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Goeijenbier M, van der Bie S, Souverein D, Bolluyt D, Nagel M, Stoof SP, Vermin B, Weenink J, van Gorp ECM, Euser S, Kalpoe J, van Houten MA, Endeman H, Gommers D, Haas LEM, van Lelyveld SFL. Post COVID-19 Pandemic Increased Detection of Mycoplasma Pneumoniae in Adults Admitted to the Intensive Care. J Clin Med 2024; 13:3443. [PMID: 38929972 PMCID: PMC11204797 DOI: 10.3390/jcm13123443] [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: 05/12/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Mycoplasma pneumoniae (M. pneumoniae) infections can progress to severe respiratory complications, necessitating intensive care treatment. Recent post COVID-19 pandemic surges underscore the need for timely diagnosis, given potential diagnostic method limitations. Methods: A retrospective case series analysis was conducted on M. pneumonia PCR-positive patients admitted to two Dutch secondary hospitals' ICUs between January 2023 and February 2024. Clinical presentations, treatments, outcomes, and mechanical ventilation data were assessed. Results: Seventeen ICU-admitted patients were identified, with a median age of 44 years, primarily due to hypoxia. Non-invasive ventilation was effective for most, while five required invasive mechanical ventilation. None of the patients required extracorporeal membrane oxygenation. No fatalities occurred. Post-PCR, treatment was adjusted to doxycycline or azithromycin; seven received steroid treatment. Discussion: Increased ICU admissions for M. pneumoniae infection were observed. Diverse clinical and radiological findings emphasize heightened clinical awareness. Early molecular diagnostics and tailored antibiotic regimens are crucial since beta-lactam antibiotics are ineffective. Conclusion: This study highlights the escalating challenge of severe M. pneumoniae infections in ICUs, necessitating a multifaceted approach involving accurate diagnostics, vigilant monitoring, and adaptable treatment strategies for optimal patient outcomes.
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Affiliation(s)
- M. Goeijenbier
- Department of Intensive Care Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands; (S.v.d.B.); (B.V.); (J.W.)
- Department of Intensive Care Medicine, Erasmus MC University Medical Centre, 3015 GD Rotterdam, The Netherlands; (H.E.); (D.G.)
| | - S. van der Bie
- Department of Intensive Care Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands; (S.v.d.B.); (B.V.); (J.W.)
| | - D. Souverein
- Regional Public Health Laboratory Kennemerland, 2035 RC Haarlem, The Netherlands; (D.S.); (S.E.); (J.K.)
| | - D. Bolluyt
- Department of Internal Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands (S.F.L.v.L.)
| | - M. Nagel
- Department of Intensive Care Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands; (M.N.); (L.E.M.H.)
| | - S. P. Stoof
- Department of Medical Microbiology and Immunology, Diakonessenhuis, 3582 KE Utrecht, The Netherlands;
| | - B. Vermin
- Department of Intensive Care Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands; (S.v.d.B.); (B.V.); (J.W.)
| | - J. Weenink
- Department of Intensive Care Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands; (S.v.d.B.); (B.V.); (J.W.)
| | - E. C. M. van Gorp
- Department of Viroscience, Erasmus MC University Medical Centre, 3015 GD Rotterdam, The Netherlands;
| | - S. Euser
- Regional Public Health Laboratory Kennemerland, 2035 RC Haarlem, The Netherlands; (D.S.); (S.E.); (J.K.)
| | - J. Kalpoe
- Regional Public Health Laboratory Kennemerland, 2035 RC Haarlem, The Netherlands; (D.S.); (S.E.); (J.K.)
| | - M. A. van Houten
- Department of Paediatrics, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands;
| | - H. Endeman
- Department of Intensive Care Medicine, Erasmus MC University Medical Centre, 3015 GD Rotterdam, The Netherlands; (H.E.); (D.G.)
| | - D. Gommers
- Department of Intensive Care Medicine, Erasmus MC University Medical Centre, 3015 GD Rotterdam, The Netherlands; (H.E.); (D.G.)
| | - L. E. M. Haas
- Department of Intensive Care Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands; (M.N.); (L.E.M.H.)
| | - S. F. L. van Lelyveld
- Department of Internal Medicine, Spaarne Gasthuis, 2035 RC Haarlem, The Netherlands (S.F.L.v.L.)
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Zhang X, Sun R, Jia W, Li P, Song C. A new dynamic nomogram for predicting the risk of severe Mycoplasma pneumoniae pneumonia in children. Sci Rep 2024; 14:8260. [PMID: 38589453 PMCID: PMC11002011 DOI: 10.1038/s41598-024-58784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/03/2024] [Indexed: 04/10/2024] Open
Abstract
Mycoplasma pneumoniae pneumonia (MPP) is usually mild and self-limiting, but still about 12% of them will progress to severe Mycoplasma pneumoniae pneumonia (SMPP), which have poor survival rates and often require intensive medical resource utilization. We retrospectively collected clinical data from 526 children with MPP admitted to the Children's Hospital Affiliated to Zhengzhou University from June 2018 to February 2023 and randomly divided the data into a training cohort and a validation cohort at a ratio of 4:1. Univariate and multivariate logistic regressions were used to identify independent risk factors for SMPP. Age, AGR, NLR, CRP, ESR, MPV, coinfection, pleural effusion, primary disease, fever days ≥ 7 and wheeze are independent risk factors for SMPP in children. Then, we built an online dynamic nomogram ( https://ertongyiyuanliexiantu.shinyapps.io/SMPP/ ) based on the 11 independent risk factors. The C-index, ROC curve, DCA curve and calibration curve were used to assess the performance of the nomogram, which all showed that the dynamic nomogram has excellent clinical value. Based on age, AGR, NLR, CRP, ESR, MPV, coinfection, pleural effusion, primary disease, fever days ≥ 7 and wheeze, the first dynamic nomogram for accurately predicting SMPP was successfully established.
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Affiliation(s)
- Xue Zhang
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Ruiyang Sun
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Wanyu Jia
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Peng Li
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Chunlan Song
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450052, Henan, China.
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Meyer Sauteur PM. Childhood community-acquired pneumonia. Eur J Pediatr 2024; 183:1129-1136. [PMID: 38112800 PMCID: PMC10950989 DOI: 10.1007/s00431-023-05366-6] [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: 09/27/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
Community-acquired pneumonia (CAP) is a common disease in children, and its aetiological and clinical diagnosis are challenging for physicians in both private practice and hospitals. Over the past three decades, conjugate vaccines have successfully reduced the burden of the former main causes of CAP, Streptococcus pneumoniae and Haemophilus influenzae type b. Today, viruses are by far the most commonly detected pathogens in children with CAP. Conclusion: New insights into the aetiology and treatment of CAP in children in recent years have influenced management and are the focus of this review. In addition to reducing diagnostic uncertainty, there is an urgent need to reduce antibiotic overuse and antimicrobial resistance in children with CAP. What is Known: • Conjugate vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b have shifted the epidemiology of childhood CAP to predominantly viral pathogens and Mycoplasma pneumoniae. • Clinical, laboratory, and radiological criteria cannot reliably distinguish between bacterial and viral aetiology in children with CAP. What is New: • Test results and epidemiological data must be carefully interpreted, as no single diagnostic method applied to non-pulmonary specimens has both high sensitivity and high specificity for determining pneumonia aetiology in childhood CAP. • This review provides a simple and pragmatic management algorithm for children with CAP to aid physicians in providing optimal and safe care and reducing antibiotic prescribing.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland.
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Zhang X, Sun R, Jia W, Li P, Song C. Clinical Characteristics of Lung Consolidation with Mycoplasma pneumoniae Pneumonia and Risk Factors for Mycoplasma pneumoniae Necrotizing Pneumonia in Children. Infect Dis Ther 2024; 13:329-343. [PMID: 38265626 PMCID: PMC10904708 DOI: 10.1007/s40121-023-00914-x] [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: 11/12/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Mycoplasma pneumoniae necrotizing pneumonia (MPNP) is an uncommon but increasingly recognized severe complication of pneumonia, and the delayed diagnosis and treatment are prone to pulmonary sequelae. The aim of this study is to explore independent risk factors for MPNP in children with lung consolidation. METHODS A retrospective observational study was conducted on 118 children with MPNP (MPNP group) and 184 children with lung consolidation of Mycoplasma pneumoniae pneumonia (MPP) (control group) admitted to Children's Hospital Affiliated to Zhengzhou University from June 2018 to August 2023. Clinical manifestations and laboratory data were analyzed and the independent risk factors for MPNP in children were analyzed by multivariate logistic regression. RESULTS The age of onset, hospitalization days, fever days, proportion of dyspnea, chest pain, complications, and need for fiberoptic bronchoscopic alveolar lavage (FBAL) were higher than those in the control group, and the difference was statistically significant (P < 0.05). The levels of white blood cells (WBC), platelets, neutrophil percentage (N%), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), fibrinogen (Fbg), D-dimer (D-D), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), γ-glutamyl transpeptidase (γ-GGT), globulin, lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), urea, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), complement component 3, antistreptolysin O (ASO), serum ferritin, and interleukin-6 (IL-6) in the MPNP group were higher than those in the control group. Red blood cell (RBC), lymphocyte percentage (L%), activated partial thromboplastin time (APTT), alkaline phosphatase (ALP), total protein, albumin, albumin-to-globulin ratio (AGR), creatine kinase (CK), uric acid, natrium, chlorine, calcium, and complement C4 in the MPNP group were lower than those in the control group, and the difference was statistically significant (P < 0.05). The results of multivariate logistic regression analysis showed that age ≥ 83.50 months, fever days ≥ 10.50, ALT ≥ 15.25 U/l, IgM ≥ 1.46 g/l, complement C3 ≥ 1.47 g/l, Fbg ≥ 3.93 g/l, dyspnea and needing FBAL were independent risk factors for MPNP in children. CONCLUSIONS Age, fever days, ALT, IgM, complement C3, Fbg, dyspnea, and needing FBAL were independent risk factors for MPNP in children. For children suspected of MPNP, pediatricians should pay close attention to the above indicators, strive for early diagnosis and treatment, and improve prognosis.
