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Sun YW, Cen YH, Chen MH, Yan XK, Jin XF. Safety profiles and adverse reactions of azithromycin in the treatment of pediatric respiratory diseases: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36306. [PMID: 38050289 PMCID: PMC10695561 DOI: 10.1097/md.0000000000036306] [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: 05/01/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Azithromycin (AZM) is an antimicrobial agent and frequently used in the treatment of pediatric respiratory diseases due to its well-recognized clinical efficacy. Despite some favorable findings from many studies, there is a lack of research reports focusing on the safety profiles and adverse reactions. METHODS The randomized controlled trials of AZM in the treatment of pediatric respiratory diseases on internet databases were searched. The search databases included Chinese CNKI, Wanfang, VIP, PubMed, EMBASE, and Cochrane Library. Two researchers of this study independently assessed the eligibility, risk of bias, and extracted the data. The included literature was meta-analyzed and subgroup analyzed by revman 5.1 software. RESULTS A total of 14 eligible studies were included. The results of meta-analysis showed that the incidence of adverse reactions after AZM treatment was 24.20%, which was lower than 48.05% in the control group (OR = 0.42, 95% CI 0.12-0.72, P < .001). In the subgroup of sequential therapy, AZM had a lower incidence of adverse reactions in sequential therapy (OR = 0.29, 95% CI 0.09-0.60, P < .001). In the subgroup of intravenous administration, AZM had a lower the incidence of adverse reactions (OR = 0.57, 95% CI 0.12-0.84, P = .003). In the subgroup of oral administration, AZM had a lower the incidence of adverse reactions (OR = 0.45, 95% CI 0.13-0.69 P < .001). Overall, it was also found that the incidence of adverse reactions in the AZM subgroup was significantly lower than that in other treatment subgroup. CONCLUSION AZM has fewer adverse reactions and better safety profiles, which make AZM a more attractive option in the treatment of pediatric respiratory diseases.
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Affiliation(s)
- Ying-wen Sun
- Department of Pediatrics, The People’s Hospital of Fenghua, Ningbo City, Zhejiang Province, China
| | - Yuan-hua Cen
- Department of Pediatrics, The People’s Hospital of Fenghua, Ningbo City, Zhejiang Province, China
| | - Mu-heng Chen
- Department of Pediatrics, The People’s Hospital of Fenghua, Ningbo City, Zhejiang Province, China
| | - Xu-ke Yan
- Department of Pediatrics, The People’s Hospital of Fenghua, Ningbo City, Zhejiang Province, China
| | - Xiao-fen Jin
- Department of Pediatrics, The People’s Hospital of Fenghua, Ningbo City, Zhejiang Province, China
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Wang T, Sun H, Lu Z, Jiang W, Dai G, Huang L, Wang M, Zhu C, Wang Y, Hao C, Yan Y, Chen Z. The CARDS toxin of Mycoplasma pneumoniae induces a positive feedback loop of type 1 immune response. Front Immunol 2022; 13:1054788. [PMID: 36532054 PMCID: PMC9752573 DOI: 10.3389/fimmu.2022.1054788] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Within the past 3-5 years, Mycoplasma pneumoniae has become a major pathogen of community-acquired pneumonia in children. The pathogenic mechanisms involved in M. pneumoniae infection have not been fully elucidated. Methods Previous protein microarray studies have shown a differential expression of CXCL9 after M. pneumoniae infection. Here, we conducted a hospital-based study to explore the clinical significance of the type 1 immune response inflammatory factors interferon (IFN)-γ and CXCL9 in patients with M. pneumoniae pneumonia (MPP). Then, through in vitro experiments, we explored whether CARDS toxin stimulated F-DCs (dendritic cells incubated with Flt3L) to promote Th-cell differentiation; we also investigated the IFN-γ-induced CXCL9 secretion pathway in macrophages and the role of CXCL9 in promoting Th1 cell migration. Results The CXCL9 expression level was upregulated among patients with a higher fever peak, fever duration of