometric analysis via Citespace software, VOSviewer software and R language, focusing on variables such as publication volume, contributing nations, institutions and authors, references and keywords. RESULTS A total of 1,729 articles pertinent to pediatric MPP were included in the analysis. China and the United States emerged as the nations with the highest publication output. Italian scholar Susanna Esposito and Japanese scholar Kazunobu Ouchi were the most influential authors in the domain of pediatric MPP. Highly-cited articles primarily focused on the epidemiological investigation of pediatric MPP, the clinical characteristics and treatment of macrolide-resistant MPP, and biomarkers for refractory Mycoplasma pneumoniae pneumonia (RMPP). From the corpus of 1,729 articles, 636 keywords were extracted and categorized into ten clusters: Cluster #0 centered on molecular-level typing of macrolide-resistant strains; Cluster #1 focused on lower respiratory tract co-infections; Clusters #2 and #6 emphasized other respiratory ailments caused by MP; Cluster #3 involved biomarkers and treatment of RMPP; Clusters #4 and #9 pertained to extrapulmonary complications of MPP, Clusters #5 and #7 addressed etiological diagnosis of MPP, and Cluster #8 explored pathogenic mechanisms. CONCLUSIONS The past few years have witnessed extensive attention directed towards pediatric MPP. Research in pediatric MPP principally revolves around diagnostic techniques for MP, macrolide resistance, complications of MPP, treatment and diagnosis of RMPP, and elucidation of pathogenic mechanisms. The present study provides pediatric clinicians and researchers with the research status and focal points in this field, thereby guiding the orientation of future research endeavors.
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Affiliation(s)
- Zhe Song
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangyuan Jia
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guangzhi Luo
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chengen Han
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Baoqing Zhang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiao Wang
- Department of Pediatrics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Iannuzo N, Dy ABC, Guerra S, Langlais PR, Ledford JG. The Impact of CC16 on Pulmonary Epithelial-Driven Host Responses during Mycoplasma pneumoniae Infection in Mouse Tracheal Epithelial Cells. Cells 2023; 12:1984. [PMID: 37566063 PMCID: PMC10416898 DOI: 10.3390/cells12151984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
Club Cell Secretory Protein (CC16) plays many protective roles within the lung; however, the complete biological functions, especially regarding the pulmonary epithelium during infection, remain undefined. We have previously shown that CC16-deficient (CC16-/-) mouse tracheal epithelial cells (MTECs) have enhanced Mp burden compared to CC16-sufficient (WT) MTECs; therefore, in this study, we wanted to further define how the pulmonary epithelium responds to infection in the context of CC16 deficiency. Using mass spectrometry and quantitative proteomics to analyze proteins secreted apically from MTECs grown at an air-liquid interface, we investigated the protective effects that CC16 elicits within the pulmonary epithelium during Mycoplasma pneumoniae (Mp) infection. When challenged with Mp, WT MTECs have an overall reduction in apical protein secretion, whereas CC16-/- MTECs have increased apical protein secretion compared to their unchallenged controls. Following Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) assessment, many of the proteins upregulated from CC16-/- MTECS (unchallenged and during Mp infection) were related to airway remodeling, which were not observed by WT MTECs. These findings suggest that CC16 may be important in providing protection within the pulmonary epithelium during respiratory infection with Mp, which is the major causative agent of community-acquired pneumoniae.
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Affiliation(s)
- Natalie Iannuzo
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85724, USA;
| | | | - Stefano Guerra
- Asthma and Airway Disease Research Center, Tucson, AZ 85724, USA
| | - Paul R. Langlais
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Julie G. Ledford
- Department of Cellular and Molecular Medicine, University of Arizona, Tucson, AZ 85724, USA;
- Asthma and Airway Disease Research Center, Tucson, AZ 85724, USA
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Shi H, Wang T, Zhao Z, Norback D, Wang X, Li Y, Deng Q, Lu C, Zhang X, Zheng X, Qian H, Zhang L, Yu W, Shi Y, Chen T, Yu H, Qi H, Yang Y, Jiang L, Lin Y, Yao J, Lu J, Yan Q. Prevalence, risk factors, impact and management of pneumonia among preschool children in Chinese seven cities: a cross-sectional study with interrupted time series analysis. BMC Med 2023; 21:227. [PMID: 37365601 DOI: 10.1186/s12916-023-02951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Pneumonia is a common disease worldwide in preschool children. Despite its large population size, China has had no comprehensive study of the national prevalence, risk factors, and management of pneumonia among preschool children. We therefore investigated the prevalence of pneumonia among preschool children in Chinese seven representative cities, and explore the possible risk factors of pneumonia on children, with a view to calling the world's attention to childhood pneumonia to reduce the prevalence of childhood pneumonia. METHODS Two group samples of 63,663 and 52,812 preschool children were recruited from 2011 and 2019 surveys, respectively. Which were derived from the cross-sectional China, Children, Homes, Health (CCHH) study using a multi-stage stratified sampling method. This survey was conducted in kindergartens in seven representative cities. Exclusion criteria were younger than 2 years old or older than 8 years old, non-permanent population, basic information such as gender, date of birth and breast feeding is incomplete. Pneumonia was determined on the basis of parents reported history of clearly diagnosed by the physician. All participants were assessed with a standard questionnaire. Risk factors for pneumonia, and association between pneumonia and other respiratory diseases were examined by multivariable-adjusted analyses done in all participants for whom data on the variables of interest were available. Disease management was evaluated by the parents' reported history of physician diagnosis, longitudinal comparison of risk factors in 2011 and 2019. RESULTS In 2011 and 2019, 31,277 (16,152 boys and 15,125 girls) and 32,016 (16,621 boys and 15,395 girls) preschool children aged at 2-8 of permanent population completed the questionnaire, respectively, and were thus included in the final analysis. The findings showed that the age-adjusted prevalence of pneumonia in children was 32.7% in 2011 and 26.4% in 2019. In 2011, girls (odds ratio [OR] 0.91, 95%CI [confidence interval]0.87-0.96; p = 0.0002), rural (0.85, 0.73-0.99; p = 0.0387), duration of breastfeeding ≥ 6 months(0.83, 0.79-0.88; p < 0.0001), birth weight (g) ≥ 4000 (0.88, 0.80-0.97; p = 0.0125), frequency of putting bedding to sunshine (Often) (0.82, 0.71-0.94; p = 0.0049), cooking fuel type (electricity) (0.87, 0.80-0.94; p = 0.0005), indoor use air-conditioning (0.85, 0.80-0.90; p < 0.0001) were associated with a reduced risk of childhood pneumonia. Age (4-6) (1.11, 1.03-1.20; p = 0.0052), parental smoking (one) (1.12, 1.07-1.18; p < 0.0001), used antibiotics (2.71, 2.52-2.90; p < 0.0001), history of parental allergy (one and two) (1.21, 1.12-1.32; p < 0.0001 and 1.33, 1.04-1.69; p = 0.0203), indoor dampness (1.24, 1.15-1.33; p < 0.0001), home interior decoration (1.11, 1.04-1.19; p = 0.0013), Wall painting materials (Paint) (1.16, 1.04-1.29; p = 0.0084), flooring materials (Laminate / Composite wood) (1.08, 1.02-1.16; p = 0.0126), indoor heating mode(Central heating)(1.18, 1.07-1.30, p = 0.0090), asthma (2.38, 2.17-2.61; p < 0.0001), allergic rhinitis (1.36, 1.25-1.47; p < 0.0001), wheezing (1.64, 1.55-1.74; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (2.53, 2.31-2.78; p < 0.0001), allergic rhinitis (1.41, 1.29-1.53; p < 0.0001) and wheezing (1.64, 1.55-1.74; p < 0.0001). In 2019, girls (0.92, 0.87-0.97; p = 0.0019), duration of breastfeeding ≥ 6 months (0.92, 0.87-0.97; p = 0.0031), used antibiotics (0.22, 0.21-0.24; p < 0.0001), cooking fuel type (Other) (0.40, 0.23-0.63; p = 0.0003), indoor use air-conditioning (0.89, 0.83-0.95; p = 0.0009) were associated with a reduced risk of childhood pneumonia. Urbanisation (Suburb) (1.10, 1.02-1.18; p = 0.0093), premature birth (1.29, 1.08-1.55; p = 0.0051), birth weight (g) < 2500 (1.17, 1.02-1.35; p = 0.0284), parental smoking (1.30, 1.23-1.38; p < 0.0001), history of parental asthma (One) (1.23, 1.03-1.46; p = 0.0202), history of parental allergy (one and two) (1.20, 1.13-1.27; p < 0.0001 and 1.22, 1.08-1.37; p = 0.0014), cooking fuel type (Coal) (1.58, 1.02-2.52; p = 0.0356), indoor dampness (1.16, 1.08-1.24; p < 0.0001), asthma (1.88, 1.64-2.15; p < 0.0001), allergic rhinitis (1.57, 1.45-1.69; p < 0.0001), wheezing (2.43, 2.20-2.68; p < 0.0001) were associated with an elevated risk of childhood pneumonia; pneumonia was associated with an elevated risk of childhood asthma (1.96, 1.72-2.25; p < 0.0001), allergic rhinitis (1.60, 1.48-1.73; p < 0.0001) and wheezing (2.49, 2.25-2.75; p < 0.0001). CONCLUSIONS Pneumonia is prevalent among preschool children in China, and it affects other childhood respiratory diseases. Although the prevalence of pneumonia in Chinese children shows a decreasing trend in 2019 compared to 2011, a well-established management system is still needed to further reduce the prevalence of pneumonia and reduce the burden of disease in children.
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Affiliation(s)
- Haonan Shi
- School of Nursing & Health Management, Shanghai University of Medicine & Health Sciences, No.279, Zhouzhu Highway, Pudong New District, Shanghai, 201318, China
| | - Tingting Wang
- School of Nursing & Health Management, Shanghai University of Medicine & Health Sciences, No.279, Zhouzhu Highway, Pudong New District, Shanghai, 201318, China.
