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Ye Z, Chen Y, Tian X. Case report: a co-occurring case of severe Mycoplasma pneumoniae pneumonia and Anti-IgLON5 antibody-associated encephalitis in a pediatric patient. Front Med (Lausanne) 2024; 11:1393540. [PMID: 39224609 PMCID: PMC11366704 DOI: 10.3389/fmed.2024.1393540] [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: 02/29/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
This case report details the clinical course of a 16-year-old female student with Mycoplasma pneumoniae infection complicated by autoimmune encephalitis, spanning from 6 February 2022, to 12 April 2022, with a one-year follow-up. The patient presented with a two-week history of cough and fever, followed by altered consciousness and neuropsychiatric symptoms, including hyperactivity and incoherent speech. Despite normal brain MRI findings, cerebrospinal fluid (CSF) analysis confirmed Mycoplasma pneumoniae with titers of, and positive IgLON5 antibodies. Initial treatment included azithromycin, ceftriaxone, and acyclovir, followed by mechanical ventilation and ECMO due to respiratory failure. The antibiotic regimen was switched to intravenous omadacycline based on genetic testing results. Autoimmune encephalitis was managed with intravenous methylprednisolone, intravenous immunoglobulin (IVIG), and plasma exchange. The patient's condition improved, and she was discharged on 12 March 2022, with normal cognitive and behavioral functions. However, she was readmitted one month later due to cognitive decline and sleep disturbances, with a Mini-Mental State Examination (MMSE) score of 20/30 and a modified Rankin Scale (mRS) score of 3. At the one-year follow-up, her MMSE score had improved to 28/30, and her mRS score was 1. This case underscores the importance of comprehensive diagnostic approaches and personalized treatment strategies in managing complex cases of mycoplasma-related infections and associated autoimmune conditions.
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Affiliation(s)
| | | | - Xin Tian
- Department of Intensive Care Unit, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
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Wang YS, Zhou YL, Bai GN, Li SX, Xu D, Chen LN, Chen X, Dong XY, Fu HM, Fu Z, Hao CL, Hong JG, Liu EM, Liu HM, Lu XX, Luo ZX, Tang LF, Tian M, Yin Y, Zhang XB, Zhang JH, Zhang HL, Zhao DY, Zhao SY, Zhu GH, Zou YX, Lu Q, Zhang YY, Chen ZM. Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. World J Pediatr 2024:10.1007/s12519-024-00831-0. [PMID: 39143259 DOI: 10.1007/s12519-024-00831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is a significant contributor to community-acquired pneumonia among children. Since 1968, when a strain of M. pneumoniae resistant to macrolide antibiotics was initially reported in Japan, macrolide-resistant M. pneumoniae (MRMP) has been documented in many countries worldwide, with varying incidence rates. MRMP infections lead to a poor response to macrolide antibiotics, frequently resulting in prolonged fever, extended antibiotic treatment, increased hospitalization, intensive care unit admissions, and a significantly higher proportion of patients receiving glucocorticoids or second-line antibiotics. Since 2000, the global incidence of MRMP has gradually increased, especially in East Asia, which has posed a serious challenge to the treatment of M. pneumoniae infections in children and attracted widespread attention from pediatricians. However, there is still no global consensus on the diagnosis and treatment of MRMP in children. METHODS We organized 29 Chinese experts majoring in pediatric pulmonology and epidemiology to write the world's first consensus on the diagnosis and treatment of pediatric MRMP pneumonia, based on evidence collection. The evidence searches and reviews were conducted using electronic databases, including PubMed, Embase, Web of Science, CNKI, Medline, and the Cochrane Library. We used variations in terms for "macrolide-resistant", "Mycoplasma pneumoniae", "MP", "M. pneumoniae", "pneumonia", "MRMP", "lower respiratory tract infection", "Mycoplasma pneumoniae infection", "children", and "pediatric". RESULTS Epidemiology, pathogenesis, clinical manifestations, early identification, laboratory examination, principles of antibiotic use, application of glucocorticoids and intravenous immunoglobulin, and precautions for bronchoscopy are highlighted. Early and rapid identification of gene mutations associated with MRMP is now available by polymerase chain reaction and fluorescent probe techniques in respiratory specimens. Although the resistance rate to macrolide remains high, it is fortunate that M. pneumoniae still maintains good in vitro sensitivity to second-line antibiotics such as tetracyclines and quinolones, making them an effective treatment option for patients with initial treatment failure caused by macrolide antibiotics. CONCLUSIONS This consensus, based on international and national scientific evidence, provides scientific guidance for the diagnosis and treatment of MRMP in children. Further studies on tetracycline and quinolone drugs in children are urgently needed to evaluate their effects on the growth and development. Additionally, developing an antibiotic rotation treatment strategy is necessary to reduce the prevalence of MRMP strains.