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Affiliation(s)
- Xue Zhang
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Longhu Waihuan East Road, Zhengdong New District, Zhengzhou, 450018, Henan, China
| | - Ruiyang Sun
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Longhu Waihuan East Road, Zhengdong New District, Zhengzhou, 450018, Henan, China
| | - Wanyu Jia
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Longhu Waihuan East Road, Zhengdong New District, Zhengzhou, 450018, Henan, China
| | - Peng Li
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Longhu Waihuan East Road, Zhengdong New District, Zhengzhou, 450018, Henan, China
| | - Chunlan Song
- Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care, Children's Hospital Affiliated to Zhengzhou University, Longhu Waihuan East Road, Zhengdong New District, Zhengzhou, 450018, Henan, China.
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Papan C, Sidorov S, Greiter B, Bühler N, Berger C, Becker SL, Meyer Sauteur PM. Combinatorial host-response biomarker signature (BV score) and its subanalytes TRAIL, IP-10, and CRP in children with Mycoplasma pneumoniae community-acquired pneumonia. J Infect Dis 2023:jiad573. [PMID: 38092364 DOI: 10.1093/infdis/jiad573] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/04/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Host-response biomarkers to differentiate bacterial from viral etiology in children with respiratory infections have shown high accuracies, but are understudied in Mycoplasma pneumoniae (Mp) infections. METHODS We compared BV scores (0-34 indicating viral, and 66-100 indicating bacterial etiology), TRAIL (pg/mL), IP-10 (pg/mL), and CRP (mg/L) serum levels between Mp positive (Mp+) and negative (Mp-) community-acquired pneumonia (CAP). We performed receiver operating characteristic (ROC) curve analyses for clinical features and biomarkers. RESULTS Of 80 CAP patients (median age 6.3 years, 57.5% male), 26 were Mp + CAP. By comparing Mp + CAP with Mp-CAP patients, BV scores were lower (median 14.0, IQR 3.0-27.8 vs. 54.0, IQR 12.0-84.8; P = 0.0008), TRAIL levels were higher (86.5, IQR 67.4-123.0 vs. 65.5, IQR 42.5-103.9; P = 0.025), CRP levels were lower (12.9, IQR 4.0-22.3 vs. 36.7, IQR 13.0-132.8; P = 0.0019), and IP-10 levels were comparable (366.0, IQR 150.2-603.8 vs. 331.0, IQR 154.3-878.8; P = 0.73). ROC analyses yielded a comparable discriminatory accuracy for the combination of age, fever duration, respiratory symptoms duration, with either procalcitonin or BV (AUC 0.87 vs. 0.86, P = 0.94). CONCLUSIONS Children with Mp + CAP have atypically low, viral levels of the BV score, underscoring the complementary role of microbiological testing.
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Affiliation(s)
- Cihan Papan
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Germany
- Institute for Hygiene and Public Health, University Hospital Bonn, Germany
| | - Semjon Sidorov
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Beat Greiter
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Nina Bühler
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Germany
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
| | - Sören L Becker
- Centre for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Germany
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland
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Guo H, Liang J, Lin H, Zhou X, Zhang Z, Lai L, Zhang T, Wang Z, Zhou J, Sun J, Liao J, Jiang M, Yang Z. Differentiate Clinical Characteristics Between Viral Pneumonia and Mycoplasma pneumoniae and Nomograms for Predicting Mycoplasma pneumoniae : A Retrospective Study in Primary Hospitals. Pediatr Infect Dis J 2023; 42:1035-1040. [PMID: 37820276 PMCID: PMC10629606 DOI: 10.1097/inf.0000000000004082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To identify the difference in clinical characteristics between viral pneumonia and Mycoplasma pneumoniae , providing cues on their differential diagnosis for primary hospitals with the insufficient pathogen detection capacity. METHODS We retrospectively reviewed the medical records of hospitalized children with acute respiratory tract infections, and pathogenic microbes test results were analyzed. Clinical characteristics, routine blood parameters and hospitalization duration and fee were compared between M. pneumoniae and viral pneumonia. We used in the multivariable logistic regression to predict the probability of children with M. pneumoniae and graphically represented by a dynamic nomogram. The discrimination and clinical utility of the model were confirmed by receiver operating characteristic and decision curve analysis curves. RESULT A total of 375 children with community-acquired pneumonia were included. Mycoplasma infection accounted for the largest proportion (22.13%). The incidence of both hypothermia and vomiting was lower in M. pneumoniae compared to viral pneumonia (hypothermia: 10.50% vs. 0.00%; vomiting: 7.90% vs. 0.00%). The prevalence of hyperthermia was higher in M. pneumoniae (hyperthermia: 89.5% vs. 100%). Procalcitonin, peripheral blood white blood cell count and lymphocyte levels were higher in the viral pneumonia group, and eosinophil levels were conversely lower. As for the duration of illness, the mean length of stay was 5.20 ± 2.12 (viral pneumonia) and 6.27 ± 2.48 days ( M. pneumoniae ). Children with M. pneumoniae had higher overall hospital costs and required more medical treatment. The above were all statistically significant with a P < 0.05. The scoring system was established based on the above results. Receiver operating characteristic curves showed good model-discrimination ability with 0.844 of the area under the curve in the training set and 0.778 in the test set. Decision curve analysis curves demonstrated the discriminative superiority of this model. The web-based dynamic nomogram calculator is accessible at https://zhxylxy0160128.shinyapps.io/Nomogram/ . CONCLUSION Nomograms have satisfactory discrimination, and clinical utility may benefit in predicting the probability of developing M. pneumoniae in children. Children with M. pneumoniae have a higher burden than those with viral pneumonia and may require more intensive in-hospital monitoring.
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Affiliation(s)
- Huixian Guo
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Jingyi Liang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Haowen Lin
- Department of Clinical Medicine, The First Clinical College, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xingyou Zhou
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhou Zhang
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Laiqing Lai
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Tao Zhang
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Zhufeng Wang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Junhou Zhou
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jiaxi Sun
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jiayi Liao
- From the Department of Respiration, Guangzhou Yuexiu District Children’s Hospital, Guangzhou, China
| | - Mei Jiang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Zifeng Yang
- Department of Respiratory Research, National Center for Respiratory medicine, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
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Koenen MH, de Groot RCA, de Steenhuijsen Piters WAA, Chu MLJN, Arp K, Hasrat R, de Bruijn ACJM, Estevão SC, van der Vries E, Langereis JD, Boes M, Bogaert D, van Rossum AMC, Unger WWJ, Verhagen LM. Mycoplasma pneumoniae carriage in children with recurrent respiratory tract infections is associated with a less diverse and altered microbiota. EBioMedicine 2023; 98:104868. [PMID: 37950996 PMCID: PMC10679896 DOI: 10.1016/j.ebiom.2023.104868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in school-aged children and can be preceded by asymptomatic carriage. However, its role in recurrent respiratory tract infections is unclear. We studied the prevalence of M.pneumoniae carriage in children with recurrent respiratory infections and identified associated factors. METHODS We tested M.pneumoniae carriage by qPCR in children with recurrent infections and their healthy family members in a cross-sectional study. Serum and mucosal total and M.pneumoniae-specific antibody levels were measured by ELISA and nasopharyngeal microbiota composition was characterized by 16S-rRNA sequencing. FINDINGS Prevalence of M.pneumoniae carriage was higher in children with recurrent infections (68%) than their family members without infections (47% in siblings and 27% in parents). M.pneumoniae carriage among family members appeared to be associated with transmission within the household, likely originating from the affected child. In logistic regression corrected for age and multiple comparisons, IgA (OR 0.16 [0.06-0.37]) and total IgG deficiency (OR 0.15 [0.02-0.74]) were less prevalent in M.pneumoniae carriers (n = 78) compared to non-carriers (n = 36). In multivariable analysis, the nasopharyngeal microbiota of M.pneumoniae carriers had lower alpha diversity (OR 0.27 [0.09-0.67]) and a higher abundance of Haemophilus influenzae (OR 45.01 [2.74-1608.11]) compared to non-carriers. INTERPRETATION M.pneumoniae carriage is highly prevalent in children with recurrent infections and carriers have a less diverse microbiota with an overrepresentation of disease-associated microbiota members compared to non-carriers. Given the high prevalence of M.pneumoniae carriage and the strong association with H. influenzae, we recommend appropriate antibiotic coverage of M.pneumoniae and H. influenzae in case of suspected pneumonia in children with recurrent respiratory tract infections or their family members. FUNDING Wilhelmina Children's Hospital Research Fund, 'Christine Bader Stichting Irene KinderZiekenhuis', Sophia Scientific Research Foundation, ESPID Fellowship funded by Seqirus, Hypatia Fellowship funded by Radboudumc and The Netherlands Organisation for Health Research and Development (ZonMW VENI grant to LM Verhagen).
