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Wang H, Zhang Y, Zhao C, Peng Y, Song W, Xu W, Wen X, Liu J, Yang H, Shi R, Zhao S. Serum IL-17A and IL-6 in paediatric Mycoplasma pneumoniae pneumonia: implications for different endotypes. Emerg Microbes Infect 2024; 13:2324078. [PMID: 38407218 PMCID: PMC10997354 DOI: 10.1080/22221751.2024.2324078] [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] [Received: 11/29/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Paediatric Mycoplasma pneumoniae pneumonia (MPP) is a heterogeneous disease with a diverse spectrum of clinical phenotypes. No studies have demonstrated the relationship between underlying endotypes and clinical phenotypes as well as prognosis about this disease. Thus, we conducted a multicentre prospective longitudinal study on children hospitalized for MPP between June 2021 and March 2023, with the end of follow-up in August 2023. Blood samples were collected and processed at multiple time points. Multiplex cytokine assay was performed to characterize serum cytokine profiles and their dynamic changes after admission. Cluster analysis based on different clinical phenotypes was conducted. Among the included 196 patients, the levels of serum IL-17A and IL-6 showed remarkable variabilities. Four cytokine clusters based on the two cytokines and four clinical groups were identified. Significant elevation of IL-17A mainly correlated with diffuse bronchiolitis and lobar lesion by airway mucus hypersecretions, while that of IL-6 was largely associated with lobar lesion which later developed into lung necrosis. Besides, glucocorticoid therapy failed to inhibit IL-17A, and markedly elevated IL-17A and IL-6 levels may correlate with lower airway obliterans. Our study provides critical relationship between molecular signatures (endotypes) and clustered clinical phenotypes in paediatric patients with MPP.
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Affiliation(s)
- Heng Wang
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Yanli Zhang
- Division of Pulmonology, Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
| | - Chengsong Zhao
- Department of Infectious Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Yun Peng
- Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Wenqi Song
- Department of Clinical Laboratory, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Weihan Xu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Xiaohui Wen
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Jinrong Liu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Haiming Yang
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Ruihe Shi
- Division of Pulmonology, Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
| | - Shunying Zhao
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
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Kumar S, Narayanasamy S, Nepal P, Kumar D, Wankhar B, Batchala P, Kaur N, Buddha S, Jose J, Ojili V. Imaging of pulmonary infections encountered in the emergency department in post-COVID 19 era- common, rare and exotic. Bacterial and viral. Emerg Radiol 2024; 31:543-550. [PMID: 38834862 DOI: 10.1007/s10140-024-02248-8] [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] [Received: 04/26/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
Pulmonary infections contribute substantially to emergency department (ED) visits, posing a considerable health burden. Lower respiratory tract infections are prevalent, particularly among the elderly, constituting a significant percentage of infectious disease-related ED visits. Timely recognition and treatment are crucial to mitigate morbidity and mortality. Imaging studies, primarily chest radiographs and less frequently CT chests, play a pivotal role in diagnosis. This article aims to elucidate the imaging patterns of both common and rare pulmonary infections (bacterial and viral) in the post COVID-19 era, emphasizing the importance of recognizing distinct radiological manifestations. The integration of clinical and microbiological evidence aids in achieving accurate diagnoses, and guiding optimal therapeutic interventions. Despite potential overlapping manifestations, a nuanced understanding of radiological patterns, coupled with comprehensive clinical and microbiological information, enhances diagnostic precision in majority cases.
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Affiliation(s)
- Shruti Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Pankaj Nepal
- Department of Radiology, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Devendra Kumar
- Department of Clinical imaging, Hamad Medical Corporation, Doha, Qatar
| | - Baphiralyne Wankhar
- Department of Radiology and Medical Imaging, UVA Health, Charlottesville, VA, USA
| | - Prem Batchala
- Department of Radiology and Medical Imaging, UVA Health, Charlottesville, VA, USA
| | - Neeraj Kaur
- Department of Radiology, Scarborough Health Network, Toronto, Canada
| | - Suryakala Buddha
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joe Jose
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA.
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Pochepnia S, Grabczak EM, Johnson E, Eyuboglu FO, Akkerman O, Prosch H. Imaging in pulmonary infections of immunocompetent adult patients. Breathe (Sheff) 2024; 20:230186. [PMID: 38595938 PMCID: PMC11003523 DOI: 10.1183/20734735.0186-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/06/2024] [Indexed: 04/11/2024] Open
Abstract
Pneumonia is a clinical syndrome characterised by fever, cough and alveolar infiltration of purulent fluid, caused by infection with a microbial pathogen. It can be caused by infections with bacteria, viruses or fungi, but a causative organism is identified in less than half of cases. The most common type of pneumonia is community-acquired pneumonia, which is caused by infections acquired outside the hospital. Current guidelines for pneumonia diagnosis require imaging to confirm the clinical suspicion of pneumonia. Thus, imaging plays an important role in both the diagnosis and management of pneumonia, with each modality having specific advantages and limitations. Chest radiographs are commonly used but have limitations in terms of sensitivity and specificity. Lung ultrasound shows high sensitivity and specificity. Computed tomography scans offer higher diagnostic accuracy but involve higher radiation doses. Radiological patterns, including lobar, lobular and interstitial pneumonia, provide valuable insights into causative pathogens and treatment decisions. Understanding these radiological patterns is crucial for accurate diagnosis. In this review, we will summarise the most important aspects pertaining to the role of imaging in pneumonia and will highlight the imaging characteristics of the most common causative organisms.
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Affiliation(s)
- Svitlana Pochepnia
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Elzbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Emma Johnson
- Clinical and Molecular Medicine, University of Dundee, Dundee, UK
| | - Fusun Oner Eyuboglu
- Baskent University School of Medicine, Pulmonary Diseases Department, Baskeny University Hospital, Ankara, Turkey
| | - Onno Akkerman
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, TB center Beatrixoord, Groningen, The Netherlands
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Sui DX, Ma HC, Wang CC, Shao HY, Xu SH, Fang NN. Diagnostic significance of HRCT imaging features in adult mycoplasma pneumonia: a retrospective study. Sci Rep 2024; 14:153. [PMID: 38168479 PMCID: PMC10761950 DOI: 10.1038/s41598-023-50702-3] [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] [Received: 09/14/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Mycoplasma pneumoniae pneumonia (MPP) often overlaps with the clinical manifestations and chest imaging manifestations of other types of community-acquired pneumonia (CAP). We retrospectively analyzed the clinical and imaging data of a group of patients with CAP, summarized their clinical and imaging characteristics, and discussed the diagnostic significance of their certain HRCT findings. The HRCT findings of CAP researched in our study included tree-in-bud sign (TIB), ground-glass opacity (GGO), tree fog sign (TIB + GGO), bronchial wall thickening, air-bronchogram, pleural effusion and cavity. The HRCT findings of all cases were analyzed. Among the 200 cases of MPP, 174 cases showed the TIB, 193 showed the GGO, 175 showed the tree fog sign, 181 lacked air-bronchogram. In case taking the tree fog sign and lack of air-bronchogram simultaneously as an index to distinguish MPP from OCAP, the sensitivity was 87.5%, the specificity was 97.5%, the accuracy was 92.5%. This study showed that that specific HRCT findings could be used to distinguish MPP from OCAP. The combined HRCT findings including the tree fog sign and lacked air-bronchogram simultaneously would contribute to a more accurate diagnosis of MPP.