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Affiliation(s)
- Ying-Shuo Wang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Yun-Lian Zhou
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Guan-Nan Bai
- Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Shu-Xian Li
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Dan Xu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Li-Na Chen
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xing Chen
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Xiao-Yan Dong
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hong-Min Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Children's Hospital, Kunming 650034, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Chuang-Li Hao
- Department of Pulmonology, Children's Hospital of Soochow University, Suzhou 215003, China
| | - Jian-Guo Hong
- Department of Pediatrics, Shanghai General Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200080, China
| | - En-Mei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Han-Min Liu
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao-Xia Lu
- Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Zheng-Xiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Lan-Fang Tang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Man Tian
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Xiao-Bo Zhang
- Department of Respiratory Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Jian-Hua Zhang
- Department of Pediatric Pulmonology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201102, China
| | - Hai-Lin Zhang
- Department of Pediatric Respiratory Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - De-Yu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Shun-Ying Zhao
- National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Guo-Hong Zhu
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
| | - Ying-Xue Zou
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin 300074, China
| | - Quan Lu
- Department of Pulmonology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China.
| | - Yuan-Yuan Zhang
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
| | - Zhi-Min Chen
- Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China.
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Qian Y, Tao Y, Wu L, Zhou C, Liu F, Xu S, Miao H, Gao X, Ge X. Model based on the automated AI-driven CT quantification is effective for the diagnosis of refractory Mycoplasma pneumoniae pneumonia. Sci Rep 2024; 14:16172. [PMID: 39003340 PMCID: PMC11246496 DOI: 10.1038/s41598-024-67255-8] [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: 09/06/2023] [Accepted: 07/09/2024] [Indexed: 07/15/2024] Open
Abstract
The prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP) remains a clinically significant challenge. This study aimed to develop an early predictive model utilizing artificial intelligence (AI)-derived quantitative assessment of lung lesion extent on initial computed tomography (CT) scans and clinical indicators for RMPP in pediatric inpatients. A retrospective cohort study was conducted on patients with M. pneumoniae pneumonia (MP) admitted to the Children's Hospital of Nanjing Medical University, China from January 2019 to December 2020. An early prediction model was developed by stratifying the patients with Mycoplasma pneumoniae pneumonia (MPP) into two cohorts according to the presence or absence of refractory pneumonia. A retrospective cohort of 126 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) was utilized as a training set, with 85 cases classified as RMPP. Subsequently, a prospective cohort comprising 54 MPP cases, including 37 instances of RMPP, was assembled as a validation set to assess the performance of the predictive model for RMPP from January to December 2021. We defined a constant Φ which can combine the volume and CT value of pulmonary lesions and be further used to calculate the logarithm of Φ to the base of 2 (Log2Φ). A clinical-imaging prediction model was then constructed utilizing Log2Φ and clinical characteristics. Performance was evaluated by the area under the receiver operating characteristic curve (AUC). The clinical model demonstrated AUC values of 0.810 and 0.782, while the imaging model showed AUC values of 0.764 and 0.769 in the training and test sets, respectively. The clinical-imaging model, incorporating Log2Φ, temperature(T), aspartate aminotransferase (AST), preadmission fever duration (PFD), and preadmission macrolides therapy duration (PMTD), achieved the highest AUC values of 0.897 and 0.895 in the training and test sets, respectively. A prognostic model developed through automated quantification of lung disease on CT scans, in conjunction with clinical data in MPP may be utilized for the early identification of RMPP.
