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Mazur NI, Caballero MT, Nunes MC. Severe respiratory syncytial virus infection in children: burden, management, and emerging therapies. Lancet 2024; 404:1143-1156. [PMID: 39265587 DOI: 10.1016/s0140-6736(24)01716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/25/2024] [Accepted: 08/16/2024] [Indexed: 09/14/2024]
Abstract
The global burden of respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) in young children is high. The RSV prevention strategies approved in 2023 will be essential to lowering the global disease burden. In this Series paper, we describe clinical presentation, burden of disease, hospital management, emerging therapies, and targeted prevention focusing on developments and groundbreaking publications for RSV. We conducted a systematic search for literature published in the past 15 years and used a non-systematic approach to analyse the results, prioritising important papers and the most recent reviews per subtopic. Annually, 33 million episodes of RSV LRTI occur in children younger than 5 years, resulting in 3·6 million hospitalisations and 118 200 deaths. RSV LRTI is a clinical diagnosis but a clinical case definition and universal clinical tool to predict severe disease are non-existent. The advent of molecular point-of-care testing allows rapid and accurate confirmation of RSV infection and could reduce antibiotic use. There is no evidence-based treatment of RSV, only supportive care. Despite widespread use, evidence for high-flow nasal cannula (HFNC) therapy is insufficient and increased paediatric intensive care admissions and intubation indicate the need to remove HFNC therapy from standard care. RSV is now a vaccine-preventable disease in young children with a market-approved long-acting monoclonal antibody and a maternal vaccine targeting the RSV prefusion protein. To have a high impact on life-threatening RSV infection, infants at high risk, especially in low-income and middle-income countries, should be prioritised as an interim strategy towards universal immunisation. The implementation of RSV preventive strategies will clarify the full burden of RSV infection. Vaccine probe studies can address existing knowledge gaps including the effect of RSV prevention on transmission dynamics, antibiotic misuse, the respiratory microbiome composition, and long-term sequalae.
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Affiliation(s)
- Natalie I Mazur
- Department of Pediatrics, Wilhelmina Children's Hospital, Utrecht, Netherlands.
| | - Mauricio T Caballero
- Centro INFANT de Medicina Traslacional (CIMeT), Escuela de Bio y Nanotecnología, Universidad Nacional de San Martín (UNSAM), Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Marta C Nunes
- Center of Excellence in Respiratory Pathogens, Hospices Civils de Lyon and Centre International de Recherche en Infectiologie, Équipe Santé Publique, Épidémiologie et Écologie Évolutive des Maladies Infectieuses, Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France; South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Sun H, Wang WQ, Lin L, Shao ZY, Zhan L, Tang LF. Case Report: Mycoplasma pneumoniae-associated acute pancreatitis. Front Pediatr 2024; 12:1416189. [PMID: 39296668 PMCID: PMC11408195 DOI: 10.3389/fped.2024.1416189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/13/2024] [Indexed: 09/21/2024] Open
Abstract
Mycoplasma pneumoniae is the primary pathogen causing community-acquired pneumonia in children, accounting for approximately 10%-40% of cases. It can lead to various extrapulmonary complications, including acute pancreatitis, which has been reported in approximately 30 cases to date. Here, we report a 4-year-old girl who presented with fever, cough, and elevated levels of M. pneumoniae IgM antibodies, followed by the onset of abdominal pain, elevated lipase, and elevated blood and urine amylase. Abdominal CT implied diffuse inflammation of the pancreas. Serum inflammatory cytokines, such as interleukin (IL)-2, IL-6, IL-17A, tumor necrosis factor, and interferon-gamma, were elevated. After excluding other causes, it was determined that M. pneumoniae infection was the cause of her acute pancreatitis. She was treated with macrolides and glucocorticoids and ultimately made a full recovery. Therefore, acute pancreatitis should be included in the differential diagnosis for patients with M. pneumoniae infection who present with abdominal pain. Inflammatory cytokines may play a role in mediating pancreatic damage.
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Affiliation(s)
- Hong Sun
- Department of Pediatrics, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Wei-Qun Wang
- Department of Pediatrics, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Long Lin
- Department of Pediatrics, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Zheng-Yang Shao
- Department of Pediatrics, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Lu Zhan
- Department of Pediatrics, Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang, China
| | - Lan-Fang Tang
- Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Li Y, Wu M, Liang Y, Yang Y, Guo W, Deng Y, Wen T, Tan C, Lin C, Liu F, Lin Y, Chen Q. Mycoplasma pneumoniae infection outbreak in Guangzhou, China after COVID-19 pandemic. Virol J 2024; 21:183. [PMID: 39129001 PMCID: PMC11318190 DOI: 10.1186/s12985-024-02458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUNDS Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen causing respiratory diseases in children. This study aimed to characterize epidemiological and disease severity shifts of M. pneumoniae: infections in Guangzhou, China during and after the coronavirus disease 2019 (COVID-19) pandemic. METHODS Throat swab samples were obtained from 5405 hospitalized patients with symptoms of acute respiratory infections to detect M. pneumoniae. Differences in epidemiological and clinical characteristics of M. pneumoniae: infections were investigated during 2020-2022 and after COVID-19 pandemic (2023). RESULTS M. pneumoniae were detected in 849 (15.6%, 849/5405) patients. The highest annual positive rate was 29.4% (754/2570) in 2023, followed by 5.3% (72/1367) in 2022, 1.2% (12/1015) in 2021, and 2.0% (11/553) in 2020, with significantly increasing annual prevalence from 2020 to 2023. M. pneumoniae incidence peaked between July and December post-COVID-19 pandemic in 2023, with the highest monthly positive rate (56.4%, 165/293). Clinical characteristics and outcomes of patients with M. pneumoniae did not vary between periods during and after COVID-19 pandemic except that patients with M. pneumoniae post-COVID-19 pandemic were more likely to develop fever. Patients with severe M. pneumoniae pneumonia (SMPP) were more likely to develop respiratory complications, myocardial damage, and gastrointestinal dysfunction than those with non-SMPP. Patients with SMPP had lower lymphocytes, CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and higher IL-4, IL-6, IL-10 levels than those with non-SMPP. Bronchoalveolar lavage fluid specimens from infected patients were obtained to identify macrolide resistance mutations. Macrolide-resistant M. pneumoniae (MRMP) proportion in 2023 was 91.1% (215/236). CONCLUSION Outbreaks of M. pneumoniae: occurred in Guangzhou, China in 2023 upon Non-pharmaceutical interventions easing. Despite the increasing incidence of M. pneumoniae, the disease severity remained similar during and after the COVID-19 pandemic.
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Affiliation(s)
- Ya Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Minzhi Wu
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Ying Liang
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Yihao Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Wenyu Guo
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Yuezhi Deng
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Tao Wen
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Caiwei Tan
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Cheng Lin
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China
| | - Feifei Liu
- Guangzhou Kingmed Center for Clinical Laboratory, Guangzhou, Guangdong, China
| | - Yongping Lin
- Department of Laboratory Medicine, National Cancer Center, National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Shenzhen, China.
| | - Qigao Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Department of Clinical Laboratory, The Key Laboratory of Advanced Interdisciplinary Studies Center, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, Guangdong, China.
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Ding X, Li S, Liu X, Zhan X, Wang Z, Wang M, Wu G. Study on the Correlation Between the Expression of NF-Ƙb in the Alveolar Lavage Fluid of Children with Severe Mycoplasma Pneumoniae Pneumonia, Its Clinical Characteristics, and Cellular Immunity. Infect Drug Resist 2024; 17:2469-2484. [PMID: 38915319 PMCID: PMC11194830 DOI: 10.2147/idr.s411361] [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: 03/16/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2024] Open
Abstract
Objective This study explored the level of nuclear factor-ƙB (NF-ƙB) in the bronchoalveolar lavage fluid (BALF) of children with severe Mycoplasma Pneumoniae pneumonia (SMPP) and the correlation between NF-ƙB, cellular immunity, and clinical characteristics. Methods A total of 41 hospitalized children diagnosed with SMPP were selected and included in the SMPP group, and 13 bronchial foreign bodies (FB) without infection during the same period were included in the FB group. The NF-ƙB in the BALF of participants was detected by enzyme-linked immunosorbent assay. The correlation between NF-ƙB and laboratory findings, cellular immunity, and the clinical features in children with SMPP was analyzed. The differences in chest imaging and bronchoscopy in children with SMPP were observed. Results The levels of NF-ƙB were significantly increased in the SMPP group compared with the FB group (P < 0.001). There were correlations between different NF-ƙB pairs in the SMPP group (P < 0.01). Nuclear factor-ƙB (NF-ƙB) correlated with IL-6, the mycoplasma load in BALF, fever peak, length of hospital stay, and sputum suppository (P < 0.05). The higher the intracellular NF-ƙB level in BALF, the lower the CD3+ CD4+ value in peripheral blood (P < 0.05). Intracellular NF-ƙB and total NF-ƙB correlated with pleural effusion, pericardial effusion, and extrapulmonary complications (P < 0.05). Conclusion NF-ƙB is involved in airway inflammation changes in children with SMPP. The higher the level of NF-ƙB in the airway, the more severe the clinical manifestations, and the longer the length of hospital stay is likely to be.