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200433, China
- Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, 200433, China
| | - Dan Norback
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, SE-751, Uppsala, Sweden
| | - Xiaowei Wang
- Department of Operation and Security, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
| | - Yongsheng Li
- Department of Preventive Medicine, Medical College, Shihezi University, Shihezi, 832002, China
| | - Qihong Deng
- School of Public Health, Central South University, Changsha, 410083, China
| | - Chan Lu
- School of Public Health, Central South University, Changsha, 410083, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, 237016, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, 214135, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, 214135, China
| | - Ling Zhang
- Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Wei Yu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, 400044, China
- National Centre for International Research of Low-Carbon and Green Buildings, Ministry of Science and Technology), Chongqing University, Chongqing, 400044, China
| | - Yuqing Shi
- Wuhan University of Science and Technology, Wuhan, 430081, China
| | - Tianyi Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200433, China
| | - Huaijiang Yu
- People's Hospital of Bayingguoleng Mongolian Autonomous Prefecture, Kuerle, 841099, China
| | - Huizhen Qi
- Department of Neurology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Ye Yang
- Department of No.1 Cadres, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830063, China
| | - Lan Jiang
- Department of Laboratory Medicine, Xinjiang Uyghur Autonomous Region Maternal and Child Health Hospital, Urumqi, 830001, China
| | - Yuting Lin
- Department of Laboratory Medicine, Xinjiang Uyghur Autonomous Region Maternal and Child Health Hospital, Urumqi, 830001, China
| | - Jian Yao
- School of Public Health, Xinjiang Medical University, Urumqi, 830054, China
- Xinjiang Key Laboratory of Special Environment and Health Research, Urumqi, 830054, China
| | - Junwen Lu
- School of Public Health, Xinjiang Medical University, Urumqi, 830054, China
- Xinjiang Key Laboratory of Special Environment and Health Research, Urumqi, 830054, China
| | - Qi Yan
- School of Public Health, Xinjiang Medical University, Urumqi, 830054, China
- Xinjiang Key Laboratory of Special Environment and Health Research, Urumqi, 830054, China
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Zhou X, Jiang W, Zhou Q, Yang W. The role of serum inflammatory in mycoplasma pneumonia infection with respiratory asthma. J Asthma 2023:1-10. [PMID: 36511625 DOI: 10.1080/02770903.2022.2158101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE With the growing frequency of Mycoplasma pneumoniae infections linked to respiratory asthma (MP-RA), particularly in children, the quest for novel diagnostic molecular markers has become critical. We examined the link between serum immunoglobulin, inflammatory variables, vitamin A, and vitamin D levels in MP-RA patients and then found markedly diagnostic indicators. METHODS From January 2015 to March 2020, our hospital screened 55 cases of healthy control children (HC), 53 instances of mycoplasma pneumonia infection complicated with respiratory asthma (MP-RA), and 58 cases of non-respiratory asthma children for pneumonia mycoplasma infection (MP). Serum immunoglobulins, inflammatory markers, vitamin D, and vitamin A levels were analyzed, and a predictive model including the feature chosen in the least absolute shrinkage and selection operator regression model was developed. RESULTS Serum TNF- and IL-1b levels were greater in MP-RA children than in MP children, but 25(OH)D, IgG, and IgA levels were lower. Our findings verified the link between IgA, TNF-a, 25(OH)D, and vitamin A with MP-RA. In addition, TNF-a, IL-1b, 25(OH)D (Vit-D), IgG, and IgA were the predictors in the prediction nomogram, showing the combined influence of serum inflammation in MP-RA. C-index of 0.985 (95% CI: -1.25 to 1.68) shows high scaling ability and the model exhibits good discriminative capacity. With range validation, the high C-index value of 0.96 is still possible. CONCLUSION TNF-a, IL-1b, 25(OH)D (Vit-D), IgG, and IgA were considered as predictors in children with MP-RA was investigated in this research.
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Affiliation(s)
- Xiaoju Zhou
- Department of Infective disease, First Center Hospital, TianJin City, China
| | - Wei Jiang
- Department of Infective disease, First Center Hospital, TianJin City, China
| | - Qianyi Zhou
- Department of Infective disease, First Center Hospital, TianJin City, China
| | - Wenjie Yang
- Department of Infective disease, First Center Hospital, TianJin City, China
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Zhou X, Zhang P, Tan H, Dong B, Jing Z, Wu H, Luo J, Zhang Y, Zhang J, Sun X. Progress in diagnosis and treatment of difficult-to-treat asthma in children. Ther Adv Respir Dis 2023; 17:17534666231213637. [PMID: 38069568 PMCID: PMC10710755 DOI: 10.1177/17534666231213637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
At present, medications containing inhaled corticosteroids (ICS-containing) are the keystones of asthma treatment. The majority of asthmatic children can significantly improve clinical outcomes with little worsening by standardized inhaled glucocorticoid treatment, but there is still a small proportion of children who are unable to achieve good symptom control even after the maximum standardized treatment, known as 'children with difficult-to-treat asthma (DA)'. The high heterogeneity of DA makes therapy challenging and expensive, which poses a serious risk to children's health and makes it extremely difficult for clinical physicians to accurately identify and treat children with DA. This article reviews the definition, evaluation, and treatment of this asthma in order to provide a reference for optimal clinical decision-making.
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Affiliation(s)
- Xuehua Zhou
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Panpan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Hong Tan
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Bo Dong
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zenghui Jing
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Huajie Wu
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jianfeng Luo
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yao Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Juan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
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10
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Luo J, Chen H, Zhang Q, Huang X, Qin X, Li J, Chen S, Xiao Y, Sun L, Sun B. Metabolism Characteristics of Mycoplasma pneumoniae Infection in Asthmatic Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:713-729. [PMID: 36426399 PMCID: PMC9709688 DOI: 10.4168/aair.2022.14.6.713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 07/30/2023]
Abstract
PURPOSE Studies have shown that Mycoplasma pneumoniae (Mp) infection can aggravate symptoms in asthmatics. However, the mechanism by which Mp infection exacerbates asthma remains unclear. Metabolomics can help identify the mechanism of Mp aggravating asthma in children, thereby providing more a potential target for improving clinical treatment programs. In this article, we analyzed the metabolic level of patients to explain how Mp aggravates asthma in children. METHODS We divided the subjects into the asthma, Mp infection, asthma combined with Mp infection and healthy groups. Patients' peripheral blood was collected for metabolic and interaction analysis. Cytokine levels were measured via serum and exhaled breath condensate (EBC). RESULTS A total of 150 participating subjects were divided into four groups after exclusion. We found out that there were different metabolic pathways between the healthy and disease groups. The major pathways of both asthma and asthma combined with Mp infection were valine, leucine and isoleucine biosynthesis; malate-aspartate shuttle was the main differential pathway for Mp infection. Moreover, even though three disease groups involved 81 metabolites at the same time, compared with asthma combined with Mp infection, 2 single disease groups still involved different amino acid pathways (phenylalanine, tyrosine and tryptophan biosynthesis; valine, leucine and isoleucine biosynthesis). Interaction analysis showed that Mp infection in asthmatic patients not only activated cytokines, but also activated Toll-like receptors (TLRs) 2 and 6. Finally, the levels of interleukin (IL)-4, IL-8, IL-13 and tumor necrosis factor-α in EBC with asthma combined with Mp infection were significantly higher than the 2 single disease groups. CONCLUSIONS Mp infection in asthmatic children can cause changes in the levels of various amino acids in the body, which were enriched in the pathways such as valine, leucine and isoleucine biosynthesis. Palmitic acid can activate TLR2, and iloprost reduces IL-10 levels, ultimately leading to the increased airway inflammation.
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Affiliation(s)
- Jiaying Luo
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huian Chen
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiyong Zhang
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinyun Huang
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xu Qin
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- Institute of Integrated Traditional Chinese and Western Medicine, Guangzhou Medical University, Guangzhou, China
| | - Siyi Chen
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongxin Xiao
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lihong Sun
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Baoqing Sun
- State Key Lab of Respiratory Disease, National Clinical Research Center of Respiratory Disease, and Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Gavitt TD, Mara AB, Goodridge ML, Ozyck RG, Reinhardt E, Miller JM, Hunte M, Tulman ER, Frasca Jr S, Silbart LK, Geary SJ, Szczepanek SM. B cells oppose Mycoplasma pneumoniae vaccine enhanced disease and limit bacterial colonization of the lungs. NPJ Vaccines 2022; 7:130. [PMID: 36310317 PMCID: PMC9618410 DOI: 10.1038/s41541-022-00556-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
Development of an effective vaccine for Mycoplasma pneumoniae has been hindered by reports of Vaccine Enhanced Disease (VED) in test subjects vaccinated and challenged in studies conducted in the 1960s. The exact mechanism of disease exacerbation has yet to be fully described, but host immune responses to Lipid-Associated Membrane Proteins (LAMPs) lipoprotein lipid moieties have been implicated. LAMPs-induced exacerbation appears to involve helper T cell recall responses, due in part to their influence on neutrophil recruitment and subsequent inflammatory responses in the lung. Herein, we characterized the functions of host B cell responses to M. pneumoniae LAMPs and delipidated-LAMPs (dLAMPs) by conducting passive transfer and B cell depletion studies to assess their contribution to disease exacerbation or protection using a BALB/c mouse model. We found that antibody responses to M. pneumoniae LAMPs and dLAMPs differ in magnitude, but not in isotype or subclass. Passive transfer, dLAMP denaturation, and monoclonal antibody studies indicate that antibodies do not cause VED, but do appear to contribute to control of bacterial loads in the lungs. Depletion of B cells prior to LAMPs-vaccination results in significantly enhanced pathology in comparison to B cell competent controls, suggesting a possible regulatory role of B cells distinct from antibody secretion. Taken together, our findings suggest that B cell antibody responses to M. pneumoniae contribute to, but are insufficient for protection against challenge on their own, and that other functional properties of B cells are necessary to limit exacerbation of disease in LAMPs-vaccinated mice after infection.