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Affiliation(s)
- Yali Qian
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yunxi Tao
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lihui Wu
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changsheng Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shenglong Xu
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongjun Miao
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiucheng Gao
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Xuhua Ge
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Wei D, Zhao Y, Zhang T, Xu Y, Guo W. The role of LDH and ferritin levels as biomarkers for corticosteroid dosage in children with refractory Mycoplasma pneumoniae pneumonia. Respir Res 2024; 25:266. [PMID: 38965565 PMCID: PMC11225272 DOI: 10.1186/s12931-024-02892-1] [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: 11/07/2023] [Accepted: 06/25/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND This study explored the relationship between inflammatory markers and glucocorticoid dosage upon admission. METHODS We conducted a retrospective analysis of 206 patients with refractory Mycoplasma pneumoniae pneumonia (RMPP) admitted to a Children's Hospital from November 2017 to January 2022. Patients were categorized into three groups based on their methylprednisolone dosage: low-dose (≤ 2 mg/kg/d), medium-dose (2-10 mg/kg/d), and high-dose (≥ 10 mg/kg/d). We compared demographic data, clinical manifestations, laboratory findings, and radiological outcomes. Spearman's rank correlation coefficient was used to assess relationships between variables. RESULTS The median age was highest in the low-dose group at 7 years, compared to 5.5 years in the medium-dose group and 6 years in the high-dose group (P < 0.001). The body mass index (BMI) was also highest in the low-dose group at 16.12, followed by 14.86 in the medium-dose group and 14.58 in the high-dose group (P < 0.001). More severe radiographic findings, longer hospital stays, and greater incidence of hypoxia were noted in the high-dose group (P < 0.05). Additionally, significant increases in white blood cells, C-reactive protein, procalcitonin, lactate dehydrogenase (LDH), alanine transaminase, aspartate transaminase, ferritin, erythrocyte sedimentation rate, and D-dimer levels were observed in the high-dose group (P < 0.05). Specifically, LDH and ferritin were markedly higher in the high-dose group, with levels at 660.5 U/L and 475.05 ng/mL, respectively, compared to 450 U/L and 151.4 ng/mL in the medium-dose group, and 316.5 U/L and 120.5 ng/mL in the low-dose group. Correlation analysis indicated that LDH and ferritin levels were significantly and positively correlated with glucocorticoid dose (Spearman ρ = 0.672 and ρ = 0.654, respectively; P < 0.001). CONCLUSIONS Serum LDH and ferritin levels may be useful biomarkers for determining the appropriate corticosteroid dosage in treating children with RMPP.
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Affiliation(s)
- DiWei Wei
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
- Children's Clinical College of Tianjin Medical University, Tianjin, China
| | - YiDi Zhao
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
- Children's Clinical College of Tianjin Medical University, Tianjin, China
| | - TongQiang Zhang
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
| | - YongSheng Xu
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China
| | - Wei Guo
- Department of Pulmonology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin Pediatric Research Institute and Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, 300134, China.
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Jia W, Dou W, Zeng H, Wang Q, Shi P, Liu J, Liu Z, Zhang J, Zhang J. Diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome complicated by infection: a single center retrospective study. Pediatr Res 2024; 95:722-728. [PMID: 37773440 DOI: 10.1038/s41390-023-02830-9] [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: 02/21/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE The purpose was to look into the diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome co-infection. METHODS One hundred and forty-nine children with nephrotic syndrome who met the inclusion and exclusion criteria were included in this study. The children were divided into three groups: bacterial infection group, non-bacterial infection group, and non-infection group. The diagnostic value was analyzed and compared using the ROC curve. RESULTS There was no statistically significant difference in the Leukocyte counts among three groups. The mean results of serum CRP, PCT and IL-6 were significantly higher in the bacterial infection group compared to those in the non-infection group (p < 0.05). AUC of CRP, PCT, IL-6 in bacterial infection were 0.791, 0.859, 0.783. The following combinations CRP + PCT + IL-6, IL-6 + PCT, CRP + PCT significantly increased the efficiency of bacterial infection diagnosis, the AUCs were 0.881, 0.884, and 0.884, respectively. AUC of PCT in non-bacterial infection was 0.663. The combinations of these three clinical indicators performed no better than PCT in ROC analysis. CONCLUSION Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve the diagnostic value. IMPACT This study evaluated the diagnostic value of the serum concentrations of CRP, PCT and IL-6 and assessed whether the value of their combined application is better than when used alone for diagnosing primary nephrotic syndrome complicated by infection. The elevation in leukocyte count cannot be used to diagnose children with nephrotic syndromes on long-term glucocorticoid treatment who have bacterial infections. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve diagnostic value, sensitivity, and specificity.