greater than 7 days, an imaging manifestation of lobar or segmental, or combined pleural effusion (P<0.05). The peripheral blood levels of IFN-γ and CXCL9, which were higher in patients than in the healthy control group, were positively correlated with each other (r=0.502, P<0.05). In patients, the CXCL9 expression level was significantly higher in the bronchoalveolar lavage fluid (BALF) than in the peripheral blood, and the BALF CXCL9 expression level was higher than that in the healthy control group (all P<0.05). Our flow cytometry analysis revealed that M1-phenotype macrophages (CD16 + CD64 + CD163-) were predominant in the BALF from children with MPP. In in vitro experiments, F-DCs stimulated with CARDS toxin promoted the differentiation of CD4 + IFN-γ + Th (Th1) cells (P<0.05). Moreover, IFN-γ induced high levels of CXCL9 expression in M1-type macrophages in a dose-dependent and time-dependent manner. Additionally, macrophages transfection with STAT1-siRNA-1 downregulated the expression of CXCL9 (P<0.05), and CXCL9 promoted Th1 cell migration (P<0.05). Conclusions Our findings suggest that CARDS toxin induces a type 1 immune response positive feedback loop during M. pneumoniae infection; this putative mechanism may be useful in future investigations of immune intervention approaches for M. pneumoniae pneumonia.
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Affiliation(s)
- Ting Wang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Huiming Sun
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Zhitao Lu
- Department of Pediatrics, Zhangjiagang No.1 People’s Hospital, Affiliated Hospital of Soochow University, Suzhou, China
| | - Wujun Jiang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Ge Dai
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Li Huang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Meijuan Wang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Canhong Zhu
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China
| | - Yongdong Yan
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China,*Correspondence: Zhengrong Chen, ; Yongdong Yan,
| | - Zhengrong Chen
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, China,*Correspondence: Zhengrong Chen, ; Yongdong Yan,
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Han LP, Xiao HY, Fang LL. A retrospective study of azithromycin and ceftizoxime for the management of children with Mycoplasma pneumoniae pneumonia. Medicine (Baltimore) 2021; 100:e27564. [PMID: 34871221 PMCID: PMC8568348 DOI: 10.1097/md.0000000000027564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of this study was to compare the clinical efficacy of azithromycin and ceftizoxime (AC) and erythromycin and amoxicillin/sulbactam (EAS) in the treatment of children with Mycoplasma pneumoniae pneumonia (MPP).In this retrospective study, a total of 92 eligible children with MPP were included, and they were divided into a treatment group (n = 46) and a control group (n = 46). All patients were treated with intravenous ambroxol, and nebulized inhalation of budesonide and terbutaline. In addition, patients in the treatment group received AC. Patients in the control group underwent EAS. All patients in both groups were treated for a total of 10 days. Outcomes consist of erythrocyte sedimentation rate, C-reactive protein, serum lactate dehydrogenase, and interleukin 6, fever clearance time, time of cough disappearance, time of rale disappearance, time of signs disappeared by X-ray, and adverse events. All outcomes were measured after 10-day treatment.After treatment, patients who received AC exerted better improvements in erythrocyte sedimentation rate (P < .01), C-reactive protein (P < .01), serum lactate dehydrogenase (P < .01), interleukin 6 (P < .01), fever clearance time (P < .01), time of cough disappearance (P < .01), time of rale disappearance (P < .01), and time of signs disappeared by X-ray (P < .01), than those in patients who received EAS. In addition, there were not significant differences in adverse events between 2 groups.The results of this study showed that AC may benefit more than EAS for the children with MPP.