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Affiliation(s)
- Tyler D. Gavitt
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,US Animal Vaccinology Research Coordination Network, Storrs, CT 06238 USA
| | - Arlind B. Mara
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,US Animal Vaccinology Research Coordination Network, Storrs, CT 06238 USA
| | - Meagan L. Goodridge
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA
| | - Rosemary Grace Ozyck
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA
| | - Emily Reinhardt
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,Connecticut Veterinary Medical Diagnostic Laboratory, Storrs, CT 06238 USA
| | - Jeremy M. Miller
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,US Animal Vaccinology Research Coordination Network, Storrs, CT 06238 USA
| | - Morgan Hunte
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,grid.417555.70000 0000 8814 392XPresent Address: Sanofi, Meriden, CT 06450 USA
| | - Edan R. Tulman
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,US Animal Vaccinology Research Coordination Network, Storrs, CT 06238 USA
| | - Salvatore Frasca Jr
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA
| | - Lawrence K. Silbart
- grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Department of Allied of Health Sciences, University of Connecticut, Storrs, CT 06238 USA
| | - Steven J. Geary
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,US Animal Vaccinology Research Coordination Network, Storrs, CT 06238 USA
| | - Steven M. Szczepanek
- grid.63054.340000 0001 0860 4915Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06238 USA ,grid.63054.340000 0001 0860 4915Center of Excellence for Vaccine Research, University of Connecticut, Storrs, CT 06238 USA ,US Animal Vaccinology Research Coordination Network, Storrs, CT 06238 USA
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12
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Álvaro Varela AI, Aguinaga Pérez A, Navascués Ortega A, Castilla J, Ezpeleta Baquedano C. Clinical characteristics of patients with Mycoplasma pneumoniae infection. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:449-452. [PMID: 36154990 DOI: 10.1016/j.eimce.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the characteristics of patients diagnosed with Mycoplasma pneumoniae infection. METHODS A retrospective study of clinical and epidemiological characteristics of acute infections by M. pneumoniae confirmed by PCR was carried out in the Navarra Health Service (Spain) in 2014-2018. RESULTS M. pneumoniae infection was confirmed in 9.5% of analyzed patients. Among 123 confirmed cases, 65% were 5-14 years old, 21.1% <5 years old, and 13.8% were ≥14 years old. Pneumonia was radiologically confirmed in 83.7% of cases, and 22.0% presented extra-respiratory manifestations. A total of 44.7% of cases required hospitalization. Bilateral pneumonia, asthmatic crisis and extra-respiratory manifestations were associated to higher risk of hospitalization (81.3, 72.2 and 66.7%, respectively). Microbiological targeted treatment was monotherapy with macrolides in 60.2% of cases and combined with other antibiotics in 13.0%. CONCLUSION M. pneumoniae was the cause of acute respiratory infection affecting mainly to children younger than 14 years old and frequently required hospitalization.
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Affiliation(s)
| | - Aitziber Aguinaga Pérez
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Ana Navascués Ortega
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain; CIBER, Epidemiologia y Salud Pública (CIBERESP)
| | - Carmen Ezpeleta Baquedano
- Servicio de Microbiología Clínica, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain
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13
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Características clínicas de pacientes con infección por Mycoplasma pneumoniae. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Mycoplasma pneumoniae Compared to Streptococcus pneumoniae Avoids Induction of Proinflammatory Epithelial Cell Responses despite Robustly Inducing TLR2 Signaling. Infect Immun 2022; 90:e0012922. [PMID: 35862703 PMCID: PMC9387261 DOI: 10.1128/iai.00129-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Mycoplasma pneumoniae and Streptococcus pneumoniae are the most common bacterial causes of pneumonia in children. The clinical characteristics of pneumonia differ significantly between the two bacteria. We aimed to elucidate the differences in pathogenesis between M. pneumoniae and S. pneumoniae by characterizing the respiratory epithelial cell immune response to both pathogens. Using primary human bronchial epithelial cells in air-liquid interface cultures, we observed lower production of the proinflammatory cytokines interleukin-6 (IL-6) and IL-8 in response to M. pneumoniae than to S. pneumoniae. In contrast to the differences in proinflammatory cytokine production, Toll-like receptor 2 (TLR2)-mediated signaling in response to M. pneumoniae was stronger than to S. pneumoniae. This difference largely depended on TLR1 and not TLR6. We found that M. pneumoniae, but not S. pneumoniae, also induced signaling of TLR10, a coreceptor of TLR2 that has inhibitory properties. M. pneumoniae-induced TLR10 signaling on airway epithelial cells was partially responsible for low IL-8 production, as blocking TLR10 by specific antibodies increased cytokine production. M. pneumoniae maintained Th2-associated cytokine production by epithelial cells, which concurs with the known association of M. pneumoniae infection with asthma. M. pneumoniae left IL-33 levels unchanged, whereas S. pneumoniae downregulated IL-33 production both under homeostatic and Th2-promoting conditions. By directly comparing M. pneumoniae and S. pneumoniae, we demonstrate that M. pneumoniae avoids induction of proinflammatory cytokine response despite its ability to induce robust TLR2 signaling. Our new findings suggest that this apparent paradox may be partially explained by M. pneumoniae-induced signaling of TLR2/TLR10.
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Ghimire JJ, Jat KR, Sankar J, Lodha R, Iyer VK, Gautam H, Sood S, Kabra SK. Azithromycin for Poorly Controlled Asthma in Children: A Randomized Controlled Trial. Chest 2022; 161:1456-1464. [PMID: 35202621 DOI: 10.1016/j.chest.2022.02.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Azithromycin has immunomodulatory actions, and its beneficial effects have been demonstrated in asthmatic adults. Data on children are limited. RESEARCH QUESTION Does the addition of oral azithromycin to standard therapy in children with poorly controlled asthma improve asthma control compared with standard treatment alone? STUDY DESIGN AND METHODS This open-label randomized controlled trial included children (5-15 years of age) with poorly controlled asthma defined by Asthma Control Test (ACT) and Childhood Asthma Control Test (CACT) score of ≤ 19. They were randomized to receive azithromycin (10 mg/kg) three times weekly for 3 months along with standard treatment or standard treatment alone. The primary outcome was the ACT and CACT scores at 3 months. Secondary outcomes were asthma control according to Global Initiative for Asthma (GINA) guidelines, the number of exacerbations, change in spirometry parameters, change in fractional exhaled nitric oxide (Feno) level, positive throat swab results, and side effects. RESULTS The trial included 120 children (89 boys; 60 in each group). The mean ± SD age was 9.9 ± 3 years. The baseline parameters were similar between the groups. Mean ± SD ACT and CACT scores (available for 115 children) at 3 months of intervention were 21.71 ± 2.17 vs 18.33 ± 2.19 (P < .001) in the azithromycin and control groups, respectively. The numbers of children with well-controlled asthma according to GINA guidelines were 41 of 56 vs 10 of 56 in the azithromycin and control groups, respectively (P < .001). The median number of exacerbations requiring emergency visit and steroid use were fewer in the azithromycin group: 0 (interquartile range [IQR], 3) vs 1 [IQR, 6]; P < .001). No difference was found in Feno level, spirometry parameters, positive throat swab results, and adverse effects between the groups. INTERPRETATION The use of azithromycin in children with poorly controlled asthma resulted in improved asthma control and reduced exacerbations. TRIAL REGISTRY Clinical Trials Registry - India; No.: CTRI/2019/06/019727; URL: www.ctri.nic.in.
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Affiliation(s)
- Jagat Jeevan Ghimire
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, New Delhi, India
| | - Kana Ram Jat
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, New Delhi, India.
| | - Jhuma Sankar
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, New Delhi, India
| | - Rakesh Lodha
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, New Delhi, India
| | - Venkat K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, New Delhi, India
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16
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Li J, Fu Y, Jing W, Li J, Wang X, Chen J, Sun S, Yue H, Dai Y. Biomarkers of Mycoplasma pneumoniae pneumonia in children by urine metabolomics based on Q Exactive liquid chromatography/tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2022; 36:e9234. [PMID: 34897870 DOI: 10.1002/rcm.9234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
RATIONALE Mycoplasma pneumoniae has become one of the common pathogens causing pediatric respiratory infections. In clinical diagnosis, throat swabs are very difficult to obtain from children, and there is a possibility of false positive results; hence, there are few clinically available diagnostic methods. METHODS In this study, Q Exactive liquid chromatography/tandem mass spectrometry was used to analyze the metabolites in the urine of healthy children (HC) and M. pneumoniae pneumonia in children (MPPC) patients. A multivariate statistical analysis was performed to screen the differential metabolites. Based on the HMDB and KEGG, the possible metabolic pathways subject to biological alteration were identified. RESULTS Compared with HC, 73 different metabolites in MPPC patients disrupted nine metabolic pathways through different change trends; after integrating various parameters, 20 significantly different metabolites were identified as MPPC potential biomarkers. Through the above two analysis modes, acetylphosphate and 2,5-dioxopentanoate were both screened out and used as potential biomarkers for the early diagnosis of MPPC for the first time. CONCLUSIONS The characterization of 20 potential biomarkers provides a scientific basis for predicting and diagnosing MPPC. This article further indicates that urine metabolic profiling has great potential in diagnosing MPPC and can effectively prevent the disease from causing further deterioration.
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Affiliation(s)
- Jing Li
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Yunhua Fu
- Jilin Ginseng Academy, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Changchun University of Chinese Medicine, Changchun, China
| | - Wei Jing
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jie Li
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Xin Wang
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jialing Chen
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Shuxin Sun
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Hao Yue
- Jilin Ginseng Academy, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Changchun University of Chinese Medicine, Changchun, China
| | - Yulin Dai
- Jilin Ginseng Academy, Key Laboratory of Active Substances and Biological Mechanisms of Ginseng Efficacy, Ministry of Education, Changchun University of Chinese Medicine, Changchun, China
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17
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Current opinion on the role of vitamin D supplementation in respiratory infections and asthma/COPD exacerbations: A need to establish publication guidelines for overcoming the unpublished data. Clin Nutr 2022; 41:755-777. [DOI: 10.1016/j.clnu.2022.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/29/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022]
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18
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Choi YJ, Chung EH, Lee E, Kim CH, Lee YJ, Kim HB, Kim BS, Kim HY, Cho Y, Seo JH, Sol IS, Sung M, Song DJ, Ahn YM, Oh HL, Yu J, Jung S, Lee KS, Lee JS, Jang GC, Jang YY, Chung HL, Choi SM, Han MY, Shim JY, Kim JT, Kim CK, Yang HJ, Suh DI. Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study. J Clin Med 2022; 11:jcm11020306. [PMID: 35054002 PMCID: PMC8779611 DOI: 10.3390/jcm11020306] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.
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Affiliation(s)
- Yun Jung Choi
- Hospital Medicine Center, Seoul National University Hospital, Seoul KS013, Korea;
- Department of Pediatrics, Seoul National University Hospital, Seoul KS013, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon KS015, Korea;
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju KS018, Korea;
| | - Chul-Hong Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon KS011, Korea; (C.-H.K.); (J.S.L.)
| | - Yong Ju Lee
- Department of Pediatrics, Yongin Severance Hospital, Yongin KS009, Korea;
| | - Hyo-Bin Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul KS013, Korea; (H.-B.K.); (C.-K.K.)
| | - Bong-Seong Kim
- Department of Pediatrics, Ulsan University Gangneung Asan Hospital, Gangneung KS007, Korea;
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan KS011, Korea; (H.Y.K.); (S.J.)
| | - Yoojung Cho
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul KS013, Korea;
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University Hospital, Dankook University Medical School, Cheonan KS002, Korea;
| | - In Suk Sol
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul KS013, Korea; (I.S.S.); (J.Y.S.)