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Affiliation(s)
- Mischa H Koenen
- Center of Translational Immunology, UMC Utrecht, Utrecht, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Ruben C A de Groot
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Wouter A A de Steenhuijsen Piters
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Center for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Mei Ling J N Chu
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Kayleigh Arp
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Raïza Hasrat
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Ad C J M de Bruijn
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Silvia C Estevão
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Erhard van der Vries
- Department of Research & Development, GD Animal Health, Deventer, the Netherlands
| | - Jeroen D Langereis
- Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marianne Boes
- Center of Translational Immunology, UMC Utrecht, Utrecht, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Debby Bogaert
- Center for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Annemarie M C van Rossum
- Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, Erasmus MC University Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Wendy W J Unger
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center Rotterdam - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Lilly M Verhagen
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Laboratory of Medical Immunology, Department of Laboratory Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands.
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Ma J, Guo P, Mei S, Li M, Yu Z, Zhang Y, Shen A, Sun H, Li L. Influence of COVID-19 pandemic on the epidemiology of Mycoplasma pneumoniae infections among hospitalized children in Henan, China. Heliyon 2023; 9:e22213. [PMID: 38106667 PMCID: PMC10722323 DOI: 10.1016/j.heliyon.2023.e22213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Background Increasing reports have indicated that non-pharmaceutical interventions to control the COVID-19 pandemic may also have an effect on the prevalence of other pathogens. Mycoplasma pneumoniae is an important atypical pathogen prevalent in children with high rates of macrolide resistance. The aim of this study was to investigate the epidemiological characteristics of M. pneumoniae infection in children before and during the COVID-19 pandemic. Methods In this study, M. pneumoniae detection results were extracted from Henan Children's Hospital from 2018 to 2021. The epidemiological characteristics of pediatric M. pneumoniae infection were analyzed. Results We found that the highest positive rate of M. pneumoniae infection was 11.00 % in 2018, 14.01 % in 2019, followed by 11.24 % in 2021 and 8.75 % in 2020 (p < 0.001). Most tested children had respiratory system manifestations, and pneumoniae was the most common diagnosis (53.23 %). An increase in the number of positive cases was observed with an increase in age, with a higher number of cases among children over 6 years old. No positive cases were identified among children aged 1-28 days. The decrease in the positive rate among children aged between1-6 years old in 2020 and 2021 was found to be statistically significant (p < 0.001). The pre-pandemic period demonstrated a higher incidence rate in the fall, whereas the summers and winters exhibited a significantly higher positive rate during the pandemic period (p < 0.001). Different regions in Henan also showed different epidemic patterns. Conclusions In summary, strict pandemic measures influenced the spread of M. pneumoniae to some extent and changed demographic characteristics, including age, season and regional distribution. Continuous monitoring is required for the control and prevention of related diseases.
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Affiliation(s)
- Jiayue Ma
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Pengbo Guo
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Shiyue Mei
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Mingchao Li
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Zhidan Yu
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yaodong Zhang
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Adong Shen
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Huiqing Sun
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Lifeng Li
- Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
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9
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Shen H, Liu T, Shen M, Zhang Y, Chen W, Chen H, Wang Y, Liu J, Tao J, He L, Lu G, Yan G. Utilizing metagenomic next-generation sequencing for diagnosis and lung microbiome probing of pediatric pneumonia through bronchoalveolar lavage fluid in pediatric intensive care unit: results from a large real-world cohort. Front Cell Infect Microbiol 2023; 13:1200806. [PMID: 37655299 PMCID: PMC10466250 DOI: 10.3389/fcimb.2023.1200806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background Metagenomic next-generation sequencing (mNGS) is a powerful method for pathogen detection in various infections. In this study, we assessed the value of mNGS in the pathogen diagnosis and microbiome analysis of pneumonia in pediatric intensive care units (PICU) using bronchoalveolar lavage fluid (BALF) samples. Methods A total of 104 pediatric patients with pneumonia who were admitted into PICU between June 2018 and February 2020 were retrospectively enrolled. Among them, 101 subjects who had intact clinical information were subject to parallel comparison of mNGS and conventional microbiological tests (CMTs) for pathogen detection. The performance was also evaluated and compared between BALF-mNGS and BALF-culture methods. Moreover, the diversity and structure of all 104 patients' lung BALF microbiomes were explored using the mNGS data. Results Combining the findings of mNGS and CMTs, 94.06% (95/101) pneumonia cases showed evidence of causative pathogenic infections, including 79.21% (80/101) mixed and 14.85% (15/101) single infections. Regarding the pathogenesis of pneumonia in the PICU, the fungal detection rates were significantly higher in patients with immunodeficiency (55.56% vs. 25.30%, P =0.025) and comorbidities (40.30% vs. 11.76%, P=0.007). There were no significant differences in the α-diversity either between patients with CAP and HAP or between patients with and without immunodeficiency. Regarding the diagnostic performance, the detection rate of DNA-based BALF-mNGS was slightly higher than that of the BALF-culture although statistically insignificant (81.82% vs.77.92%, P=0.677) and was comparable to CMTs (81.82% vs. 89.61%, P=0.211). The overall sensitivity of DNA-based mNGS was 85.14% (95% confidence interval [CI]: 74.96%-92.34%). The detection rate of RNA-based BALF-mNGS was the same with CMTs (80.00% vs 80.00%, P>0.999) and higher than BALF-culture (80.00% vs 52.00%, P=0.045), with a sensitivity of 90.91% (95%CI: 70.84%-98.88%). Conclusions mNGS is valuable in the etiological diagnosis of pneumonia, especially in fungal infections, and can reveal pulmonary microecological characteristics. For pneumonia patients in PICU, the mNGS should be implemented early and complementary to CMTs.
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Affiliation(s)
- Huili Shen
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Tingyan Liu
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Meili Shen
- Medical Department, Nanjing Dinfectome Technology Inc., Nanjing, Jiangsu, China
| | - Yi Zhang
- Department of Clinical Epidemiology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Weiming Chen
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Hanlin Chen
- Medical Department, Nanjing Dinfectome Technology Inc., Nanjing, Jiangsu, China
| | - Yixue Wang
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Jing Liu
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Jinhao Tao
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Liming He
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Guoping Lu
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Gangfeng Yan
- Pediatric Intensive Care Unit, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
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10
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Rodman Berlot J, Dolenc Š, Krivec U, Keše D. Clinical, Laboratory, and Radiographic Features Can Help Predict Mycoplasma pneumoniae Lower Respiratory Tract Infection in Children. Microorganisms 2023; 11:1358. [PMID: 37317331 DOI: 10.3390/microorganisms11051358] [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: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
Mycoplasma pneumoniae (Mp) is a common cause of lower respiratory tract infection (LRTI) in children that is difficult to distinguish from LRTI of other etiologies. We aimed to determine if a combination of clinical, laboratory, and chest radiographic features can help identify patients at higher risk of Mp LRTI. We reviewed medical charts of children referred to our tertiary hospital with suspected acute mycoplasmal LRTI. Pharyngeal swabs obtained from patients were tested by Mp PCR. We compared epidemiological and clinical data of children with positive and negative Mp PCR results. In addition, a multivariable logistic regression analysis was performed to predict Mp LRTI based on the patient's age, duration of symptoms, presence of extrapulmonary manifestations, laboratory findings, and chest radiographic findings. We included 65 children with Mp PCR-negative and 49 with Mp PCR-positive LRTI and no viral co-detection. Children with Mp LRTI were older (median age 5.8 vs. 2.2 years, p < 0.001), had a longer duration of symptoms on referral (median 7 vs. 4 days, p < 0.001), and lower median WBC (9.9 vs. 12.7 × 109/L, p < 0.001). On chest radiograph, unilateral infiltrates were more frequently observed in the Mp PCR-positive group (57.5% vs. 24.1%, p = 0.001). Age, duration of symptoms, and chest radiographic findings had the highest predictive value for Mp LRTI in a multivariable logistic regression model. Our analysis suggests that a combination of clinical, laboratory, and chest radiographic features can be used to assess the likelihood of Mp LRTI and assist in decision-making for which children need further tests or macrolide antibiotic treatment.