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Affiliation(s)
- Wanyu Jia
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Wenjie Dou
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Huiqin Zeng
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Qin Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Peipei Shi
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jing Liu
- Department of Nephrology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhen Liu
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jin Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China
| | - Jianjiang Zhang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Clinical Center of Pediatric Nephrology of Henan Province, Zhengzhou, 450052, China.
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Luo Y, Dai J, Tang G, He S, Fu W. Development and validation of a simple-to-use nomogram for predicting the delayed radiographic recovery in children with mycoplasma pneumoniae pneumonia complicated with atelectasis. J Investig Med 2023; 71:722-729. [PMID: 37269107 DOI: 10.1177/10815589231169686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study aimed to develop and validate a simple-to-use nomogram for predicting the delayed radiographic recovery in children with mycoplasma pneumoniae pneumonia (MPP) complicated with atelectasis. A retrospective study of 306 children with MPP complicated with atelectasis was performed at the Children's Hospital of Chongqing Medical University from February 2017 to March 2020.The patients were divided into recovery group and delayed recovery group based on chest CT scan 1 month after discharge. A least absolute shrinkage and selection operator (LASSO) regression model was used to identify the optimal predictors, and the predictive nomogram was plotted by multivariable logistic regression. The nomogram was assessed by calibration, discrimination, and clinical utility. LASSO regression analysis identified that lactate dehydrogenase (LDH), duration of illness prior to bronchoalveolar lavage (BAL), systemic glucocorticoid use and extrapulmonary complications were the optimal predictors for delayed radiographic recovery. The nomogram was plotted by the four predictors. The area under the Receiver Operating Characteristic (ROC) curve of the nomogram was 0.840 (95% CI = 784 ∼ 0.896) in the training set and 0.833 (95% CI = 0.8737 ∼ 0.930) in the testing set. The calibration curve demonstrated that the nomogram was well-fitted, and decision curve analysis (DCA) showed that the nomogram was clinically beneficial. This study developed and validated a simple-to-use nomogram for predicting delayed radiographic recovery in children with MPP complicated with atelectasis. This might be generally applied in clinical practice.
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Affiliation(s)
- Yonghan Luo
- Second Department of Infectious Disease, Kunming Children's Hospital, Kunming, Yunnan, P.R. China
| | - Jihong Dai
- Chongqing Key Laboratory of Pediatrics, Department of Respiratory Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Guojing Tang
- Department of Critical Care Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Shan He
- Chongqing Key Laboratory of Pediatrics, Department of Respiratory Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Wenlong Fu
- Chongqing Key Laboratory of Pediatrics, Department of Respiratory Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P. R. China
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Asif M, Chaudhry HS, Aslam S, Nadeem I, Chaudhry SS, Khan W. Heart Failure Associated With Mycoplasma Pneumoniae Infection, A Case and Review of Literature. J Community Hosp Intern Med Perspect 2023; 13:55-58. [PMID: 37877064 PMCID: PMC10593156 DOI: 10.55729/2000-9666.1182] [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: 01/22/2023] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 10/26/2023] Open
Abstract
Mycoplasma pneumoniae is well known to cause pulmonary infection. However, it often has extrapulmonary manifestations as well. We diagnosed and treated a 41-year-old female who presented with symptoms of pneumonia along with multisystem involvement, including rash, acute hepatitis, and new onset heart failure that improved with steroids and doxycycline. Subsequent guideline-directed medical therapy for non-ischemic cardiomyopathy (NICM) coincided with the complete recovery of the left ventricular function in three months. We also did a brief literature review with similar prior reported cases.