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Affiliation(s)
- Xinyao Ding
- Department of Paediatrics, Luohe Yancheng District People’s Hospital, Luohe, Henan, 462300, People’s Republic of China
| | - Shujun Li
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Xue Liu
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Xiaowen Zhan
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Zhiyuan Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Mengzhu Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
| | - Guannan Wu
- Department of ICU, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, 453100, People’s Republic of China
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M S, Vaithilingan S. Childhood Pneumonia in Low- and Middle-Income Countries: A Systematic Review of Prevalence, Risk Factors, and Healthcare-Seeking Behaviors. Cureus 2024; 16:e57636. [PMID: 38586234 PMCID: PMC10998654 DOI: 10.7759/cureus.57636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Abstract
Childhood pneumonia is a major contributor to illness and death in children under the age of five globally. Despite advancements in medical science, the burden of pediatric community-acquired pneumonia (CAP) remains high, particularly in low- and middle-income countries. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and healthcare-seeking behaviors associated with pediatric CAP to inform the development of targeted community-based interventions. An extensive search of various databases such as Medline, EMBASE, Web of Science, Cochrane, PubMed, PubMed Central, Helinet, SpringerLink, Google Scholar, and Biomed Central was performed, resulting in 65 potentially relevant studies. After a thorough evaluation process, 25 studies were selected for the final analysis. These selected studies offered valuable information on the epidemiology, risk factors, and healthcare-seeking behaviors associated with childhood pneumonia. The review revealed that environmental factors such as indoor air pollution, overcrowding, and exposure to tobacco smoke are significant risk factors for pediatric pneumonia. Additionally, socioeconomic factors, including poverty and a lack of access to clean water and sanitation, contribute to the vulnerability of children to this disease. Poor healthcare-seeking behaviors, driven by limited knowledge and awareness of pneumonia symptoms and treatment, further exacerbate the situation. The review also highlighted the critical role of vaccination, particularly against Haemophilus influenzae type b (Hib) and pneumococcus, in preventing pneumonia. However, gaps in vaccination coverage and challenges in accessing healthcare services remain barriers to effective pneumonia control. In light of these findings, the review recommends the implementation of community-based interventions that address the multifaceted determinants of pediatric pneumonia. These interventions should focus on improving environmental conditions, enhancing access to preventive measures such as vaccination, and promoting better healthcare-seeking behaviors through education and awareness campaigns. It is essential for healthcare providers, policymakers, and community members to collaborate in developing and implementing culturally appropriate and sustainable interventions. This cooperation aims to lessen the impact of pneumonia on children and their families.
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Affiliation(s)
- Selvi M
- Community Health Nursing Department, Vinayaka Mission's Research Foundation, Salem, IND
| | - Sasi Vaithilingan
- Community Health Nursing Department, Vinayaka Mission's College of Nursing, Puducherry, IND
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Yun KW. Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clin Exp Pediatr 2024; 67:80-89. [PMID: 37321577 PMCID: PMC10839192 DOI: 10.3345/cep.2022.01452] [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] [Received: 12/17/2022] [Revised: 01/19/2023] [Accepted: 02/08/2023] [Indexed: 06/17/2023] Open
Abstract
Pneumonia is a common pediatric infectious disease that is familiar to pediatricians and a major cause of hospitalization worldwide. Recent well-designed epidemiologic studies in developed countries indicated that respiratory viruses are detected in 30%-70%, atypical bacteria in 7%-17%, and pyogenic bacteria in 2%-8% of children hospitalized with community-acquired pneumonia (CAP). The etiological distribution of CAP varies widely by child age and the epidemiological season of the respiratory pathogen. Moreover, diagnostic tests, particularly for the detection of Streptococcus pneumoniae and Mycoplasma pneumoniae, the 2 major bacterial pathogens involved in pediatric CAP, have several limitations. Therefore, management and empirical antimicrobial therapy for children with CAP should be applied in a stepwise manner based on recent epidemiological, etiological, and microbiological evidence.
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Affiliation(s)
- Ki Wook Yun
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
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Li J, Zhang H, Guo J, Ma X. Clinical features of Mycoplasma pneumoniae pneumonia in children without fever. BMC Pediatr 2024; 24:52. [PMID: 38229052 DOI: 10.1186/s12887-023-04512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Mycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children. Most children have fever. In 2021, we found that the proportion of children without fever increased. The aim of this study is to summarize the differences in the clinical characteristics of children with MP pneumonia who are febrile or not, and to raise awareness of children who are not febrile. METHOD Demographic information of the children was collected on admission. Clinical manifestations during the course of the disease and the first laboratory, imaging, and pulmonary function tests before discharge were recorded and compared. RESULTS From August to December, a total of 542 people were included in the study. We found that older children were more likely to have fever. Inflammatory indicators including procalcitonin (P = 0.030), C-reaction protein (P < 0.001), erythrocyte sedimentation rate (P < 0.001), ferritin (P = 0.040) and the rate of atelectasis (P = 0.049) of febrile children were higher in febrile children. However, the elevated lactate dehydrogenase and pulmonary function impairment (P all > 0.05), especially the small airway function impairment, are no lower in afebrile children than in febrile children. CONCLUSION The fever rate is lower in younger children, but wheezing is more common. In afebrile children, the impairment of organ and lung function was no less than in febrile children. Therefore, attention should also be paid to children who are not febrile.
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Affiliation(s)
- Jialin Li
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China
| | - Hua Zhang
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China
| | - Jing Guo
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China
| | - Xiang Ma
- Department of Respiratory Disease, Children's Hospital affiliated to Shandong University, Jinan, 250022, Shandong, China.
- Jinan Key Laboratory of Pediatric Respiratory diseases, Jinan Children's Hospital, Jinan, China.
- Shandong Provincial Clinical Research Center for Children's Health and Disease, Jinan, 250022, Shandong, China.
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Suh JH, Ahn B, Song SH, Choi S, Choi SH, Lee H, Han MS, Park JY, Choi EH, Yun KW. Etiology and Clinical Characteristics of Community-Acquired Pneumonia in Korean Children During the Pre-COVID-19 Period, 2015-2020. J Korean Med Sci 2023; 38:e339. [PMID: 37935166 PMCID: PMC10627724 DOI: 10.3346/jkms.2023.38.e339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/18/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND There have been many epidemiologic studies on community-acquired pneumonia (CAP) among children, most of which had substantial limitations. This study investigated the etiologic distribution and clinical characteristics of CAP in Korean children for 5 years before the coronavirus disease 2019 (COVID-19) pandemic. METHODS A retrospective analysis of children hospitalized for CAP at 4 referral hospitals during 2015-2020 was performed. Cases in which bronchiolitis was suspected or pulmonary infiltration was not evident on chest radiography (CXR) were excluded. Viruses and atypical bacteria were defined as detected when positive in the polymerase chain reaction test performed for respiratory specimens. Serologic testing result for Mycoplasma pneumoniae was incorporated with strict interpretation. Pyogenic bacteria were included only when cultured in blood, pleural fluid, or bronchoalveolar lavage, but those cultured in endotracheal aspirate or sputum when the case was clinically evident bacterial pneumonia were also included. RESULTS A total of 2,864 cases of suspected pneumonia were selected by diagnosis code and CXR findings. Medical chart and CXR review excluded nosocomial pneumonia and cases without evident infiltration, resulting in 517 (18.1%) CAP cases among 489 children. Regarding clinical symptoms, high fever was present in 59.4% and dyspnea in 19.9% of cases. Respiratory support was required for 29.2% of patients, including mechanical ventilation for 3.9%. Pathogens were detected in 49.9% of cases, with viruses in 32.3%, atypical bacteria in 17.8%, and pyogenic bacteria in 2.3% of cases. As single pathogens, M. pneumoniae (16.8%) and respiratory syncytial virus (RSV, 13.7%) were the most common. Parenteral β-lactam and macrolide antibiotics were administered in 81.6% and 50.7% of cases, respectively. A total of 12 (2.3%) cases resulted in poor outcomes, including 3 deaths. CONCLUSION M. pneumoniae and RSV were the most commonly detected pathogens of pediatric CAP, which was selected by strict clinical and radiologic criteria. It is necessary to carefully decide whether to use parenteral antibiotics based on the epidemiology and clinical features of CAP in children.
