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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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He M, Xie J, Rui P, Li X, Lai M, Xue H, Chen C. Clinical efficacy of macrolide antibiotics in mycoplasma pneumoniae pneumonia carrying a macrolide-resistant mutation in the 23 S rRNA gene in pediatric patients. BMC Infect Dis 2024; 24:758. [PMID: 39085799 PMCID: PMC11292884 DOI: 10.1186/s12879-024-09612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The global prospective surveillance data showed the re-emergence of mycoplasma pneumoniae pneumonia (MPP) in Europe and Asia after the coronavirus disease 2019 pandemic. We sought to observe the effect of macrolide antibiotics in the treatment of MPP carrying a macrolide-resistant mutation gene and the potential of targeted next-generation sequencing (tNGS) as a front-line diagnostic in MPP patients. METHODS The baseline characteristics of 91 children with MPP hospitalized from January to October 2023 were retrospectively analyzed. They were divided into two groups according to whether carrying the macrolide-resistant mutation or not. The logistic and linear regression analyses were used to determine whether the mutation was a standalone predictive predictor of the duration of fever and hospital length of stay. RESULTS First, no patients had a fever for ≥ 7 days after macrolide treatment. But length of stay and hormone concentration were significantly different between the two groups (P < 0.05). There were also no statistical association between the mutation and the duration of fever and hospital length of stay. CONCLUSION Macrolides can be administered to MPP children carrying a macrolide-resistant mutation. tNGS can be seen as a front-line diagnostic in MPP.
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Affiliation(s)
- Mengyuan He
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Junfeng Xie
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Pu Rui
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Xiaoyu Li
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Min Lai
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Hongman Xue
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Chun Chen
- Pediatric Hematology Laboratory, Division of Hematology/Oncology, Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China.
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Yun KW. Community-acquired pneumonia in children: updated perspectives on its etiology, diagnosis, and treatment. Clin Exp Pediatr 2024; 67:80-89. [PMID: 37321577 PMCID: PMC10839192 DOI: 10.3345/cep.2022.01452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/19/2023] [Accepted: 02/08/2023] [Indexed: 06/17/2023] Open
Abstract
Pneumonia is a common pediatric infectious disease that is familiar to pediatricians and a major cause of hospitalization worldwide. Recent well-designed epidemiologic studies in developed countries indicated that respiratory viruses are detected in 30%-70%, atypical bacteria in 7%-17%, and pyogenic bacteria in 2%-8% of children hospitalized with community-acquired pneumonia (CAP). The etiological distribution of CAP varies widely by child age and the epidemiological season of the respiratory pathogen. Moreover, diagnostic tests, particularly for the detection of Streptococcus pneumoniae and Mycoplasma pneumoniae, the 2 major bacterial pathogens involved in pediatric CAP, have several limitations. Therefore, management and empirical antimicrobial therapy for children with CAP should be applied in a stepwise manner based on recent epidemiological, etiological, and microbiological evidence.
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Affiliation(s)
- Ki Wook Yun
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
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Li YT, Zhang J, Wang MZ, Ma YM, Zhi K, Dai FL, Li SJ. Changes in coagulation markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for Mycoplasma severity. Ital J Pediatr 2023; 49:143. [PMID: 37858230 PMCID: PMC10588045 DOI: 10.1186/s13052-023-01545-1] [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: 09/11/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND This study investigates the correlation between coagulation levels and the severity of Mycoplasma pneumoniae pneumonia (MPP) in children. In addition, the study analyses the predictive value of coagulation abnormalities in MPP combined with necrotising pneumonia (NP). METHODS A total of 170 children with MPP who underwent treatment between June 2021 and February 2022 were selected for this study. The study population was divided into groups according to the severity of the disease to compare differences in the incidence of coagulation abnormalities between the groups. The participants were also divided into groups according to imaging manifestations to compare the differences in coagulation function among the different groups. All data information was processed for statistical analysis using SPSS Statistics 25.0 and GraphPad Prism 7.0 statistical analysis software. RESULTS The incidence of coagulation abnormalities in the children in the severe MPP (SMPP) group was significantly higher than that in the normal MPP (NMPP) group (P < 0.05). The multi-factor logistic regression analysis revealed that the D-dimer level is an independent risk factor for the development of NP in SMPP (P < 0.05). The receiver operating characteristic curve analysis revealed statistically significant differences (P < 0.05) in D-dimer, fibrinogen degeneration products (FDP), neutrophils, lactate dehydrogenase and serum ferritin for predicting SMPP combined with NP. Bronchoscopic manifestations of coagulation indicators (D-dimer and FDP levels) were significantly higher in the mucus plug group than in the non-mucus plug group, while the activated partial thromboplastin time levels were lower in the former than in the latter (P < 0.05). CONCLUSION The degree of elevated D-dimer and FDP levels was positively correlated with the severity of MPP, with elevated serum D-dimer levels (> 3.705 mg/L) serving as an independent predictor of MPP combined with NP in children.