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Affiliation(s)
- Muhammad Asif
- Avera Mckennan Hospital and University Health Center, Sioux Falls, SD,
USA
| | - Hammad S. Chaudhry
- Avera Mckennan Hospital and University Health Center, Sioux Falls, SD,
USA
| | - Sadia Aslam
- Avera Mckennan Hospital and University Health Center, Sioux Falls, SD,
USA
| | - Ifrah Nadeem
- Avera Mckennan Hospital and University Health Center, Sioux Falls, SD,
USA
| | | | - Wahab Khan
- Avera Mckennan Hospital and University Health Center, Sioux Falls, SD,
USA
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Han J, Cao L, Liang Y, Wang Y. Clinical observation of Tanreqing combined with azithromycin in sequential treatment of mycoplasma pneumonia in children. Minerva Pediatr (Torino) 2023; 75:161-163. [PMID: 36519792 DOI: 10.23736/s2724-5276.22.07117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jia Han
- Department of Pharmacy, Affiliated Hospital of Hebei University, Baoding, China
| | - Lian Cao
- Department of Cardiology, General Hospital of North China Petroleum Administration, Renqiu, China
| | - Yanhui Liang
- Department of Head and Neck Surgery, Affiliated Hospital of Hebei University, Baoding, China
| | - Yuxia Wang
- Department of Cardiology, General Hospital of North China Petroleum Administration, Renqiu, China -
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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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Shen HX, Liu C, Lin HJ, Xu LJ, Wang GY, Yan MX. The efficacy and safety of minocycline as adjuvant therapy in refractory mycoplasma pneumonia in Chinese children: a meta-analysis. Ital J Pediatr 2022; 48:176. [PMID: 36131320 PMCID: PMC9494764 DOI: 10.1186/s13052-022-01362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background To explore the efficacy and safety of minocycline as adjuvant therapy for refractory mycoplasma pneumonia in Chinese children. Methods PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched. Studies where minocycline was used as adjuvant therapy for refractory mycoplasma pneumonia in Chinese children were included. The effect of numeration data and the measurement data were represented by odds ratios (OR) and weighted mean differences (MD), respectively. Review Manager version 5.3 was used to compare the treatment efficacy, time for the cough to subside, defervescence time, hospitalisation time, adverse events and other indicators. Results Ten studies involving 857 patients were included in the final analysis. Compared with the conventional treatment of refractory mycoplasma pneumonia in children, the addition of minocycline as adjuvant therapy was found to improve the treatment efficacy (OR: 5.45; 95% CI: 3.46, 8.57, p < 0.001); shorten the duration of cough (MD: -3.61; 95%CI: -4.25, -2.97, p < 0.001), fever time (MD: -4.77; 95% CI: -6.30, -3.23, p < 0.001) and hospitalisation time (MD: -5.53 (95% CI: -7.19, -3.88, p < 0.001); and decrease the concentration of C-reactive protein (MD: -13.95; 95%CI: -18.61, -9.29; p < 0.001) and the erythrocyte sedimentation rate (MD: -10.88; 95% CI: -14.05, -7.72, p < 0.001). The use of minocycline did not lead to significant adverse events (OR = 0.63; 95% CI: 0.39, 1.01, p = 0.05). Conclusion The use of minocycline as adjuvant treatment of refractory mycoplasma pneumonia in Chinese children has good efficacy and safety and may be promoted in clinical practice.
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Affiliation(s)
- Hong-Xia Shen
- Department of Pharmacy, Women and Children's Hospital, Qingdao University, No. 6 of Tongfu Street, Shibei District, Qingdao, 266034, China
| | - Chang Liu
- Department of Pharmacy, Women and Children's Hospital, Qingdao University, No. 6 of Tongfu Street, Shibei District, Qingdao, 266034, China
| | - Hui-Jun Lin
- Department of Pharmacy, Women and Children's Hospital, Qingdao University, No. 6 of Tongfu Street, Shibei District, Qingdao, 266034, China
| | - Lu-Jie Xu
- Department of Pharmacy, Women and Children's Hospital, Qingdao University, No. 6 of Tongfu Street, Shibei District, Qingdao, 266034, China
| | - Guang-Yan Wang
- Department of Pharmacy, Women and Children's Hospital, Qingdao University, No. 6 of Tongfu Street, Shibei District, Qingdao, 266034, China
| | - Mei-Xing Yan
- Department of Pharmacy, Women and Children's Hospital, Qingdao University, No. 6 of Tongfu Street, Shibei District, Qingdao, 266034, China.