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Affiliation(s)
- Jung Ho Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Bin Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Seung Ha Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Sujin Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Hwan Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
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Li M, Wei X, Zhang SS, Li S, Chen SH, Shi SJ, Zhou SH, Sun DQ, Zhao QY, Xu Y. Recognition of refractory Mycoplasma pneumoniae pneumonia among Myocoplasma pneumoniae pneumonia in hospitalized children: development and validation of a predictive nomogram model. BMC Pulm Med 2023; 23:383. [PMID: 37817172 PMCID: PMC10566172 DOI: 10.1186/s12890-023-02684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUD The current diagnostic criteria for refractory Mycoplasma pneumoniae pneumonia (RMPP) among Mycoplasma pneumoniae Pneumonia (MPP) are insufficient for early identification, and potentially delayed appropriate treatment. This study aimed to develop an effective individualized diagnostic prediction nomogram for pediatric RMPP. METHODS A total of 517 hospitalized children with MPP, including 131 with RMPP and 386 without RMPP (non-RMPP), treated at Lianyungang Maternal and Child Health Care Hospital from January 2018 to December 2021 were retrospectively enrolled as a development (modeling) cohort to construct an RMPP prediction nomogram. Additionally, 322 pediatric patients with MPP (64 with RMPP and 258 with non-RMPP, who were treated at the Affiliated Hospital of Xuzhou Medical University from June 2020 to May 2022 were retrospectively enrolled as a validation cohort to assess the prediction accuracy of model. Univariable and multivariable logistic regression analyses were used to identify RMPP risk factors among patients with MPP. Nomogram were generated based on these risk factors using the rms package of R, and the predictive performance was evaluated based on receiver operating characteristic (ROC) curves and using decision curve analysis (DCA). RESULTS Multivariate analysis revealed five significant independent predictors of RMPP among patients with MPP: age (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.08-1.33, P = 0.038), fever duration (HR 1.34, 95%CI 1.20-1.50, P < 0.001), lymphocyte count (HR 0.45, 95%CI 0.23-0.89, P = 0.021), serum D-dimer (D-d) level (HR 1.70, 95%CI 1.16-2.49, P = 0.006), and pulmonary imaging score (HR 5.16, 95%CI 2.38-11.21, P < 0.001). The area under the ROC curve was 90.7% for the development cohort and 96.36% for the validation cohort. The internal and external verification calibration curves were almost linear with slopes of 1, and the DCA curve revealed a net benefit with the final predictive nomogram. CONCLUSION This study proposes a predictive nomogram only based on five variables. The nomogram can be used for early identification of RMPP among pediatric patients with MPP, thereby facilitating more timely and effective intervention.
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Affiliation(s)
- Meng Li
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Xiang Wei
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Shan-Shan Zhang
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Shan Li
- Department of Pediatric Endocrinology, Lianyungang Maternal and Child Health Care Hospital, Lianyungang, Jiangsu, China
| | - Su-Hong Chen
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Su-Jie Shi
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Shao-Hong Zhou
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Da-Quan Sun
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China
| | - Qian-Ye Zhao
- Pediatric Respiratory Ward I, Lianyungang Maternal and Child Health Care Hospital, No. 669, Qindongmen Street, Haizhou District, Lianyungang, 220003, Jiangsu, China.
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.
| | - Yan Xu
- Neonatology Department, The Affiliated Hospital of Xuzhou Medical University, No. 99, Huaihai West Road, Quanshan District, Xuzhou, 221000, Jiangsu, China.
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10
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Lee DH, Choi YJ, Kim J, Han E, Bae MH. Pre-Pandemic Distribution of Bacterial Species in Nasopharyngeal Swab Specimens from Pediatric and Adult Patients Detected via RT-PCR Using the Allplex Respiratory Panel. Life (Basel) 2023; 13:1840. [PMID: 37763244 PMCID: PMC10532938 DOI: 10.3390/life13091840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Recently, panel-based molecular diagnostics for the simultaneous detection of respiratory viruses and bacteria in nasopharyngeal swab (NPS) specimens have been highlighted. We identified the distribution of bacterial species in NPS specimens collected from pediatric and adult patients by employing RT-PCR (Allplex respiratory panel 4, RP4, Seegene) to estimate its applicability in a panel-based assay for detecting respiratory viruses. Methods: We used 271 and 173 NPS specimens from pediatric and adult patients, respectively. The results of the Allplex RP4 panel using NPS (NPS-RP4) from adult patients were compared with those of the Seeplex PneumoBacter ACE Detection assay (Seegene), which used sputum for testing (sputum-Seeplex). Results: A total of 147 specimens (54.2%) were positive for the NPS-RP4 panel in pediatric patients. There were 94, 77, 10, 3, 3, and 2 specimens that were positive for Haemophilus influenzae (HI), Streptococcus pneumoniae (SP), Mycoplasma pneumoniae (MP), Chlamydia pneumoniae (CP), Bordetella pertussis (BP), and B. parapertussis (BPP), respectively. Among 173 adult patients, 39 specimens (22.5%) were positive in the NPS-RP4. Thirty specimens were positive for HI, and 13 were positive for SP. One specimen tested positive for both MP and Legionella pneumophila (LP). CP, BP, and BPP results were all negative. However, 126 specimens (72.8%) had positive results with sputum-Seeplex (99 SP, 59 HI, three LP, and two MP), and the overall percentage of agreement between the two assays was 39.3% in the adult patients. Conclusions: Bacterial species in NPS from more than half of pediatric patients were detected. Performing the Allplex RP4 assay with NPS revealed additional respiratory bacteria that are not detected in current clinical practices, which do not include bacterial testing, demanding the use of sputum specimens. However, the use of NPS showed low agreement with standard assays using sputum in adult patients. Thus, more research is needed to develop a reliable RT-PCR method using NPS specimens in adult patients.
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Affiliation(s)
- Dong-Hyun Lee
- Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
| | - Young-Jin Choi
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Republic of Korea
| | - Jieun Kim
- Division of Infectious Disease, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Republic of Korea
| | - Eunhee Han
- Department of Laboratory Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Mi-Hyun Bae
- Department of Laboratory Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Republic of Korea
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11
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Suh DI. Community-acquired pneumonia in Korean children: time to read between the lines. Clin Exp Pediatr 2023; 66:22-23. [PMID: 36397258 PMCID: PMC9815943 DOI: 10.3345/cep.2022.00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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12
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Zhang J, Xu C, Yan S, Zhang X, Zhao D, Liu F. A nomogram for predicting severe adenovirus pneumonia in children. Front Pediatr 2023; 11:1122589. [PMID: 36937948 PMCID: PMC10014818 DOI: 10.3389/fped.2023.1122589] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Adenoviral pneumonia in children was an epidemic that greatly impacted children's health in China in 2019. Currently, no simple or systematic scale has been introduced for the early identification and diagnosis of adenoviral pneumonia. The early recognition scale of pediatric severe adenovirus pneumonia was established based on an analysis of the children's community-acquired pneumonia clinical cohort. This study analyzed the clinical data of 132 children with adenoviral pneumonia who were admitted to the Children's Hospital of Nanjing Medical University. The clinical parameters and imaging features were analyzed using univariate and multivariate logistic regression analyses. A nomogram was constructed to predict the risk of developing severe adenovirus pneumonia in children. There were statistically significant differences in age, respiratory rate, fever duration before admission, percentage of neutrophils and lymphocytes, CRP, ALT, and LDH between the two groups. Logistic regression analysis was conducted using the R language, and respiratory rate, percentage of neutrophils, percentage of lymphocytes, and LDH were used as scale indicators. Using the ROC curve, the sensitivity and specificity of the scale were 93.3% and 92.1%. This scale has good sensitivity and specificity through internal verification, which proves that screening for early recognition of severe adenovirus pneumonia can be realized by scales. This predictive scale helps determine whether a child will develop severe adenovirus pneumonia early in the disease course.
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Affiliation(s)
| | | | | | | | | | - Feng Liu
- Correspondence: Deyu Zhao Feng Liu
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13
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Roh EJ, Shim JY, Chung EH. Epidemiology and surveillance implications of community-acquired pneumonia in children. Clin Exp Pediatr 2022; 65:563-573. [PMID: 36265520 PMCID: PMC9742763 DOI: 10.3345/cep.2022.00374] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/26/2022] [Indexed: 11/05/2022] Open
Abstract
Community-acquired pneumonia (CAP) is the single largest infectious cause of hospitalization and death in children worldwide. With improved immunizations, the incidence of bacterial pneumonia and the number of colonized bacteria have decreased. However, respiratory viruses are still an important cause of CAP, especially as new infectious agents such severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerge. The SARS-CoV-2 virus emerged in 2019 and caused the current coronavirus disease 2019 pandemic. Therefore, it is necessary to elucidate the epidemiology and causative pathogens of CAP. Recently, the Pneumonia and Respiratory Disease Study Group, affiliated with the Korean Academy of Pediatric Allergy and Respiratory Disease, investigated the causative pathogens of respiratory infections in children hospitalized with CAP, the serotype of Streptococcus pneumoniae, and the prevalence of Mycoplasma pneumoniae with gene mutations. Antibiotic resistance and serotype test results can determine the use of empirical antibiotics. Moreover, it is possible to help develop future vaccines by comparing bacterial culture results with vaccine serotype and identifying the changes and prevalence of each serotype. Therefore, we will perform continuous national surveillance and monitor the epidemiology of respiratory pathogens in Korea and worldwide. The surveillance of these respiratory infections can play a role in monitoring the emergence of new infectious diseases such as SARS-CoV-2.