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Affiliation(s)
- Dong-Xin Sui
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Han-Chen Ma
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Chao-Chao Wang
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Hong-Yan Shao
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Shao-Hua Xu
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Ning-Ning Fang
- Department of Anesthesiology, Qilu Hospital of Shandong University, No. 107, Wenhua Xi Road, Jinan, 250012, Shandong, China.
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Huang X, Gu H, Wu R, Chen L, Lv T, Jiang X, Li H, Guo B, Liu J, Li D, Zhao D, Liu F. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes. Respir Med 2024; 221:107480. [PMID: 38043865 DOI: 10.1016/j.rmed.2023.107480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The imaging findings of Mycoplasma pneumoniae pneumonia (MPP) vary; however, few studies have focused on the relationship of imaging classification with clinical manifestations and outcomes. OBJECTIVE To prospectively investigate whether chest imaging classification in Mycoplasma pneumoniae pneumonia (MPP) is associated with its clinical features and outcomes. METHODS A total of 1,401 hospitalized children with MPP were enrolled from January 2019 to December 2021. Imaging findings were categorized as bronchopneumonia and consolidation/atelectasis according to X-ray, and bronchopneumonia, consolidation/atelectasis, bronchiolitis, and mosaic pattern according to computed tomography (CT). Clinical characteristics and outcomes of patients with different imaging classifications were prospectively analyzed based on electronic medical records. RESULTS Bronchopneumonia was the most common finding (59.6%), while consolidation/atelectasis was the most severe group. Clinical manifestations and laboratory indicators for the consolidation/atelectasis group included serious abnormalities. Further, outcomes of the patients were worse, including having longer total durations of fever and hospitalization, greater hospitalization expenses, and a higher likelihood of developing refractory MPP, necrotizing pneumonia, and bronchiolitis obliterans (BO) in this group. The incidence of bronchiolitis, a disease characterized by a high prevalence of fever, moist rales, and an atopic constitution, tended to increase after the coronavirus disease pandemic and predisposed patients to BO. A mosaic pattern occurred in allergic and young individuals, with wheezing as the main manifestation, with patients having relatively mild symptoms and good outcomes. CONCLUSION Different imaging classifications have different clinical features and clinical outcomes; thus, formulating an imaging-based classification system is of great clinical value.
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Affiliation(s)
- Xia Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Haiyan Gu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ruxi Wu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Lei Chen
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Tian Lv
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xinyi Jiang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Huili Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Bin Guo
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jie Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Dan Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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Chu C, Wang L, Wu Y, Li H, Xu S, Zhang L, Liu Q, Zhang X, Xu L, Gao C, Huang L. Multidimensional analysis using low-dose computed tomography to evaluate the severity of Mycoplasma pneumoniae pneumonia in children. Quant Imaging Med Surg 2023; 13:1874-1886. [PMID: 36915342 PMCID: PMC10006136 DOI: 10.21037/qims-22-508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023]
Abstract
Background It is unclear whether local pathological pulmonary changes truly reflect the severity of childhood Mycoplasma pneumoniae infection, which is characterized by rapid progress and potential mortality. This study multi-dimensionally analyzed low-dose computed tomography findings to assess the severity of Mycoplasma pneumoniae infection and predict its progress in such patients. Methods In all, 752 children with Mycoplasma pneumoniae pneumonia (MPP) who underwent low-dose computed tomography examinations from February 2016 to July 2020 were retrospectively enrolled to conduct a cohort study. Clinical and radiological variables were analyzed using univariate analysis, and radiological variables were further analyzed using multivariable logistic regression in severe cases. Then, the correlation between the key computed tomography features and clinical symptoms, laboratory indicators, and medical costs were assessed using the chi-squared and Kruskal-Wallis H tests. Kaplan-Meier curves and Cox regression models were created to evaluate the correlations between the key computed tomography features, fever duration, and the length of hospital stay. Results Of the 752 included patients, 16.2% (122/752) developed severe MPP. Atelectasis, pleural effusion, and lung consolidation occurred in 9.7% (73/752), 15.8% (119/752), and 90.3% (679/752) of patients, respectively. In addition to pleural effusion, the number of lobes of lung consolidation was the highest risk feature of severe MPP. Patients with consolidation in 2, 3, and 4 lobes had a 1.0-, 3.1-, and 7.5-fold increased risk of severe MPP, compared with patients with consolidation in fewer than 1 lobe. The duration of fever prior to admission had no effect on the proportions of the lobar consolidation (P=0.14) but did have significant effect on the incidence of pleural effusion (P=0.004). Levels of inflammatory markers and medical costs rose consistently with the increase in the number of lobar consolidations (P<0.001). After adjustments for pleural effusion, 1, 2, 3, and 4 lobes of consolidation remained positively associated with fever duration [1 lobe: hazard ratio (HR) =1.55, 95% CI: 1.10-2.18; 2 lobes: HR =1.65, 95% CI: 1.13-2.42l; 3 lobes: HR =1.82, 95% CI: 1.11-2.98; 4 lobes: HR =2.87, 95% CI: 1.25-6.61] compared to 0 lobes of consolidation. Compared to 0 lobes of consolidation, 1, 2, 3, and 4 lobes of consolidation were also positively correlated with the length of hospital stay (1 lobe: HR =2.24, 95% CI: 1.73-2.89; 2 lobes: HR =2.56, 95% CI: 1.91-3.43; 3 lobes: HR =2.87, 95% CI: 1.90-4.32; 4 lobes: HR =4.12, 95% CI: 2.01-8.46). Conclusions Lobar consolidation is a stable and reliable computed tomography feature that can be used to assess the severity of MPP in children. Quantitative analysis of lobar consolidation can comprehensively and accurately predict the progression of Mycoplasma pneumoniae. Low-dose computed tomography is recommended for children with severe MPP with complicated courses.
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Affiliation(s)
- Caiting Chu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijun Wang
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhang Wu
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huajun Li
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Xu
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liya Zhang
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quanhua Liu
- Department of Pediatric Respiration, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengjin Gao
- Department of Emergency, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisu Huang
- Department of Infectious Diseases, Xinhua Children's Hospital, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Development and validation of a nomogram for predicting Mycoplasma pneumoniae pneumonia in adults. Sci Rep 2022; 12:21859. [PMID: 36528731 PMCID: PMC9759542 DOI: 10.1038/s41598-022-26565-5] [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: 06/08/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
The study aimed to explore predictors of Mycoplasma pneumoniae pneumonia (MPP) in adults and develop a nomogram predictive model in order to identify high-risk patients early. We retrospectively analysed the clinical data of a total of 337 adult patients with community-acquired pneumonia (CAP) and divided them into MPP and non-MPP groups according to whether they were infected with MP. Univariate and multivariate logistic regression analyses were used to screen independent predictors of MPP in adults and to developed a nomogram model. Receiver operating characteristic (ROC) curve, calibration curve, concordance index (C-index), and decision curve analysis (DCA) were used for the validation of the evaluation model. Finally, the nomogram was further evaluated by internal verification. Age, body temperature, dry cough, dizziness, CRP and tree-in-bud sign were independent predictors of MPP in adults (P < 0.05). The nomogram showed high accuracy with C-index of 0.836 and well-fitted calibration curves in both the training and validation sets. The area under the receiver operating curve (AUROC) was 0.829 (95% CI 0.774-0.883) for the training set and 0.847 (95% CI 0.768-0.925) for the validation set. This nomogram prediction model can accurately predict the risk of MPP occurrence in adults, which helps clinicians identify high-risk patients at an early stage and make drug selection and clinical decisions.