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Gumi KS010, Korea;
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul KS013, Korea;
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulju University, Seoul KS013, Korea;
| | - Hea Lin Oh
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul KS013, Korea;
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul KS013, Korea;
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan KS011, Korea; (H.Y.K.); (S.J.)
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri KS013, Korea;
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon KS011, Korea; (C.-H.K.); (J.S.L.)
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Goyang KS007, Korea;
| | - Yoon-Young Jang
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu KS002, Korea; (Y.-Y.J.); (H.L.C.)
| | - Hai Lee Chung
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu KS002, Korea; (Y.-Y.J.); (H.L.C.)
| | - Sung-Min Choi
- Department of Pediatrics, Dongguk University Gyeongju Hospital, Gyeongju KS010, Korea;
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam KS009, Korea;
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul KS013, Korea; (I.S.S.); (J.Y.S.)
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul KS013, Korea;
| | - Chang-Keun Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul KS013, Korea; (H.-B.K.); (C.-K.K.)
| | - Hyeon-Jong Yang
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul KS013, Korea;
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul KS013, Korea
- Correspondence: (H.-J.Y.); (D.I.S.); Tel.: +82-02-709-9114 (H.-J.Y.); +82-2-2072-7559 (D.I.S.)
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul KS013, Korea
- Correspondence: (H.-J.Y.); (D.I.S.); Tel.: +82-02-709-9114 (H.-J.Y.); +82-2-2072-7559 (D.I.S.)
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19
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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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20
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Leung JS. Paediatrics: how to manage acute asthma exacerbations. Drugs Context 2021; 10:dic-2020-12-7. [PMID: 34113386 PMCID: PMC8166724 DOI: 10.7573/dic.2020-12-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background Asthma is the most common chronic disease of childhood and a major source of childhood health burden worldwide. These burdens are particularly marked when children experience characteristic ‘symptom flare-ups’ or acute asthma exacerbations (AAEs). AAE are associated with significant health and economic impacts, including acute Emergency Department visits, occasional hospitalizations, and rarely, death. To treat children with AAE, several medications have been studied and used. Methods We conducted a narrative review of the literature with the primary objective of understanding the evidence of their efficacy. We present this efficacy evidence in the context of a general stepwise management pathway for paediatric AAEs. This framework is developed from the combined recommendations of eight established (inter)national paediatric guidelines. Discussion Management of paediatric AAE centres around four major care goals: (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient; and (4) safe discharge plans. Several medications are currently recommended with varying efficacies, including heliox, systemic corticosteroids, first-line bronchodilators (salbutamol/albuterol), adjunctive bronchodilators (ipratropium bromide, magnesium sulfate) and second-line bronchodilators (aminophylline, i.v. salbutamol, i.v. terbutaline, epinephrine, ketamine). Care of children with AAE is further enhanced using clinical severity scoring, pathway-driven care and after-event discharge planning. Conclusions AAEs in children are primarily managed by medications supported by a growing body of literature. Continued efforts to study the efficacy of second-line bronchodilators, integrate AAE management with long-term asthma control and provide fair/equitable care are required.
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Affiliation(s)
- James S Leung
- McMaster University, Faculty of Health Sciences, Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
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21
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Luo Y, Li C, Zhou Z, Gong Z, Zhu C, Lei A. Biological functions of IL-17-producing cells in mycoplasma respiratory infection. Immunology 2021; 164:223-230. [PMID: 33930194 DOI: 10.1111/imm.13346] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 12/17/2022] Open
Abstract
Mycoplasmas are the smallest and simplest bacteria that lack a cell wall but have the capability of self-replication. Among them, Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia. The hallmark of mycoplasma respiratory diseases is the persistence of lung inflammation that involves both innate and adaptive immune responses. In recent years, a growing body of evidence demonstrates that IL-17 plays an important role in respiratory mycoplasma infection, and associates with the pathologic outcomes of infection, such as pneumonitis and asthma. Numerous studies have shown that a variety of cells, in particular Th17 cells, in the lung can secrete IL-17 during respiratory mycoplasma infection. In this article, we review the biological functions of distinct IL-17-producing cells in mycoplasma respiratory infection with a focus on the effect of IL-17 on the outcomes of infection.
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Affiliation(s)
- Ying Luo
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation enter for Molecular Target New Drug Study, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China.,Changsha Central Hospital, University of South China, Changsha, China
| | - Cheng Li
- Changsha Central Hospital, University of South China, Changsha, China
| | - Zhou Zhou
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation enter for Molecular Target New Drug Study, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Zhande Gong
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation enter for Molecular Target New Drug Study, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Cuiming Zhu
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation enter for Molecular Target New Drug Study, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
| | - Aihua Lei
- Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hunan Province Cooperative Innovation enter for Molecular Target New Drug Study, Hengyang Medical College, Institute of Pathogenic Biology, University of South China, Hengyang, China
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22
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Mycoplasma pneumoniae infection and risk of childhood asthma: A systematic review and meta-analysis. Microb Pathog 2021; 155:104893. [PMID: 33932544 DOI: 10.1016/j.micpath.2021.104893] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 01/11/2023]
Abstract
The etiology of childhood asthma is multifactorial, atypical bacterial pathogens, including Mycoplasma pneumoniae, have been proposed as possible risk factors or contributors. This review aims to assess the possible association between M. pneumoniae infection and childhood asthma. We searched major international literature databases (up to January 10, 2021) to identify relevant studies. We used a random-effects meta-analysis (REM) model to generate the pooled odds ratio (OR) and 95% confidence intervals (CIs). Several subgroups analyses were performed concerning the IgG, IgM, and DNA detection of M. pneumoniae infection. We included 22 eligible studies; these studies involved a total of 5064 children. We found that there was a statistically significant association between M. pneumoniae infection, as determined by IgM serology (OR, 3.13; 95% CI, 1.78-5.48), and DNA detection (OR, 1.57; 95% CI, 1.25-1.97) with increased risk of any type of childhood asthma. Moreover, children with acute asthma had significantly higher seropositivity for anti- M. pneumoniae IgM antibodies (OR, 4.43; 95% CI, 2.80-7.02) than children with stable asthma. Although our findings indicate a positive association between M. pneumoniae infection and childhood asthma, well-designed and -controlled studies are need in the future to rigorously test this association and identify the underlying mechanisms.
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23
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Esposito S, Argentiero A, Gramegna A, Principi N. Mycoplasma pneumoniae: a pathogen with unsolved therapeutic problems. Expert Opin Pharmacother 2021; 22:1193-1202. [PMID: 33544008 DOI: 10.1080/14656566.2021.1882420] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Despite the amount of new information, the most effective approach for the diagnosis and treatment of Mycoplasma pneumoniae infections is not established. In this narrative review the pharmacological options for macrolide-resistant (ML) M. pneumoniae infections in children are discussed. AREAS COVERED Despite significant improvement in the diagnosis and in the definition of diseases potentially associated with this pathogen, not all the problems related to M. pneumoniae infection are solved. True epidemiology of M. pneumoniae diseases and the real role of this pathogen in extra-respiratory manifestations is still unestablished. This reflects on therapy. It is not known whether antibiotics are really needed in all the cases, independently of severity and localization. The choice of antibiotic therapy is debated as it is not known whether ML resistance has clinical relevance. Moreover, not precisely defined is the clinical importance of corticosteroids for improvement of severe cases, including those associated with ML-resistant strains. EXPERT OPINION Improvement in M. pneumoniae identification is mandatory to reduce antibiotics overuse , especially in the presence of ML-resistant strains. Priority for future studies includes the evaluation of the true benefit of therapeutic approaches including corticosteroids in patients with severe CAP and in those with extra-respiratory M. pneumoniae diseases.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Andrea Gramegna
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Nicola Principi
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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24
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Kong K, Ding Y, Wu B, Lu M, Gu H. Clinical Predictors of Wheezing Among Children Infected With Mycoplasma Pneumoniae. Front Pediatr 2021; 9:693658. [PMID: 34631611 PMCID: PMC8492963 DOI: 10.3389/fped.2021.693658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Mycoplasma pneumoniae (MP) not only was a common pathogen of respiratory tract infections, but also could trigger the exacerbation of asthmatic symptoms in children with or without asthma. Objective: This study aimed to identify possible risk factors associated with wheezing among children diagnosed with MP infection. Methods: A retrospective analysis of medical records of children aged 28 days to 18 years old who visited the Shanghai Children's Hospital between January 2019 and January 2020 was carried out, and all children were then classified into three groups: two wheezing groups (with or without MP infection) and a non-wheezing group with MP infection. Information including patient's demographics, clinical features, laboratory data, and radiography findings was extracted from the electronic medical record system. Chest radiographs were reviewed independently by two board-certified, blinded pediatric radiologists. Results: A total of 1,512 patients were included in our study, and 21.9% of them belonged to the wheezing group without MP infection. Among 1,181 patients with MP infection, 295 people (25.0%) suffered from wheezing, and males accounted for 61%. Through the multivariable logistic regression analyses, we found that six variables were positively associated with wheezing attacks in children with MP infection: male gender (likelihood ratio [LR] = 2.124, 95% confidence interval [CI]: 1.478-3.053), history of allergy (LR= 3.301, 95% CI: 2.206-4.941), history of wheezing (LR = 7.808, 95% CI: 5.276-11.557), autumn in reference to summer (LR = 2.414, 95% CI: 1.500-3.885), non-end-point infiltration in reference to consolidation or pleural effusion (LR = 1.982, 95% CI: 1.348-2.914), and infiltration scope (LR = 1.773, 95% CI: 1.293-2.432). However, the model showed that the probability of wheezing after MP infection decreased as age increased (LR = 0.257, 95% CI: 0.196-0.337). Moreover, the area under the curve (AUC) of the regression model was as high as 0.901 (0.847-0.955). Conclusion: The model integrated with factors including gender, age, season, radiological patterns, infiltration scope, and history of allergy performed well in predicting wheezing attack after MP infection in children.
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Affiliation(s)
- Kaimeng Kong
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Beirong Wu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoxiang Gu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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25
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Mycoplasma pneumoniae: Atypical Pathogen in Community Acquired Pneumonia. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.4.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is a one of most common reasons of respiratory tract infections in both adolescents and children with severity ranged from moderate to high. Many facts in the previous years regarding infections were induced via this organism having extra pathogenic mechanisms. Clinically, resistance to macrolide has produced internationally and represents a treatment trouble. Antimicrobial sensitivity checking out techniques have been applied, and novel antibiotics which are effective towards M. pneumoniae are present processing development. That evaluate concentrates on the several trends occurring in the previous quite a few years which beautify the grasp of that microorganism, which is one of the smallest pathogenic bacteria; however, is of extreme medical significance.