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Affiliation(s)
- Jasna Rodman Berlot
- Department of Paediatric Pulmonology, University Children's Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Špela Dolenc
- Department of Paediatric Pulmonology, University Children's Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Uroš Krivec
- Department of Paediatric Pulmonology, University Children's Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Darja Keše
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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11
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Yu H, Chen L, Yue CJ, Xu H, Cheng J, Cornett EM, Kaye AD, Urits I, Viswanath O, Liu H. Effects of propofol and sevoflurane on T-cell immune function and Th cell differentiation in children with SMPP undergoing fibreoptic bronchoscopy. Ann Med 2022; 54:2574-2580. [PMID: 36370066 PMCID: PMC9665898 DOI: 10.1080/07853890.2022.2121416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The potentially different effects of commonly used anaesthetic agents propofol and sevoflurane on T-cell immune function and Th cell differentiation were investigated in patients with severe mycoplasmal pneumonia (SMPP) undergoing fibreoptic bronchoscopy. METHODS Sixty children (2-12 years of age) with SMPP were randomized into the sevoflurane group and the propofol group. Patients in the sevoflurane group were anaesthetised with inhalational sevoflurane and intravenous remifentanil. Patients in the propofol group were anaesthetised with intravenous propofol and remifentanil. Patients in both groups underwent fibreoptic bronchoscopy and lavage therapy. We compared the clinical outcomes, cellular immunity function, and Th cell differentiation into Th1 and Th2 levels in both groups. RESULTS There was no significant difference in clinical outcomes and hospital stay between the two groups (7.94 vs 7.36, p > .05). However, the CD3+ T cells, CD4+ T cells, and CD4+/CD8+ in the propofol group were significantly higher than those in the sevoflurane group (T1 51.96 vs 48.33, T2 58.08 vs 55.31, p < .05). The ratio of Th1/Th2 in the two groups was significantly increased postoperatively in both groups (Sevoflurane 8.53 vs 7.23, Propofol 9.35 vs 7.18), and the propofol group was significantly higher than the sevoflurane group (9.35 vs 8.53, p < .05). CONCLUSIONS Propofol might have a less inhibitory effect on T lymphocytes in children with SMPP than sevoflurane. And propofol may have less impact on the differentiation of Th cells into Th1 cells and better preserving the Th1/Th2 ratio than sevoflurane. KEY MESSAGESThe pathogenesis of SMPP is still unclear, likely through alveolar infiltration with neutrophils and lymphocytes, lymphocyte/plasma cell infiltrates in the peri-bronchovascular area, and immune dysfunction.Recent experimental and clinical studies showed that sevoflurane might have immunosuppressive effects, and multiple studies confirmed that the immune function of children with SMPP had been reduced.This study found that propofol administered in children with SMPP had a less inhibitory effect on T lymphocytes than inhalational sevoflurane, had little inhibitory effect on the differentiation of Th cells into Th1 cells, and better preserve Th1/Th2 ratio and maintain the balanced immune function.
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Affiliation(s)
- Hui Yu
- Department of Anesthesiology, Hubei Women and Children's Hospital, Tongji Medical College, Huazhong University Science & Technology, Wuhan, Hubei, China
| | - Lin Chen
- Department of Anesthesiology, Hubei Women and Children's Hospital, Tongji Medical College, Huazhong University Science & Technology, Wuhan, Hubei, China
| | - Cheng-Jin Yue
- Department of Anesthesiology, Hubei Women and Children's Hospital, Tongji Medical College, Huazhong University Science & Technology, Wuhan, Hubei, China
| | - Heng Xu
- Department of Anesthesiology, Hubei Women and Children's Hospital, Tongji Medical College, Huazhong University Science & Technology, Wuhan, Hubei, China
| | - Jing Cheng
- Department of Anesthesiology, Hubei Women and Children's Hospital, Tongji Medical College, Huazhong University Science & Technology, Wuhan, Hubei, China
| | - Elyse M Cornett
- Departments of Anesthesiology and Pharmacology, Toxicology & Neuroscience, LSU Health Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology & Neuroscience, LSU Health Shreveport, Shreveport, LA, USA
| | - Ivan Urits
- Departments of Anesthesiology and Pharmacology, Toxicology & Neuroscience, LSU Health Shreveport, Shreveport, LA, USA.,Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA, USA
| | - Omar Viswanath
- Departments of Anesthesiology and Pharmacology, Toxicology & Neuroscience, LSU Health Shreveport, Shreveport, LA, USA.,University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, USA
| | - Henry Liu
- Department of Anesthesiology & Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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12
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Zhang H, Li H, Wang L, Huang L, Ma Q, Wu H, Pang H, Chen Y, Ruan Z. Development of a model for early differentiation of adenovirus pneumonia from Mycoplasma pneumoniae pneumonia. Transl Pediatr 2022; 11:1766-1775. [PMID: 36506774 PMCID: PMC9732605 DOI: 10.21037/tp-22-6] [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: 01/05/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adenovirus pneumonia (AVP) and Mycoplasma pneumoniae pneumonia (MPP) have similar clinical manifestations such as a high prevalence of lung consolidation, making the differential diagnosis difficult before the etiology is reported. This study aimed to compare AVP and MPP, and to build a predictive model to differentiate them early. METHODS We selected 198 cases of AVP and 876 cases of MPP. Clinical manifestations, computed tomography (CT) features, and biomarkers were compared. A logistic regression model was built to predict AVP. The area under the curve (AUC) of the receiver-operating characteristic was calculated to evaluate the discriminant ability of the prediction model. RESULTS Patients in the AVP group were mainly infants and toddlers, while the MPP group had more pre-school age children. The rate of hypoxemia and severe pneumonia was 3- and 11-times higher, respectively, in the AVP group than in the MPP group (5.6% vs. 1.8%, 27.8% vs. 2.5%, P<0.01). The proportion of patients with a Pediatric Logistic Organ Dysfunction-2 score ≥2 was 10 times higher in the AVP group than in the MPP group (17.4% vs. 1.7%, P<0.01). Bilateral pneumonia was present in 90.2% of the AVP group. Biomarkers, such as interleukin (IL)-2 receptor, IL-10 and lactic dehydrogenase (LDH), were considerably higher in the AVP group than in the MPP group (P<0.01). The predictive model included eight variables, namely: age, severe pneumonia, bilateral pneumonia, ground-glass attenuation, consolidation, atelectasis, C-reactive protein, and LDH. The AUC was 86.6%. CONCLUSIONS Compared with MPP, AVP affects younger children, presents a more severe respiratory tract involvement, results in a larger range of lung lesions, and is associated with higher inflammatory biomarkers. Our predictive model includes a combination of clinical features, imaging findings, and biomarkers. It may help pediatricians in the early differentiation of AVP from MPP.
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Affiliation(s)
- Hu Zhang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Pediatric Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huajun Li
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijun Wang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisu Huang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qibo Ma
- Emergency Department, Chuzhou Children's Hospital, The First People's Hospital of Chuzhou, Chuzhou, China
| | - Hanwen Wu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huanchun Pang
- Department of Pediatrics, Chengmai County People's Hospital, Chengmai, China
| | - Yiping Chen
- Department of Pediatric Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhengshang Ruan
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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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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14
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Zhao L, Shang Y, Luo Q, Ma X, Ni W, He Y, Yang D, Xu Y, Gao Z. Decreased plasma fetuin-A level as a novel bioindicator of poor prognosis in community-acquired pneumonia: A multi-center cohort study. Front Med (Lausanne) 2022; 9:807536. [PMID: 35966877 PMCID: PMC9372348 DOI: 10.3389/fmed.2022.807536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 07/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) is a respiratory disease that frequently requires hospital admission, and is a significant cause of death worldwide. Plasma fetuin-A levels were significantly lower in patients with sepsis, but data regarding CAP are scarce. This study aimed to evaluate the usefulness of fetuin-A as a prognostic biomarker of CAP. Methods A multicenter cohort study on CAP was conducted between January 2017 and December 2018. Demographic and clinical data were recorded for all enrolled patients. Plasma fetuin-A levels were determined using a quantitative enzyme-linked immunosorbent assay. A Cox proportional hazards regression analysis was used to analyse the effect of variables on 30-day mortality. A logistic regression analysis was performed to assess risk factors associated with severe CAP (SCAP) and 30-day mortality. A receiver operating characteristic (ROC) curve was used to verify the association between variables and CAP prognosis. Correlations were assessed using Spearman's test. Survival curves were constructed and compared using the log-rank test. Results A total of 283 patients with CAP were enrolled in this study. Fetuin-A levels were decreased in patients with CAP, especially in SCAP and non-survivors. A cox regression analysis showed that CURB-65 and fetuin-A levels were independent prognostic indicators of 30-day mortality. Via a multiple logistic regression analysis, plasma level of fetuin-A (<202.86 mg/L) was determined to be the strongest independent predictor of 30-day mortality considered (odds ratio, 57.365), and also was also determined to be an independent predictor of SCAP. The area under the curve (AUC) of fetuin-A for predicting 30-day mortality was 0.871, and accuracy was high (P < 0.05). Plasma fetuin-A levels were negatively correlated with WBC, NE%, Glu, CRP, PCT, CURB-65, and pneumonia severity index scores and positively correlated with albumin level. Kaplan–Meier curves showed that lower plasma levels of fetuin-A levels were associated with increased 30-day mortality levels (P < 0.0001). Conclusion Plasma fetuin-A levels were decreased in patients with CAP. Fetuin-A can reliably predict mortality in patients with CAP, and is a useful diagnostic indicator of SCAP.