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Affiliation(s)
- Eui Jeong Roh
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
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14
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Kim Y, Jeon Y, Kwon KT, Bae S, Hwang S, Chang HH, Kim SW, Lee WK, Yang KH, Shin JH, Shim EK. Beta-Lactam Plus Macrolide for Patients Hospitalized With Community-Acquired Pneumonia: Difference Between Autumn and Spring. J Korean Med Sci 2022; 37:e324. [PMID: 36413797 PMCID: PMC9678659 DOI: 10.3346/jkms.2022.37.e324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2017 Korean guideline on community-acquired pneumonia (CAP) recommended beta-lactam plus macrolide combination therapy for patients hospitalized with severe pneumonia, and beta-lactam monotherapy for mild-to-moderate pneumonia. However, antibiotic treatment regimen for mild-to-moderate CAP has never been evaluated for Korean patients. METHODS In this retrospective cohort study, study patients were selected from three evaluation periods (October 1 to December 31, 2014; April 1 to June 30, 2016; October 1 to December 31, 2017) of the National Quality Assessment Program for CAP management and the National Health Insurance data on the selected patients was extracted from 1 year before the first patient enrollment and 1 year after the last patient enrollment at each evaluation period for the analysis of risk adjustment and outcomes. The survival rates between beta-lactam plus macrolide (BM) groups and beta-lactam monotherapy (B) were compared using a Kaplan-Meier survival analysis after propensity score matching by age, gender, confusion, urea, respiratory rate, blood pressure at age of 65 years or older (CURB-65), and Charlson comorbidity index for risk adjustment. The differences between autumn and spring season were also evaluated. RESULTS A total of 30,053 patients were enrolled. Mean age and the male-to-female ratio were 64.7 ± 18.4 and 14,197:15,856, respectively. After matching, 2,397 patients in each group were analyzed. The 30-day survival rates did not differ between the BM and B groups (97.3% vs. 96.5%, P = 0.081). In patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.7% vs. 91.0%, P = 0.044). Among patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.3% vs. 88.5%, P = 0.009) during autumn season, which was not observed during spring (94.2% vs. 94.1%, P = 0.986). CONCLUSION Beta-lactam plus macrolide combination therapy shows potential as an empirical therapy for CAP with CURB-65 ≥ 2, especially in autumn.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin-Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Kee Lee
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki-Hwa Yang
- Quality Assessment Department, HIRA (Health Insurance Review & Assessment Service), Wonju, Korea
| | - Ji-Hyeon Shin
- Quality Assessment Department, HIRA (Health Insurance Review & Assessment Service), Wonju, Korea
| | - Eun-Kyung Shim
- Quality Assessment Department, HIRA (Health Insurance Review & Assessment Service), Wonju, Korea
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15
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Lee E, Choi I. Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children. Indian J Pediatr 2022; 89:1003-1009. [PMID: 35665905 DOI: 10.1007/s12098-022-04205-0] [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] [Received: 10/08/2021] [Accepted: 02/16/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To elucidate the clinical usefulness of lactate dehydrogenase (LDH) levels in children with Mycoplasma pneumoniae (MP) pneumonia and identify cut-off levels in various clinical conditions. METHODS The study was retrospectively performed in 145 children who were hospitalized with MP pneumonia. Laboratory findings, including LDH levels at admission and clinical features were retrospectively reviewed from patients' electronic medical records. RESULTS The mean age of the study population was 5.9 y, and the mean value of LDH was 809.7 U/L. Poor response to treatment for MP pneumonia, respiratory virus coinfection, severe MP pneumonia, development of postinfectious bronchiolitis obliterans (PIBO) after MP pneumonia, pleural effusion, and oxygen need during illness were significantly associated with serum LDH levels. The cutoff levels of LDH for predicting poor response to treatment for MP pneumonia and respiratory virus coinfection were 1058 U/L [area under the curve (AUC), 0.729] and 803 U/L (AUC, 0.682), respectively. Those for pneumonic lesions involving at least one-third of the total lung volume, prediction of PIBO development, and extrapulmonary manifestations were 1098 U/L (AUC, 0.715), 676 U/L (AUC, 0.714), and 859 U/L (AUC, 0.710), respectively. The cutoff levels for pleural effusion during illness and for the prediction of oxygen need were 894 U/L (AUC, 0.699) and 1114 U/L (AUC, 0.771), respectively. CONCLUSION LDH levels are elevated in diverse clinical conditions in children with MP pneumonia and may be useful in the identification of severe clinical courses of MP pneumonia in children.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea.
| | - Insu Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea
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16
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Kim K, Jung S, Kim M, Park S, Yang HJ, Lee E. Global Trends in the Proportion of Macrolide-Resistant Mycoplasma pneumoniae Infections: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2220949. [PMID: 35816304 PMCID: PMC9274321 DOI: 10.1001/jamanetworkopen.2022.20949] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The proportion of macrolide-resistant Mycoplasma pneumoniae (MRMP) infections has changed, and it differs according to geographical region. OBJECTIVE To analyze the global patterns, including the temporal trends, regional variations, and variant types, in the proportion of MRMP infections in this systematic review and meta-anaysis. DATA SOURCES PubMed, Cochrane Library, and Embase databases were searched for observational studies from inception to September 10, 2021. STUDY SELECTION Observational studies reporting the proportion of MRMP infections were screened independently by 2 authors. The presence of MRMP infection was defined as any case of M pneumoniae infection positive for any variants associated with macrolide resistance identified using respiratory samples. DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was used. Random-effects meta-analyses were used to estimate the proportion of MRMP infections. MAIN OUTCOMES AND MEASURES The global patterns in the proportion of MRMP infections were estimated, and the temporal trends and variant types of MRMP infection with regional differences were investigated. RESULTS This study included 153 studies from 150 articles (27 408 samples in 26 countries) in the meta-analysis. The global patterns in the proportion of MRMP infections showed an increasing trend with regional differences. The proportion of MRMP infections was highest in the Western Pacific regions (53.4%; 95% CI, 47.4%-60.3%), followed by the South East Asian region (9.8%; 95% CI, 0.8%-100%), the region of the Americas (8.4%; 95% CI, 6.1%-11.6%), and the European region (5.1%; 95% CI, 3.3%-8.0%). The most commonly identified variant of MRMP infection was A2063G (96.8%; 95% CI, 95.8%-97.7%), followed by A2064G (4.8%; 95% CI, 3.5%-6.7%). The proportion of MRMP infections was the highest in studies including only children (37.0%; 95% CI, 29.8%-46.1%), followed by those including only adults (15.9%; 95% CI, 6.4%-39.7%) and those including both children and adults (16.7%; 95% CI, 10.1%-27.6%). CONCLUSIONS AND RELEVANCE This study provides global trends in the proportion of MRMP infections and suggests that strategies to prevent the spread of MRMP infection and to treat MRMP infections are needed to decrease disease burden.
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Affiliation(s)
- Kyunghoon Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Mina Kim
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Suyeon Park
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
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17
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Choo S, Lee YY, Lee E. Clinical significance of respiratory virus coinfection in children with Mycoplasma pneumoniae pneumonia. BMC Pulm Med 2022; 22:212. [PMID: 35637540 PMCID: PMC9150047 DOI: 10.1186/s12890-022-02005-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia has been increasing. However, few studies have investigated the impact of respiratory virus coinfection in patients with MP pneumonia, and their results have been inconclusive. This study aimed to investigate the impact of respiratory virus coinfection in children hospitalized with MP pneumonia. METHODS This study enrolled 145 children hospitalized with MP pneumonia between May 2019 and March 2020. The patients were divided into two groups: the respiratory virus coinfection and non-coinfection groups. All the children underwent polymerase chain reaction testing for respiratory virus infection. Information on clinical, laboratory, and radiologic findings were obtained retrospectively via medical chart reviews. RESULTS Children in the respiratory virus coinfection group were younger than those in the non-coinfection group. Respiratory virus coinfection in children hospitalized with MP pneumonia was significantly associated with persistence of fever more than 6 days (adjusted odds ratio [aOR], 2.394; 95% confidence interval [95% CI], 1.172-4.892), severe pneumonia (aOR, 4.602; 95% CI, 1.154-18.353), and poor response to the stepwise approach for MP pneumonia (aOR, 4.354; 95% CI, 1.374-13.800). In addition, higher levels of liver enzymes and lactate dehydrogenase at admission were associated with respiratory virus coinfection in children with MP pneumonia. CONCLUSIONS The results of this study suggest that respiratory virus coinfection in children hospitalized with MP pneumonia may be associated with refractory MP pneumonia.
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Affiliation(s)
- Soojeong Choo
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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18
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The Diagnostic Value of High-Resolution Computed Tomography Features Combined with Mycoplasma Pneumoniae Ribonucleic Acid Load Detection for Refractory Mycoplasma Pneumonia. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6460865. [PMID: 35601566 PMCID: PMC9095367 DOI: 10.1155/2022/6460865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate the value of high-resolution computed tomography (CT) images and mycoplasma pneumoniae (MP) ribonucleic acid (RNA) load detection in the early diagnosis of refractory mycoplasma pneumoniae (RMP) and provide more methods for the diagnosis and treatment of RMP. Seventy children with MP were divided into the RMP group (H1 group, 31 cases) and the MP group (H2 group, 39 cases) according to pathological findings, and all of them underwent CT scanning. MP-RNA load and genotype distribution were analyzed in both groups, and the diagnostic efficacy of CT combined with MP-RNA load for RMP was calculated. The sensitivity of children in the H1 group to erythromycin (59.17% vs 71.56%) and clarithromycin (53.21% vs 67.03%) was lower than that in the H2 group, and the resistance rate of children in the H1 group to erythromycin (71.43% vs 67.53%) and clarithromycin (64.24% vs 50.37%) was higher than that in the H2 group (P < 0.05); the regression coefficients between lactate dehydrogenase (LDH) and the MPLI value of RMP were −0.064 and −0.413, respectively, which were significantly negatively correlated (P < 0.05); the accuracy (96.5%), sensitivity (92.5%), and specificity (88%) of CT + MP-RNA in the diagnosis of RMP were significantly higher than those of CT alone (91%, 88%, and 82%) and MP-RNA alone (88%, 84.5%, and 74%), which were significantly different (P < 0.05). The results of high MP-RNA load detection can be used as an indicator to predict RMP, and the diagnostic efficacy is significantly improved after combination with high-resolution CT, with high clinical application value.