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11
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Liang M, Meng Y, Wang X, Wang L, Tang G, Wang W. The Effectiveness of Wogonin on Treating Cough Mice With Mycoplasma Pneumoniae Infection. Front Mol Biosci 2022; 9:803842. [PMID: 35911969 PMCID: PMC9335494 DOI: 10.3389/fmolb.2022.803842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Abstract
Background: Cough is the main symptom of mycoplasma pneumoniae (MP) infection. Cough potential protein transient receptor potential A1 (TRPA1) plays an important role in cough reflex. The purpose of this study was to clarify the mechanism of wogonin, the effective component of Qinbai Qingfei concentrated pellet (Qinbai), in the treatment of cough after MP infection. Methods: The Biacore™ system was used to detect whether there was specific binding between Qinbai and cough potential protein TRPA1. Biacore™ fishing technology and UPLC-Q-TOF-MS technology were used during fishing combined active components and identification and analysis of recovered samples. The expression levels of TRPA1, substance P (SP), calcitonin gene-related peptide (CGRP), cough-related proteins, and mRNA in the lung tissues from each group were detected by immunohistochemistry, Western blot, and real-time PCR. Results: Biacore™ results showed that Qinbai had strong specific binding to TRPA1 protein with a binding value of 99.0 resonance unit (RU). The samples obtained from angling were identified and analyzed by UPLC-Q-TOF-MS as wogonin. The results of immunohistochemistry, Western blot, and real-time PCR showed that compared with the model group, the wogonin group had lower expressions of mRNA, TRPA1, SP, and CGRP in the lung tissue of cough mice with MP infection (p < 0.01 or p < 0.05), and the effects were superior to those of azithromycin and pentoxyverine control groups. Conclusion: Wogonin can treat cough after MP infection by affecting the expressions of cough-related proteins, such as TRPA1, SP, and CGRP. This study provided a theoretical foundation for the clinical research of Qinbai.
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Affiliation(s)
- Mingchuan Liang
- Heilongjiang Academy of Chinese Medicine Sciences, Harbin, China
| | - Yanli Meng
- Heilongjiang Academy of Chinese Medicine Sciences, Harbin, China
- *Correspondence: Yanli Meng, ; Guixin Tang, ; Weiming Wang,
| | - Xiaoxi Wang
- Heilongjiang Academy of Chinese Medicine Sciences, Harbin, China
| | - Lei Wang
- Heilongjiang Academy of Chinese Medicine Sciences, Harbin, China
| | - Guixin Tang
- Advanced Microscopy and Instrumentation Research Center, Harbin Institute of Technology, Harbin, China
- *Correspondence: Yanli Meng, ; Guixin Tang, ; Weiming Wang,
| | - Weiming Wang
- Heilongjiang Academy of Chinese Medicine Sciences, Harbin, China
- School of Chinese Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Yanli Meng, ; Guixin Tang, ; Weiming Wang,
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12
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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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13
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Study on the Therapeutic Effect of Azithromycin Combined with Glucocorticoid on Pulmonary Function and Inflammatory Response in Children with Pneumonia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:5288148. [PMID: 35388320 PMCID: PMC8977326 DOI: 10.1155/2022/5288148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/28/2022]
Abstract
Objective The objective is to explore the efficacy of azithromycin combined with glucocorticoids in the treatment of children with pneumonia and its effect on the inflammatory response. Methods A total of 86 children with pneumonia were divided into the experimental group (EG) and the control group (CG). Both groups received conventional treatment, the CG was treated with azithromycin and the EG was additionally treated with glucocorticoid methylprednisolone. The therapeutic effect, disappearance time of clinical symptoms, pulmonary function, inflammatory factors, immune function, quality of life, and adverse reactions were measured in the two groups. Results After treatment, compared with CG, the total effective rate was significantly elevated, the disappearance time of various clinical symptoms was earlier, and various pulmonary function indexes were increased in the EG. The interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), and CD8+ levels were reduced, and CD3+ and CD4+ levels were increased in the EG. The quality-of-life scores were upregulated in the EG. Moreover, there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion The combined use of azithromycin and glucocorticoids in the treatment of children with Mycoplasma pneumoniae infection has a good curative effect, can significantly improve lung function, restore pulmonary inflammatory indexes to normal, and enhance patients' immune function and improve their quality of life, with fewer adverse reactions and safety.
