Post-infectious Bronchiolitis Obliterans: HRCT, DECT, Pulmonary Scintigraphy Images, and Clinical Follow-up in Eight Children

Serum inflammatory markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for mycoplasma severity

BACKGROUND

Mycoplasma pneumoniae pneumonia (MPP) significantly impacts pediatric health, necessitating markers for early severe disease identification.

AIM

To investigate the correlation between serum inflammatory marker and the severity of MPP in children.

METHODS

A prospective study was carried out from January 2023 to November 2023. A total of 160 children with MPP who underwent treatment were selected: 80 had severe MPP and 80 had mild MPP. Clinical and laboratory data were collected at the time of hospital admission and during hospitalization. Receiver operating characteristic curves were utilized to assess the diagnostic and prognostic for severe MPP.

RESULTS

Fever duration and length of hospitalization in pediatric patients with severe MPP exceeded those with mild MPP. The incidence of pleural effusion, lung consolidation, and bronchopneumonia on imaging was markedly elevated in the severe MPP cohort compared to the mild MPP cohort. In contrast to the mild cohort, there was a notable increase in C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate, lactic dehydrogenase, D-dimer, and inflammatory cytokines [interleukin (IL)-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α] in the severe MPP group were significantly higher.

CONCLUSION

Serum inflammatory markers (CRP, PCT, IL-6, D-dimer, IL-10 and TNF-α) were considered as predictors in children with severe MPP.

Update in postinfectious bronchiolitis obliterans

Postinfectious bronchiolitis obliterans (PiBO) is a rare and severe form of chronic obstructive lung disease caused by an infectious injury to the lower respiratory tract. The most commonly recognized inciting stimuli leading to PiBO are airway pathogens, such as adenovirus and Mycoplasma. PiBO is characterized by persistent and nonreversible airway obstruction, with functional and radiological evidence of small airway involvement. The literature has limited information on the aetiology, clinical profile, treatment, and outcome of PiBO.

Pulmonary Function in Post-Infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis

Owing to the rarity of post-infectious bronchiolitis obliterans (PIBO), pulmonary function in children with PIBO has been mainly investigated in small-sample sized studies. This systematic review and meta-analysis investigated pulmonary function in children with PIBO, regardless of age at respiratory insult and PIBO diagnosis. A systematic literature search revealed 16 studies reporting pulmonary function data in 480 children with PIBO. Levels of key pulmonary function parameters were summarized by pooled mean difference (MD) only in children with PIBO, and a random effect model was used. Pooled MDs (95% confidence interval [CI]) for FEV₁, FVC, and FEF_25-75% were 51.4, (44.2 to 58.5), 68.4 (64.4 to 72.3), and 26.5 (19.3 to 33.6) % predicted, respectively, with FEV₁/FVC of 68.8% (62.2 to 75.4). Pooled MDs (95% CI) of the z-scores for FEV₁, FVC, and FEF_25-75% were -2.6 (-4.2 to -0.9), -1.9 (-3.2 to -0.5), and -2.0 (-3.6 to -0.4). Pooled MD (95% CI) for the diffusion capacity of the lungs for carbon monoxide from two studies was 64.9 (45.6 to 84.3) % predicted. The post-bronchodilator use change in the FEV₁ in three studies was 6.1 (4.9 to 7.2). There was considerable heterogeneity across the studies. PIBO is associated with moderately impaired pulmonary function, and this review facilitates an understanding of PIBO pathophysiology in children.

Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children

OBJECTIVE

To elucidate the clinical usefulness of lactate dehydrogenase (LDH) levels in children with Mycoplasma pneumoniae (MP) pneumonia and identify cut-off levels in various clinical conditions.

METHODS

The study was retrospectively performed in 145 children who were hospitalized with MP pneumonia. Laboratory findings, including LDH levels at admission and clinical features were retrospectively reviewed from patients' electronic medical records.

RESULTS

The mean age of the study population was 5.9 y, and the mean value of LDH was 809.7 U/L. Poor response to treatment for MP pneumonia, respiratory virus coinfection, severe MP pneumonia, development of postinfectious bronchiolitis obliterans (PIBO) after MP pneumonia, pleural effusion, and oxygen need during illness were significantly associated with serum LDH levels. The cutoff levels of LDH for predicting poor response to treatment for MP pneumonia and respiratory virus coinfection were 1058 U/L [area under the curve (AUC), 0.729] and 803 U/L (AUC, 0.682), respectively. Those for pneumonic lesions involving at least one-third of the total lung volume, prediction of PIBO development, and extrapulmonary manifestations were 1098 U/L (AUC, 0.715), 676 U/L (AUC, 0.714), and 859 U/L (AUC, 0.710), respectively. The cutoff levels for pleural effusion during illness and for the prediction of oxygen need were 894 U/L (AUC, 0.699) and 1114 U/L (AUC, 0.771), respectively.