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26
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de Benedictis FM, Carloni I, Guidi R. Question 4: Is there a role for antibiotics in infantile wheeze? Paediatr Respir Rev 2020; 33:30-34. [PMID: 31791905 DOI: 10.1016/j.prrv.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
Acute wheezing episodes are frequent in young children and are associated with high morbidity and healthcare utilization. The role of respiratory viruses in triggering acute wheezing is well known. There is also accumulating evidence that airway bacteria, either alone or as part of bacteria-virus interaction, are important determinants of acute asthma exacerbations. Targeting airway bacteria with antibiotics to reduce the severity of acute wheezing episodes and prevent recurrent wheezing among preschool children has been recently evaluated in three randomized, double-blind, placebo-controlled trials. The results of these studies are controversial. An interventional approach with azithromycin in young children during acute wheezing episodes cannot be generically incorporated into clinical practice, due to the potential consequences of widespread use of antibiotics in such a common clinical setting. This intervention may be reserved for children with really severe, recurrent wheezing episodes. Future research should focus on risk factors that facilitate acquisition of bacterial airway infection in young children and better understanding how virus and bacteria interact with each other during wheezing attacks. Identifying objective biomarkers that may direct the treatment to specific groups of children may represent a significant step forward in the clinical approach of acute wheezing.
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Affiliation(s)
| | - Ines Carloni
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Roberto Guidi
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
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27
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Yang TI, Chang LY. Reply to correspondence of Dr. Dimitri Poddighe. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:190. [PMID: 31151768 DOI: 10.1016/j.jmii.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Tzu-I Yang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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28
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Affiliation(s)
| | - Cynthia Christy
- Division of Pediatric Infectious Diseases, University of Rochester School of Medicine and Dentistry, Rochester, NY.,Rochester General Hospital, Rochester, NY
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29
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Lopes MP, Cruz ÁA, Xavier MT, Stöcker A, Carvalho-Filho P, Miranda PM, Meyer RJ, Soledade KR, Gomes-Filho IS, Trindade SC. Prevotella intermedia and periodontitis are associated with severe asthma. J Periodontol 2019; 91:46-54. [PMID: 31342509 DOI: 10.1002/jper.19-0065] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Periodontitis, an inflammatory disease of multibacterial etiology that affects the protective and supporting tissues surrounding teeth, can influence the course of respiratory diseases, such as asthma, due to epithelial alterations arising from inflammatory and immunological processes, bronchial remodeling, or by the aspiration of pathogenic colonizers found in periodontal pockets. This study evaluated the levels of periodontal pathogens Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans in the subgingival biofilm of individuals with and without severe asthma. METHODS A case-control study enrolling 457 individuals (220 with asthma and 237 without asthma) was conducted at the Program for Control of Asthma in Bahia (ProAR) Clinic located in Salvador, Bahia, Brazil. A structured questionnaire was used to obtain data on sociodemographic, health status, and lifestyle habits. A clinical periodontal assessment was performed, including bleeding on probing, probing depth, and clinical attachment level. Subgingival biofilm was collected at the deepest site of each sextant, and bacterial DNA was extracted. Quantitative real-time PCR analysis was performed to detect and relatively quantify periodontopathogens in the biofilm. RESULTS Statistically significant positive associations were found between periodontitis and severe asthma, (odds ratio [OR]adjusted] : 4.00; 95% confidence interval [CI]: 2.26 to 7.10). High levels of P. intermedia were found in association with the presence of severe asthma (ORadjusted : 2.64; 95% CI: 1.62 to 4.39; P < 0.01). CONCLUSIONS The present results suggest that periodontitis and P. intermedia are associated with severe asthma. However, the functional consequences of this dysbiosis upon asthma susceptibility and its phenotypes remain unclear.
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Affiliation(s)
- Mabel P Lopes
- Post-Graduation Program, Federal University of Bahia, Salvador, Brazil
| | - Álvaro A Cruz
- Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Márcia T Xavier
- Department of Biointeraction, Federal University of Bahia, Salvador, Brazil
| | - Andreas Stöcker
- Universitary Hospital Professor Edgard Santos, Federal University of Bahia, Salvador, Brazil
| | | | | | - Roberto J Meyer
- Department of Biointeraction, Federal University of Bahia, Salvador, Brazil
| | - Kaliane R Soledade
- Department of Biointeraction, Federal University of Bahia, Salvador, Brazil
| | - Isaac S Gomes-Filho
- Department of Health, Feira de Santana State University, Feira de Santana, Brazil
| | - Soraya C Trindade
- Post-Graduation Program, Federal University of Bahia, Salvador, Brazil.,Department of Health, Feira de Santana State University, Feira de Santana, Brazil
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30
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Li N, Mu YP, Chen J, Li B. [Value of absolute counts of lymphocyte subsets in the early prediction of refractory Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:511-516. [PMID: 31208501 PMCID: PMC7389588 DOI: 10.7499/j.issn.1008-8830.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the value of absolute counts of lymphocyte subsets in the early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. METHODS A retrospective analysis was performed for the clinical data of 244 children with Mycoplasma pneumoniae pneumonia (MPP). Among these children, 166 had MPP, and 58 had RMPP. The two groups were compared in terms of clinical features and laboratory markers such as lymphocyte subsets, lactate dehydrogenase, C-reactive protein, procalcitonin and immunoglobulin E (IgE). The receiver operating characteristic (ROC) curve was used to evaluate the specific indices for predicting RMMP. RESULTS There were significant differences between the two groups in the absolute counts of CD3+, CD4+, CD19+, and CD56+ lymphocytes and the serum levels of lactate dehydrogenase, C-reactive protein, and IgE (P<0.05). The ROC curve analysis showed that the absolute counts of CD3+, CD4+ and CD19+ lymphocytes had an area under the ROC curve (AUC) of 0.866, 0.900 and 0.842 respectively in the differential diagnosis of RMPP and MPP, with a sensitivity of 86%, 90% and 82% respectively and a specificity of 75%, 70% and 80% respectively. CONCLUSIONS The absolute counts of CD3+, CD4+ and CD19+ lymphocytes can be used to predict RMPP in children.
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Affiliation(s)
- Na Li
- Department of Pediatric Neurology & Rehabilitation Medicine, Shenyang Children's Hospital, Shenyang 110032, China.
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31
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Balasubramanian S, Pandranki L, Maupin S, Ramasamy K, Taylor AB, Hart PJ, Baseman JB, Kannan TR. Disulfide bond of Mycoplasma pneumoniae community-acquired respiratory distress syndrome toxin is essential to maintain the ADP-ribosylating and vacuolating activities. Cell Microbiol 2019; 21:e13032. [PMID: 30977272 DOI: 10.1111/cmi.13032] [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: 12/11/2018] [Revised: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 01/13/2023]
Abstract
Mycoplasma pneumoniae is the leading cause of bacterial community-acquired pneumonia among hospitalised children in United States and worldwide. Community-acquired respiratory distress syndrome (CARDS) toxin is a key virulence determinant of M. pneumoniae. The N-terminus of CARDS toxin exhibits ADP-ribosyltransferase (ADPRT) activity, and the C-terminus possesses binding and vacuolating activities. Thiol-trapping experiments of wild-type (WT) and cysteine-to-serine-mutated CARDS toxins with alkylating agents identified disulfide bond formation at the amino terminal cysteine residues C230 and C247. Compared with WT and other mutant toxins, C247S was unstable and unusable for comparative studies. Although there were no significant variations in binding, entry, and retrograde trafficking patterns of WT and mutated toxins, C230S did not elicit vacuole formation in intoxicated cells. In addition, the ADPRT domain of C230S was more sensitive to all tested proteases when compared with WT toxin. Despite its in vitro ADPRT activity, the reduction of C230S CARDS toxin-mediated ADPRT activity-associated IL-1β production in U937 cells and the recovery of vacuolating activity in the protease-released carboxy region of C230S indicated that the disulfide bond was essential not only to maintain the conformational stability of CARDS toxin but also to properly execute its cytopathic effects.
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Affiliation(s)
- Sowmya Balasubramanian
- Department of Microbiology, Immunology and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Lavanya Pandranki
- Department of Microbiology, Immunology and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Suzanna Maupin
- Department of Microbiology, Immunology and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kumaraguruparan Ramasamy
- Department of Microbiology, Immunology and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alexander B Taylor
- Department of Biochemistry and Structural Biology, The University of Texas Health Science Center at San Antonio, San Antonio, TX.,X-ray Crystallography Core Laboratory, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Peter John Hart
- Department of Biochemistry and Structural Biology, The University of Texas Health Science Center at San Antonio, San Antonio, TX.,X-ray Crystallography Core Laboratory, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Joel B Baseman
- Department of Microbiology, Immunology and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Thirumalai R Kannan
- Department of Microbiology, Immunology and Molecular Genetics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Abstract
The airways are under continuous assault from aerosolized bacteria and oral flora. The bacteria present in the airways and gastrointestinal tract of neonates promote immune maturation and protect against asthma pathogenesis. Later bacterial infections and perturbations to the microbiome can contribute to asthma pathogenesis, persistence, and severity.
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Affiliation(s)
- Michael Insel
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, University of Arizona College of Medicine - Tucson, 1501 North Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA
| | - Monica Kraft
- Department of Medicine, College of Medicine Tucson, Asthma and Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona College of Medicine - Tucson, 1501 North Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA.