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Challenges in the Differential Diagnosis of COVID-19 Pneumonia: A Pictorial Review. Diagnostics (Basel) 2022; 12:diagnostics12112823. [PMID: 36428883 PMCID: PMC9689132 DOI: 10.3390/diagnostics12112823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
COVID-19 pneumonia represents a maximum medical challenge due to the virus's high contagiousness, morbidity, and mortality and the still limited possibilities of the health systems. The literature has primarily focused on the diagnosis, clinical-radiological aspects of COVID-19 pneumonia, and the most common possible differential diagnoses. Still, few studies have investigated the rare differential diagnoses of COVID-19 pneumonia or its overlap with other pre-existing lung pathologies. This article presents the main radiological features of COVID-19 pneumonia and the most common alternative diagnoses to establish the vital radiological criteria for a differential diagnosis between COVID-19 pneumonia and other lung pathologies with similar imaging appearance. The differential diagnosis of COVID-19 pneumonia is challenging because there may be standard radiologic features such as ground-glass opacities, crazy paving patterns, and consolidations. A multidisciplinary approach is crucial to define a correct final diagnosis, as an overlap of COVID-19 pneumonia with pre-existing lung diseases is often possible and suggests possible differential diagnoses. An optimal evaluation of HRTC can help limit the clinical evolution of the disease, promote therapy for patients and ensure an efficient allocation of human and economic resources.
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Zhang H, Li H, Wang L, Huang L, Ma Q, Wu H, Pang H, Chen Y, Ruan Z. Development of a model for early differentiation of adenovirus pneumonia from Mycoplasma pneumoniae pneumonia. Transl Pediatr 2022; 11:1766-1775. [PMID: 36506774 PMCID: PMC9732605 DOI: 10.21037/tp-22-6] [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: 01/05/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adenovirus pneumonia (AVP) and Mycoplasma pneumoniae pneumonia (MPP) have similar clinical manifestations such as a high prevalence of lung consolidation, making the differential diagnosis difficult before the etiology is reported. This study aimed to compare AVP and MPP, and to build a predictive model to differentiate them early. METHODS We selected 198 cases of AVP and 876 cases of MPP. Clinical manifestations, computed tomography (CT) features, and biomarkers were compared. A logistic regression model was built to predict AVP. The area under the curve (AUC) of the receiver-operating characteristic was calculated to evaluate the discriminant ability of the prediction model. RESULTS Patients in the AVP group were mainly infants and toddlers, while the MPP group had more pre-school age children. The rate of hypoxemia and severe pneumonia was 3- and 11-times higher, respectively, in the AVP group than in the MPP group (5.6% vs. 1.8%, 27.8% vs. 2.5%, P<0.01). The proportion of patients with a Pediatric Logistic Organ Dysfunction-2 score ≥2 was 10 times higher in the AVP group than in the MPP group (17.4% vs. 1.7%, P<0.01). Bilateral pneumonia was present in 90.2% of the AVP group. Biomarkers, such as interleukin (IL)-2 receptor, IL-10 and lactic dehydrogenase (LDH), were considerably higher in the AVP group than in the MPP group (P<0.01). The predictive model included eight variables, namely: age, severe pneumonia, bilateral pneumonia, ground-glass attenuation, consolidation, atelectasis, C-reactive protein, and LDH. The AUC was 86.6%. CONCLUSIONS Compared with MPP, AVP affects younger children, presents a more severe respiratory tract involvement, results in a larger range of lung lesions, and is associated with higher inflammatory biomarkers. Our predictive model includes a combination of clinical features, imaging findings, and biomarkers. It may help pediatricians in the early differentiation of AVP from MPP.
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Affiliation(s)
- Hu Zhang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Pediatric Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huajun Li
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijun Wang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisu Huang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qibo Ma
- Emergency Department, Chuzhou Children's Hospital, The First People's Hospital of Chuzhou, Chuzhou, China
| | - Hanwen Wu
- Department of Dermatology and Venereology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huanchun Pang
- Department of Pediatrics, Chengmai County People's Hospital, Chengmai, China
| | - Yiping Chen
- Department of Pediatric Infectious Disease, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhengshang Ruan
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sreenath K, Kabra SK, Dey AB, Chandolia A, Sagar T, Singh V, Ghimire JJ, Guleria R, Chaudhry R. Mycoplasma pneumoniae among Hospitalized Patients with Acute Respiratory Tract Infections in an Indian Tertiary Care Hospital: an Underreported Health Problem. Microbiol Spectr 2022; 10:e0158922. [PMID: 35867428 PMCID: PMC9430479 DOI: 10.1128/spectrum.01589-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
The epidemiology of Mycoplasma pneumoniae (Mp) is poorly understood in India. The present study was conducted to identify the prevalence of Mp in a large set of patients with acute respiratory tract infections (ARI) in an Indian tertiary hospital. During 2015-2020, we tested throat swab specimens from patients with the clinical diagnosis of ARI (n = 1,098) by a real-time PCR and compared the demographic, clinical, laboratory, and outcome data of Mp-positive and Mp-negative patients. During the study period, 5% (55/1,098) of the tested samples were positive for Mp by PCR. School-aged children and young adults represented 36% (20/55) of the cases and 47.3% (26/55) of the cases were registered during the summer and monsoon. Among the Mp-positive patients, 61.8% (34/55) had underlying conditions; the most common were malignancy (n = 12; 21.8%) and hypertension (n = 6; 10.9%). Fever (98.2% versus 84.9%; P = 0.006), and pharyngitis (27.3% versus 16.3%; P = 0.034) were significantly common in the Mp-positive group than Mp-negative group. Among the Mp-positive group, 20% (11/55) of patients were admitted to an intensive care unit and a total of 7/55 (12.7%) patients received ventilatory support. The mortality in the Mp-positive cohort was 13.3%. The study provides baseline data regarding Mp prevalence and clinical characteristics. The application of molecular assays for diagnosing this pathogen among hospitalized patients with ARI could reduce inappropriate empirical antibiotic treatment and improve patient outcomes. Further large-scale studies are required to avoid the underdiagnosis of Mp infections in India and such studies should address some research gaps, such as macrolide resistance and molecular typing. IMPORTANCE M. pneumoniae (Mp) is a significant pathogen causing atypical pneumonia but by far these infections are underreported clinical entities in India. In the present study, we report the prevalence of Mp and describe the demographic and baseline clinical data of Mp-positive cases in an Indian tertiary care hospital. Our study may improve the clinician's awareness of this important agent of respiratory infection therefore timely and accurate diagnostic tools can be applied for patient management decisions and outcomes.