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Affiliation(s)
- Li-ping Han
- Department of Pediatrics, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Han-yan Xiao
- Second Ward of Neurology Department, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Li-li Fang
- Department of Pediatrics, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, China
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Shuanghuanglian oral preparations combined with azithromycin for treatment of Mycoplasma pneumoniae pneumonia in Asian children: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2021; 16:e0254405. [PMID: 34255785 PMCID: PMC8277054 DOI: 10.1371/journal.pone.0254405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022] Open
Abstract
Background Mycoplasma pneumoniae is one of the main causes of community-acquired pneumonia. Due to the imperfect immune system of children, this also causes Mycoplasma pneumoniae pneumonia (MPP) to be more common in children. Globally, the incidence of MPP in children is gradually increasing. This study was the first to systematically review the clinical efficacy and safety of Shuanghuanglian (SHL) oral preparations combined with azithromycin in the treatment of MPP in children. Methods This study fully retrieved 3 Chinese databases and 5 English databases to search the randomized controlled trials (RCTs) of SHL oral preparations combined with azithromycin in the treatment of children with MPP. The search time is from the inception to September 2020. Data extraction and risk bias evaluation were performed independently by two researchers. We conducted a Meta-analysis of all the outcome indicators. Besides, Meta-regression, subgroup analysis, and heterogeneity analysis were used for the primary outcomes to find the possible potential confounding factors. Results Finally, we included 27 RCTs involving 2884 patients. SHL oral preparations combined with azithromycin were better than azithromycin alone in response rate (RR = 1.14, 95% CI[1.11, 1.18]; low certainty evidence), disappearance time of fever(MD = -1.72, 95% CI[-2.47, -0.97]; low certainty evidence), disappearance time of cough (MD = -2.95, 95% CI[-3.55, -2.34]; low certainty evidence), and disappearance time of pulmonary rales (MD = -2.13, 95% CI[-2.88, -1.38]; low certainty evidence). The Meta-regression results showed that the course of disease, age, and method of administration may be the source of heterogeneity. Subgroup analysis and sensitivity analysis have found that the results were stable. For other related clinical symptoms, T lymphocytes, and Serum inflammatory factors, SHL oral preparations combined with azithromycin was better than azithromycin alone, and the difference was statistically significant. For adverse events with low certainty evidence, safety needs further verification. Conclusion Based on the results of meta-analysis with low certainty evidence, we believed that SHL oral preparations combined with azithromycin likely be effectively improved clinical symptoms compared with azithromycin alone. Low certainty evidence showed that SHL may safety with no serious adverse events. Due to these limitations, the safety needs further verification. More high-quality, multicenter, and large-sample RCTs should be tested and verified in the future.
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Chen Z, Shi Q, Peng Y, Chen Y, Cao L, Pang B, Ji Z, Liu C, Zhang J. Traditional Chinese Medicine Oral Liquids Combined With Azithromycin for Mycoplasma pneumoniae Pneumonia in Children: A Bayesian Network Meta-Analysis. Front Pharmacol 2021; 12:652412. [PMID: 34122075 PMCID: PMC8194818 DOI: 10.3389/fphar.2021.652412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/14/2021] [Indexed: 12/14/2022] Open
Abstract