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Affiliation(s)
- Yong-Tao Li
- Department of Pediatrics, Luoyang Maternal and Child Health Hospital, No. 206 of Tongqu Road, 471000, Luoyang, Henan province, China
| | - Ju Zhang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankangroad, 453100, Weihui, Henan province, China
| | - Meng-Zhu Wang
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankangroad, 453100, Weihui, Henan province, China
| | - Yu-Mei Ma
- Department of Pediatrics, Luoyang Maternal and Child Health Hospital, No. 206 of Tongqu Road, 471000, Luoyang, Henan province, China
| | - Ke Zhi
- Department of Pediatrics, Luoyang Maternal and Child Health Hospital, No. 206 of Tongqu Road, 471000, Luoyang, Henan province, China
| | - Fu-Li Dai
- Department of Pediatrics, Luoyang Maternal and Child Health Hospital, No. 206 of Tongqu Road, 471000, Luoyang, Henan province, China
| | - Shu-Jun Li
- Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University, No. 88 of Jiankangroad, 453100, Weihui, Henan province, China.
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Deng F, Cao H, Liang X, Li Q, Yang Y, Zhao Z, Tan J, Fu G, Shu C. Analysis of cytokine levels, cytological findings, and MP-DNA level in bronchoalveolar lavage fluid of children with Mycoplasma pneumoniae pneumonia. Immun Inflamm Dis 2023; 11:e849. [PMID: 37249293 PMCID: PMC10165957 DOI: 10.1002/iid3.849] [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: 11/05/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The present study was conducted to determine the inflammatory response in the lungs of children with Mycoplasma pneumoniae pneumonia (MPP). METHODS This study retrospectively analyzed cytokine levels, cytological findings, and M. pneumoniae (MP)-DNA level in the bronchoalveolar lavage fluid (BALF) of 96 children with MPP. The study utilized Spearman's correlation method to evaluate the contribution of BALF and blood parameters in MPP children. RESULTS (1) A total of 96 MPP children were classified into the Low MP-DNA MPP group (BALF MP-DNA ≤ 105 copies/mL) and the High MP-DNA MPP group (BALF MP-DNA > 105 copies/mL); the Non-fever MPP group (no fever during the entire course of pneumonia) and the Fever MPP group; the Defervescence MPP group (fever had subsided at the time of bronchoscopy) and the Fervescence MPP group; and the Mild MPP group and the Severe MPP group. (2) The High MP-DNA MPP, Fever MPP, Fervescence MPP, and Severe MPP groups had higher levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-α (TNF-α) in their BALF (all p < .05). (3) The proportions of neutrophils and macrophages in the BALF of the High MP-DNA MPP and Fever MPP groups increased and decreased, respectively (all p < .05). (4) In the BALF of MPP children, MP-DNA, IL-6, IL-10, TNF-α, and interferon gamma (IFN-γ) levels positively correlated with neutrophil proportion while negatively correlated with macrophage proportion (all p < .05). (5) The MP-DNA, IL-6, IL-10, TNF-α, and IFN-γ levels in the BALF of MPP children were positively correlated with the levels of C-reactive protein, procalcitonin, lactic dehydrogenase, fibrinogen, and d-dimer, while they were negatively correlated with the albumin level (all p < .05). CONCLUSIONS In children with MPP, the pulmonary inflammatory immune response was stronger in the High MP-DNA MPP, Fever MPP, Fervescence MPP, and Severe MPP groups. The relationship between pulmonary cytokine levels, MP-DNA load, and serum inflammatory parameters were found to be weak.
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Affiliation(s)
- Fang Deng
- Department of Respiratory, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical DisordersChongqing Key Laboratory of PediatricsChongqingChina
- Department of PediatricsAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Huiling Cao
- Department of NeonatologyChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaohua Liang
- Department of Clinical Epidemiology and BiostatisticsChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Qubei Li
- Department of Respiratory, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical DisordersChongqing Key Laboratory of PediatricsChongqingChina
| | - Yang Yang
- Department of Respiratory, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical DisordersChongqing Key Laboratory of PediatricsChongqingChina
| | - Zhihua Zhao
- Department of Respiratory, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical DisordersChongqing Key Laboratory of PediatricsChongqingChina
| | - Junjie Tan
- Clinical Molecular Medical CenterChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Guo Fu
- Clinical Molecular Medical CenterChildren's Hospital of Chongqing Medical UniversityChongqingChina
| | - Chang Shu
- Department of Respiratory, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical DisordersChongqing Key Laboratory of PediatricsChongqingChina