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Rhim JW, Kang HM, Yang EA, Lee KY. Epidemiological relationship between Mycoplasma pneumoniae pneumonia and recurrent wheezing episode in children: an observational study at a single hospital in Korea. BMJ Open 2019; 9:e026461. [PMID: 30975681 PMCID: PMC6500193 DOI: 10.1136/bmjopen-2018-026461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study was aimed to evaluate epidemiological and clinical relationship between Mycoplasma pneumoniae (MP) infection and childhood recurrent wheezing episode (RWE). DESIGN Retrospective case note review. SETTING Paediatric department at a single Korean institution. PARTICIPANTS Consecutive admitted patients with MP pneumonia and RWE (0-15 years of age) between 2003 and 2014. METHODS The retrospective medical records of patients with (MP) pneumonia (n=793 for epidemiological analysis and n=501 for clinical analysis) and those with RWE (n=384) from 2003 to 2014 were analysed. Diagnosis of MP pneumonia was made based on two-times titration of IgM antibody during hospitalisation. An RWE patient was defined as one with expiratory wheezing with at least one or more wheezing episodes based on medical records. RESULTS During three MP pneumonia epidemics, there were no corresponding increases of patients with RWE in the epidemic years. In the 501 MP pneumonia patients, 52 (10.4%) had wheezing at presentation and 15 (3%) had RWE. The MP pneumonia patients with wheezing at presentation (n=52) were younger and were more likely to have an allergic disease history than those without wheezing (n=449). Among wheezing patients at presentation, 10 patients had previously RWE history. In a follow-up study, 13 patients (including 5 RWE) with initial wheezing and 25 patients (including 2 RWE) without wheezing had wheezy episodes after discharge. Among the total 501 patients, it was estimated that at least 31 MP pneumonia patients (6.2%) showed recurrent wheezing after initial MP infection. CONCLUSIONS A small part of children with MP pneumonia showed recurrent wheezing after MP pneumonia, and patients with RWE had a greater likelihood of experiencing wheezing when they had an initial MP infection. However, there were no increased admitted patients with RWE in MP pneumonia epidemic periods because of rarity of MP reinfection in children including patients with RWE or asthma.
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Affiliation(s)
- Jung Woo Rhim
- Department of Paediatrics, College of Medicne, The Catholic University of Kora, Seoul, Republic of Korea
- Department of Paediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Hyun Mi Kang
- Department of Paediatrics, College of Medicne, The Catholic University of Kora, Seoul, Republic of Korea
- Department of Paediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Eun Ae Yang
- Department of Paediatrics, College of Medicne, The Catholic University of Kora, Seoul, Republic of Korea
- Department of Paediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
| | - Kyung Yil Lee
- Department of Paediatrics, College of Medicne, The Catholic University of Kora, Seoul, Republic of Korea
- Department of Paediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Republic of Korea
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34
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Tian M, Chen M, Bao Y, Xu C, Qin Q, Zhang W, He Y, Shao Q. Microbial contributions to bronchial asthma occurrence in children: A metagenomic study. J Cell Biochem 2019; 120:13853-13860. [PMID: 30957268 DOI: 10.1002/jcb.28658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/21/2018] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
Abstract
Bronchial asthma, a common chronic respiratory disease in children, is traditionally regarded as a noninfectious disease. Current hypotheses, however, argue that asthma can be caused by microbial infection. We, therefore, hypothesize that a variety of microbes are more commonly found in the sputum of children with asthma, and these microbes may contribute to the occurrence and development of asthma. The present study proposes to use metagenomic approach to explore microbial diversity and to identify the microbial community characteristics of sputum from children with asthma. We found that microbial communities in the sputum of children differed significantly between asthmatics and controls. Kruskal-Wallis testing showed that 16 phyla, 104 genera, and 159 species were significantly downregulated, whereas two phyla including Platyhelminthes phylum and Chordata phylum, two genera including Spirometra genus and Homo sapiens, and the Spirometra erinaceieuropaei species were significantly upregulated in asthma patients compared with controls (P < 0.05). Among them, H. sapiens and S. erinaceieuropaei exhibited 2.3- and 2.0-fold overabundance in asthmatics vs controls, respectively. Meanwhile, metastats assay demonstrated that 31 phyla, 400 genera, and 813 species were significantly downregulated, whereas two phyla, 10 genera, and 16 species were significantly upregulated in asthma patients compared with controls (P < 0.05). Among them, Tetrahymena thermophila and Candidatus Zinderia insecticola exhibited 4.7-fold overabundance in asthmatics vs controls. Our study establishes a link between microbial infection and the mechanisms leading to asthma development, which will be useful for developing novel diagnostic biomarkers and aiding in the prevention and control of asthma.
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Affiliation(s)
- Man Tian
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Meng Chen
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Yuling Bao
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Changdi Xu
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Qiaozhi Qin
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Wenxin Zhang
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Yuting He
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Qi Shao
- Department of Respiratory Medicine, Affiliated Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
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Effects of Macrolide Treatment during the Hospitalization of Children with Childhood Wheezing Disease: A Systematic Review and Meta-Analysis. J Clin Med 2018; 7:jcm7110432. [PMID: 30423980 PMCID: PMC6262331 DOI: 10.3390/jcm7110432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 10/28/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022] Open
Abstract
Children are susceptible to a variety of respiratory infections. Wheezing is a common sign presented by children with respiratory infections. Asthma, bronchiolitis, and bronchitis are common causes of childhood wheezing disease (CWD) and are regarded as overlapping disease spectra. Macrolides are common antimicrobial agents with anti-inflammatory effects. We conducted a comprehensive literature search and a systematic review of studies that investigated the influences of macrolide treatment on CWD. The primary outcomes were the impact of macrolides on hospitalization courses of patients with CWD. Data pertaining to the study population, macrolide treatment, hospital courses, and recurrences were analyzed. Twenty-three studies with a combined study population of 2210 patients were included in the systematic review. Any kind of benefit from macrolide treatment was observed in approximately two-thirds of the studies (15/23). Eight studies were included in the meta-analysis to investigate the influence of macrolides on the length of stay (LOS), duration of oxygen demand (DOD), symptoms and signs of respiratory distress, and re-admission rates. Although the benefits of macrolide treatment were reported in several of the studies, no significant differences in LOS, DOD, symptoms and signs of respiratory distress, or re-admission rates were observed in patients undergoing macrolide treatment. In conclusion, any kind of benefit of macrolide treatment was observed in approximately two-thirds of the studies; however, no obvious benefits of macrolide treatment were observed in the hospitalization courses of children with CWD. The routine use of macrolides to improve the hospitalization course of children with CWD is not suggested.
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Schwarze J, Openshaw P, Jha A, Giacco SR, Firinu D, Tsilochristou O, Roberts G, Selby A, Akdis C, Agache I, Custovic A, Heffler E, Pinna G, Khaitov M, Nikonova A, Papadopoulos N, Akhlaq A, Nurmatov U, Renz H, Sheikh A, Skevaki C. Influenza burden, prevention, and treatment in asthma-A scoping review by the EAACI Influenza in asthma task force. Allergy 2018; 73:1151-1181. [PMID: 29105786 DOI: 10.1111/all.13333] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 12/19/2022]
Abstract
To address uncertainties in the prevention and management of influenza in people with asthma, we performed a scoping review of the published literature on influenza burden; current vaccine recommendations; vaccination coverage; immunogenicity, efficacy, effectiveness, and safety of influenza vaccines; and the benefits of antiviral drugs in people with asthma. We found significant variation in the reported rates of influenza detection in individuals with acute asthma exacerbations making it unclear to what degree influenza causes exacerbations of underlying asthma. The strongest evidence of an association was seen in studies of children. Countries in the European Union currently recommend influenza vaccination of adults with asthma; however, coverage varied between regions. Coverage was lower among children with asthma. Limited data suggest that good seroprotection and seroconversion can be achieved in both children and adults with asthma and that vaccination confers a degree of protection against influenza illness and asthma-related morbidity to children with asthma. There were insufficient data to determine efficacy in adults. Overall, influenza vaccines appeared to be safe for people with asthma. We identify knowledge gaps and make recommendations on future research needs in relation to influenza in patients with asthma.
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Affiliation(s)
- J. Schwarze
- Centre for Inflammation Research The Queens Medical Research Institute University of Edinburgh Edinburgh UK
| | - P. Openshaw
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - A. Jha
- Respiratory Sciences National Heart and Lung Institute Imperial College London London UK
| | - S. R. Giacco
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | - D. Firinu
- Department of Medical Sciences and Public Health “M. Aresu” University of Cagliari Cagliari Italy
| | | | - G. Roberts
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - A. Selby
- Faculty of Medicine Southampton and David Hide Asthma and Allergy Centre St Mary's Hospital University of Southampton Newport Isle of Wight UK
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland
| | - I. Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University Brasov Brasov Romania
| | - A. Custovic
- Department of Paediatrics Imperial College London London UK
| | - E. Heffler
- Personalized Medicine Asthma and Allergy Clinic Department of Biomedical Sciences Humanitas University Milan Italy
| | - G. Pinna
- Department of Medical Microbiology National Kapodistrian University of Athens Athens Greece
| | - M. Khaitov
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - A. Nikonova
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - N. Papadopoulos
- Division of Infection, Inflammation & Respiratory Medicine The University of Manchester Manchester UK
- Allergy Department 2nd Paediatric Clinic National Kapodistrian University of Athens Athens Greece
| | - A. Akhlaq
- Department of Health and Hospital Management Institute of Business Management Korangi Creek Karachi 75190 Pakistan
| | - U. Nurmatov
- Division of Population Medicine School of Medicine Cardiff University the National Centre for Population Health and Wellbeing Research Wales UK
| | - H. Renz
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
| | - A. Sheikh
- Asthma UK Centre for Applied Research Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | - C. Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry Molecular Diagnostics Philipps University Marburg University Hospital Giessen & Marburg Marburg Germany
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37
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Ye Q, Mao JH, Shu Q, Shang SQ. Mycoplasma pneumoniae induces allergy by producing P1-specific immunoglobulin E. Ann Allergy Asthma Immunol 2018; 121:90-97. [PMID: 29555351 DOI: 10.1016/j.anai.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Our previous study found that most Mycoplasma pneumoniae (MP) pneumonia (MPP)patients had elevated serum total immunoglobulin E (IgE) levels. OBJECTIVE To determine components of MP that can cause an IgE increase in children, and to clarify its specific mechanism. METHODS The components of MP cells were isolated by serum IgE from patients with MP pneumonia. These components obtained through the prokaryotic expression were used as allergens to detect the proportion of allergen-specific IgE produced in MPP patients, and the clinical characteristics and related immune parameters of these patients who produced this allergen-specific IgE were also analyzed. In addition, a cell experiment was used to verify the biological effect of these components in vitro. RESULTS P1-specific IgE was detected in serum of MPP children. An approximately 24-kDa polypeptide of P1 protein was obtained through prokaryotic expression purified by nickel agarose affinity chromatography. Approximately 9.2% of MPP patients produced IgE against this polypeptide of P1 protein, which was more likely to be produced in MPP patients with no history of allergies or family history of allergy-related diseases. P1-specific IgE-positive MPP patients had more severe clinical symptoms, with excessive secretion of interleukin (IL)-4 and IL-5 and overdifferentiation of Th0 cells into Th2 cells. Tests also demonstrated that the P1 protein stimulated excessive secretion of IL-4 and IL-5 in peripheral blood mononuclear cells from the peripheral blood of healthy donors. CONCLUSION Mycoplasma pneumoniae is not only an infectious agent but also an allergen for certain individuals. The P1 protein of MP can induce the production of P1-specific IgE.
