Benefits and risks of therapeutic alternatives for macrolide resistant Mycoplasma pneumoniae pneumonia in children

Cytokines and refractory mycoplasma pneumoniae pneumonia in children: a systematic review

INTRODUCTION

The relationship between cytokines and refractory mycoplasma pneumoniae pneumonia (RMPP) in children was conflicting. The aim of the current study was to perform a systematic review to determine the relationship between cytokines and RMPP in children.

EVIDENCE ACQUISITION

We searched PubMed, and the search was done on 21 November 2022. This search was limited to human studies, with language restriction of English. Studies were included if they reported the relationship between cytokines and RMPP.

EVIDENCE SYNTHESIS

A total of 22 relevant full articles were included in the review. TNF-α levels in the bronchoalveolar lavage fluid (BALF) and IL-18 levels in the blood samples were likely to be associated with RMPP. IL-2 and IL-4 lost significance regardless in the BALF or blood samples. Additionally, there was no significant difference in IFN-γ levels between RMPP patients and non-refractory mycoplasma pneumoniae pneumonia (NRMPP) patients in the BALF. Patients receiving different treatments had different levels of cytokines.

CONCLUSIONS

This analysis offers evidence linking abnormalities of cytokines with RMPP in children, which may be essential for identifying individuals with RMPP. Large prospective studies are needed for further clarification of roles of cytokines in RMPP.

Construction of a Nomogram for Identifying Refractory Mycoplasma pneumoniae Pneumonia Among Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children

OBJECTIVE

The individualized prediction of treatment regimens of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is scarce. The aim of this study was, therefore, to evaluate the relevant data of patients and construct a nomogram for identifying refractory Mycoplasma pneumoniae pneumonia (RMPP) among children continued to be treated with macrolide after the confirmation of MUMPP, providing a reference for the choice of treatment regimen.

METHODS

We performed a retrospective study involving 162 children who continued to be treated with macrolide (azithromycin) after the confirmation of MUMPP without antibiotic changes between January 2020 and January 2022. We collected data on clinical feature, hospitalization period, treatments, laboratory data, extrapulmonary symptoms, parapneumonic effusion, and connections with other respiratory pathogens. In addition, the independent risk factors for RMPP were determined through univariate and multivariate analyses, and then a nomogram was constructed and validated.

RESULTS

In this study, the multivariate logistic regression analysis showed that age, leukocyte count, neutrophil proportion, serum procalcitonin, and lactate dehydrogenase were independent risk factors for RMPP. Using the five independent associated factors, the nomogram for identification of RMPP was constructed. Moreover, the area under the ROC curve (AUC) was 0.925 (95% CI: 0.882-0.968) for the nomogram showing excellent discrimination. The calibration curve, close to the 45-degree line, exhibited good calibration of nomogram.

CONCLUSION

We constructed and validated a visual and user-friendly nomogram for individualized prediction of RMPP risk in children who continued to be treated with macrolide after the confirmation of MUMPP based on five variables. According to the nomogram model, continuation of macrolide should be considered rather than second-line antibiotics including tetracyclines (doxycycline or minocycline) and fluoroquinolones for MUMPP children with low predictive values.

Mycoplasmas as Host Pantropic and Specific Pathogens: Clinical Implications, Gene Transfer, Virulence Factors, and Future Perspectives

Mycoplasmas as economically important and pantropic pathogens can cause similar clinical diseases in different hosts by eluding host defense and establishing their niches despite their limited metabolic capacities. Besides, enormous undiscovered virulence has a fundamental role in the pathogenesis of pathogenic mycoplasmas. On the other hand, they are host-specific pathogens with some highly pathogenic members that can colonize a vast number of habitats. Reshuffling mycoplasmas genetic information and evolving rapidly is a way to avoid their host's immune system. However, currently, only a few control measures exist against some mycoplasmosis which are far from satisfaction. This review aimed to provide an updated insight into the state of mycoplasmas as pathogens by summarizing and analyzing the comprehensive progress, current challenge, and future perspectives of mycoplasmas. It covers clinical implications of mycoplasmas in humans and domestic and wild animals, virulence-related factors, the process of gene transfer and its crucial prospects, the current application and future perspectives of nanotechnology for diagnosing and curing mycoplasmosis, Mycoplasma vaccination, and protective immunity. Several questions remain unanswered and are recommended to pay close attention to. The findings would be helpful to develop new strategies for basic and applied research on mycoplasmas and facilitate the control of mycoplasmosis for humans and various species of animals.

Effects of bronchoalveolar lavage on Mycoplasma Pneumoniae pneumonia: A propensity score matched-cohort study

BACKGROUND

The purpose of this study was to evaluate the efficacy and safety of BAL in treating MPP.

METHODS

From January 2013 to January 2019, 1,689 pediatric patients with MPP were analyzed retrospectively. Patients were subdivided into BAL group and non-BAL group according to whether they received BAL treatment within seven days after admission. The propensity score matching method matched patients' baseline characteristics (1:1). The primary outcomes were hospital stays and the cure rate. Secondary outcomes included mortality, co-infection, repeat hospitalization within 30 days, and total cost of treatment.