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Affiliation(s)
- K. Sreenath
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - S. K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - A. B. Dey
- Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amita Chandolia
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwajeet Singh
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Jagat Jeevan Ghimire
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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11
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Hu S, Zhu Y, Dong D, Wang B, Zhou Z, Wang C, Tian J, Peng Y. Chest Radiographs Using a Context-Fusion Convolution Neural Network (CNN): Can It Distinguish the Etiology of Community-Acquired Pneumonia (CAP) in Children? J Digit Imaging 2022; 35:1079-1090. [PMID: 35585465 PMCID: PMC9116701 DOI: 10.1007/s10278-021-00543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
Clinical symptoms and inflammatory markers cannot reliably distinguish the etiology of CAP, and chest radiographs have abundant information related with CAP. Hence, we developed a context-fusion convolution neural network (CNN) to explore the application of chest radiographs to distinguish the etiology of CAP in children. This retrospective study included 1769 cases of pediatric pneumonia (viral pneumonia, n = 487; bacterial pneumonia, n = 496; and mycoplasma pneumonia, n = 786). The chest radiographs of the first examination, C-reactive protein (CRP), and white blood cell (WBC) were collected for analysis. All patients were stochastically divided into training, validation, and test cohorts in a 7:1:2 ratio. Automatic lung segmentation and hand-crafted pneumonia lesion segmentation were performed, from which three image-based models including a full-lung model, a local-lesion model, and a context-fusion model were built; two clinical characteristics were used to build a clinical model, while a logistic regression model combined the best CNN model and two clinical characteristics. Our experiments showed that the context-fusion model which integrated the features of the full-lung and local-lesion had better performance than the full-lung model and local-lesion model. The context-fusion model had area under curves of 0.86, 0.88, and 0.93 in identifying viral, bacterial, and mycoplasma pneumonia on the test cohort respectively. The addition of clinical characteristics to the context-fusion model obtained slight improvement. Mycoplasma pneumonia was more easily identified compared with the other two types. Using chest radiographs, we developed a context-fusion CNN model with good performance for noninvasively diagnosing the etiology of community-acquired pneumonia in children, which would help improve early diagnosis and treatment.
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Affiliation(s)
- Shasha Hu
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Yongbei Zhu
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Bei Wang
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Zuofu Zhou
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fujian Medical University, Fuzhou, 350000, China
| | - Chi Wang
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China.
| | - Yun Peng
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
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12
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Debray MP, Carette MF, Loubet P, Pasquet B, Houhou Fidouh N, Benjoar M, Varon E, Brun AL, Claessens YE, Duval X, Khalil A. CT features of community-acquired pneumonia at the emergency department. Respir Med Res 2022; 81:100892. [PMID: 35489109 DOI: 10.1016/j.resmer.2022.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/26/2022] [Accepted: 02/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chest computed tomography (CT) was reported to improve the diagnosis of community-acquired pneumonia (CAP) as compared to chest X-ray (CXR). The aim of this study is to describe the CT-patterns of CAP in a large population visiting the emergency department and to see if some of them are more frequently missed on CXR. MATERIALS AND METHODS This is an ancillary analysis of the prospective multicenter ESCAPED study including 319 patients. We selected the 163 definite or probable CAP based on adjudication committee classification; 147 available chest CT scans were reinterpreted by 3 chest radiologists to identify CAP patterns. These CT-patterns were correlated to epidemiological, biological and microbiological data, and compared between false negative and true positive CXR CAP. RESULTS Six patterns were identified: lobar pneumonia (51/147, 35%), including 35 with plurifocal involvement; lobular pneumonia (43/147, 29%); unilobar infra-segmental consolidation (24/147, 16%); bronchiolitis (16/147, 11%), including 4 unilobar bronchiolitis; atelectasis and bronchial abnormalities (8/147, 5.5%); interstitial pneumonia (5/147, 3.5%). Bacteria were isolated in 41% of patients with lobar pneumonia-pattern (mostly Streptococcus pneumoniae and Mycoplasma pneumonia) versus 19% in other patients (p = 0.01). Respiratory viruses were equally distributed within all patterns. CXR was falsely negative in 46/147 (31%) patients. Lobar pneumonia was significantly less missed on CXR than other patterns (p = 0.003), especially lobular pneumonia and unilobar infra-segmental consolidation, missed in 35% and 58% of cases, respectively. CONCLUSION Lobar and lobular pneumonias are the most frequent CT-patterns. Lobar pneumonia is appropriately detected on CXR and mainly due to Streptococcus pneumoniae or Mycoplasma pneumoniae. Chest CT is very useful to identify CAP in other CT-patterns. Prior the COVID pandemic, CAP was rarely responsible for interstitial opacities on CT.
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Affiliation(s)
- Marie Pierre Debray
- AP-HP, Hôpital Bichat, Service de radiologie, 46 rue Henri Huchard, 75018 Paris, France; Université de Paris Cité; INSERM UMR 1152, Paris, France.
| | - Marie France Carette
- Sorbonne Université, UPMC, Paris VI, Paris, France ; AP-HP, Hôpital Tenon, Service de radiologie, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Paul Loubet
- VBMID, Inserm U1047, Department of Infectious and Tropical Diseases, CHU Nîmes, Place du Pr R. Debré, Univ Montpellier, 30029 Nîmes Cedex 9, France
| | - Blandine Pasquet
- AP-HP, Unité de Recherche Clinique, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Nadhira Houhou Fidouh
- AP-HP, Hôpital Bichat, Service de virologie, 46 rue Henri Huchard, 75018 Paris, France
| | - Mikhael Benjoar
- AP-HP, Hôpital Tenon, Service de radiologie, 4 rue de la Chine, 75970, Paris Cedex 20, France
| | - Emmanuelle Varon
- National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Anne Laure Brun
- APHP, Groupe Hospitalier Pitié-Salpêtrière, Service de radiologie, 83 Boulevard de l'Hôpital, 75013 Paris, France; Foch Hospital, Service de radiologie, 40 rue Worth, 92150 Suresnes, France
| | - Yann Erick Claessens
- Department of Emergency Medicine, Princess Grace Hospital Center, Avenue Pasteur MC-98002 Monaco, Monaco
| | - Xavier Duval
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, F-75018 Paris, France ; Université de Paris, IAME, INSERM, F-75018 Paris
| | - Antoine Khalil
- AP-HP, Hôpital Bichat, Service de radiologie, 46 rue Henri Huchard; Université de Paris Cité - Faculté de Médecine Bichat, 75018 Paris, France; INSERM UMR 1152, Paris, France
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13
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Unni A, Hidayathulla P, Kavitha K, Paloth MN, Nair PR, Kumar P J, Radhakrishnan C. A fulminant pneumonia due to Mycoplasma pneumoniae – Case report and literature review. IDCases 2022; 29:e01552. [PMID: 35832783 PMCID: PMC9271957 DOI: 10.1016/j.idcr.2022.e01552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Fulminant pneumonia due to Mycoplasma pneumoniae [MP] is quite rare even though there is a high prevalence of Mycoplasma species infection in the general population. We report a case of an atypical pneumonia with Acute Respiratory Distress Syndrome (ARDS) due to Mycoplasma pneumoniae in a young female and the clinical challenges encountered along with the current literature review.
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Affiliation(s)
- Athira Unni
- Department of Emergency Medicine, Government Medical College, Kozhikode 673008, Kerala, India
| | - P.K. Hidayathulla
- Department of Emergency Medicine, Government Medical College, Kozhikode 673008, Kerala, India
| | - K.P. Kavitha
- Department of Emergency Medicine, Government Medical College, Kozhikode 673008, Kerala, India
| | - Mohammed Niyas Paloth
- Department of Emergency Medicine, Government Medical College, Kozhikode 673008, Kerala, India
| | | | - Jayesh Kumar P
- Department of Medicine, Government Medical College, Kozhikode 673008, Kerala, India
| | - Chandni Radhakrishnan
- Department of Emergency Medicine, Government Medical College, Kozhikode 673008, Kerala, India
- Correspondence to: Emergency Medicine, Government Medical College, Kozhikode 673008, Kerala, India.