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Affiliation(s)
- Lili Zhao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Ying Shang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Qiongzhen Luo
- Department of Respiratory and Critical Care Medicine, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xinqian Ma
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Wentao Ni
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yukun He
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Donghong Yang
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yu Xu
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, Beijing, China
- Yu Xu
| | - Zhancheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
- *Correspondence: Zhancheng Gao
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15
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Meyer Sauteur PM, Beeton ML, Uldum SA, Bossuyt N, Vermeulen M, Loens K, Pereyre S, Bébéar C, Keše D, Day J, Afshar B, Chalker VJ, Greub G, Nir-Paz R, Dumke R. Mycoplasma pneumoniae detections before and during the COVID-19 pandemic: results of a global survey, 2017 to 2021. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35551702 PMCID: PMC9101966 DOI: 10.2807/1560-7917.es.2022.27.19.2100746] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Mycoplasma pneumoniae respiratory infections are transmitted by aerosol and droplets in close contact. Aim We investigated global M. pneumoniae incidence after implementation of non-pharmaceutical interventions (NPIs) against COVID-19 in March 2020. Methods We surveyed M. pneumoniae detections from laboratories and surveillance systems (national or regional) across the world from 1 April 2020 to 31 March 2021 and compared them with cases from corresponding months between 2017 and 2020. Macrolide-resistant M. pneumoniae (MRMp) data were collected from 1 April 2017 to 31 March 2021. Results Thirty-seven sites from 21 countries in Europe, Asia, America and Oceania submitted valid datasets (631,104 tests). Among the 30,617 M. pneumoniae detections, 62.39% were based on direct test methods (predominantly PCR), 34.24% on a combination of PCR and serology (no distinction between methods) and 3.37% on serology alone (only IgM considered). In all countries, M. pneumoniae incidence by direct test methods declined significantly after implementation of NPIs with a mean of 1.69% (SD ± 3.30) compared with 8.61% (SD ± 10.62) in previous years (p < 0.01). Detection rates decreased with direct but not with indirect test methods (serology) (–93.51% vs + 18.08%; p < 0.01). Direct detections remained low worldwide throughout April 2020 to March 2021 despite widely differing lockdown or school closure periods. Seven sites (Europe, Asia and America) reported MRMp detections in one of 22 investigated cases in April 2020 to March 2021 and 176 of 762 (23.10%) in previous years (p = 0.04). Conclusions This comprehensive collection of M. pneumoniae detections worldwide shows correlation between COVID-19 NPIs and significantly reduced detection numbers.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael L Beeton
- Microbiology and Infection Research Group, Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Søren A Uldum
- Department of Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | - Nathalie Bossuyt
- Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium
| | | | - Katherine Loens
- Department of Microbiology, National Reference Centre for Respiratory Pathogens, University Hospital Antwerp, Antwerp, Belgium
| | - Sabine Pereyre
- UMR CNRS 5234, Fundamental Microbiology and Pathogenicity, University of Bordeaux, Bordeaux, France
| | - Cécile Bébéar
- UMR CNRS 5234, Fundamental Microbiology and Pathogenicity, University of Bordeaux, Bordeaux, France
| | - Darja Keše
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jessica Day
- Public Health England, London, United Kingdom
| | | | | | - Gilbert Greub
- Institute of Microbiology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ran Nir-Paz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Roger Dumke
- TU Dresden, University Hospital Carl Gustav Carus, Institute of Medical Microbiology and Virology, Dresden, Germany
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- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC) "Mycoplasma pneumoniae detections before and during the COVID-19 pandemic (MyCOVID)" Study Team members are listed under collaborators
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16
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Tran Quang K, Tran Do H, Pham Hung V, Nguyen Vu T, Tran Xuan B, Larsson M, Duong-Quy S, Nguyen-Thi-Dieu T. Study on the co-infection of children with severe community-acquired pneumonia. Pediatr Int 2022; 64:e14853. [PMID: 34661955 DOI: 10.1111/ped.14853] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/01/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUD Pneumonia is one of the leading causes of death in children under 5 years old. Viruses have historically been the most common cause of community-acquired pneumonia in children. Co-infections in severe pneumonia are more concern by clinicians. METHOD It was a perspective and descriptive study. Real-time polymerase chain reaction (RT-PCR) is a modern test that was used to detect many new pathogens, including microbiological co-infections. RT-PCR technique was used in this study to investigate the causes of severe pneumonia. RESULTS Through the analysis of nasopharyngeal aspiration samples from 95 children with severe community-acquired pneumonia, the positive RT-PCR rate was 90.5%. Viral-bacterial co-infection accounted for the highest proportion (43.1%), followed by bacterial co-infection (33.7%), viral infection (7.4%), bacterial infection (6.3%) and the remaining 9.5% was unknown. In the co-infections groups, the five main bacteria species detected by PCR were Streptococcus pneumoniae, Haemophilus influenzae, MRSA, Moraxella catarrhalis and Mycoplasma pneumoniae. CONCLUSION Antibiotic treatment should focus on detected microbes in cases of severe pneumonia for having a good result.
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Affiliation(s)
- Khai Tran Quang
- Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Hung Tran Do
- Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Van Pham Hung
- Laboratory of Nam Khoa Biotek Company, International Research of Gene and Immunology Institute, Ho Chi Minh City, Vietnam
| | - Trung Nguyen Vu
- Department of Paediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Bach Tran Xuan
- Department of Paediatrics, Hanoi Medical University, Hanoi, Vietnam
| | - Mattias Larsson
- Global Public Health Department, Karolinska Institutet, Stockholm, Sweden
| | - Sy Duong-Quy
- Department of Respiratory Diseases, Lam Dong Medical College, Dalat, Vietnam.,Division of Immuno-Allergology, Penn State Medical College, Hershey Medical Center, Hershey, PA, USA
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17
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Chen J, Yin Y, Zhao L, Zhang L, Zhang J, Yuan S. Mycoplasma pneumoniae infection prediction model for hospitalized community-acquired pneumonia children. Pediatr Pulmonol 2021; 56:4020-4028. [PMID: 34547836 DOI: 10.1002/ppul.25665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to develop a nomogram to predict Mycoplasma pneumoniae (Mp) infection among hospitalized children with community-acquired pneumonia (CAP) and compare it with another model developed from age and duration of fever. METHODS Data on 5904 CAP children who were enrolled at Shanghai Children's Medical Center were retrospectively collected and divided into a training set (n = 4133) and a validation set (n = 1771). The model's performance was determined by concordance index (C-index), calibration curves, Brier scores, and decision curve analyses (DCAs). Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used for model comparisons. RESULTS Incorporating five factors (age, duration of fever, erythrocyte sedimentation rate, leukocyte count, and neutrophil proportion), the nomogram achieved good C-index values of 0.74 (95% confidence interval [CI]: 0.72-0.76) and 0.75 (95% CI: 0.73-0.78) and good Brier scores of 0.14 (95% CI: 0.13-0.15) and 0.17 (95% CI: 0.15-0.18) in predicting Mp infection in the training and validation cohorts, respectively, and had moderate fitted calibration plots. The DCAs showed good clinical usefulness of the nomogram. Patients were effectively divided into low, medium, and high risk groups by two cut-off score points of the nomogram, 210 and 300. With the lower AIC (3673.5) and BIC (3774.7) value, the model of five predictors is the better model. CONCLUSIONS By using five predictor variables, a simple nomogram of good predictive accuracy for Mp infection and moderate agreements between the actual outcome and the predicted probability was constructed. It could serve as a tool to aid physicians in clinical decision-making processes.
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Affiliation(s)
- Jiande Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liebin Zhao
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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18
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Gunaratnam LC, Robinson JL, Hawkes MT. Systematic Review and Meta-Analysis of Diagnostic Biomarkers for Pediatric Pneumonia. J Pediatric Infect Dis Soc 2021; 10:891-900. [PMID: 34213563 DOI: 10.1093/jpids/piab043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/26/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pneumonia causes significant morbidity and mortality in children worldwide, especially in resource-poor settings. Accurate identification of bacterial etiology leads to timely antibiotic initiation, minimizing overuse, and development of resistance. Host biomarkers may improve diagnostic sensitivity and specificity. We assessed the ability of biomarkers to correctly identify bacterial pneumonia in children who present with respiratory distress. METHODS A librarian-directed search was conducted of MEDLINE, EMBASE, CENTRAL, Global Health, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to May 2020 with no language restriction. Included studies compared a diagnostic biomarker in children with bacterial pneumonia to those with nonbacterial respiratory distress. RESULTS There were 31 observational studies of 23 different biomarkers. C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were the biomarkers with sufficient data for meta-analysis. Meta-analysis revealed that CRP and PCT best differentiated bacterial from viral pneumonia with CRP summary AUROC (area under the receiver operating characteristic curve) 0.71 (0.69-0.73), Youden index 53 mg/L, sensitivity 0.70 (0.68-0.78), and specificity 0.64 (0.58-0.68) and PCT summary AUROC 0.70 (0.67-0.74), Youden index 0.59 ng/mL, sensitivity 0.69 (0.65-0.77), and specificity 0.64 (0.60-0.68). WBC and ESR did not perform as well. Nineteen other inflammatory and immunologic biomarkers were identified including CRP/mean platelet value, neutrophil/leukocyte ratio, interleukin 6, and interferon-alpha, with sensitivities from 60% to 85% and specificities from 76% to 83%. CONCLUSION CRP and PCT performed better than WBC and ESR but had suboptimal sensitivity. Some less well-studied novel biomarkers appear to have promise particularly in combination.