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14
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Lei W, Fei-Zhou Z, Jing C, Shu-Xian L, Xi-Ling W, Lan-Fang T. Pseudomembranous necrotizing laryngotracheobronchitis due to Mycoplasma pneumoniae: a case report and literature review. BMC Infect Dis 2022; 22:183. [PMID: 35197010 PMCID: PMC8867838 DOI: 10.1186/s12879-022-07160-5] [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: 11/25/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pseudomembranous necrotizing laryngotracheobronchitis refers to an acute diffuse necrotizing inflammation in the mucosa of the larynx, trachea, and bronchus. It often occurs in infants and children having viral infections secondary to bacterial infections. Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen that causes pneumonia in children. In recent years, serious complications due to M. pneumoniae infection, including necrotizing pneumonia, pulmonary embolism, and pleural effusion, have been increasingly reported. Case presentation An 11-year-old girl was admitted to our unit with cough, fever, and hoarseness persistent for a week. The results of the M. pneumoniae serological test, PCR examination with bronchial aspirate and bronchoalveolar lavage fluid (BALF), next-generation sequencing (mNGS) for BALF, all suggested the presence of M. pneumoniae infection. High-resolution CT scanning of the chest showed inflammation of the middle and lower lobes of the right lung. By bronchoscopy, the necrosis of the vocal cords, trachea, and bronchial mucosa was observed; each bronchial lumen contained a large amount of white viscous sputum. Pathological findings for bronchial mucosa suggested inflammatory necrosis. After administration of azithromycin and glucocorticoids, the symptoms of the patients were ameliorated. After 2 weeks post-discharge, the X-ray scan of her chest indicated the pneumonia resolution in the right lung. Conclusions In patients with pneumonia due to M. pneumoniae infection, which causes obvious hoarseness, bronchoscopy is necessary even if the lung lesions are not massively consolidated. When necrotizing lesions of the larynx, trachea, and bronchi are detected by bronchoscopy, the necrotic tissues in the corresponding parts should be conducted tissue biopsy for pathological examination. Apart from macrolide antibiotics, the administration of small doses of glucocorticoids is necessary.
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Affiliation(s)
- Wu Lei
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, 310052, Zhejiang, China
| | - Zhang Fei-Zhou
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, 310052, Zhejiang, China
| | - Chen Jing
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, 310052, Zhejiang, China
| | - Li Shu-Xian
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, 310052, Zhejiang, China
| | - Wu Xi-Ling
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, 310052, Zhejiang, China
| | - Tang Lan-Fang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Rd, Hangzhou, 310052, Zhejiang, China.
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15
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Chen N, Li M. Case Report and Literature Review: Clinical Characteristics of 10 Children With Mycoplasma pneumoniae-Induced Rash and Mucositis. Front Pediatr 2022; 10:823376. [PMID: 35311047 PMCID: PMC8927760 DOI: 10.3389/fped.2022.823376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023] Open
Abstract
Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a rare disease, which has not been reported in northern China previously. We retrospectively analyzed the clinical characteristics, diagnosis and treatment of 10 cases of MIRM in order to help clinicians to identify MIRM and to distinguish it from the similar mucositis and cutaneous characteristics of Stevens-Johnson syndrome. All 10 children included in the study had MIRM with skin and mucosal symptoms, but the characteristics of the skin and mucosal lesions differed by age. Most of the older children had sparse erythema and a vesicular rash, but the younger children had dense erythema without blisters but with purulent exudation. The mucositis was relatively mild in the younger children. The erythrocyte sedimentation rate, the levels of C-reactive protein, lactate dehydrogenase, and D-dimer were significantly elevated in most children with MIRM. Concomitant treatment of glucocorticoids and/or IVIG with macrolides may shorten the duration of fever and accelerate the clinical recovery. Additional case reports are needed to improve knowledge of the characteristics of MIRM and its response to therapy.