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Choo S, Kim SH, Lee E. Clinical significance of Mycoplasma pneumoniae specific IgM titer in children hospitalized with Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2022; 22:470. [PMID: 35578177 PMCID: PMC9109195 DOI: 10.1186/s12879-022-07456-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The present study aimed to identify the clinical significance of Mycoplasma pneumoniae (MP)-specific immunoglobulin M (IgM) titer, in addition to a diagnosis of MP infection, in children with MP pneumonia. METHODS This study was performed in 155 children hospitalized with MP pneumonia. The clinical features and laboratory and radiographic findings on admission in children with positive or negative MP-specific IgM titers were retrospectively reviewed from the electronic medical records. RESULTS The mean age of the included children was 6.0 years, and 118 (76.1%) of the children were positive for MP-specific IgM. A longer duration between symptom onset and admission (adjusted odds ratio [aOR] 1.47, 95% confidence interval [CI] 1.24-1.75), longer duration of symptoms during the illness (aOR 1.15, 95% CI 1.02-1.30), and development of extra-pulmonary manifestations (aOR 9.16, 95% CI 1.96-42.81) were significantly associated with a positive MP-specific IgM titer. Serum lactate dehydrogenase levels (aOR 1.00, 95% CI 1.00-1.01) and pneumonic infiltration involving > 50% of the total lung volume on chest radiography (aOR 4.68, 95% CI 1.12-19.55) were associated with positive MP-specific IgM in children with MP pneumonia. A poor response to stepwise treatment for MP pneumonia was more common in children with a positive MP-specific IgM titer than those with a negative MP-specific IgM titer on admission. CONCLUSIONS A positive MP-specific IgM titer at diagnosis of MP pneumonia may partially suggest an exaggerated immune response with a higher disease burden compared to children with MP pneumonia with a negative MP-specific IgM titer.
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Affiliation(s)
- Soojeong Choo
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Seo-Hee Kim
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea.
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20
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Chen G, Yu J, Chen H, Cen K, Zhou Y, You Q, Wu S. EasyNAT MP Assay: A Simple, Rapid, and Low-Cost Method to Detect Mycoplasma pneumoniae Using Cross-Priming Amplification Technology. Mol Diagn Ther 2022; 26:345-352. [PMID: 35430704 PMCID: PMC9098574 DOI: 10.1007/s40291-022-00582-6] [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] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
Background Mycoplasma pneumoniae (MP) is the most common pathogen of atypical pneumonia and the main cause of community-acquired pneumonia (CAP) in infants and older adults. This study aimed at investigating a method based on the cross-priming amplification (CPA) technique for the rapid detection of MP in clinical specimens collected from patients with CAP. Methods The sensitivity and specificity of the EasyNAT MP assay were determined. Oropharyngeal swab specimens were collected from 162 in-patients of Hangzhou First People’s Hospitals from January 2018 to December 2020. The patients were aged between 1 and 15 years with symptoms, signs, and chest radiographs consistent with CAP. This study evaluated the presence of MP in the clinical specimens using the EasyNAT method and the conventional fluorescence quantitative PCR technique. Results The limit of detection using the EasyNAT MP assay was 500 copies/mL, while the test results of the other 13 common pathogens causing CAP or colonizing in the upper respiratory tract showed no cross-reactivity. Of 162 specimens, EasyNAT MP gave a positive indication in 82 specimens. Compared with conventional fluorescence quantitative PCR, the positive coincidence rate and the negative coincidence rate of EasyNAT MP was found to be 100.00% and 97.56%, respectively. Of the 82 specimens, two specimens were determined to be negative by the conventional fluorescence quantitative PCR, but were positive for EasyNAT MP. The two samples were re-extracted and confirmed to be positive by conventional fluorescence quantitative PCR. Conclusion EasyNAT MP is suitable as an initial test for MP diagnosis due to its simplicity, low turnaround time, and high sensitivity and specificity.
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Affiliation(s)
- Guang Chen
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310012, Zhejiang, People's Republic of China
| | - Junwei Yu
- Ustar Biotechnologies (Hangzhou) Ltd., Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Hanlu Chen
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, People's Republic of China
| | - Ke Cen
- Department of Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, People's Republic of China
| | - Yanqiong Zhou
- Ustar Biotechnologies (Hangzhou) Ltd., Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Qimin You
- Ustar Biotechnologies (Hangzhou) Ltd., Hangzhou, 310053, Zhejiang, People's Republic of China
| | - Shenghai Wu
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, People's Republic of China. .,Department of Laboratory, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, People's Republic of China.
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21
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Cheng Y, Cheng Y, Dai S, Hou D, Ge M, Zhang Y, Fan L, Pei Y, Yu L, Xue G, Ma L, Sun H. The Prevalence of Mycoplasma Pneumoniae Among Children in Beijing Before and During the COVID-19 Pandemic. Front Cell Infect Microbiol 2022; 12:854505. [PMID: 35573799 PMCID: PMC9103471 DOI: 10.3389/fcimb.2022.854505] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Mycoplasma pneumoniae (M. pneumoniae) is an important pathogen of community acquired pneumonia. With the outbreak of coronavirus disease 2019 (COVID-19), the prevalence of some infectious respiratory diseases has varied. Epidemiological features of M. pneumoniae in children from Beijing (China) before and during the COVID-19 pandemic were investigated. Methods Between June 2016 and May 2021, a total of 569,887 children with respiratory infections from Children’s Hospital Affiliated to Capital Institute of Pediatrics (Beijing, China) were included in this study. M. pneumoniae specific-IgM antibody in serum specimens of these patients was tested by a rapid immunochromatographic assay kit. The relevant clinical data of M. pneumoniae-positive cases were also collected, and analyzed by RStudio software. Results The results showed that 13.08% of collected samples were positive for M. pneumoniae specific-IgM antibody. The highest annual positive rate was 17.59% in 2019, followed by 12.48% in 2018, 12.31% in 2017, and 11.73% in 2016, while the rate dropped to 8.9% in 2020 and 4.95% in 2021, with significant difference. Among the six years, the positive rates in summer and winter seasons were significantly higher than those in spring and autumn seasons (p < 0.001). The positive rate was the highest in school-age children (22.20%), and lowest in the infant group (8.76%, p < 0.001). The positive rate in boys (11.69%) was lower than that in girls (14.80%, p < 0.001). There were no significant differences in different seasons, age groups, or genders before and during the COVID-19 pandemic (p > 0.05). Conclusions Our study demonstrated that an M. pneumoniae outbreak started from the summer of 2019 in Beijing. After the COVID-19 pandemic outbreak in the end of 2019, the M. pneumoniae positive rates dropped dramatically. This may be due to the restrictive measures of the COVID-19 pandemic, which effectively controlled the transmission of M. pneumoniae. The relationships between M. pneumoniae positive rates and season, age, and gender were not statistically significant before and during the COVID-19 pandemic.
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Affiliation(s)
- Yuan Cheng
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yijing Cheng
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Shuzhi Dai
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Dongqing Hou
- Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, China
| | - Menglei Ge
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yi Zhang
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Lei Fan
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yingying Pei
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Li Yu
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
- *Correspondence: Lijuan Ma, ; Guanhua Xue,
| | - Lijuan Ma
- Department of Clinical Laboratory, Children’s Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
- *Correspondence: Lijuan Ma, ; Guanhua Xue,
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
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22
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Roh EJ, Lee MH, Lee JY, Kim HB, Ahn YM, Kim JK, Kim HY, Jung SS, Kim M, Kang EK, Yang EA, Lee SJ, Park Y, Seo JH, Lee E, Yang ES, Park KS, Shin M, Chung HL, Jang YY, Choi BS, Jung JA, Yu ST, Sung M, Kim JT, Kim BS, Hwang YH, Sol IS, Yang HJ, Han MY, Yew HY, Cho HM, Kim HY, Ahn YH, Lee ES, Kim DH, Hwang K, Jung SO, Shim JY, Chung EH. Analysis of national surveillance of respiratory pathogens for community-acquired pneumonia in children and adolescents. BMC Infect Dis 2022; 22:330. [PMID: 35379181 PMCID: PMC8977558 DOI: 10.1186/s12879-022-07263-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 03/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Respiratory infections among children, particularly community-acquired pneumonia (CAP), is a major disease with a high frequency among outpatient and inpatient visits. The causes of CAP vary depending on individual susceptibility, the epidemiological characteristics of the community, and the season. We performed this study to establish a nationwide surveillance network system and identify the causative agents for CAP and antibiotic resistance in Korean children with CAP. Methods The monitoring network was composed of 28 secondary and tertiary medical institutions. Upper and lower respiratory samples were assayed using a culture or polymerase chain reaction (PCR) from August 2018 to May 2020. Results A total of 1023 cases were registered in patients with CAP, and PCR of atypical pneumonia pathogens revealed 422 cases of M. pneumoniae (41.3%). Respiratory viruses showed a positivity rate of 65.7% by multiplex PCR test, and human rhinovirus was the most common virus, with 312 cases (30.5%). Two hundred sixty four cases (25.8%) were isolated by culture, including 131 cases of S. aureus (12.8%), 92 cases of S. pneumoniae (9%), and 20 cases of H. influenzae (2%). The cultured, isolated bacteria may be colonized pathogen. The proportion of co-detection was 49.2%. The rate of antibiotic resistance showed similar results as previous reports. Conclusions This study will identify the pathogens that cause respiratory infections and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infections. Additionally, in preparation for new epidemics, including COVID-19, monitoring respiratory infections in children and adolescents has become more important, and research on this topic should be continuously conducted in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07263-z.