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14
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Wang J, Ma X, Wei S, Yang T, Tong Y, Jing M, Wen J, Zhao Y. Clinical Efficacy and Safety of Shashen Maidong Decoction in the Treatment of Pediatric Mycoplasma Pneumonia: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:765656. [PMID: 34712144 PMCID: PMC8546205 DOI: 10.3389/fphar.2021.765656] [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: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: This study was intended to provide data to support the effect of Shashen Maidong Decoction in improving mycoplasma pneumonia in pediatric patients through systematic evaluation. Methods: PubMed, the Web of Science, EMbase, CNKI, CQVIP, Wan-Fang, and CBM databases were comprehensively searched from established in June 2021. Randomized controlled trials of TRQI were selected by screening the literature and extracting information. The Cochrane RCT Evaluation Manual was used to evaluate the methodological quality of all included studies, and Meta-analysis was performed using Stata 14.0 and Review Manager 5.4 software. Results: A total of 1,127 patients from 12 clinical studies met the inclusion criteria. Meta-analysis results showed that the treatment group of Shashen Maidong Decoction was able to significantly increase the overall efficiency level and significantly reduce the incidence of adverse reactions, time for disappearance of cough, time for relief of cough, time for defervescence, time for disappearance of lung rales, time for return to normal of chest X-ray, T lymphocyte subpopulation (CD3+) and tumor necrosis factor-α (TNF-α) and other index levels (p < 0.05). Conclusion: Shashen Maidong Decoction has a significant improvement in the levels of relevant indexes in pediatric mycoplasma pneumonia, which provides a basis for the safety and efficacy of pediatric mycoplasma pneumonia. However, due to the small sample size included in the study, the study quality was not high, and more randomized controlled trials of high quality are required for further validation.
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Affiliation(s)
- Jiawei Wang
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China.,College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao Ma
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shizhang Wei
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China.,College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Yang
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China.,College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuling Tong
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China.,College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Manyi Jing
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jianxia Wen
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China.,College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanling Zhao
- Department of Pharmacy, The Fifth Medical Center of PLA General Hospital, Beijing, China
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15
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Li H, Li T, Cai Q, Wang X, Liao Y, Cheng Y, Zhou Q. Development and Validation of a Radiomics Nomogram for Differentiating Mycoplasma Pneumonia and Bacterial Pneumonia. Diagnostics (Basel) 2021; 11:diagnostics11081330. [PMID: 34441265 PMCID: PMC8392308 DOI: 10.3390/diagnostics11081330] [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: 06/28/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To develop and validate a radiological nomogram combining radiological and clinical characteristics for differentiating mycoplasma pneumonia and bacterial pneumonia with similar CT findings. Methods: A total of 100 cases of pneumonia patients receiving chest CT scan were retrospectively analyzed, including 60 patients with mycoplasma pneumonia and 40 patients with bacterial pneumonia. The patients were divided into the train set (n = 70) and the test set (n = 30). The features were extracted from chest CT images of each patient by AK analysis software, then univarite analysis, spearman correlation analysis, and least absolute shrinkage and selection operator (LASSO) were utilized for dimension reduction in training set. A radiomics model was built by multivariable logistic regression based on the selected features, and a radiomics-clinical multivariable logistic regression model was built by combining imaging radiomics and clinical risk factors (age and temperature). ROC, AUC, sensitivity, specificity, and accuracy were calculated to validate the two models. The nomogram of the radiomics-clinical was built and evaluated by calibration curve. The clinical benefit of the two models was measured by using decision curve. Results: A total of 396 texture features were extracted from each chest CT image, and 10 valuable features were screened out. In the radiomics model, the AUC, sensitivity, specificity, and accuracy for the train set is 0.877, 0.762, 0.821, 78.6%, and for the test set it is 0.810, 0.667, 0.750 and 70.0%, respectively. In the radiomics-clinical model, the AUC, sensitivity, specificity, and accuracy for the train set is 0.905, 0.976, 0.714, 87.1%, and for the test set is is 0.847, 0.889, 0.667 and 80.0%, respectively. Decision curve analysis shows that both the two models increase the clinical benefits of the patients, and the radiomics-clinical model gains higher clinical benefits, compared to the radiomics model. Conclusion: The radiomics-clinical nomogram had good performance in identifying mycoplasma pneumonia and bacterial pneumonias, which would be helpful in clinical decision-making.
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Affiliation(s)
- Honglin Li
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
| | - Ting Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China;
| | - Qinxin Cai
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
| | - Xiaozhuan Wang
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
| | | | - Yuanxiong Cheng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China;
- Correspondence: (Y.C.); (Q.Z.)
| | - Quan Zhou
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
- Correspondence: (Y.C.); (Q.Z.)
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16
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Liu L, Maharjan S, Sun JL, Li YC, Cheng HJ. Prevalence and clinical characteristics of septicemia in children with Mycoplasma pneumoniae pneumonia. J Int Med Res 2021; 49:3000605211021733. [PMID: 34167353 PMCID: PMC8236790 DOI: 10.1177/03000605211021733] [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] [Indexed: 12/04/2022] Open
Abstract
Background Mycoplasma pneumoniae (MP) pneumonia in children can be challenging to treat, and the impact of MP blood infection is unclear. The present study aims to determine the prevalence and clinical characteristics of MP septicemia among pediatric patients. Methods Children hospitalized at our center for MP pneumonia between October 2017 and June 2018 were included. Healthy controls visiting our outpatient clinic for regular physical examinations were also enrolled. MP was detected by real-time polymerase chain reaction (qPCR) analysis of plasma and peripheral blood mononuclear cell (PBMC) samples. Results Sixty-one children with MP pneumonia and 30 healthy children were included. Among children with MP infection, 31 (50.8%) were positive for MP by qPCR (19 in plasma samples, 8 in PBMC samples, and 4 in both). All healthy controls were negative for MP by qPCR. Conclusions The prevalence of MP septicemia in children with MP pneumonia is moderate. However, detection of MP in blood samples may have limited clinical value for guiding treatment.
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Affiliation(s)
- Li Liu
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Shobha Maharjan
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jia-Liang Sun
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yan-Chun Li
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Huan-Ji Cheng
- Department of Pediatric Pulmonology, The First Hospital of Jilin University, Changchun, Jilin Province, China
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17
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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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黄 丽, 黄 冬, 鲁 灵, 黎 静, 彭 淑. [Value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid for predicting refractory Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:471-474. [PMID: 34020736 PMCID: PMC8140331 DOI: 10.7499/j.issn.1008-8830.2012095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid (BALF) for predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. METHODS A total of 50 children with common Mycoplasma pneumoniae pneumonia (MPP) and 22 children with RMPP were enrolled. The two groups were compared in terms of clinical features, laboratory examination results, imaging findings, and YKL-40 levels in BALF. The receiver operating characteristic (ROC) curve was used to evaluate the value of YKL-40 in BALF for predicting RMPP. RESULTS Compared with the common MPP group, the RMPP group had significantly higher incidence rates of fever, shortness of breath, lung consolidation, and pleural effusion (P < 0.05) and significantly higher serum levels of C-reactive protein and lactate dehydrogenase (P < 0.05). The RMPP group had a significantly higher level of YKL-40 in BALF than the common MPP group (P < 0.05). The ROC curve plotted based on the level of YKL-40 in BALF had an area under the ROC curve of 0.750, a sensitivity of 72.7% and a specificity of 64.0% for predicting RMPP. CONCLUSIONS There is an increase in the level of YKL-40 in BALF in children with RMPP, and the level of YKL-40 in BALF has a certain value for predicting RMPP.