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Affiliation(s)
- Ning Chen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Miao Li
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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16
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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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17
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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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18
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Kim YS, Lee YY, Lee E. Cases of macrolide-resistant Mycoplasma pneumoniae pneumonia-associated pulmonary thromboembolism. Pediatr Pulmonol 2021; 56:1796-1799. [PMID: 33559952 DOI: 10.1002/ppul.25298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/02/2021] [Accepted: 01/23/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Yi-Seul Kim
- Department of Pediatrics, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Yun Y Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, 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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Prediction model for prolonged fever in patients with Mycoplasma pneumoniae pneumonia: a retrospective study of 716 pediatric patients. BMC Pulm Med 2021; 21:168. [PMID: 34006256 PMCID: PMC8130327 DOI: 10.1186/s12890-021-01534-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To identify patients with Mycoplasma pneumoniae pneumonia (MPP) with a risk of prolonged fever while on macrolides. Methods A retrospective study was performed with 716 children admitted for MPP. Refractory MPP (RMPP-3) was defined as fever persisting for > 72 h without improvement in clinical and radiologic findings after macrolide antibiotics (RMPP-3) or when fever persisted for > 120 h (RMPP-5) without improvement in clinical and radiologic findings. Radiological data, laboratory data, and fever profiles were compared between the RMPP and non-RMPP groups. Fever profiles included the highest temperature, lowest temperature, and frequency of fever. Prediction models for RMPP were created using the logistic regression method and deep neural network. Their predictive values were compared using receiver operating characteristic curves. Results Overall, 716 patients were randomly divided into two groups: training and test cohorts for both RMPP-3 and RMPP-5. For the prediction of RMPP-3, a conventional logistic model with radiologic grouping showed increased sensitivity (63.3%) than the model using laboratory values. Adding laboratory values in the prediction model using radiologic grouping did not contribute to a meaningful increase in sensitivity (64.6%). For the prediction of RMPP-5, laboratory values or radiologic grouping showed lower sensitivities ranging from 12.9 to 16.1%. However, prediction models using predefined fever profiles showed significantly increased sensitivity for predicting RMPP-5, and neural network models using 12 sequential fever data showed a greatly increased sensitivity (64.5%). Conclusion RMPP-5 could not be effectively predicted using initial laboratory and radiologic data, which were previously reported to be predictive. Further studies using advanced mathematical models, based on large-sized easily accessible clinical data, are anticipated for predicting RMPP.
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Severe Mycoplasma pneumoniae infections with prolonged fever in a child: Delayed treatment is as important as macrolide resistance. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 54:333-335. [DOI: 10.1016/j.jmii.2020.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/18/2022]
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Characteristics and Outcome of Severe Mycoplasma pneumoniae Pneumonia Admitted to PICU in Shanghai: A Retrospective Cohort Study. Crit Care Explor 2021; 3:e0366. [PMID: 33786442 PMCID: PMC7994047 DOI: 10.1097/cce.0000000000000366] [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: 01/16/2023] Open
Abstract
Objectives: We aimed to describe the characteristics and outcome in children with severe Mycoplasma pneumoniae pneumonia in a Chinese PICU. Design: A retrospective observational study from 2017 to 2019. Setting: A 36-bed university tertiary PICU at Shanghai Children’s Hospital. Patients: Patients admitted to a tertiary PICU 29 days to 18 years old screened for laboratory-confirmed severe M. pneumoniae pneumonia. Interventions: None. Measurements and Main Results: Descriptive analysis of baseline characteristics for patients included hospital mortality, organ dysfunctions, use of mechanical ventilation, continuous renal replacement therapy, and/or extracorporeal membrane oxygenation. A total of 817 children with severe pneumonia were admitted to PICU, and 203 of 817 cases (24.8%) with severe M. pneumoniae pneumonia were included in this study. The median age was 41 months (interquartile range, 20–67 mo), of which 77.3% (157/203) were younger than 6 years old. Among 163 patients with the test for macrolide resistance, 90.2% cases (147/163) were macrolide-resistant M. pneumoniae. Severe M. pneumoniae pneumonia-associated organ dysfunction included acute respiratory failure (203 cases, 100%), followed by cardiovascular disorder (79/203, 38.9%), gastrointestinal dysfunction (24/203, 11.8%). The main complications were pleural effusion (79/203, 38.9%), capillary leak syndrome (58/203, 28.6%), and plastic bronchitis (20/203, 9.9%). All patients needed respiratory support, including 64.5% patients (131/203) who received mechanical ventilation and 35.5% patients (72/203) who received high-flow nasal oxygen. Twenty-five patients (12.3%) treated with continuous renal replacement therapy and nine cases (4.4%) received extracorporeal membrane oxygenation. The case fatality rate was 3.9% (8/203). Furthermore, cardiovascular dysfunction, liver injury, or multiple organ dysfunction syndrome were associated with longer mechanical ventilation duration, delayed PICU discharge, and high hospital mortality. Coinfection was a risk factor of delayed PICU discharge. Conclusions: Children with severe M. pneumoniae pneumonia mainly occur under the age of 6 years, showing a high proportion of extrapulmonary organ dysfunction and macrolide resistances. Extrapulmonary organ dysfunction and coinfection are associated with worse outcomes. The overall mortality is relatively low after treated with appreciate antibiotics, respiratory support, and extracorporeal life support.
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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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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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