Background:Mycoplasma pneumoniae pneumonia (MPP) causes flu-like symptoms in children, increasing the burden on the health and education systems. In China, traditional Chinese medicine oral liquids (TCMOLs) combined with azithromycin (TCMOLs + Azithromycin) is commonly used to treat MPP in children. However, TCMOLs with the optimal clinical applicability remain unknown. Here, we evaluated the clinical effectiveness and safety of TCMOLs + Azithromycin in children with MPP. Methods: We searched PubMed, Embase, Cochrane Library, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and VIP information resource integration service platform databases for eligible randomized controlled trials (RCTs) published from database inception to October 2020. Two reviewers independently performed data extraction and risk of bias assessment. After Bayesian random effect modeling and surface under the cumulative ranking curve (SUCRA) scoring, we ranked each intervention. We assessed heterogeneity using multivariate meta-regression for potential modifiers and used the Grading of Recommendations, Assessment, Development, and Evaluation to rate pooled evidence’s certainty. Results: In the 63 included RCTs with 6,410 children, five different TCMOLs were combined with azithromycin. TCMOLs + Azithromycin had significantly better primary outcomes than did azithromycin alone. Of all TCMOLs, Xiaoer Xiaoji Zhike (XEXJZK)+Azithromycin showed the best effectiveness with respect to the response rate (odds ratio [OR] = 6.5, 95% credible interval [CrI] = 4.3–10; low certainty) and pulmonary rales disappearance time (mean difference [MD] = −2.1, 95% CrI: −2.9 to −1.2; low certainty) with SUCRA 85 and 80%, respectively. Pudilan Xiaoyan + Azithromycin showed the highest effectiveness with respect to cough disappearance time (MD = −2.6, 95% CrI: −3.4 to −1.7; very low certainty) and fever disappearance time (MD = −1.8, 95% CrI: −2.3 to −1.3; very low certainty) with SUCRA 87 and 87%, respectively. The difference in the adverse effects between TCMOLs + Azithromycin and azithromycin alone was nonsignificant. Conclusion: Of the different TCMOLs, XEXJZK may be the best option to combine with azithromycin to treat children with MPP. However, our results should be interpreted with caution due to the low certainty of evidence. In general, TCMOLs’ safety remains unclear because of a lack of evidence. More high-quality RCTs are needed to further evaluate efficacy and safety of these TCMOLs.
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Affiliation(s)
- Zhe Chen
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qingyang Shi
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yingying Peng
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Statistic, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lujia Cao
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bo Pang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhaochen Ji
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunxiang Liu
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Han R, Yu Q, Zhang G, Li B, Han S, Li G. Comparison of azithromycin and erythromycin in the treatment of mycoplasma pneumonia in children. Pak J Med Sci 2019; 36:156-159. [PMID: 32063951 PMCID: PMC6994860 DOI: 10.12669/pjms.36.2.1441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: To study and compare the clinical effects of azithromycin and erythromycin on children with mycoplasma pneumonia. Methods: Total 132 children with mycoplasma pneumonia who were admitted to our hospital between November 2017 and September 2018 were selected as the research subjects. All the children were divided into an observation group and a control group according to random number table, 66 each. The observation group was treated with azithromycin, while the control group was treated with erythromycin. The therapeutic effect, incidence of adverse reactions and disappearance time of clinical symptoms were compared between the two groups. Results: The total efficacy of the observation group was 98.04%, and that of the control group was 74.51%; there was a significant difference (X2=7.184, P=0.007). The incidence of adverse reactions in the observation group was 15.69%, significantly lower than that in the control group (41.18%) (X2=6.376, P=0.002). The disappearance of fever, cough, rale and X ray shadow of the observation group was significantly earlier than that of the control group, and the difference was statistically significant (P<0.05). Conclusion: Compared with erythromycin, azithromycin is more effective in the treatment of mycoplasma pneumonia in children. Azithromycin can further shorten the improvement time of clinical symptoms and signs and has few adverse reactions and high safety. It is worth clinical application.