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Affiliation(s)
- Eui Jeong Roh
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Mi-Hee Lee
- Department of Pediatrics, Incheon Medical Center, Incheon, Republic of Korea
| | - Ji Young Lee
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji University Hospital, Seoul, Republic of Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hyoung Young Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Sung-Su Jung
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Republic of Korea
| | - Minji Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Eun Kyeong Kang
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Eun-Ae Yang
- Department of Pediatrics, The Catholic University of Korea Daejeon's St. Mary's Hospital, Daejeon, Republic of Korea
| | - Soo Jin Lee
- Department of Pediatrics, Eulji University Hospital, Daejeon, Republic of Korea
| | - Yang Park
- Department of Pediatrics, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Seok Yang
- Department of Pediatrics, College of Medicine, Chosun University, Chosun University Hospital, Gwangju, Republic of Korea
| | - Kang Seo Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hai Lee Chung
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Yoon Young Jang
- Department of Pediatrics, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Bong Seok Choi
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin-A Jung
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seung Taek Yu
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Hospital, Gumi, Republic of Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Bong-Seong Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Yoon Ha Hwang
- Department of Pediatrics, Busan St. Mary's Hospital, Busan, Republic of Korea
| | - In-Suk Sol
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hae Young Yew
- Department of Pediatrics, Kogel Hospital, Daejeon, Republic of Korea
| | - Hyoung Min Cho
- Department of Pediatrics, Kwangju Christian Hospital, Kwangju, Republic of Korea
| | - Hye-Young Kim
- Department of Pediatrics, Pusan National University Hospital, Pusan, Republic of Korea
| | - Yeon-Hwa Ahn
- Department of Pediatrics, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
| | - Eun Sil Lee
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Dong Hyeok Kim
- Divison of Bacterial Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Sejong, Republic of Korea
| | - Kyujam Hwang
- Divison of Bacterial Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Sejong, Republic of Korea
| | - Sang Oun Jung
- Divison of Bacterial Diseases, Bureau of Infectious Disease Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Sejong, Republic of Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Republic of Korea.
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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23
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Choi YJ, Chung EH, Lee E, Kim CH, Lee YJ, Kim HB, Kim BS, Kim HY, Cho Y, Seo JH, Sol IS, Sung M, Song DJ, Ahn YM, Oh HL, Yu J, Jung S, Lee KS, Lee JS, Jang GC, Jang YY, Chung HL, Choi SM, Han MY, Shim JY, Kim JT, Kim CK, Yang HJ, Suh DI. Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study. J Clin Med 2022; 11:jcm11020306. [PMID: 35054002 PMCID: PMC8779611 DOI: 10.3390/jcm11020306] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 02/04/2023] Open
Abstract
Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.
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Affiliation(s)
- Yun Jung Choi
- Hospital Medicine Center, Seoul National University Hospital, Seoul KS013, Korea;
- Department of Pediatrics, Seoul National University Hospital, Seoul KS013, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon KS015, Korea;
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju KS018, Korea;
| | - Chul-Hong Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon KS011, Korea; (C.-H.K.); (J.S.L.)
| | - Yong Ju Lee
- Department of Pediatrics, Yongin Severance Hospital, Yongin KS009, Korea;
| | - Hyo-Bin Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul KS013, Korea; (H.-B.K.); (C.-K.K.)
| | - Bong-Seong Kim
- Department of Pediatrics, Ulsan University Gangneung Asan Hospital, Gangneung KS007, Korea;
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan KS011, Korea; (H.Y.K.); (S.J.)
| | - Yoojung Cho
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul KS013, Korea;
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University Hospital, Dankook University Medical School, Cheonan KS002, Korea;
| | - In Suk Sol
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul KS013, Korea; (I.S.S.); (J.Y.S.)
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Gumi KS010, Korea;
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul KS013, Korea;
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulju University, Seoul KS013, Korea;
| | - Hea Lin Oh
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul KS013, Korea;
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul KS013, Korea;
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan KS011, Korea; (H.Y.K.); (S.J.)
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri KS013, Korea;
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon KS011, Korea; (C.-H.K.); (J.S.L.)
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service, Ilsan Hospital, Goyang KS007, Korea;
| | - Yoon-Young Jang
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu KS002, Korea; (Y.-Y.J.); (H.L.C.)
| | - Hai Lee Chung
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu KS002, Korea; (Y.-Y.J.); (H.L.C.)
| | - Sung-Min Choi
- Department of Pediatrics, Dongguk University Gyeongju Hospital, Gyeongju KS010, Korea;
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam KS009, Korea;
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul KS013, Korea; (I.S.S.); (J.Y.S.)
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul KS013, Korea;
| | - Chang-Keun Kim
- Asthma and Allergy Center, Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul KS013, Korea; (H.-B.K.); (C.-K.K.)
| | - Hyeon-Jong Yang
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul KS013, Korea;
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul KS013, Korea
- Correspondence: (H.-J.Y.); (D.I.S.); Tel.: +82-02-709-9114 (H.-J.Y.); +82-2-2072-7559 (D.I.S.)
| | - Dong In Suh
- Department of Pediatrics, Seoul National University Hospital, Seoul KS013, Korea
- Correspondence: (H.-J.Y.); (D.I.S.); Tel.: +82-02-709-9114 (H.-J.Y.); +82-2-2072-7559 (D.I.S.)
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24
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Park YK, Park YN, Moon JE, Kim HB, Shin M, Lee E, Kim CH, Lee JS, Lee YJ, Kim BS, Kim HY, Jung S, Kim Y, Kim S, Park C, Seo JH, Shim JY, Sol IS, Sung M, Song DJ, Ahn YM, Oh HL, Yu J, Lee KS, Jang GC, Jang YY, Chung HL, Chung EH, Choi SM, Choi YJ, Han MY, Kim JT, Kim CK, Yang HJ. The incidence and risk factors of extrapulmonary manifestations in Mycoplasma pneumoniae pneumonia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.4.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoo Kyung Park
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - You Na Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ji Eun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Chul-Hong Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yong Ju Lee
- Department of Pediatrics, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan, Korea
| | - Yunsun Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sangyoung Kim
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Chorong Park
- SCH Biomedical Informatics Research Unit, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Ju-Hee Seo
- Departmentof Pediatrics, Dankook University Hospital, Dankook University Medical School, Cheonan, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Hea Lin Oh
- Department of Pediatrics, Korea Cancer Center Hospital, Ilsan, Korea
| | - Jinho Yu
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Korea
| | - Yoon-Young Jang
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Hai Lee Chung
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Eun Hee Chung
- Department of Pediatrics, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sung-Min Choi
- Department of Pediatrics, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Yun Jung Choi
- Departmentof Pediatrics, Seoul National University Children Hospital, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jin Tack Kim
- Department of Pediatrics, The Catholic University of Korea Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Chang-Keun Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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25
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Lee M, Kim YA, Jung S. Clinical characteristics and associated factors of Mycoplasma pneumoniae pneumonia with atelectasis in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2022. [DOI: 10.4168/aard.2022.10.3.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Miran Lee
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Young A Kim
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University School of Medicine, Yangsan, Korea
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26
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Clinical Significance of Pleural Effusion in Mycoplasma pneumoniae Pneumonia in Children. Pathogens 2021; 10:pathogens10091075. [PMID: 34578108 PMCID: PMC8469935 DOI: 10.3390/pathogens10091075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
The clinical significance of pleural effusion in Mycoplasma pneumoniae (MP) pneumonia in children has not yet been elucidated. Herein, we investigated the clinical implications of pleural effusion in children with MP pneumonia. Overall, 150 children with MP pneumonia transferred to a tertiary hospital were enrolled in this study. Information on their clinical, laboratory, and radiological features was retrospectively obtained from medical chart reviews. In total, 24 (16.0%) children had pleural effusion at the time of admission. The duration of fever and length of hospitalization were significantly longer in the pleural effusion group than in the non-pleural effusion group. A significantly higher proportion of individuals in the pleural effusion group had a poor response to stepwise treatment for MP pneumonia. The mean C-reactive protein, lactate dehydrogenase, and aspartate aminotransferase levels were significantly higher in the pleural effusion group than in the non-pleural effusion group at admission. The prevalence of severe pneumonia, defined on the basis of the extent of pneumonic lesions on chest radiography, was higher in the pleural effusion group than in the non-pleural effusion group. However, there was no significant intergroup difference in the proportion of macrolide-resistant MP cases or respiratory viral coinfections. The presence of pleural effusion in children with MP pneumonia indicated a more severe clinical course and poor treatment response. The results of the present study would help in the creation of a therapeutic plan and prediction of the clinical course of MP pneumonia in children.