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Affiliation(s)
- 丽林 黄
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 冬平 黄
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 灵龙 鲁
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 静 黎
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 淑梅 彭
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
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19
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黄 丽, 黄 冬, 鲁 灵, 黎 静, 彭 淑. [Value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid for predicting refractory Mycoplasma pneumoniae pneumonia in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:471-474. [PMID: 34020736 PMCID: PMC8140331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/26/2021] [Indexed: 08/11/2024]
Abstract
OBJECTIVE To evaluate the value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid (BALF) for predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. METHODS A total of 50 children with common Mycoplasma pneumoniae pneumonia (MPP) and 22 children with RMPP were enrolled. The two groups were compared in terms of clinical features, laboratory examination results, imaging findings, and YKL-40 levels in BALF. The receiver operating characteristic (ROC) curve was used to evaluate the value of YKL-40 in BALF for predicting RMPP. RESULTS Compared with the common MPP group, the RMPP group had significantly higher incidence rates of fever, shortness of breath, lung consolidation, and pleural effusion (P < 0.05) and significantly higher serum levels of C-reactive protein and lactate dehydrogenase (P < 0.05). The RMPP group had a significantly higher level of YKL-40 in BALF than the common MPP group (P < 0.05). The ROC curve plotted based on the level of YKL-40 in BALF had an area under the ROC curve of 0.750, a sensitivity of 72.7% and a specificity of 64.0% for predicting RMPP. CONCLUSIONS There is an increase in the level of YKL-40 in BALF in children with RMPP, and the level of YKL-40 in BALF has a certain value for predicting RMPP.
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Affiliation(s)
- 丽林 黄
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 冬平 黄
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 灵龙 鲁
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 静 黎
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
| | - 淑梅 彭
- />广东省妇幼保健院儿科, 广东广州 510010Department of Pediatrics, Guangdong Women and Children's Hospital, Guangzhou 510010, China
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Wang J, Mao J, Chen G, Huang Y, Zhou J, Gao C, Jin D, Zhang C, Wen J, Sun J. Evaluation on blood coagulation and C-reactive protein level among children with mycoplasma pneumoniae pneumonia by different chest imaging findings. Medicine (Baltimore) 2021; 100:e23926. [PMID: 33545964 PMCID: PMC7837868 DOI: 10.1097/md.0000000000023926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2020] [Indexed: 12/13/2022] Open
Abstract
Mycoplasma pneumoniae infection may induce a systemic hypercoagulable abnormality, like organ embolism and infarction. Indexes of blood coagulation and C-reactive protein (CRP) have been reported different between healthy people and mycoplasma pneumoniae pneumonia (MPP) patients, but this difference in MPP patients with different chest imaging findings has rarely been reported.We performed a retrospective study of 101 children with MPP and 119 controls, combined with radiological examination and blood tests, to compare the blood coagulation and CRP level among MPP children with different chest imaging findings.For the MPP children with different chest imaging findings, there were significant differences in CRP, fibrinogen (FIB) and D-dimer (D-D) levels among subgroups (P = .004, P = .008 and P < .001 respectively). The CRP level in group of interstitial pneumonia was significantly higher than that in groups of bronchopneumonia and hilar shadow thickening (P = .003 and P = .001 respectively). And the FIB and D-D values in group of lung consolidation were significantly higher than that in the other 3 groups (all P < .05). When compared with controls, the white blood cell, CRP, FIB, and D-D levels in MPP children were significantly higher, and the activated partial thromboplastin time and thrombin time levels were significantly lower (all P < .05).Our results showed that CRP level changed most significantly in group of interstitial pneumonia, whereas FIB, D-D levels changed most significantly in the lung consolidation group.
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Affiliation(s)
| | | | | | | | | | | | | | - Chenying Zhang
- Department of Respiratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Juan Wen
- Nanjing Maternity and Child Health Care Institute, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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HUO X, XUE X, YUAN S, ZHANG D, GAO Q, GONG T. [Early differential diagnosis between COVID-19 and mycoplasma pneumonia with chest CT scan]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:468-473. [PMID: 32985160 PMCID: PMC8800730 DOI: 10.3785/j.issn.1008-9292.2020.07.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To early differentiate between coronavirus disease 2019 (COVID-19) and adult mycoplasma pneumonia with chest CT scan. METHODS Twenty-six patients with COVID-19 and 21 patients with adult mycoplasma pneumonia confirmed with RT-PCR test were enrolled from Zibo First Hospital and Lanshan People's Hospital during December 1st 2019 and March 14th 2020. The early chest CT manifestations were analyzed and compared between the two groups. RESULTS The interstitial changes with ground glass density shadow (GGO) were similar in two groups during first chest CT examination (P>0.05). There were more lung lobes involved on the first chest CT in COVID-19 patients, which were mostly distributed in the dorsal outer zone (23/26, 88.5%), and nearly half of them (12/26, 46.2%) were accompanied by crazy-paving sign; while the lesions in adult mycoplasma pneumonia patients were mostly distributed along the bronchi, and the bronchial wall was thickened (19/21, 90.5%), accompanied with tree buds / fog signs (19/21, 90.5%). The above CT signs were significantly different between the two kinds of pneumonia (all P<0.01). COVID-19 had a longer course compared with mycoplasma pneumonia, the disease peaks of COVID-19 patients was on day (10.5±3.8), while the disease on CT was almost absorbed on day (7.9±2.2) in adult mycoplasma pneumonia. The length of hospital stay in COVID-19 patients was significantly longer than that of mycoplasma pneumonia patients [(19.5±4.3) d vs (7.9±2.2) d, P<0.01]. CONCLUSIONS The lesions of adult mycoplasma pneumonia are mostly distributed along the bronchi with tree buds/fog signs, while the lesions of COVID-19 are mainly distributed in the dorsal outer zone accompanied by crazy-paving sign, which can early distinguish two diseases.
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Affiliation(s)
| | | | | | | | | | - Tao GONG
- 巩涛(1988-), 男, 博士, 住院医师, 主要从事影像医学与核医学研究; E-mail:
;
https://orcid.org/0000-0001-9689-0420
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Xu W, Yang H, Liu H, Tang X, Xu H, Li H, Zhao S. Bronchoalveolar lavage T cell cytokine profiles and their association with lung function in children with Mycoplasma pneumoniae -associated bronchiolitis obliterans. Pediatr Pulmonol 2020; 55:2033-2040. [PMID: 32478954 DOI: 10.1002/ppul.24882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) infection may progress to bronchiolitis obliterans (BO), with an underlying chronic inflammatory process. The aim of this study was to investigate the cytokine profiles in pulmonary T-lymphocytes and their associations with lung function in patients with BO following M. pneumoniae infection. METHODS Bronchoalveolar lavage (BAL) samples were obtained from 10 controls and 18 children with M. pneumoniae-associated BO. We analyzed the BAL T cells for interferon (IFN)-γ, interleukin (IL)-4, IL-9, IL-17, CD25, and Foxp3 by intercellular flow cytometry. The associations with T-cell subpopulations and lung function parameters were determined. RESULTS In BAL fluid, significantly increased proportions of T-helper 1 (Th1), Th17, and Tc1 cells were found in M. pneumoniae-associated BO patients when compared with controls. The percentages of Th17 cells showed correlations with forced expiratory volume in 1 second % predicted value (r = -0585; P < .05) and forced expiratory flow at 25% to 75% (FEF25%-75% ) % predicted value (r = -.618; P < .01). Higher proportions of Tc1 (r = -.488; P < .05) and Tc17 (r = -.542; P < .05) were significantly correlated with a reduced FEF25%-75% % predicted value in M. pneumoniae-associated BO patients. CONCLUSIONS Our comprehensive cytokines analysis of BAL T cells revealed correlations of IL-17-producing and IFN-γ-producing T cells with lung function, suggesting that increased T-cell subpopulations may play a role in M. pneumoniae-associated BO progression.