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Affiliation(s)
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Distinguished Researcher, Stollery Science Lab, University of Alberta, Edmonton, Alberta, Canada.,Member, Women and Children's Research Institute, University of Alberta, Edmonton, Alberta, Canada
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19
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Xu HG, Tian M, Pan SY. Clinical utility of procalcitonin and its association with pathogenic microorganisms. Crit Rev Clin Lab Sci 2021; 59:93-111. [PMID: 34663176 DOI: 10.1080/10408363.2021.1988047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In this review, we summarize the relationship of PCT with pathogens, evaluate the clinical utility of PCT in the diagnosis of clinical diseases, condition monitoring and evaluation, and guiding medical decision-making, and explore current knowledge on the mechanisms by which pathogens cause changes in PCT levels. The lipopolysaccharides of the microorganisms stimulate cytokine production in host cells, which in turn stimulates production of serum PCT. Pathogens have different virulence mechanisms that lead to variable host inflammatory responses, and differences in the specific signal transduction pathways result in variable serum PCT concentrations. The mechanisms of signal transduction have not been fully elucidated. Further studies are necessary to ascertain the PCT fluctuation range of each pathogen. PCT levels are helpful in distinguishing between certain pathogens, in deciding if antibiotics are indicated, and in monitoring response to antibiotics.
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Affiliation(s)
- Hua-Guo Xu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Tian
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shi-Yang Pan
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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20
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Desai S, Hall M, Lipsett SC, Shah SS, Brogan TV, Hersh AL, Williams DJ, Grijalva CG, Gerber JS, Blaschke AJ, Neuman MI, Ambroggio L. Mycoplasma Pneumoniae Testing and Treatment Among Children With Community-Acquired Pneumonia. Hosp Pediatr 2021; 11:760-763. [PMID: 34583319 DOI: 10.1542/hpeds.2020-005215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe testing and treatment practices for Mycoplasma pneumoniae (Mp) among children hospitalized with community-acquired pneumonia (CAP). METHODS We conducted a retrospective cohort study using the Pediatric Health Information Systems database. We included children 3 months to 18 years old hospitalized with CAP between 2012 and 2018 and excluded children who were transferred from another hospital and those with complex chronic conditions. We examined the proportion of patients receiving Mp testing and macrolide therapy at the hospital level and trends in Mp testing and macrolide prescription over time. At the patient level, we examined differences in demographics, illness severity (eg, blood gas, chest tube placement), and outcomes (eg, ICU admission, length of stay, readmission) among patients with and without Mp testing. RESULTS Among 103 977 children hospitalized with CAP, 17.3% underwent Mp testing and 31.1% received macrolides. We found no correlation between Mp testing and macrolide treatment at the hospital level (R 2 = 0.05; P = .11). Patients tested for Mp were more likely to have blood gas analysis (15.8% vs 12.8%; P < .1), chest tube placement (1.4% vs 0.8%; P < .1), and ICU admission (3.1% vs 1.4%; P < .1). Mp testing increased (from 15.8% to 18.6%; P < .001), and macrolide prescription decreased (from 40.9% to 20.6%; P < .001) between 2012 and 2018. CONCLUSIONS Nearly one-third of hospitalized children with CAP received macrolide antibiotics, although macrolide prescription decreased over time. Clinicians were more likely to perform Mp testing in children with severe illness, and Mp testing and macrolide treatment were not correlated at the hospital level.
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Affiliation(s)
- Sanyukta Desai
- Divisions of Hospital Medicine .,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | | | - Susan C Lipsett
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.,Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Samir S Shah
- Divisions of Hospital Medicine and.,Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Thomas V Brogan
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Critical Care, Seattle Children's Hospital, Seattle, Washington
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | | | - Carlos G Grijalva
- Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne J Blaschke
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.,Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado and Department of Pediatrics, University of Colorado, Aurora, Colorado
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21
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de Groot RCA, Cristina Estevão S, Meyer Sauteur PM, Perkasa A, Hoogenboezem T, Spuesens EBM, Verhagen LM, van Rossum AMC, Unger WWJ. Mycoplasma pneumoniae carriage evades induction of protective mucosal antibodies. Eur Respir J 2021; 59:13993003.00129-2021. [PMID: 34561284 PMCID: PMC8989055 DOI: 10.1183/13993003.00129-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/05/2021] [Indexed: 11/21/2022]
Abstract
Background Mycoplasma pneumoniae is the most common bacterial cause of pneumonia in children hospitalised for community-acquired pneumonia (CAP). Prevention of infection by vaccines may be an important strategy in the presence of emerging macrolide-resistant M. pneumoniae. However, knowledge of immune responses to M. pneumoniae is limited, complicating vaccine design. Methods We studied the antibody response during M. pneumoniae respiratory tract infection and asymptomatic carriage in two different cohorts. Results In a nested case–control study (n=80) of M. pneumoniae carriers and matched controls we observed that carriage by M. pneumoniae does not lead to a rise in either mucosal or systemic M. pneumoniae-specific antibodies, even after months of persistent carriage. We replicated this finding in a second cohort (n=69) and also found that during M. pneumoniae CAP, mucosal levels of M. pneumoniae-specific IgA and IgG did increase significantly. In vitro adhesion assays revealed that high levels of M. pneumoniae-specific antibodies in nasal secretions of paediatric patients prevented the adhesion of M. pneumoniae to respiratory epithelial cells. Conclusions Our study demonstrates that M. pneumoniae-specific mucosal antibodies protect against bacterial adhesion to respiratory epithelial cells, and are induced only during M. pneumoniae infection and not during asymptomatic carriage. This is strikingly different from carriage with bacteria such as Streptococcus pneumoniae where mucosal antibodies are induced by bacterial carriage. Antibodies against M. pneumoniae, the most common bacterial cause of pneumonia in children, are able to prevent adhesion of M. pneumoniae to epithelial cells, but are only induced during infection and not during asymptomatic carriagehttps://bit.ly/3CNdAhM
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Affiliation(s)
- Ruben Cornelis Anthonie de Groot
- Department of Pediatrics, Laboratory of Pediatrics, Erasmus MC University Medical Centre Rotterdam - Sophia Children"s Hospital, Rotterdam, The Netherlands
| | - Silvia Cristina Estevão
- Department of Pediatrics, Laboratory of Pediatrics, Erasmus MC University Medical Centre Rotterdam - Sophia Children"s Hospital, Rotterdam, The Netherlands
| | - Patrick Michael Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Aditya Perkasa
- Department of Pediatrics, Laboratory of Pediatrics, Erasmus MC University Medical Centre Rotterdam - Sophia Children"s Hospital, Rotterdam, The Netherlands
| | - Theo Hoogenboezem
- Department of Pediatrics, Van Weel Bethesda Hospital, Dirksland, The Netherlands
| | - Emiel Benny Margriet Spuesens
- Department of Pediatrics, Laboratory of Pediatrics, Erasmus MC University Medical Centre Rotterdam - Sophia Children"s Hospital, Rotterdam, The Netherlands
| | - Lilly Maria Verhagen
- Department of Pediatrics, Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anna Maria Christiane van Rossum
- Department of Pediatrics, Division of Paediatric Infectious Diseases and Immunology, Erasmus MC University Medical Centre Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wendy Wilhelmina Josephina Unger
- Department of Pediatrics, Laboratory of Pediatrics, Erasmus MC University Medical Centre Rotterdam - Sophia Children"s Hospital, Rotterdam, The Netherlands
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22
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He XT, Wang CC. Applying Clinical and Laboratory Features Associated With Mycoplasma pneumoniae (Mp) Infection With the New Diagnostic Test of Mp-Specific Immunoglobulin M (IgM) Antibody-Secreting Cells to Mp-IgM Seroconversion in Mp-Positive Children With Community-Acquired Pneumonia. Clin Infect Dis 2021; 73:937-938. [PMID: 33581697 DOI: 10.1093/cid/ciab135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Xin-Tian He
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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23
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Rivaya B, Jordana-Lluch E, Fernández-Rivas G, Molinos S, Campos R, Méndez-Hernández M, Matas L. Macrolide resistance and molecular typing of Mycoplasma pneumoniae infections during a 4 year period in Spain. J Antimicrob Chemother 2021; 75:2752-2759. [PMID: 32653897 PMCID: PMC7678890 DOI: 10.1093/jac/dkaa256] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 02/05/2023] Open
Abstract
Background Mycoplasma pneumoniae (MP) causes community-acquired pneumonia affecting mainly children, and tends to produce cyclic outbreaks. The widespread use of macrolides is increasing resistance rates to these antibiotics. Molecular tools can help in diagnosis, typing and resistance detection, leading to better patient management. Objectives To assess the MP genotypes and resistance pattern circulating in our area while comparing serological and molecular diagnosis of MP. Methods Molecular and serological diagnosis of MP was performed in 821 samples collected in Badalona (Barcelona, Spain) from 2013 to 2017. Multiple locus variable number tandem repeat analysis (MLVA) and macrolide resistance detection by pyrosequencing were performed in those cases positive by PCR. Presence of respiratory viruses and relevant clinical data were also recorded. Results MP was detected in 16.8% of cases by PCR, with an overall agreement with serology of 76%. Eleven different MLVA types were identified, with 4-5-7-2 (50.1%) and 3-5-6-2 (29.2%) being the most abundant, with the latter showing a seasonal increase during the study. A total of 8% of the strains harboured a point substitution associated with macrolide resistance, corresponding mainly to an A2063G 23S rRNA mutation and directly related to previous macrolide therapy. Analysis of respiratory viruses showed viral coinfections in most cases. Conclusions Serological and molecular tools combined could improve MP diagnosis and the analysis of its infection patterns. Macrolide resistance is associated with previous therapy. Given that MP pneumonia usually resolves spontaneously, it should be reconsidered whether antibiotic treatment is suitable for all cases.