CONCLUSION

LDH levels are elevated in diverse clinical conditions in children with MP pneumonia and may be useful in the identification of severe clinical courses of MP pneumonia in children.

Artificial Intelligence Algorithm-Based High-Resolution Computed Tomography Image in the Treatment of Children with Bronchiolitis Obliterans by Traditional Chinese Medicine Method of Resolving Phlegm and Removing Blood Stasis

This research was aimed to explore the application of high-resolution computed tomography (HRCT) based on intelligent iterative reconstruction technique in the early diagnosis and treatment of bronchiolitis obliterans (BO) in children and to explore the efficacy of traditional Chinese medicine (TCM) in resolving phlegm and removing blood stasis. Sixty pediatric patients with BO were selected as the study subjects and diagnosed by HRCT scanning, and the scanned images were processed by iterative reconstruction technique. The patients were treated with TCM therapy of resolving phlegm and removing blood stasis alone (group A), HRCT-guided TCM therapy of resolving phlegm and removing blood stasis (group B), and iterative reconstruction HRCT-guided TCM therapy of resolving phlegm and removing blood stasis (group C). The results showed that the lung HRCT image after iterative reconstruction was closer to the original image than that after filtered back projection reconstruction, and the edge of the image after filtered back projection reconstruction was more blurred and the noise was higher. The image obtained by iterative reconstruction technique was smoother and clearer, and the image stability after iterative reconstruction was higher. The treatment results showed that the proportion of moderate and severe obstruction in group C was 5.18%, which was significantly lower than that in group A (18.75%) and group B (11.29%), and group B was significantly lower than that in group A (18.75%) (P < 0.05). The proportion of clinical effect in group C after treatment was 70.18%, significantly higher than that in group A (55.5%) and group B (63.34%), and that in group B was significantly higher than that in group A (55.5%) (P < 0.05). In summary, the lung HRCT after iterative reconstruction can more clearly and intuitively show the lesion site, which has a key role in guiding the early diagnosis and treatment planning of BO; the HRCT image based on iterative reconstruction technique combined with TCM treatment of removing blood stasis and resolving phlegm has a better therapeutic effect on children, with a high application value.

Risk Factors for Post-infectious Bronchiolitis Obliterans in Children: A Systematic Review and Meta-Analysis

BACKGROUND

Post-infectious bronchiolitis obliterans (PIBO) is a long-term sequela after an initial insult to the lower respiratory tract. A comprehensive understanding of the factors that contribute to a high risk of developing PIBO is important to help define therapeutic strategies and improve prognosis.

METHODS

We performed a systematic review of published literature available in the online databases including PubMed, Embase, Web of Science, CNKI, Wan Fang, and VIP, with the last search updated on 27 January 2022. Observational studies and case-control studies that provide sufficient data to examine associations between potential risk factors and PIBO were included. Pooled odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) and heterogeneity were calculated.

RESULTS

A total of 14 risk factors were selected from 9 studies included in the analysis. The strongest risk factors were hypoxemia, mechanical ventilation, tachypnea, and wheezing. Hypoxemia conferred the greatest risk with pooled OR of 21.54 (95% CI: 10-46.36, p < 0.001). Mechanical ventilation ranked second (pooled OR 14.61, 95% CI: 7.53-28.35, p < 0.001). Use of γ-globulin, use of glucocorticoids, co-infection of bacteria, a history of wheezing, and being male were other prominent risk factors. The effects of premature birth, allergic rhinitis, and imaging finding (pulmonary consolidation, atelectasis, pleural effusion) are less clear and require further confirmation. Cases that developing PIBO had a lower age compared with controls (MD, -8.76 months, 95% CI: -16.50 to -1.02, p = 0.03). No significant differences were observed in the duration of fever (MD, 1.74 days, 95% CI: -0.07 to 3.54, p = 0.06). Children diagnosed with PIBO had higher LDH levels (MD, 264.69 U/L, 95% CI: 67.43 to 461.74, p = 0.008) and duration of hospitalization (MD, 4.50 days, 95% CI: 2.63 to 6.37, p < 0.001).

CONCLUSION

In this study, we found that the strongest risk factors for PIBO were hypoxemia, mechanical ventilation, tachypnea, and wheezing. Use of glucocorticoids, γ-globulin, co-infection of bacteria, a history of wheezing, and being male may also play a role. The factors discussed above can inform the generation of a clinical prediction model for the developing PIBO in children.