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Affiliation(s)
- Weihan Xu
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Haiming Yang
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaolei Tang
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Huimin Li
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shunying Zhao
- Department 2 of Respiratory Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Correlation between chest radiographic findings and clinical features in hospitalized children with Mycoplasma pneumoniae pneumonia. PLoS One 2019; 14:e0219463. [PMID: 31461462 PMCID: PMC6713385 DOI: 10.1371/journal.pone.0219463] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/24/2019] [Indexed: 01/30/2023] Open
Abstract
Background Radiologic evaluation of children with Mycoplasma pneumoniae is important for diagnosis and management. Objective To investigate the correlation between chest radiographic findings and the clinical features in children with Mycoplasma pneumoniae pneumonia. Materials and methods This study included 393 hospitalized children diagnosed with M. pneumoniae pneumonia between January 2000 and August 2016. Their clinical features and chest radiographs were reviewed. Radiographic findings were categorized and grouped as consolidation group (lobar or segmental consolidation) and non-consolidation group (patchy infiltration, localized reticulonodular infiltration, or parahilar peribronchial infiltration). Results Lobar or segmental consolidation (37%) was the most common finding, followed by parahilar or peribronchial infiltration (27%), localized reticulonodular infiltration (21%) and patchy infiltration (15%). The consolidation group was more frequently accompanied by pleural effusions (63%), compared to the non-consolidation group (16%). Compared with patients in the non-consolidation group, those in the consolidation group were associated with a significantly higher rate of hypoxia, tachypnea, tachycardia, extrapulmonary manifestations, prolonged fever, and longer periods of anti-mycoplasma therapy and hospitalization. Lobar or segmental consolidation was significantly more frequent in children ≥5 years old (44%) compared with children 2–5 years old (34%) and <2 years old (13%). Parahilar peribronchial infiltration was significantly more frequent in children <2 years old (56%) compared with children 2–5 years old (32%) and ≥5 years old (18%). Conclusion The chest radiographic findings of children with M. pneumoniae pneumonia correlate well with the clinical features. Consolidative lesions were frequently observed in older children and were associated with more severe clinical features.
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Salem I, Kimak M, Conic R, Bragazzi NL, Watad A, Adawi M, Bridgewood C, Pacifico A, Santus P, Rizzi M, Petrou S, Colombo D, Fiore M, Pigatto PDM, Damiani G. Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7315274. [PMID: 31281845 PMCID: PMC6590566 DOI: 10.1155/2019/7315274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions.
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Affiliation(s)
- Iman Salem
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Mark Kimak
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Nicola L. Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Pierachille Santus
- Department of Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Maurizio Rizzi
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Stephen Petrou
- Emergency Medicine, Good Samaritan Hospital Medical Center, New York, USA
| | - Delia Colombo
- Department of Pharmacology, University of Milan, Milan, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo D. M. Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Spectrum of imaging findings in pulmonary infections. Part 1: Bacterial and viral. Pol J Radiol 2019; 84:e205-e213. [PMID: 31481992 PMCID: PMC6717952 DOI: 10.5114/pjr.2019.85812] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/11/2019] [Indexed: 12/27/2022] Open
Abstract
Chest radiography is generally the first imaging modality used for the evaluation of pneumonia. It can establish the presence of pneumonia, determine its extent and location, and assess the response to treatment. Computed tomography is not used for the initial evaluation of pneumonia, but it may be used when the response to treatment is unusually slow. It helps to identify complications, detect any underlying chronic pulmonary disease, and also to characterise complex pneumonias. Although not diagnostic, certain imaging findings may suggest a particular microbial cause over others. Knowledge of whether pneumonia is community-acquired or nosocomial, as well as the age and immune status of the patient, can help us in narrowing the differential diagnoses. The purpose of this article is to briefly review the various pulmonary imaging manifestations of pathogenic organisms. This knowledge along with clinical history and laboratory investigations of the patient may help in guiding the treatment of pneumonia.
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Wen X, Liu J, Li H, Zhao C, Zhao S. Clinicoradiologic features of Mycoplasma pneumoniae bronchiolitis in children. Pediatr Investig 2018; 2:248-252. [PMID: 32851274 PMCID: PMC7331297 DOI: 10.1002/ped4.12108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 10/09/2018] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Acute Mycoplasma pneumoniae bronchiolitis can progress into bronchiolitis obliterans (BO) in children, which has a major influence on a child's quality of life and is associated with M. pneumoniae bronchiolitis. Early identification and treatment of M. pneumoniae bronchiolitis is important to prevent the development of BO. OBJECTIVE To enhance the understanding of the diagnosis and treatment of M. pneumoniae bronchiolitis in children. METHODS Eight patients with M. pneumoniae bronchiolitis were retrospectively analyzed. RESULTS Five of the patients with M. pneumoniae bronchiolitis were male and three of them were female. All patients suffered from fever and cough. Moist rales and wheezing were noted in both lungs in six patients. High-resolution computed tomography of the chest showed bronchiolitis in all patients, with large airway injury in two and focal bronchopneumonia in six. Two patients were confirmed to have asthma. Seven patients had personal and/or family histories of atopic diseases. Allergen testing was performed in six patients, which produced positive results in four; the remaining two patients had negative results, but their total IgE levels were > 200 IU/ml. Azithromycin therapy and glucocorticoid therapy was administered to all eight patients. One patient required noninvasive ventilation. Treatment of all patients was successful, with no development of bronchiolitis obliterans during the 4- to 8-month follow-up. INTERPRETATION Mycoplasma pneumoniae bronchiolitis can occur in children, especially in atopic individuals. The use, time of initiation, and effects of glucocorticoids administration in these patients for the prevention of BO require further investigation.
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Affiliation(s)
- Xiaohui Wen
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Jinrong Liu
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Huimin Li
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Chengsong Zhao
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Shunying Zhao
- Department of Respiratory MedicineBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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Seo H, Cha SI, Shin KM, Lim JK, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Relationship Between Clinical Features and Computed Tomographic Findings in Hospitalized Adult Patients With Community-Acquired Pneumonia. Am J Med Sci 2018; 356:30-38. [PMID: 30049328 PMCID: PMC7093861 DOI: 10.1016/j.amjms.2018.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/05/2023]
Abstract
Background Data on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images. Methods Patients with CAP who underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data. Results A total of 40 patients (2.4%) were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups. Conclusions The bronchiolitis group was characterized by a higher frequency of M. pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.
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Affiliation(s)
- Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
| | - Kyung-Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Huang L, Chen H, Peng S. Spontaneous pneumomediastinum, emphysema, and pulmonary bullae associated with refractory Mycoplasma pneumoniae pneumonia in a child. Pediatr Pulmonol 2017; 52:E77-E80. [PMID: 28752681 DOI: 10.1002/ppul.23761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/15/2017] [Indexed: 11/10/2022]
Abstract
We report a 21-month-old child with spontaneous pneumomediastinum (PM), emphysema, and pulmonary bullae caused by Mycoplasma pneumonia (M. pneumoniae) pneumonia. The patient presented with stubborn dyspnea and wheezing although received integrated treatment, including anti-infection, anti-inflammation, and intravenous immunoglobulin. This case was unique in that pulmonary bullae kept increasing. PM and emphysema were refractory in our patient, which have been reported as benign and limited. Surgical intervention was implemented to ultimately cure the case. Clinicians should be aware of air leaks in patients with M. pneumoniae pneumonia since this complication may be fatal.