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Affiliation(s)
- Belén Rivaya
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Jordana-Lluch
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gema Fernández-Rivas
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sònia Molinos
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roi Campos
- Paediatric Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Lurdes Matas
- Microbiology Department, Laboratori Clinic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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24
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Abstract
Factors leading to the wide range of manifestations associated with Mycoplasma pneumoniae infection are unclear. We investigated whether M. pneumoniae genotypes are associated with specific clinical outcomes. We compared M. pneumoniae loads and genotypes of children with mucocutaneous disease to those of children with pneumonia, family members with upper respiratory tract infection (URTI), and carriers from a prospective cohort study (n = 47; 2016 to 2017) and to those of other children with mucocutaneous disease from a case series (n = 7; 2017 to 2020). Genotyping was performed using macrolide resistance determination, P1 subtyping, multilocus variable-number tandem-repeat analysis (MLVA), and multilocus sequence typing (MLST). Comparisons were performed with a pairwise Wilcoxon rank sum test and a Fisher exact test with corrections for multiple testing, as appropriate. M. pneumoniae loads did not statistically differ between patients with mucocutaneous disease and those with pneumonia or carriers. Macrolide resistance was detected in 1 (1.9%) patient with mucocutaneous disease. MLVA types from 2016 to 2017 included 3-5-6-2 (n = 21 [46.7%]), 3-6-6-2 (n = 2 [4.4%]), 4-5-7-2 (n = 14 [31.1%]), and 4-5-7-3 (n = 8 [17.8%]), and they correlated with P1 subtypes and MLST types. MLVA types were not associated with specific outcomes such as mucocutaneous disease, pneumonia, URTI, or carriage. They were almost identical within families but varied over geographic location. MLVA types in patients with mucocutaneous disease differed between 2016 to 2017 (3-5-6-2, n = 5 [62.5%]) and 2017 to 2020 (4-5-7-2, n = 5 [71.4%]) (P = 0.02). Our results suggest that M. pneumoniae genotypes may not determine specific clinical outcomes.
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25
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Liu HY, Xiang HX, Xiang Y, Xu Z, Feng CM, Fei J, Fu L, Zhao H. The associations of serum S100A9 with the severity and prognosis in patients with community-acquired pneumonia: a prospective cohort study. BMC Infect Dis 2021; 21:327. [PMID: 33827454 PMCID: PMC8028176 DOI: 10.1186/s12879-021-06020-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Previous studies found that S100A9 may involve in the pathophysiology of community-acquired pneumonia (CAP). However, the role of S100A9 was unclear in the CAP. The goal was to explore the correlations of serum S100A9 with the severity and prognosis of CAP patients based on a prospective cohort study. METHODS A total of 220 CAP patients and 110 control subjects were recruited. Demographic and clinical data were collected. Serum S100A9 and inflammatory cytokines were measured. RESULTS Serum S100A9 was elevated in CAP patients on admission. Serum S100A9 was gradually elevated parallelly with CAP severity scores. Additionally, inflammatory cytokines were increased and blood routine parameters were changed in CAP patients compared with control subjects. Correlation analysis found that serum S100A9 was positively associated with CAP severity scores, blood routine parameters (WBC, NLR and MON) and inflammatory cytokines. Further, logistic regression analysis demonstrated that there were positive associations between serum S100A9 and CAP severity scores. Besides, the prognosis of CAP was tracked. Serum higher S100A9 on the early stage elevated the death of risk and hospital stay among CAP patients. CONCLUSION Serum S100A9 is positively correlated with the severity of CAP. On admission, serum higher S100A9 elevates the risk of death and hospital stay in CAP patients, suggesting that S100A9 may exert a certain role in the pathophysiology of CAP and regard as a serum diagnostic and managing biomarker for CAP.
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Affiliation(s)
- Hong-Yan Liu
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China
| | - Hui-Xian Xiang
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China
| | - Ying Xiang
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China
| | - Zheng Xu
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China
| | - Chun-Mei Feng
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China
| | - Jun Fei
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China
| | - Lin Fu
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China. .,Department of Toxicology, Anhui Medical University, Hefei, 230032, China.
| | - Hui Zhao
- Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, China.
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26
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Bi Y, Zhu Y, Ma X, Xu J, Guo Y, Huang T, Zhang S, Wang X, Zhao D, Liu F. Development of a scale for early prediction of refractory Mycoplasma pneumoniae pneumonia in hospitalized children. Sci Rep 2021; 11:6595. [PMID: 33758243 PMCID: PMC7987979 DOI: 10.1038/s41598-021-86086-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/09/2021] [Indexed: 12/25/2022] Open
Abstract
Now there is no clinical scale for early prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP). The aim of this study is to identify indicators and develop an early predictive scale for RMPP in hospitalized children. First we conducted a retrospective cohort study of children with M. pneumoniae pneumonia admitted to Children's Hospital of Nanjing Medical University, China in 2016. Children were divided into two groups, according to whether their pneumonia were refractory and the results were used to develop an early predictive scale. Second we conducted a prospective study to validate the predictive scale for RMPP in children in 2018. 618 children were included in the retrospective study, of which 73 with RMPP. Six prognostic indicators were identified and included in the prognostic assessment scale. The sensitivity of the prognostic assessment scale was 74.0% (54/73), and the specificity was 88.3% (481/545) in the retrospective study. 944 children were included in the prospective cohort, including 92 with RMPP, the sensitivity of the prognostic assessment scale was 78.3% (72/92) and the specificity was 86.2% (734/852). The prognostic assessment scale for RMPP has high diagnostic accuracy and is suitable for use in standard clinical practice.
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Affiliation(s)
- Ying Bi
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
- Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yifan Zhu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Xiao Ma
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Jiejing Xu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
- Department of Pediatrics, The Second People's Hospital of Changzhou, Affiliate Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Yun Guo
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
- Department of Respiratory Medicine, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, China
| | - Tianyu Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Siqing Zhang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Xin Wang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China.
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, China.
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27
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Meyer Sauteur PM, Trück J, van Rossum AMC, Berger C. Circulating Antibody-Secreting Cell Response During Mycoplasma pneumoniae Childhood Pneumonia. J Infect Dis 2021; 222:136-147. [PMID: 32034406 DOI: 10.1093/infdis/jiaa062] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We recently demonstrated that the measurement of Mycoplasma pneumoniae (Mp)-specific immunoglobulin (Ig)M antibody-secreting cells (ASCs) improved diagnosis of Mp infection. Here, we aimed to describe Mp ASC kinetics and duration in comparison to conventional measures such as pharyngeal Mp deoxyribonucleic acid (DNA) and serum antibodies. METHODS This is a prospective longitudinal study of 63 community-acquired pneumonia (CAP) patients and 21 healthy controls (HCs), 3-18 years of age, from 2016 to 2017. Mycoplasma pneumoniae ASCs measured by enzyme-linked immunospot assay were assessed alongside Mp DNA and antibodies during 6-month follow-up. RESULTS Mycoplasma pneumoniae ASCs of the isotype IgM were found in 29 (46%), IgG were found in 27 (43%), and IgA were found in 27 (43%) CAP patients. Mycoplasma pneumoniae ASCs were detected from 2 days to a maximum of 6 weeks after symptom onset, whereas Mp DNA and antibodies persisted until 4 months (P = .03) and 6 months (P < .01). Mycoplasma pneumoniae ASCs were undetectable in HCs, in contrast to detection of Mp DNA in 10 (48%) or antibodies in 6 (29%) controls for a prolonged time. The Mp ASC response correlated with clinical disease, but it did not differ between patients treated with or without antibiotics against Mp. CONCLUSIONS Mycoplasma pneumoniae-specific ASCs are short-lived and associated with clinical disease, making it an optimal resource for determining Mp pneumonia etiology.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Johannes Trück
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.,Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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28
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Early Confirmation of Mycoplasma pneumoniae Infection by Two Short-Term Serologic IgM Examination. Diagnostics (Basel) 2021; 11:diagnostics11020353. [PMID: 33672480 PMCID: PMC7923409 DOI: 10.3390/diagnostics11020353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study is to re-evaluate the clinical application of two-times serologic immunoglobulin M (IgM) tests using microparticle agglutination assay (MAA), an enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR) assay in diagnosing Mycoplasma pneumoniae (MP) infection. A retrospective analysis of 62 children with MP pneumonia during a recent epidemic (2019–2020) was conducted. The MAA and ELISA immunoglobulin M (IgM) and IgG measurements were conducted twice at admission and around discharge, and MP PCR once at presentation. Diagnostic rates in each test were calculated at presentation and at discharge. The seroconverters were 39% (24/62) of patients tested by MAA and 29% (18/62) by ELISA. At presentation, the diagnostic positive rates of MAA, ELISA, and PCR tests were 61%, 71%, and 52%, respectively. After the second examination, the rates were 100% in both serologic tests. There were positive correlations between the titers of MAA and the IgM values of ELISA. The single serologic IgM or PCR tests had limitations to select patients infected with MP in the early stage. The short-term, paired IgM serologic tests during hospitalization can reduce patient-selection bias in MP infection studies.