RESULTS

After matching, 524 patients (BAL: 262; control: 262) were recorded. The BAL group had significantly shorter hospital stays (OR: 0.5, 95% CI: 0.4-0.7). Meanwhile, BAL did not significantly modify the cost, co-infection rate, and mortality. In subgroup analyses, the group with BAL intervention within three days had a significantly shorter hospital stay (OR: 0.4, 95% CI: 0.3-0.5) compared with the group with BAL intervention three days after admission.

CONCLUSIONS

Early BAL intervention is a better treatment than conventional drug therapy alone, and no significant complications were seen in this study. BAL intervention has an excellent clinical benefit. The earlier the intervention, the better the effect.

Epidemiology and clinical manifestations of children with macrolide-resistant Mycoplasma pneumoniae pneumonia in Southern Taiwan

BACKGROUND

Mycoplasma pneumoniae is a pneumonia-causing pathogen commonly found in pediatric patients in Taiwan. Recently, macrolide-resistant (MR) strains have been emerging globally. The prevalence of pneumonia due to MR-M. pneumoniae (hereafter, MPP) in northern Taiwan before 2017 has been reported to be 12.3-24%. The prevalence of MR-MPP within a specific location can vary. Hence, we investigated the prevalence of MR-MPP in southern Taiwan.

METHODS

Eighty-one children with PCR-confirmed MPP were enrolled between July 2016 and June 2019. They were assigned to macrolide-sensitive (MS) and MR groups based on their PCR results, and their clinical manifestations and laboratory data were compared.

RESULTS

The proportions of patients with MS-MPP and MR-MPP varied with time. The average ratio of the proportion of MR-MPP was 54.3% in this study. Patients with MR-MPP had lower neutrophil counts, higher lymphocyte counts, and higher platelet counts than those with MS-MPP. In contrast with the 40% of the MR-MPP group that still had a fever after three days of azithromycin treatment, only 11.8% of the MS-MPP group still had a fever.

CONCLUSION

Our study provided valuable epidemiological survey information for children with MR-MPP in southern Taiwan. The prevalence of MR-MPP was different from that reported in previous studies in northern Taiwan. Specific MR strains should be considered in children with MPP if they still have a fever after three days of macrolide treatment.

Mycoplasma pneumoniae: Atypical Pathogen in Community Acquired Pneumonia

Mycoplasma pneumoniae is a one of most common reasons of respiratory tract infections in both adolescents and children with severity ranged from moderate to high. Many facts in the previous years regarding infections were induced via this organism having extra pathogenic mechanisms. Clinically, resistance to macrolide has produced internationally and represents a treatment trouble. Antimicrobial sensitivity checking out techniques have been applied, and novel antibiotics which are effective towards M. pneumoniae are present processing development. That evaluate concentrates on the several trends occurring in the previous quite a few years which beautify the grasp of that microorganism, which is one of the smallest pathogenic bacteria; however, is of extreme medical significance.

Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children

Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fever and clinical deterioration may occur, leading to severe disease. Two major complicated conditions that may be clinically encountered are macrolide-resistant MPP and refractory MPP. Regarding the epidemics in Taiwan, before 2017, the mean rate of macrolide resistance was below 30%. Notably, since 2018, the prevalence of macrolide-resistant MPP in Taiwan has increased rapidly. Macrolide-resistant MPP shows persistent fever and/or no radiological regression to macrolide antibiotics and may even progress to severe and complicated pneumonia. Tetracyclines (doxycycline or minocycline) or fluoroquinolones are alternative treatments for macrolide-resistant MPP. Refractory MPP is characterized by an excessive immune response against the pathogen. In this context, corticosteroids have been suggested as an immunomodulator for downregulating the overactive host immune reaction. Overuse of macrolides may contribute to macrolide resistance, and thereafter, an increase in macrolide-resistant MPP. Delayed effective antimicrobial treatment is associated with prolonged and/or more severe disease. Thus, the appropriate prescription of antibiotics, as well as the rapid and accurate diagnosis of MPP, is important. The exact starting point, dose, and duration of the immunomodulator are yet to be established. We discuss these important issues in this review.

Tigecycline in the treatment of fulminant Mycoplasma pneumoniae pneumonia non-responsive to azithromycin and fluoroquinolone: A case report

RATIONALE

Fulminant macrolide-resistant Mycoplasma pneumoniae pneumonia (MPP) has seldom been reported, and cases of MPP usually show rapid improvement after fluoroquinolones or tetracyclines addition. The purpose of this case report is to highlight the importance of proper selection of antibiotics for treatment of severe MPP and increase awareness concerning the emergence of fluoroquinolone-resistant MPP.

PATIENT CONCERNS

A case of severe life-threatening pneumonia in a 26-year-old man with high fever and cough was non-responsive to azithromycin and fluoroquinolones.

DIAGNOSES

The patient was diagnosed with MPP based on the test results of bronchoalveolar lavage using real-time quantitative PCR method.

INTERVENTIONS

Tigecycline was given to the patient after azithromycin and fluoroquinolones failed.

OUTCOMES

The patients fever subsided within the first day of tigecycline therapy. He showed rapid symptom resolution and improvement in lung infiltration after 4 days of tigecycline therapy.

LESSONS

The case suggests that fulminant MPP should be timely treated with proper antibiotics, and the possible emergence of fluoroquinolone-resistant MPP should be of concern.