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Affiliation(s)
- Lilin Huang
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Huajia Chen
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Shumei Peng
- Department of Pediatrics, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Zhao C, Liu J, Yang H, Xiang L, Zhao S. Mycoplasma pneumoniae-Associated Bronchiolitis Obliterans Following Acute Bronchiolitis. Sci Rep 2017; 7:8478. [PMID: 28814783 PMCID: PMC5559585 DOI: 10.1038/s41598-017-08861-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/14/2017] [Indexed: 11/24/2022] Open
Abstract
The characteristics of Mycoplasma pneumonia (M. pneumoniae)-associated bronchiolitis obliterans (BO) are not well known. We retrospectively reviewed 17 patients with M. pneumoniae–associated BO. All patients had M. pneumoniae–associated acute bronchiolitis prior to the development of BO. In the acute bronchiolitis stage, all patients had fever and cough; six patients also had wheezing and dyspnoea. BO was diagnosed approximately 1.5–8 months later based on clinical manifestations and chest high-resolution computed tomography (HRCT) findings. All patients presented with wheezing and/or dyspnoea at the time of diagnosis of BO. HRCT findings included mosaic attenuation, pronounced air trapping, central bronchiectasis and emphysema, according to disease severity. Lung function tests revealed mild to severe airway obstruction. Fourteen of 17 patients had a greater than 12% increase in forced expiratory volume in 1 second values after taking salbutamol. All patients had positive allergy test results and family or personal history of atopic disease. Four patients had a history of asthma before M. pneumonia bronchiolitis. Asthma was diagnosed before, at the time of or after the diagnosis of BO in 11 cases. M. pneumoniae–associated BO may therefore develop following M. pneumonia bronchiolitis and overlap with asthma.
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Affiliation(s)
- Chengsong Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, People's Republic of China
| | - Jinrong Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, People's Republic of China
| | - Haiming Yang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, People's Republic of China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, People's Republic of China
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, 100045, People's Republic of China.
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Deng H, Rui J, Zhao D, Liu F. Mycoplasma pneumoniae 23S rRNA A2063G mutation does not influence chest radiography features in children with pneumonia. J Int Med Res 2017; 46:150-157. [PMID: 28760082 PMCID: PMC6011311 DOI: 10.1177/0300060517716312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To measure the rate of the A2063G mutation in the Mycoplasma pneumoniae (M. pneumoniae) 23S rRNA domain V in children with pneumonia and to determine the correlation between radiographic findings and the presence of the A2063G mutation. Methods Patients who were hospitalized with a confirmed diagnosis of M. pneumoniae pneumonia were enrolled in this study. M. pneumoniae strains were collected for genotype analysis. Chest radiography was performed on all children prior to and following macrolide treatment. Clinical and imaging data were obtained. Results Of 211 patients, 195 (92.42%) harboured M. pneumoniae with the A2063G mutation. No significant differences were identified in inflammation score, chest radiography inflammation absorption grade before and after macrolide treatment, or pulmonary complications (atelectasis, hydrothorax, or pleuritis) prior to macrolide treatment when children were stratified based on the presence or absence of the A2063G mutation. Conclusions A high proportion of children with pneumonia harboured strains of M. pneumoniae with the A2063G mutation in the 23S rRNA domain V. However, no obvious chest radiographic features of M. pneumoniae pneumonia were associated with the A2063G variant.
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Affiliation(s)
- Huan Deng
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Jun Rui
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Advanced Role of Neutrophils in Common Respiratory Diseases. J Immunol Res 2017; 2017:6710278. [PMID: 28589151 PMCID: PMC5447318 DOI: 10.1155/2017/6710278] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/22/2017] [Accepted: 04/16/2017] [Indexed: 12/18/2022] Open
Abstract
Respiratory diseases, always being a threat towards the health of people all over the world, are most tightly associated with immune system. Neutrophils serve as an important component of immune defense barrier linking innate and adaptive immunity. They participate in the clearance of exogenous pathogens and endogenous cell debris and play an essential role in the pathogenesis of many respiratory diseases. However, the pathological mechanism of neutrophils remains complex and obscure. The traditional roles of neutrophils in severe asthma, chronic obstructive pulmonary diseases (COPD), pneumonia, lung cancer, pulmonary fibrosis, bronchitis, and bronchiolitis had already been reviewed. With the development of scientific research, the involvement of neutrophils in respiratory diseases is being brought to light with emerging data on neutrophil subsets, trafficking, and cell death mechanism (e.g., NETosis, apoptosis) in diseases. We reviewed all these recent studies here to provide you with the latest advances about the role of neutrophils in respiratory diseases.
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Zhao JL, Wang X, Wang YS. Relationships between Th1/Th2 cytokine profiles and chest radiographic manifestations in childhood Mycoplasma pneumoniae pneumonia. Ther Clin Risk Manag 2016; 12:1683-1692. [PMID: 27956836 PMCID: PMC5113916 DOI: 10.2147/tcrm.s121928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Mycoplasma pneumoniae pneumonia (MPP) is one of the most common childhood community-acquired pneumonias, and the chest radiograph usually shows bronchial pneumonia, segmental/lobar pneumonia, or segmental/lobar pneumonia with pleural effusion. The imbalance of Th1/Th2 function after Mycoplasma pneumoniae infection is an important immunological mechanism of MPP. In this study, we aimed to evaluate the correlations between Th1/Th2 cytokine profiles and chest radiographic manifestations in MPP children. Patients and methods A total of 87 children with MPP were retrospectively reviewed in this study. According to the chest radiographic manifestations, they were divided into the following three groups: bronchial MPP group, segmental/lobar MPP group, and segmental/lobar MPP with pleural effusion group. Clinical features and changes in Th1/Th2 cytokines were further analyzed. Results The incidence of tachypnea and cyanosis was higher in children with segmental/lobar MPP with pleural effusion than in those with segmental/lobar or bronchial MPP. The peak body temperature of segmental/lobar MPP was higher than that of bronchial MPP, and the duration of fever and hospitalization was positively correlated with the severity of MPP. MPP children’s chest radiograph showed a relationship with the changes in Th1/Th2 cytokines. Serum interleukin-4, interleukin-10 (IL-10), interferon-γ, and tumor necrosis factor-α (TNF-α) of segmental/lobar MPP were significantly higher than those of bronchial MPP, and serum IL-10 (cutoff value: 27.25 pg/mL) can be used as a diagnostic predictor for segmental/lobar MPP. Serum TNF-α and interleukin-6 of segmental/lobar MPP with pleural effusion were significantly higher than those of segmental/lobar MPP without pleural effusion. Serum TNF-α (cutoff value: 60.25 pg/mL) can be used as a diagnostic predictor for segmental/lobar MPP with pleural effusion. Conclusion There were significant correlations between Th1/Th2 cytokine profiles and chest radiographic manifestations in MPP children. Serum IL-10 and TNF-α can be used as an optimal predictor for segmental/lobar MPP and segmental/lobar MPP with pleural effusion, respectively.
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Affiliation(s)
- Jiu-Ling Zhao
- Department of Pediatrics, Tianjin Nankai Hospital; Nankai Clinical School, Tianjin Medical University, Nankai, Tianjin, People's Republic of China
| | - Xin Wang
- Department of Pediatrics, Tianjin Nankai Hospital
| | - Yu-Shui Wang
- Department of Pediatrics, Tianjin Nankai Hospital
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