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Affiliation(s)
- Qing Ye
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| | - Jian-Hua Mao
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Shu
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shi-Qiang Shang
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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38
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Ramasamy K, Balasubramanian S, Manickam K, Pandranki L, Taylor AB, Hart PJ, Baseman JB, Kannan TR. Mycoplasma pneumoniae Community-Acquired Respiratory Distress Syndrome Toxin Uses a Novel KELED Sequence for Retrograde Transport and Subsequent Cytotoxicity. mBio 2018; 9:e01663-17. [PMID: 29362229 PMCID: PMC5784248 DOI: 10.1128/mbio.01663-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/01/2017] [Indexed: 12/21/2022] Open
Abstract
Mycoplasma pneumoniae is an atypical bacterium that causes respiratory illnesses in humans, including pharyngitis, tracheobronchitis, and community-acquired pneumonia (CAP). It has also been directly linked to reactive airway disease, asthma, and extrapulmonary pathologies. During its colonization, M. pneumoniae expresses a unique ADP-ribosylating and vacuolating cytotoxin designated community-acquired respiratory distress syndrome (CARDS) toxin. CARDS toxin persists and localizes in the airway in CAP patients, asthmatics, and trauma patients with ventilator-associated pneumonia. Although CARDS toxin binds to specific cellular receptors, is internalized, and induces hyperinflammation, histopathology, mucus hyperplasia, and other airway injury, the intracellular trafficking of CARDS toxin remains unclear. Here, we show that CARDS toxin translocates through early and late endosomes and the Golgi complex and concentrates at the perinuclear region to reach the endoplasmic reticulum (ER). Using ER-targeted SNAP-tag, we confirmed the association of CARDS toxin with the ER and determined that CARDS toxin follows the retrograde pathway. In addition, we identified a novel CARDS toxin amino acid fingerprint, KELED, that is required for toxin transport to the ER and subsequent toxin-mediated cytotoxicity.IMPORTANCEMycoplasma pneumoniae, a leading cause of bacterial community-acquired pneumonia (CAP) among children and adults in the United States, synthesizes a 591-amino-acid ADP-ribosylating and vacuolating protein, designated community-acquired respiratory distress syndrome (CARDS) toxin. CARDS toxin alone is sufficient to induce and mimic major inflammatory and histopathological phenotypes associated with M. pneumoniae infection in rodents and primates. In order to elicit its ADP-ribosylating and vacuolating activities, CARDS toxin must bind to host cell receptors, be internalized via clathrin-mediated pathways, and subsequently be transported to specific intracellular organelles. Here, we demonstrate how CARDS toxin utilizes its unique KELED sequence to exploit the retrograde pathway machinery to reach the endoplasmic reticulum (ER) and fulfill its cytopathic potential. The knowledge generated from these studies may provide important clues to understand the mode of action of CARDS toxin and develop interventions that reduce or eliminate M. pneumoniae-associated airway and extrapulmonary pathologies.
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Affiliation(s)
- Kumaraguruparan Ramasamy
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sowmya Balasubramanian
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Krishnan Manickam
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Lavanya Pandranki
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alexander B Taylor
- X-Ray Crystallography Core Laboratory, Institutional Research Cores and Department of Biochemistry and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - P John Hart
- X-Ray Crystallography Core Laboratory, Institutional Research Cores and Department of Biochemistry and Structural Biology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Joel B Baseman
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - T R Kannan
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Wood PR, Kampschmidt JC, Dube PH, Cagle MP, Chaparro P, Ketchum NS, Kannan TR, Singh H, Peters JI, Baseman JB, Brooks EG. Mycoplasma pneumoniae and health outcomes in children with asthma. Ann Allergy Asthma Immunol 2017. [PMID: 28634021 DOI: 10.1016/j.anai.2017.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acute infections with Mycoplasma pneumoniae (Mp) have been associated with worsening asthma in children. Mp can be present in the respiratory tract for extended periods; it is unknown whether the long-term persistence of Mp in the respiratory tract affects long-term asthma control. OBJECTIVE To determine the effect of Mp on asthma control. METHODS We enrolled 31 pediatric subjects 3 to 10 years of age with persistent asthma who completed up to 8 visits over a 24-month period. We detected Mp by antigen capture and polymerase chain reaction. Primary outcome measurements included symptom scores, quality of life, medication scores, oral corticosteroid use, health care usage, school absences, and exhaled breath condensate pH. RESULTS Low levels of Mp community-acquired respiratory distress syndrome toxin were detected in 20 subjects (64.5%) at enrollment. Subjects with Mp positivity at a given visit had a .579 probability of remaining Mp positive at the subsequent visit, whereas those with Mp negativity had a .348 probability of becoming Mp positive at the following visit. The incidence of Mp overall was higher in the spring and summer months. Overall, we found no significant relation between the detection of Mp and worse outcome measurements at the same visit or at subsequent visits. CONCLUSION The long-term persistence of Mp in the respiratory tract is common in children with asthma. However, the detection of Mp was not associated significantly with worse asthma symptoms, quality of life, health care usage, school absences, or exhaled breath condensate pH in this pediatric asthma cohort.
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Affiliation(s)
- Pamela R Wood
- Department of Pediatrics, UT Health San Antonio, San Antonio, Texas.
| | | | - Peter H Dube
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Marianna P Cagle
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Paola Chaparro
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Norma S Ketchum
- Department of Epidemiology and Biostatistics, UT Health San Antonio, San Antonio, Texas
| | - Thirumalai R Kannan
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Harjinder Singh
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Jay I Peters
- Department of Medicine, UT Health San Antonio, San Antonio, Texas
| | - Joel B Baseman
- Department of Microbiology, Immunology and Molecular Genetics, UT Health San Antonio, San Antonio, Texas
| | - Edward G Brooks
- Department of Pediatrics, UT Health San Antonio, San Antonio, Texas
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Abstract
BACKGROUND Childhood community-acquired pneumonia is a leading cause of childhood morbidity in low-income countries. The etiologic agents are usually Staphylococcus aureus, Streptococcus pneumoniae and Mycoplasma pneumoniae. M. pneumoniae was recognized as a cofactor in asthmatic disease. High asthma prevalence was reported in Madagascar. Our aim was to clarify the prevalence of M. pneumoniae infection in this country and its relationship with asthma. METHODS A prospective study was conducted in 351 children (from 2 to 16 years of age) from January 2012 to December 2014. According to the clinical symptoms, children were enrolled in 3 groups: "control group" (CG, n = 106), "asthma group" (n = 129) and "pneumonia group" (n = 116). The IgG and IgM M. pneumoniae status was evaluated by an enzyme-linked immunosorbent assay. Clinical signs of infection, socioeconomic data and antimicrobial treatment were recorded. RESULTS The overall prevalence of M. pneumoniae infection was 18.2%. The multivariate analysis demonstrated that M. pneumoniae infection was significantly more frequent in the CG [pneumonia group vs. CG: odds ratio = 0.45 (0.21-0.91), P = 0.037 and asthma group vs. CG: odds ratio = 0.39 (0.18-0.87), P = 0.021]. The C-reactive protein value was significantly higher in children with M. pneumonia-positive serology (85 vs. 61 mg/L, P = 0.03). Of note, 99 (41%) children received antibiotics before attending. CONCLUSIONS We report a prevalence of 18.2% for M. pneumoniae infection in children in Madagascar. The prevalence of M. pneumoniae infection was higher in the control patients than in asthmatic ones.
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Saraya T. Mycoplasma pneumoniae infection: Basics. J Gen Fam Med 2017; 18:118-125. [PMID: 29264006 PMCID: PMC5689399 DOI: 10.1002/jgf2.15] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/05/2016] [Indexed: 01/08/2023] Open
Abstract
Mycoplasma pneumoniae (Mp) is one of the leading causes of community‐acquired pneumonia and can cause a number of extrapulmonary manifestations in the absence of pneumonia. In this regard, primary care physicians should know how to suspect, diagnose, and manage patients with Mp infection. This review gives a general overview of the basic clinical aspects of Mp infection with special reference to pneumonia, which will help further understanding of the disease.
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Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine Kyorin University School of Medicine Tokyo Japan
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Changes in the Levels of Interleukin-17 Between Atopic and Non-atopic Children with Mycoplasma pneumoniae Pneumonia. Inflammation 2017; 39:1871-1875. [PMID: 27531365 DOI: 10.1007/s10753-016-0422-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
As previous study showed that Mycoplasma pneumoniae (MP) induced a cellular immune response associated with interleukin-17 (IL-17), we designed this study to explore IL-17 in MP pneumonia patients with atopic sensitization and 144 patients were evaluated and divided into three groups: atopic MP pneumonia group (n = 38), non-atopic MP pneumonia group (n = 74), and atopic non-MP pneumonia group (n = 32). Serum IL-17 was measured at admission acute phase and at recovery phase. We found IL-17 levels only in the atopic MP pneumonia group that were significantly higher at recovery phase than at acute phase, and its levels were also higher in the atopic MP pneumonia group than the other two groups at clinical recovery phase. In addition, acute asthma attack was higher in the atopic MP pneumonia group. Therefore, IL-17 should be related with asthma and it can be a good marker warning an acute asthma attack in atopic MP pneumonia. Necessary measures can be taken as prevention.
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Sharma L, Losier A, Tolbert T, Dela Cruz CS, Marion CR. Atypical Pneumonia: Updates on Legionella, Chlamydophila, and Mycoplasma Pneumonia. Clin Chest Med 2016; 38:45-58. [PMID: 28159161 DOI: 10.1016/j.ccm.2016.11.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) has multiple causes and is associated with illness that requires admission to the hospital and mortality. The causes of atypical CAP include Legionella species, Chlamydophila, and Mycoplasma. Atypical CAP remains a diagnostic challenge and, therefore, likely is undertreated. This article reviews the advancements in the evaluation and treatment of patients and discusses current conflicts and controversies of atypical CAP.
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Affiliation(s)
- Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S440, New Haven, CT 06510, USA
| | - Ashley Losier
- Department of Internal Medicine, Norwalk Hospital, 34 Maple Street, Norwalk, CT 06856, USA
| | - Thomas Tolbert
- Department of Internal Medicine, Yale University School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S440, New Haven, CT 06510, USA
| | - Chad R Marion
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S440, New Haven, CT 06510, USA.