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27
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Ling X, Sun X, Kong H, Peng S, Yu Z, Wen J, Yuan B. Chinese Herbal Medicine for the Treatment of Children and Adolescents With Refractory Mycoplasma Pneumoniae Pneumonia: A Systematic Review and a Meta-Analysis. Front Pharmacol 2021; 12:678631. [PMID: 34177587 PMCID: PMC8222696 DOI: 10.3389/fphar.2021.678631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Chinese herb medicine (CHM) is one of the most popular complementary and alternative therapies, which has been widely used to treat Refractory Mycoplasma Pneumoniae Pneumonia (RMPP). However, the effect and safety of CHM remain controversial. Hence, we conducted this meta-analysis to evaluate whether CHM combination therapy could bring benefits to children and adolescents with RMPP. Methods: Seven databases were used for data searching through November 11, 2020 following the PRISMA checklist generally. Review Manager 5.3, Trial sequential analysis 0.9.5.10 Beta software and Stata16.0 were applied to perform data analyses. Mean difference or risk ratio was adopted to express the results, where a 95% confidence interval (CI) was applied. Results: In general, this research enrolled 17 trials with 1,451 participants. The overall pooled results indicated that CHM was beneficial for children and adolescents with RMPP by improving the clinical efficacy rate [RR = 1.20, 95% CI (1.15, 1.25), p < 0.00001], shortening antipyretic time [MD = -2.60, 95% CI (-3.06, -2.13), p < 0.00001], cough disappearance time [MD = -2.77, 95% CI (-3.12, -2.42), p < 0.00001], lung rale disappearance time [MD = -2.65, 95% CI (-3.15, -2.15), p < 0.00001], lung X-ray infiltrates disappearance time [MD = -2.75, 95% CI (-3.33, -2.17), p < 0.00001], reducing TNF-α level [MD = -5.49, 95% CI (-7.21, -3.77), p < 0.00001]. Moreover, subgroup results suggested that removing heat-phlegm and toxicity therapy had more advantages in shortening antipyretic time, cough disappearance time, lung X-ray infiltrates disappearance time and reducing TNF-α level. Meanwhile promoting blood circulation therapy seemed to be better at relieving lung rale. However, regarding adverse events, the two groups displayed no statistical difference [RR = 0.97, 95% CI (0.60, 1.57), p = 0.91]. Conclusion: Despite of the apparently positive results in relieving clinical symptoms, physical signs and reducing inflammation, it is premature to confirm the efficacy of CHM in treating RMPP because of the limitation of quality and the number of the included studies. More large-scale, double-blind, well-designed, randomized controlled trials are needed in future research.
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Affiliation(s)
| | | | | | | | | | | | - Bin Yuan
- Department of Pediatrics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Kohns Vasconcelos M, Weil K, Vesterling-Hörner D, Klemm M, El Scheich T, Renk H, Remke K, Bosse HM. Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm. Fam Med Community Health 2021; 9:fmch-2021-000919. [PMID: 34039654 PMCID: PMC8159664 DOI: 10.1136/fmch-2021-000919] [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] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Globally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management during the COVID-19 pandemic, and to identify challenges for patient care. DESIGN Survey of paediatric primary care practices on consultation numbers and patient management changes, and semistructured interviews to identify challenges for patient care. Surveys and interviews were partially linked in an explanatory sequential design to identify patient groups perceived to be at higher risk for worse care during the pandemic. SETTING In and around Düsseldorf, a densely populated area in Western Germany. The primary care facilities are spread over an area with approximately 2 million inhabitants. PARTICIPANTS Primary care in Germany is provided through practices run by self-employed specialist physicians that are contracted to offer services to patients under public health insurance which is compulsory to the majority of the population. The sample contained 44 paediatric primary care practices in the area, the response rate was 50%. RESULTS Numbers of consultations for scheduled developmental examinations remained unchanged compared with the previous year while emergency visits were strongly reduced (mean 87.3 less/week in March-May 2020 compared with 2019, median reduction 55.0%). Children dependent on developmental therapy and with chronic health conditions were identified as patient groups receiving deteriorated care. High patient numbers, including of mildly symptomatic children presenting for health certificates, in combination with increased organisational demands and expected staff outages are priority concerns for the winter. CONCLUSIONS Primary care paediatricians offered stable service through the early pandemic but expected strained resources for the upcoming winter. Unambiguous guidance on which children should present to primary care and who should be tested would help to allocate resources appropriately, and this guidance needs to consider age group specific issues including high prevalence of respiratory symptoms, dependency on carers and high contact rates.
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Affiliation(s)
- Malte Kohns Vasconcelos
- Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katharina Weil
- Department for General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Katharina Remke
- Department for General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Hans Martin Bosse
- Department for General Paediatrics, Neonatology and Paediatric Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
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Zhang Y, Huang Y, Ai T, Luo J, Liu H. Effect of COVID-19 on childhood Mycoplasma pneumoniae infection in Chengdu, China. BMC Pediatr 2021; 21:202. [PMID: 33910509 PMCID: PMC8079841 DOI: 10.1186/s12887-021-02679-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Following the outbreak of the COVID-19 pandemic, a change in the incidence and transmission of respiratory pathogens was observed. Here, we retrospectively analyzed the impact of COVID-19 on the epidemiologic characteristics of Mycoplasma pneumoniae infection among children in Chengdu, one of the largest cities of western China. METHOD M. pneumoniae infection was diagnosed in 33,345 pediatric patients with respiratory symptoms at the Chengdu Women's & Children's Central Hospital between January 2017 and December 2020, based on a serum antibody titer of ≥1:160 measured by the passive agglutination assay. Differences in infection rates were examined by sex, age, and temporal distribution. RESULTS Two epidemic outbreaks occurred between October-December 2017 and April-December 2019, and two infection peaks were detected in the second and fourth quarters of 2017, 2018, and 2019. Due to the public health response to COVID-19, the number of positive M. pneumoniae cases significantly decreased in the second quarter of 2020. The number of M. pneumoniae infection among children aged 3-6 years was higher than that in other age groups. CONCLUSIONS Preschool children are more susceptible to M. pneumoniae infection and close contact appears to be the predominant factor favoring pathogen transmission. The public health response to COVID-19 can effectively control the transmission of M. pneumoniae.
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Affiliation(s)
- Ying Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), West China Second University Hospital, Ministry of Education, Sichuan University, No.20 section3 South Renmin Road, Sichuan Province, 610041, Chengdu, China.,Children respiratory department,Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Yijie Huang
- Children respiratory department,Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Tao Ai
- Children respiratory department,Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Jun Luo
- Children respiratory department,Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, 611731, Chengdu, China
| | - Hanmin Liu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), West China Second University Hospital, Ministry of Education, Sichuan University, No.20 section3 South Renmin Road, Sichuan Province, 610041, Chengdu, China.
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Wen J, Su Y, Sun H, Zhang H, Li H. The combination of initial markers to predict refractory Mycoplasma pneumoniae pneumonia in Chinese children: a case control study. Respir Res 2021; 22:89. [PMID: 33752670 PMCID: PMC7983087 DOI: 10.1186/s12931-020-01577-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Thise study is aimed to identify the biomarkers for predicting refractory Mycoplasma pneumoniae pneumonia in Chinese children at the time of the hospital admission. Methods The case control study retrospectively analyzed the clinical characteristics and laboratory results of Chinese pediatric patients presenting with common and refractory Mycoplasma pneumoniae pneumonia (CMPP and RMPP). Overall, there were 216 cases in the CMPP group and 88 cases in the RMPP group. Venous blood was collected, and serum ferritin (SF), lactate dehydrogenase (LDH), D-dimer, C-reactive protein (CRP), procalcitonin (PCT), neutrophil count/lymphocyte count (NLR), and other indexes were measured. A single factor analysis, an ROC curve analysis, and a logistic regression analysis were used to determine the independent risk factors of RMPP and find combination of initial markers for RMPP. Results There were significant differences between the RMPP group and the CMPP group in mean SF (529.82 [357.86] vs. 147.22 [122.68] ng/mL), LDH (522.08 [389.08] vs. 286.85 [101.02] U/L), D-dimer (6.65 [5.66] vs. 1.46 [2.45] μg/mL), CRP (62.80 [52.15] vs. 19.03 [24.50] mg/L), PCT (0.80 [2.61] vs. 0.16 [0.44]) ng/mL, and NLR (4.14 [2.52] vs. 2.62 [1.55]), with P < 0.05 for each comparison. ROC cut-off values of the above indexes were 329.01 ng/mL, 375.50 U/L, 2.10 μg/mL, 43.08 mg/L, 0.08 ng/mL, and 2.96, respectively. The logistic regression analysis showed that SF, D-dimer, and CRP are independent risk factors to predict RMPP. Conclusion SF, D-dimer, and CRP are statistically significant biomarkers to predict RMPP in Chinese children patients in the settings of pediatric emergency department.