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29
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Meyer Sauteur PM, Ambroggio L, van Rossum AMC, Berger C. Reply to author. Clin Infect Dis 2021; 73:938-939. [PMID: 33581694 DOI: 10.1093/cid/ciab137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lilliam Ambroggio
- Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Denver, Colorado, USA
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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30
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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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31
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Chen L, Luo Q, Shang Y, He X, Xu Y, Gao Z. Predictive and Prognostic Utility of the Serum Level of Resistin-Like Molecule Beta for Risk Stratification in Patients with Community-Acquired Pneumonia. Pathogens 2021; 10:122. [PMID: 33503890 PMCID: PMC7912120 DOI: 10.3390/pathogens10020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Despite progress in intensive care, the morbidity and mortality of patients with community-acquired pneumonia (CAP) remains high. Furthermore, the predictive and prognostic utility of resistin-like molecule beta (RELM-β) in patients with CAP is uncertain. This study investigated the role of RELM-β in patients with CAP and evaluated its correlation with disease severity and the risk of death. A prospective, multicenter study was conducted in 2017, and admission serum levels of RELM-β were detected using quantitative enzyme-linked immunosorbent assay. A total of 114 and 112 patients with severe CAP (SCAP) and non-severe CAP (NSCAP) were enrolled, respectively, with 15 healthy controls. Patients with SCAP, especially non-survivors, had significantly higher levels of serum RELM-β than patients with NSCAP. RELM-β levels positively correlated with severity scores and consistently predicted SCAP in patients with CAP (area under the curve = 0.794). Increased levels of RELM-β were closely related to the severity and prognosis of patients with CAP. The accuracy of 30-day mortality predictions of CURB-65 (confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years) can be significantly improved when combined with RELM-β levels. The level of RELM-β can assist clinicians in risk stratification of patients with CAP in early stages.
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Affiliation(s)
- Li Chen
- Department of Respiratory & Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, China; (L.C.); (Q.L.); (Y.S.)
| | - Qiongzhen Luo
- Department of Respiratory & Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, China; (L.C.); (Q.L.); (Y.S.)
| | - Ying Shang
- Department of Respiratory & Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, China; (L.C.); (Q.L.); (Y.S.)
| | - Xinwei He
- Department of Internal Medicine, Xicheng District Zhanlanlu Hospital, Beijing 100032, China;
| | - Yu Xu
- Department of Respiratory & Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, China; (L.C.); (Q.L.); (Y.S.)
| | - Zhancheng Gao
- Department of Respiratory & Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, China; (L.C.); (Q.L.); (Y.S.)
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32
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Meyer Sauteur PM, Kleger GR, Albrich WC. Acute respiratory distress syndrome during the COVID-19 pandemic: not only SARS-CoV-2. New Microbes New Infect 2021; 40:100836. [PMID: 33425361 PMCID: PMC7775607 DOI: 10.1016/j.nmni.2020.100836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
A previously healthy 30-year-old woman developed severe ARDS at the beginning of the COVID-19 pandemic. SARS-CoV-2 infection was suspected, but testing was negative. Mycoplasma pneumoniae was detected by PCR in bronchoalveolar lavage fluid and blood. This case illustrates that M. pneumoniae infection can progress to septicemia and ARDS with severe respiratory failure in young healthy adults.
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Affiliation(s)
- P M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - G-R Kleger
- Division of Intensive Care, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - W C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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33
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Huang C, Zhang C, Zhang J, Zhang L, Mo Y, Mo L. Heparin-Binding Protein in Critically Ill Children With Severe Community-Acquired Pneumonia. Front Pediatr 2021; 9:759535. [PMID: 34778149 PMCID: PMC8581232 DOI: 10.3389/fped.2021.759535] [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: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to investigate possible associations between Heparin-binding protein (HBP) and the development of respiratory failure (RF) and sepsis in critically ill children with severe community-acquired pneumonia (CAP). Methods: This study enrolled 157 children with severe CAP admitted to Intensive Care Unit (ICU). At ICU admission, the levels of HBP and other biomarkers, including C-reactive protein, interleukin-6 (IL-6), procalcitonin, white blood cells, neutrophil percentage, and D-dimer, were determined. Results: Of the enrolled patients, 106 developed RF (35 with RF at enrollment and 71 with RF after enrollment), while 51 did not developed RF. The number of patients progressing to sepsis in those with or without RF were 34 (21 with severe sepsis) and 14, respectively. The plasma level of HBP at admission was more than eightfold higher than the upper normal value. HBP, IL-6, and D-dimer could significantly predict the development of RF, and a high level of HBP (odds ratio = 1.008, 95% confidence interval: 1.003-1.013) was independently associated with the development of RF in this population. Compared with other biomarkers, HBP was the best indicator of progression to severe sepsis, with an area under the receiver operating characteristic curve of 0.85, the best specificity at 96.30%, and a positive predictive value of 92.86% at the optimal cut-off value of 340.29 ng/mL. The HBP level was also positively correlated with other conventional biomarkers. Conclusion: HBP might represent a better predictor of disease progression in children with severe CAP than currently used biomarkers.
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Affiliation(s)
- Caizhi Huang
- Department of Laboratory Medicine, Hunan Children's Hospital, Changsha, China
| | - Cong Zhang
- Department of Laboratory Medicine, Hunan Children's Hospital, Changsha, China
| | - Jie Zhang
- Department of Laboratory Medicine, Hunan Children's Hospital, Changsha, China
| | - Lin Zhang
- Department of Laboratory Medicine, Hunan Children's Hospital, Changsha, China
| | - Yi Mo
- Department of Laboratory Medicine, Hunan Children's Hospital, Changsha, China
| | - Liya Mo
- Department of Laboratory Medicine, Hunan Children's Hospital, Changsha, China
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34
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Meyer Sauteur PM, Berger C. Proadrenomedullin in Mycoplasma pneumoniae community-acquired pneumonia in children. Clin Infect Dis 2020; 73:e1769-e1771. [PMID: 33367639 DOI: 10.1093/cid/ciaa1888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
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35
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Li F, Kong S, Xie K, Zhang Y, Yan P, Zhao W. High ratio of C-reactive protein/procalcitonin predicts Mycoplasma pneumoniae infection among adults hospitalized with community acquired pneumonia. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 81:65-71. [PMID: 33345630 DOI: 10.1080/00365513.2020.1858491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is limited data on serum biomarkers in distinguishing Mycoplasma pneumoniae (MP) from Streptococcus pneumoniae (SP) and viral pneumoniae (VP) etiologies of community-acquired pneumonia (CAP). A retrospective study of inpatients diagnosed with CAP at the First Affiliated Hospital of Dali University (Dali, Yunnan, China) between January 2018 and June 2020 was conducted. The demographic, clinical and laboratory data of the patients with CAP were analyzed. Univariate analyses identified predictors for MP infections. The discriminative power of C-reactive protein (CRP), procalcitonin (PCT), CRP/PCT and CRP/PCT >350 μg/ng was assessed by area under the curve (AUC) of the receiver operating characteristic (ROC) curves. A total of 552 CAP patients, including 247 (44.7%) with MP, 152 (27.6%) with SP and 153 (27.7%) with influenza A and B viruses, were enrolled. When comparing MP with SP, cough and CRP/PCT >350 μg/ng (odds ratio [OR]) 2.88, p < .001) were predictors for MP. CRP/PCT >350 μg/ng had 76% sensitivity and 100% specificity (AUC = 0.89, p < .001, 95% confidence interval [CI]:0.81-0.94) to predict MP infections. Furthermore, similar results were again obtained when comparing MP with VP. CRP/PCT >350 μg/ng present better information (OR: 4.70; AUC = 0.92, p < .001, 87% sensitivity and 100% specificity). In addition, comparing MP and non-MP (SP and VP combined), CRP/PCT >350 μg/ng exhibited excellent performance (AUC = 0.90, 95%CI 0.83-0.95, p < .001, 76% sensitivity and 100% specificity). CRP/PCT ratio may be a potential index to distinguish MP-CAP from non-MP-CAP.
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Affiliation(s)
- Fuxing Li
- Department of Clinical Laboratory, School of Clinical Medicine, Dali University, Dali, China
| | - Shan Kong
- Department of Clinical Laboratory, School of Clinical Medicine, Dali University, Dali, China
| | - Kexin Xie
- Department of Clinical Laboratory, School of Clinical Medicine, Dali University, Dali, China
| | - Yulin Zhang
- Department of Clinical Laboratory, School of Clinical Medicine, Dali University, Dali, China
| | - Ping Yan
- Department of Gastroenterology, The First Affiliated Hospital of Dali University, Dali, China
| | - Weidong Zhao
- Department of Clinical Laboratory, School of Clinical Medicine, Dali University, Dali, China.,Institute of Translational Medicine for Metabolic Diseases, Dali University, Dali, China
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