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Jacob L, Keil T, Kostev K. Comorbid disorders associated with asthma in children in Germany - National analysis of pediatric primary care data. Pediatr Allergy Immunol 2016; 27:861-866. [PMID: 27612945 DOI: 10.1111/pai.12656] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Using routine healthcare data, the goal of this study was to examine the association between asthma and comorbid disorders in children in Germany. METHODS Patients with a diagnosis of asthma documented by a German pediatrician in 2015 were identified. Demographic data included age and gender. Patients younger than 6 and older than 17 and individuals followed for less than a year before index date were excluded. Each patient was matched for age, sex, and physician with an asthma-free control. A total of 34,305 cases and 34,305 controls were available for analysis. There were three different age groups: 6-9 years, 10-13 years, and 14-17 years. Several disorders known to be associated with asthma or found in more than 1% of children and adolescents were also determined on the basis of primary care diagnoses. A multivariate logistic regression model was used to estimate the association between asthma and comorbid disorders. RESULTS The mean age was 10.9 years, and 61.6% of the subjects were boys. The most common diseases found in the three age groups were vasomotor and allergic rhinitis, chronic bronchitis, chronic rhinitis, pneumonia, and atopic dermatitis. These five comorbid disorders were associated with asthma to a significant extent. CONCLUSIONS Overall, this study, based on primary healthcare data, found a considerably high prevalence of several comorbid diseases in German children with asthma.
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Affiliation(s)
- Louis Jacob
- Department of Biology, École Normale Supérieure de Lyon, Lyon, France
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Clinic Berlin, Berlin, Germany
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Yang YZ, Cai MY, Zhang BZ, Zhou BX, Chen R, Fang RT. [Risk factors for recurrent wheezing in infants and young children suffering from dust mite allergy after their first wheezing]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:1259-1263. [PMID: 27974118 PMCID: PMC7403091 DOI: 10.7499/j.issn.1008-8830.2016.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the risk factors for recurrent wheezing in infants and young children suffering from dust mite allergy after their first wheezing. METHODS A total of 1 236 infants and young children who experienced a first wheezing episode and were hospitalized between August 2014 and February 2015 were enrolled, among whom 387 were allergic to dust mites. These infants and young children were followed up to 1 year after discharge. A total of 67 infants and young children who experienced 3 or more recurrent wheezing episodes within 1 year were enrolled as the recurrent wheezing group, while 84 infants and young children who did not experience recurrent wheezing during follow-up were enrolled as the control group. Univariate analysis and multivariate logistic stepwise regression analysis were performed to investigate the risk factors for recurrent wheezing in these patients. RESULTS The univariate analysis showed that the age on admission, wheezing time before admission, Mycoplasma pneumoniae infection rate, and influenza virus infection rate were associated with recurrent wheezing. The multivariate logistic stepwise regression analysis showed that the older age on admission (OR=2.21, P=0.04) and Mycoplasma pneumoniae infection (OR=3.54, P=0.001) were independent risk factors for recurrent wheezing. CONCLUSIONS Infants and young children who are allergic to dust mites, especially young children, have a significantly increased risk of recurrent wheezing if they are complicated by Mycoplasma pneumoniae infection during the first wheezing episode.
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Affiliation(s)
- Yan-Zhen Yang
- Department of Pediatrics, Zhangzhou Hospital, Fujian Medical University, Zhangzhou, Fujian 363000, China.
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Abstract
Chronic bacterial infection is implicated in both the development and severity of asthma. The atypical bacteria Mycoplasma pneumoniae and Chlamydophila pneumoniae have been identified in the airways of asthmatics and correlated with clinical features such as adult onset, exacerbation risks, steroid sensitivity, and symptom control. Asthmatic patients with evidence of bacterial infection may benefit from antibiotic treatment directed towards these atypical organisms. Examination of the airway microbiome may identify microbial communities that confer risk for or protection from severe asthma.
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Raissy HH, Blake K. Macrolides for Acute Wheezing Episodes in Preschool Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2016; 29:100-103. [PMID: 27458539 DOI: 10.1089/ped.2016.0663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The National Asthma Education and Prevention Program's Expert Panel Report 3, Guidelines for the Diagnosis and Management of Asthma does not recommend antibiotics for the management of acute episodes of asthma exacerbation. Macrolides seem to have some potential effect beyond or in addition to their antibacterial effect. It has been reported that macrolides may potentially benefit patients with chronic inflammatory airway diseases due to their antibacterial, antiviral, and/or anti-inflammatory effects. This review presents recent data on use of azithromycin in prevention and management of acute exacerbation of respiratory symptoms in infants and young children.
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Affiliation(s)
- Hengameh H Raissy
- Department of Pediatrics, University of New Mexico , School of Medicine, Albuquerque, New Mexico
| | - Kathryn Blake
- Department of Biomedical Research, Nemours Children's Clinic , Jacksonville, Florida
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Ambroggio L, Test M, Metlay JP, Graf TR, Blosky MA, Macaluso M, Shah SS. Beta-lactam versus beta- lactam/macrolide therapy in pediatric outpatient pneumonia. Pediatr Pulmonol 2016; 51:541-8. [PMID: 26367389 PMCID: PMC6309318 DOI: 10.1002/ppul.23312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 07/08/2015] [Accepted: 07/23/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective was to evaluate the comparative effectiveness of beta-lactam monotherapy and beta- lactam/macrolide combination therapy in the outpatient management of children with community-acquired pneumonia (CAP). METHODS This retrospective cohort study included children, ages 1-18 years, with CAP diagnosed between January 1, 2008 and January 31, 2010 during outpatient management in the Geisinger Health System. The primary exposure was receipt of beta-lactam monotherapy or beta-lactam/macrolide combination therapy. The primary outcome was treatment failure, defined as a follow-up visit within 14 days of diagnosis resulting in a change in antibiotic therapy. Logistic regression within a propensity score- restricted cohort was used to estimate the likelihood of treatment failure. RESULTS Of 717 children in the analytical cohort, 570 (79.4%) received beta-lactam monotherapy and 147 (20.1%) received combination therapy. Of those who received combination therapy 58.2% of children were under 6 years of age. Treatment failure occurred in 55 (7.7%) children, including in 8.1% of monotherapy recipients, and 6.1% of combination therapy recipients. Treatment failure rates were highest in children 6-18 years receiving monotherapy (12.9%) and lowest in children 6-18 years receiving combination therapy (4.0%). Children 6-18 years of age who received combination therapy were less likely to fail treatment than those who received beta-lactam monotherapy (propensity-adjusted odds ratio, 0.51; 95% confidence interval, 0.28, 0.95). CONCLUSION Children 6-18 years of age who received beta- lactam/macrolide combination therapy for CAP in the outpatient setting had lower odds of treatment failure compared with those who received beta-lactam monotherapy.
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Affiliation(s)
- Lilliam Ambroggio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew Test
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joshua P Metlay
- Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas R Graf
- Population Health, Geisinger Health System, Danville, Pennsylvania
| | - Mary Ann Blosky
- Center for Health Research, Geisinger Health System, Danville, Pennsylvania
| | - Maurizio Macaluso
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Iramain R, De Jesús R, Spitters C, Jara A, Jimenez J, Bogado N, Cardozo L. Chlamydia pneumoniae, and mycoplasma pneumoniae: Are they related to severe asthma in childhood? J Asthma 2016; 53:618-21. [PMID: 27120360 DOI: 10.3109/02770903.2015.1116085] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae and Chlamydia pneumoniae are frequent agents of acute respiratory diseases and they have been recognized as infectious triggers of asthma. OBJECTIVE To determine the frequency of these triggers and their relationship to severe asthma. METHODS 82 patients were enrolled in a prospective cross-sectional study from January 2007 to March 2013 and they were divided into three study groups: Group 1: 27 children with severe asthma, Group 2: 29 children with stable asthma and Group 3: 26 children which was the control group. Serological tests included IgG and IgM for both C. pneumoniae and M. pneumoniae. RESULTS Average age ± SD was 10.9 ± 2.5 for Group 1; 10.1 ± 2.9 for Group 2 and 9.9± 1.9 for Group 3 (p = 0.4). M. pneumoniae IgM was observed in 6/27 (22.2%) in Group 1, 2/29 (6.9%) in Group 2 and 0/26 in the Control Group (p = 0,01). C.pneumoniae IgM was present in 7/26 (26.9%) in Group 1, 2/29 (6.9%) in Group 2 and 0/26 in Group 3 (p = 0.005). No significant difference was observed between Group 2 and Group 3. M. pneumoniae IgG was observed in 7/27 (25.9%) in Group 1, 4/29 (13.7%) in Group 2 and 0/26 in the Control Group (p < 0,05). C.pneumoniae IgG was present in 8/26 (30.7%) in Group 1, 5/29 (17.2%) in Group 2 and 0/26 in Group 3 (p < 0,05). CONCLUSIONS M. pneumoniae and C. pneumoniae may play a role in the development of severe asthma.
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Affiliation(s)
- Ricardo Iramain
- a Emergency Department , Clinical Hospital, Pediatric Department National University of Asuncion , San Lorenzo , Paraguay.,c Instituto Privado del Niño , Azara , Asunción , Paraguay.,d Pediatric Intensive Care Unit, Clinical Hospital, National University of Asuncion , San Lorenzo , Paraguay
| | - Raùl De Jesús
- a Emergency Department , Clinical Hospital, Pediatric Department National University of Asuncion , San Lorenzo , Paraguay
| | - Cristopher Spitters
- b University of Washington Schools of Medicine and Public Health & Community Medicine , Seattle , WA , USA
| | - Alfredo Jara
- a Emergency Department , Clinical Hospital, Pediatric Department National University of Asuncion , San Lorenzo , Paraguay
| | - Jimmy Jimenez
- d Pediatric Intensive Care Unit, Clinical Hospital, National University of Asuncion , San Lorenzo , Paraguay
| | - Norma Bogado
- a Emergency Department , Clinical Hospital, Pediatric Department National University of Asuncion , San Lorenzo , Paraguay
| | - Laura Cardozo
- a Emergency Department , Clinical Hospital, Pediatric Department National University of Asuncion , San Lorenzo , Paraguay
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Parrott GL, Kinjo T, Fujita J. A Compendium for Mycoplasma pneumoniae. Front Microbiol 2016; 7:513. [PMID: 27148202 PMCID: PMC4828434 DOI: 10.3389/fmicb.2016.00513] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/29/2016] [Indexed: 12/11/2022] Open
Abstract
Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, “walking” pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review.
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Affiliation(s)
- Gretchen L Parrott
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
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