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Affiliation(s)
- Jun Wen
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, No. 227, Yanta West Road, Yanta district, Xi'an, Shaanxi, 86-710061, People's Republic of China.,Department of Emergency, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710061, People's Republic of China
| | - Yufei Su
- Department of Emergency, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710061, People's Republic of China
| | - Hongli Sun
- Shaanxi Institute for Pediatric Diseases, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710003, People's Republic of China
| | - Huiping Zhang
- Department of Neonatology, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710003, People's Republic of China
| | - Hui Li
- Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, No. 227, Yanta West Road, Yanta district, Xi'an, Shaanxi, 86-710061, People's Republic of China. .,Department of Neonatology, Xi'an Children's Hospital, Xi'an, Shaanxi, 86-710003, People's Republic of China.
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Predictive Factors of the Responses to Treatment of Mycoplasma pneumoniae Pneumonia. J Clin Med 2021; 10:jcm10061154. [PMID: 33801856 PMCID: PMC7998824 DOI: 10.3390/jcm10061154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
The prevalence of refractory Mycoplasma pneumoniae (MP) pneumonia is increasing. The present study aimed to identify the predictive factors of responses to treatment of MP pneumonia in children. A total of 149 children were diagnosed with MP pneumonia, of whom 56 were included in the good response group, 75 children in the slow response group, and 18 children in no response or progression group. Data on the clinical, laboratory, and radiologic features were retrospectively obtained through medical chart reviews. The severity of pneumonia, based on the extent of pneumonic lesions on chest x-ray (adjusted odds ratio (aOR), 10.573; 95% confidence intervals (CIs), 2.303-48.543), and lactate dehydrogenase (LDH) levels (aOR, 1.002; 95% CIs, 1.000-1.004) at the time of admission were associated with slow response to treatment of MP pneumonia. Pleural effusion (aOR, 5.127; 95% CIs, 1.404-18.727), respiratory virus co-infection (aOR, 4.354; 95% CIs, 1.374-13.800), and higher LDH levels (aOR, 1.005; 95% CIs, 1.002-1.007) as well as MP-specific IgM titer (aOR, 1.309; 95% CIs, 1.095-1.564) were associated with no response or progression of MP pneumonia. The area under the curve for the prediction of no or poor response in MP pneumonia using pleural effusion, respiratory virus co-infection, LDH levels, and MP-specific IgM titer at the time of admission was 0.8547. This study identified the predictive factors of responses to treatment of MP pneumonia in children, which would be helpful in establishing a therapeutic plan and predicting the clinical course of MP pneumonia in children.
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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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Lee E, Young Lee Y. Risk factors for the development of post-infectious bronchiolitis obliterans after Mycoplasma pneumoniae pneumonia in the era of increasing macrolide resistance. Respir Med 2020; 175:106209. [PMID: 33186845 DOI: 10.1016/j.rmed.2020.106209] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prevalence of macrolide-resistant Mycoplasma pneumoniae (MP) pneumonia has been rapidly increased. MP pneumonia is a risk factor for the development of post-infectious bronchiolitis obliterans (PIBO). The aim of the present study was to identify the risk factors for the development of PIBO after MP pneumonia in the era of increasing macrolide resistance of MP. MATERIALS AND METHODS This retrospective study enrolled 150 children with a mean age of 6.0 years admitted to the hospital due to MP pneumonia between May 2019 and February 2020 at a tertiary hospital. The clinical, radiologic, and laboratory data were obtained using retrospective chart review. RESULTS Eighteen children (12%) were diagnosed with PIBO after MP pneumonia. PIBO was diagnosed after a mean duration of 100.0 days (range, 6-268 days) from symptom onset. The respiratory virus co-infection (adjusted odds ratio [aOR], 4.069; 95% confidence interval [95% CI], 1.224-13.523), adenovirus co-infection (aOR, 5.607; 95% CI, 1.801-17.454), longer duration between symptom onset and admission (aOR, 1.150; 95% CI, 1.020-1.298), higher levels of serum lactate dehydrogenase (LDH) at the time of admission (aOR, 1.001; 95% CI, 1.000-1.003), and poor response to stepwise treatment increased the risk for development of PIBO after MP pneumonia. However, macrolide resistance of MP was not associated with development of PIBO after MP pneumonia. CONCLUSION The present study suggests that respiratory virus co-infection, including adenovirus, poor response to the treatment of MP pneumonia, and higher levels of serum LDH, but not macrolide resistance of MP, are risk factors of PIBO after MP pneumonia.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
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Shi J, Zhou Y, Wang F, Wang C, Miao H, Sun T, Shan Y, Cui Y, Zhang Y. A case series of children with adenovirus pneumonia: three-year experiences in a tertiary PICU. BMC Pediatr 2020; 20:375. [PMID: 32772917 PMCID: PMC7415409 DOI: 10.1186/s12887-020-02269-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/02/2020] [Indexed: 12/03/2022] Open
Abstract
Background Describe the outcome of adenovirus pneumonia in a pediatric intensive care unit (PICU) over a 3-year period, to identify the risk factors that may be associated with worse outcome. Methods A retrospective observational study was performed in the PICU of children’s hospital in Shanghai from July 2016 to June 2019. Sixty-seven children over 29 days to 14 years old with adenovirus pneumonia who were admitted to PICU with acute hypoxemic respiratory failure were included in this study. The primary outcome was hospital mortality, and secondary outcomes were hospital and PICU length of stay (LOS), and risk factors of worse outcome. Results Of 67 children with severe adenovirus pneumonia, the hospital mortality was 16.42% (11/67) and 28-day mortality was 14.93% (10/67). Median Pediatric Risk of Mortality III (PRISM III) score at admission was 13 (interquartile range [IQR], 10–15). Median PICU LOS stay was 11 days (8-18d) and hospital LOS was 22 days (16-31d). Among children with extracorporeal membrane oxygenation (n = 9), 6 cases survived and 3 cases died. The patients who need renal replacement therapy, neuromuscular blockade, parenteral nutrition, and packed red blood cell perfusion had higher hospital mortality (p < 0.001, p = 0.041, p = < 0.001, p = 0.012, respectively). Multivariate logistic analysis indicated that liver dysfunction and nosocomial infection were associated with high risk of mortality. Conclusions The hospital mortality of adenovirus pneumonia in our PICU was 16.42%. Patients complicated liver dysfunction and co-infection & nosocomial infection were associated with poor outcome.
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Affiliation(s)
- Jingyi Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Yiping Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Fei Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Chunxia Wang
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Huijie Miao
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Ting Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Yijun Shan
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China
| | - Yun Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
| | - Yucai Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital; Institute of Pediatric Critical Care, Shanghai Jiao Tong University, No.355 Luding Road, Putuo District, Shanghai, 200062, China.
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Xing Y, Wang D, Sheng K, Xiao X, Wei H, Liu L, Zhou W, Tong X. Dynamic change of Mycoplasma pneumoniae pneumonia in hospitalized children in a general hospital: a 3-year retrospective analysis. Transl Pediatr 2020; 9:522-531. [PMID: 32953550 PMCID: PMC7475305 DOI: 10.21037/tp-20-149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The epidemiology and economic burden of hospitalized community-acquired pneumonia (CAP) children due to MP is still poorly understood. This study aimed to investigate the dynamic changes of Mycoplasma pneumoniae pneumonia (MPP) in children in a general hospital. METHODS A total of 2011 CAP children aged 1-16 years hospitalized at Peking University Third Hospital from 2017 to 2019 were enrolled by cross-sectional study for the retrospective analysis of the clinical data mainly including seasonal distribution of MPP, hospital stay, severity, complications, use of flexible bronchoscopy, and hospitalization costs. The dynamic changes of CAP and MPP children within 3 consecutive years and the differences between the MPP group and non-MPP groups were compared. RESULTS The proportion of CAP children among hospitalized children was 32.4%, 38.5%, and 39.5% in 2017, 2018, and 2019, respectively, showing an upward trend (P<0.05).The prevalence rate of MPP was highest in the third quarter (30.2%) and the fourth quarter (39.2%) and lowest in the second quarter (13.2%) (χ2=51.8, P<0.05). Compared with the non-MPP group, the MPP group had significantly higher incidence of severe pneumonia (19.4% vs. 12.0%, χ2=20.99), incidence of complications (16.1% vs. 6.5%, χ2=48.24), proportion of patients undergoing flexible bronchoscopy (38.4% vs. 9.0%, χ2=252.79), and hospitalization costs (all P<0.05), along with significantly longer hospital stay (6 vs. 4 days, z=-11.131). A dynamic comparison of the clinical characteristics of MPP in 3 years showed that the number of children with MPP increased significantly in preschoolers in 2018 (37.3%) and in school-aged or older children in 2019 (53%) (P<0.05). MPP peaks occurred in August 2018 and November 2019. The total hospitalization costs, examination fees, and non-medication treatment costs increased significantly (the z values were 35.24, 46.79, and 9.64, respectively; P<0.05) year by year among MPP children; there was no significant difference in the medication cost over these 3 years (z=4.81, P>0.05). CONCLUSIONS The proportions of severe pneumonia, complications, and use of flexible bronchoscopy as well as the hospitalization days and costs are higher in MPP children. General hospitals should develop integrated clinical quality control programs for MPP children, so as to optimize the allocation of medical resources.
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Affiliation(s)
- Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Dan Wang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Kai Sheng
- Department of Emergency, Beijing Children's Hospital, Beijing, China
| | - Xiumei Xiao
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Hongling Wei
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Ling Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Wei Zhou
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiaomei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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