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Affiliation(s)
- Rui Han
- Rui Han, Department of Pediatrics (I), Binzhou People's Hospital, Shandong, 256610, China
| | - Qianqian Yu
- Qianqian Yu, Department of Respiration, Binzhou People's Hospital, Shandong, 256610, China
| | - Guohui Zhang
- Guohui Zhang, Department of Pediatrics (II), Binzhou People's Hospital, Shandong, 256610, China
| | - Baoqiang Li
- Baoqiang Li, Department of Pediatrics (II), Binzhou People's Hospital, Shandong, 256610, China
| | - Shuzhen Han
- Shuzhen Han, Neonatal Intensive Care Unit (NICU), Binzhou People's Hospital, Shandong, 256610, China
| | - Guiying Li
- Guiying Li, Department of Pediatrics (I), Binzhou People's Hospital, Shandong, 256610, China
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High Mycoplasma pneumoniae loads and persistent long-term Mycoplasma pneumoniae DNA in lower airway associated with severity of pediatric Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2019; 19:1045. [PMID: 31823740 PMCID: PMC6905005 DOI: 10.1186/s12879-019-4667-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background An increased number of refractory mycoplasma pneumoniae (MP) pneumonia (MPP) cases have been reported. However the duration of MP infection in lower airway and the course of anti-MP treatment remains unclear. Methods We retrospectively reviewed the medical records of 94 MPP children. Patients were classified into two groups. The long-term group (Group LT) was defined as bronchoalveolar lavage fluid (BALF) remained MP-positive by PCR after 30 days of the disease course. The non-long-term group (Group NLT) was defined as BALF became MP-negative by PCR within 30 days of disease and patients who only needed one bronchoscopy lavage therapy. MP loads, clinical outcomes were analyzed along with other clinical measurements. Results The average levels of inflammatory markers such as C reactive protein and lactate dehydrogenase in Group LT were significantly higher than those in Group NLT. Airway and lung damage in Group LT were more severe than Group NLT. 28 patients developed necrotizing pneumonia and 8 patients developed pulmonary embolism in Group LT. Mean maximum MP loads in BALF were 107.46 ± 0.93 and 104.86 ± 0.93 in Groups LT and NLT, respectively. There was persistent MP DNA in Group LT, even lasted for 120 days. One severe MPP patient in Group LT had MP-associated bloodstream infection. After 3 months of follow-up, chest imaging revealed incomplete absorption of pulmonary consolidation in 33 patients of Group LT [including 13 airway obliterans (AO) patients] and in 7 patients of Group NLT (including 2 AO patients). Conclusion MP loads of BALF were associated with the subsequent duration of MP DNA in lower airway. High MP loads and persistent long-term MP DNA in lower airway were associated with severity of pediatric MPP.
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Dai W, Wang H, Zhou Q, Li D, Feng X, Yang Z, Wang W, Qiu C, Lu Z, Xu X, Lyu M, Xie G, Li Y, Bao Y, Liu Y, Shen K, Yao K, Feng X, Yang Y, Zhou K, Li S, Zheng Y. An integrated respiratory microbial gene catalogue to better understand the microbial aetiology of Mycoplasma pneumoniae pneumonia. Gigascience 2019; 8:giz093. [PMID: 31367746 PMCID: PMC6669060 DOI: 10.1093/gigascience/giz093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/31/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The imbalanced respiratory microbiota observed in pneumonia causes high morbidity and mortality in childhood. Respiratory metagenomic analysis demands a comprehensive microbial gene catalogue, which will significantly advance our understanding of host-microorganism interactions. RESULTS We collected 334 respiratory microbial samples from 171 healthy children and 76 children with pneumonia. The respiratory microbial gene catalogue we established comprised 2.25 million non-redundant microbial genes, covering 90.52% of prevalent genes. The major oropharyngeal microbial species found in healthy children were Prevotella and Streptococcus. In children with Mycoplasma pneumoniae pneumonia (MPP), oropharyngeal microbial diversity and associated gene numbers decreased compared with those of healthy children. The concurrence network of oropharyngeal microorganisms in patients predominantly featured Staphylococcus spp. and M. pneumoniae. Functional orthologues, which are associated with the metabolism of various lipids, membrane transport, and signal transduction, accumulated in the oropharyngeal microbiome of children with pneumonia. Several antibiotic resistance genes and virulence factor genes were identified in the genomes of M. pneumoniae and 13 other microorganisms reconstructed via metagenomic data. Although the common macrolide/β-lactam resistance genes were not identified in the assembled M. pneumoniae genome, a single-nucleotide polymorphism (A2063G) related to macrolide resistance was identified in a 23S ribosomal RNA gene. CONCLUSIONS The results of this study will facilitate exploration of unknown microbial components and host-microorganism interactions in studies of the respiratory microbiome. They will also yield further insights into the microbial aetiology of MPP.
