Impact of Epstein-Barr virus coinfection in Mycoplasma pneumoniae pneumonia

Evaluating the role of interleukin-2 and interleukin-12 in pediatric patients with concurrent Mycoplasma pneumoniae and Epstein-Barr virus infections

BACKGROUND

Mycoplasma pneumoniae (MP) frequently causes respiratory infections in children, whereas Epstein-Barr virus (EBV) typically presents subclinical manifestations in immunocompetent pediatric populations. The incidence of MP and EBV co-infections is often overlooked clinically, with the contributory role of EBV in pulmonary infections alongside MP remaining unclear.

AIM

To evaluate the serum concentrations of interleukin-2 (IL-2) and interleukin-12 (IL-12) in pediatric patients with MP pneumonia co-infected with EBV and assess their prognostic implications.

METHODS

We retrospectively analyzed clinical data from patients diagnosed with MP and EBV co-infection, isolated MP infection, and a control group of healthy children, spanning from January 1, 2018 to December 31, 2021. Serum IL-2 and IL-12 levels were quantified using enzyme-linked immunosorbent assay. Logistic regression was employed to identify factors influencing poor prognosis, while receiver operating characteristic (ROC) curves evaluated the prognostic utility of serum IL-2 and IL-12 levels in co-infected patients.

RESULTS

The co-infection group exhibited elevated serum IL-2 and C-reactive protein (CRP) levels compared to both the MP-only and control groups, with a reverse trend observed for IL-12 (P < 0.05). In the poor prognosis cohort, elevated CRP and IL-2 levels, alongside prolonged fever duration, contrasted with reduced IL-12 levels (P < 0.05). Logistic regression identified elevated IL-2 as an independent risk factor and high IL-12 as a protective factor for adverse outcomes (P < 0.05). ROC analysis indicated that the area under the curves for IL-2, IL-12, and their combination in predicting poor prognosis were 0.815, 0.895, and 0.915, respectively.

CONCLUSION

Elevated serum IL-2 and diminished IL-12 levels in pediatric patients with MP and EBV co-infection correlate with poorer prognosis, with combined IL-2 and IL-12 levels offering enhanced predictive accuracy.

High specificity of metagenomic next-generation sequencing using protected bronchial brushing sample in diagnosing pneumonia in children

Background

Lower respiratory tract infections are the leading cause of morbidity and mortality in children worldwide. Timely and accurate pathogen detection is crucial for proper clinical diagnosis and therapeutic strategies. The low detection efficiency of conventional methods and low specificity using respiratory samples seriously hindered the accurate detection of pathogens.

Methods

In this study, we retrospectively enrolled 1,032 children to evaluate the performance of metagenomics next-generation sequencing (mNGS) using bronchoalveolar lavage fluid (BALF) sample and protected bronchial brushing (BB) sample in diagnosing pneumonia in children. In addition, conventional tests (CTs) were also performed.

Results

The specificity of BB mNGS [67.3% (95% CI 58.6%-75.9%)] was significantly higher than that of BALF mNGS [38.5% (95% CI 12.0%-64.9%)]. The total coincidence rate of BB mNGS [77.6% (95% CI 74.8%-80.5%)] was slightly higher than that of BALF mNGS [76.5% (95% CI 68.8%-84.1%)] and CTs [38.5% (95% CI 35.2%-41.9%)]. During the epidemics of Mycoplasma pneumoniae, the detection rate of M. pneumoniae in the >6-year group (81.8%) was higher than that in the 3-6-year (78.9%) and <3-year groups (21.5%). The highest detection rates of bacteria, fungi, and viruses were found in the <3-year, >6-year, and 3-6-year groups, respectively. mNGS detection should be performed at the duration of 5-7 days after the start of continuous anti-microbial therapy or at the duration of 6-9 days from onset to mNGS test.

Conclusions

This is the first report to evaluate the performance of BB mNGS in diagnosing pulmonary infections in children on a large scale. Based on our findings, extensive application of BB mNGS could be expected.

Effects of adjuvant pidotimod therapy on levels of inflammatory factors and expressions of serum GM-CSF and KL-6 in elderly patients with mycoplasma pneumonia

OBJECTIVE

To observe the intervention effects of adjuvant pidotimod therapy on the serum inflammatory factor and GM-CSF and KL-6 expression levels in elderly mycoplasma pneumonia patients.

METHODS

Elderly patients (n=104) diagnosed with mycoplasma pneumonia were divided into a control group (52 cases, given conventional anti-infective therapy combined with ambroxol) and a research group (52 cases, given conventional anti-infective therapy combined with ambroxol + pidotimod) according to the different treatment methods each patient was administered. The pulmonary function indexes (FVC, FEV1, FEV1/FVC), the serum inflammatory factor levels (interleukin (IL)-6, IL-8, the tumor necrosis factor α), the serum granulocyte-macrophage colony-stimulating factor (GM-CSF), and the Krebs von den Lungen-6 (KL-6) expression levels were measured before and after the treatment. The cough stopping times, the rale disappearance times, the hospital stay durations, the overall response rates, the incidences of adverse reactions during the administration, and the recurrence rates at 3, 6, and 12 months after the treatment were recorded.

RESULTS

The research group had shorter cough stopping times, rale disappearance times, and hospital stays than the control group (all P<0.05). After the treatment, the FVC, FVE1, and FVE1/FVC levels in both groups were increased, and the research group had higher levels than the control group (all P<0.05). After the treatment, the serum tumor necrosis factor α, IL-6, IL-8, GM-CSF, and KL-6 levels in the two groups were significantly decreased, and the levels of these indicators in the research group were significantly lower than they were in the control group (all P<0.05). The total overall treatment response rate was higher, and the recurrence rate at 12 months after the treatment was significantly lower in the research group than they were in the control group (P<0.05).

CONCLUSION

Adjuvant pidotimod therapy in the treatment of elderly patients with mycoplasma pneumonia can ameliorate patients' inflammatory responses and pulmonary functions, and reduce the serum GM-CSF and KL-6 factor levels, as well as the recurrence rate. Moreover, the combined medication is safe, and no significant increase in toxicity was found.