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Affiliation(s)
- Wenkui Dai
- Department of Computer Science, City University of Hong Kong, Hong Kong 999077, China
| | - Heping Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
| | - Qian Zhou
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
| | - Dongfang Li
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, No. 1037 Luoyu Road, Wuhan 430074, China
| | - Xin Feng
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
| | - Zhenyu Yang
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
| | - Chuangzhao Qiu
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
| | - Zhiwei Lu
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
| | - Ximing Xu
- Institute of Statistics, Nankai University, No. 94 Weijin Road, Tianjin 300071, China
| | - Mengxuan Lyu
- Department of Computer Science, City University of Hong Kong, Hong Kong 999077, China
| | - Gan Xie
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
| | - Yinhu Li
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
| | - Yanmin Bao
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
| | - Yanhong Liu
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
| | - Kunling Shen
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
- Department of Respiratory Diseases, Beijing Children's Hospital, Beijing 100045, China
| | - Kaihu Yao
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
- Department of Respiratory Diseases, Beijing Children's Hospital, Beijing 100045, China
| | - Xikang Feng
- Department of Computer Science, City University of Hong Kong, Hong Kong 999077, China
| | - Yonghong Yang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
- Department of Microbial Research, WeHealthGene Institute, Shenzhen 518000, China
- Department of Respiratory Diseases, Beijing Children's Hospital, Beijing 100045, China
| | - Ke Zhou
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, No. 1037 Luoyu Road, Wuhan 430074, China
| | - Shuaicheng Li
- Department of Computer Science, City University of Hong Kong, Hong Kong 999077, China
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen 518026, China
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Yan C, Xue G, Zhao H, Feng Y, Li S, Cui J, Ni S, Sun H. Molecular and clinical characteristics of severe Mycoplasma pneumoniae pneumonia in children. Pediatr Pulmonol 2019; 54:1012-1021. [PMID: 31119869 DOI: 10.1002/ppul.24327] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/25/2019] [Accepted: 03/16/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To analyze the molecular and the clinical characteristics of Mycoplasma pneumoniae (Mp) pneumonia (MPP) and to explore the related factors predicting severe MPP (SMPP). METHODS A total of 423 pediatric cases of MPP were retrospectively analyzed, in 2013-2017, in Beijing, China. Clinical information was collected from the medical records. Mp-positive specimens were characterized using P1 typing and multiple locus variable-number tandem repeat analysis (MLVA). The macrolide resistance-associated mutations were also detected. RESULTS The predominant genotype was P1-1 (88.2%) and M4-5-7-2 (87.5%), whereas percentages of type P1-2 and M3-5-6-2 increased across the 5-year period. The mutation rate of genotype M4-5-7-2 (365/370, 98.6%) was significantly higher than that of the genotype M3-5-6-2 (15/48, 32.25%; P = 0.000). Overall, 180 (42.6%) of the 423 Mp-positive patients were coinfected with other pathogens. Respiratory syncytial virus coinfection (24/180, 13.3%) was more common in cases typed M3-5-6-2 (4/23, 17.4%) than that of M4-5-7-2 (20/155, 12.9%; P = 0.038). Pleural effusion accounted for 52.6% (169/321) of the observed complications. In the mono-infection cases, cases typed M3-5-6-2 (56%, 14/25) were significantly (P = 0.020) associated with pleural effusion compared with those typed M4-5-7-2 (32.6%, 70/215); 84% (21/25) of specimens typed M3-5-6-2 were diagnosed as SMPP, whereas 63.7% (137/215) of specimens typed M4-5-7-2 were diagnosed as SMPP (P = 0.043). CONCLUSIONS In our study, we proposed for the first time that the mono-infection patients with Mp typed M3-5-6-2 appear to have a higher risk for progressing to SMPP. MLVA typing can provide hints on the clinical characteristics of Mpp.
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Affiliation(s)
- Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Shaoli Li
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Jinghua Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Shanshan Ni
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hongmei Sun
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
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Early Corticosteroid Therapy for Mycoplasma pneumoniae Pneumonia Irrespective of Used Antibiotics in Children. J Clin Med 2019; 8:jcm8050726. [PMID: 31121867 PMCID: PMC6572103 DOI: 10.3390/jcm8050726] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 01/09/2023] Open
Abstract
Antibiotics’ effect on Mycoplasma pneumoniae (MP) infection still remains controversial. A prospective study of 257 children with MP pneumonia during a recent epidemic (2015–2016) was conducted. All MP pneumonia patients were treated with corticosteroids within 24–36 h after admission. Initially, oral prednisolone (1 mg/kg) or intravenous methylprednisolone (IVMP; 1–2 mg/kg) was administered for mild pneumonia patients, and IVMP (5–10 mg/kg/day) for severe pneumonia patients. If patients showed a persistent fever for 36–48 h or disease progression, additive IVMP (5 mg/kg or 10 mg/kg) was given. Thirty-three percent of patients received only a broad-spectrum antibiotic without a macrolide. The mean age and the male-to-female ratio was 5.6 ± 3.1 years and 1:1, respectively. Seventy-four percent of patients showed immediate defervescence within 24 h, and 96% of patients showed defervescence within 72 h with improvements in clinical symptoms. Three percent of patients (8/257) who received additive IVMP also showed clinical improvement within 48 h without adverse reactions. There were no clinical or laboratory differences between patients treated with a macrolide (n = 172) and without (n = 85). Early corticosteroid therapy might reduce disease morbidity and prevent disease progression in MP pneumonia patients without side effects, and antibiotics may have limited effects on MP infection.
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Chen Y, Tian WM, Chen Q, Zhao HY, Huang P, Lin ZQ, Chen L. [Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:629-634. [PMID: 30111471 PMCID: PMC7389752 DOI: 10.7499/j.issn.1008-8830.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children. METHODS The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay. RESULTS Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P<0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group. CONCLUSIONS Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.
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Affiliation(s)
- Yu Chen
- Department of Pediatrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, China.
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Chen Y, Tian WM, Chen Q, Zhao HY, Huang P, Lin ZQ, Chen L. [Clinical features and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:629-634. [PMID: 30111471 PMCID: PMC7389752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/10/2018] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To study the clinical features of macrolide-resistant Mycoplasma pneumoniae pneumonia and its treatment regimens in children. METHODS The samples of throat swab or bronchoalveolar lavage fluid were collected from 136 children with Mycoplasma pneumoniae pneumonia. Quantitative real-time PCR was used to detect 2063/2064 A:G mutation in 23S rRNA, and according to such results, the children were divided into drug-resistance group with 81 children and sensitive group with 55 children. The two groups were compared in terms of age composition, respiratory symptoms, extrapulmonary complications, laboratory markers, imaging changes, treatment regimens, and length of hospital stay. RESULTS Compared with the sensitive group, the drug-resistance group had significantly longer duration of pyrexia and severe fever, a significantly higher percentage of children with reduced blood oxygen saturation, and significantly higher levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) (P<0.05). The conventional azithromycin treatment had a good clinical effect in the sensitive group, while corticosteroid therapy was usually needed in the drug-resistance group. CONCLUSIONS Macrolide-resistant Mycoplasma pneumoniae infection cannot be identified based on a single clinical feature, but prolonged duration of pyrexia and severe fever, reduced blood oxygen saturation, and increased ALT and LDH can suggest the presence of this disease. Azithromycin combined with glucocorticoids may be a good treatment regimen for children with macrolide-resistant Mycoplasma pneumoniae pneumonia.
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Affiliation(s)
- Yu Chen
- Department of Pediatrics, Zhongshan Hospital, Xiamen University, Xiamen, Fujian 361004, China.
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