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Liu J, He R, Zhang X, Zhao F, Liu L, Wang H, Zhao S. Clinical features and “early” corticosteroid treatment outcome of pediatric mycoplasma pneumoniae pneumonia. Front Cell Infect Microbiol 2023; 13:1135228. [PMID: 37082710 PMCID: PMC10110948 DOI: 10.3389/fcimb.2023.1135228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/10/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundMany children with mycoplasma pneumoniae (MP) pneumonia (MPP) developed sequelae such as bronchiolitis/bronchitis obliterans (BO). Early corticosteroid therapy might prevent disease progression. This study aimed to use “early” corticosteroid and observe the treatment outcome in patients with MPP.MethodsPatients who had pulmonary infiltrations on chest imaging within 5 days of the disease course and were suspected of having MP infection on admission were enrolled. Among them, patients whose disease course was within 10 days on admission were ultimately enrolled. We analyzed their data including the clinical features, the starting time and dose of corticosteroid therapy, and the treatment outcome. According to chest imaging, we divided patients into two groups (Group A: bronchiolitis-associated lesions or ground-glass opacities; Group B: pulmonary segmental/lobar consolidation).ResultsA total of 210 patients with confirmed MPP were ultimately enrolled. There were 59 patients in Group A and 151 patients in Group B. Patients in Group A were more prone to have allergy histories, hypoxemia, wheezing sound, and wet rales on auscultation than those in Group B. Corticosteroid treatment was initiated between 5 and 10 days of disease onset in all patients and 6–7 days in most patients. Methylprednisolone was prescribed in all patients within 10 days of disease onset, and the highest prescribed dose was at least 2 mg/kg/day. In Group A, methylprednisolone >2 mg/kg/day was prescribed in 22 patients, and among them, 8 patients with diffuse bronchiolitis-associated lesions received high-dose methylprednisolone therapy. After 3 months, lung CT revealed slightly segmental ground-glass opacity in three patients. In Group B, methylprednisolone >2 mg/kg/day was prescribed in 76 patients, and among them, 20 patients with pulmonary lobar consolidation received high-dose methylprednisolone therapy. After 3 months, chest imaging revealed incomplete absorption of pulmonary lesions in seven patients. Among them, five patients with consolidation in more than one pulmonary lobe ultimately had slight BO.ConclusionIn hospitalized patients with MPP, particularly severe MPP, the ideal starting time of corticosteroid treatment might be 5–10 days, preferably 6–7 days, after disease onset. The initial dosage of corticosteroid therapy should be decided according to the severity of the disease. MPP patients with diffuse bronchiolitis-associated lesions/whole lobar consolidation on imaging might require high-dose corticosteroid therapy.
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Affiliation(s)
- Jinrong Liu
- Department of Respiratory Medicine, China National Clinical Research Center of Respiratory Disease, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
- *Correspondence: Shunying Zhao, ; Jinrong Liu,
| | - Ruxuan He
- Department of Respiratory Medicine, China National Clinical Research Center of Respiratory Disease, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Xiaoyan Zhang
- Department of Respiratory Medicine, China National Clinical Research Center of Respiratory Disease, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Fei Zhao
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory of Infectious Disease Prevention and Control, Beijing, China
| | - Liyong Liu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, State Key Laboratory of Infectious Disease Prevention and Control, Beijing, China
| | - Heng Wang
- Department of Respiratory Medicine, China National Clinical Research Center of Respiratory Disease, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
| | - Shunying Zhao
- Department of Respiratory Medicine, China National Clinical Research Center of Respiratory Disease, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing, China
- *Correspondence: Shunying Zhao, ; Jinrong Liu,
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Leng M, Yang J, Zhou J. The molecular characteristics, diagnosis, and treatment of macrolide-resistant Mycoplasma pneumoniae in children. Front Pediatr 2023; 11:1115009. [PMID: 36937963 PMCID: PMC10017863 DOI: 10.3389/fped.2023.1115009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The purpose of this study is to review the molecular characteristics, the diagnosis, and treatment of the widespread infection of macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae; MRMP) in children, thus providing a better knowledge of this infection and presenting the associated problems. Single point mutations in the V region of the 23S rRNA gene of M. pneumoniae genome are associated with macrolide resistance. P1-1, MLVA4-5-7-2, and ST3 are usually the predominated genetic types in the M. pneumoniae epidemics. The short-term two times serological IgM (or together with IgG) test in the acute stage can be used for confirmation. Combined serological testing and PCR might be a more prudent method to reduce macrolide consumption and antibiotic selective pressure in a clinical setting. Molecular methods for the detection of single-nucleotide mutations in the V region of the 23S rRNA gene can be used for the diagnosis of MRMP. The routine use of macrolide for the treatment of macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections can get good effect, but the effects are limited for severe MRMP infections. Additional corticosteroids may be required for the treatment of severe MRMP infections in children in China during the era of MRMP.
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Mei X, Wang J, Zhang C, Zhu J, Liu B, Xie Q, Yuan T, Wu Y, Chen R, Xie X, Wei Y, Wang L, Shao G, Xiong Q, Xu Y, Feng Z, Zhang Z. Apigenin suppresses mycoplasma-induced alveolar macrophages necroptosis via enhancing the methylation of TNF-α promoter by PPARγ-Uhrf1 axis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 108:154504. [PMID: 36332388 DOI: 10.1016/j.phymed.2022.154504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/09/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mycoplasma-associated pneumonia is characterized by severe lung inflammation and immunological dysfunction. However, current anti-mycoplasma agents used in clinical practice do not prevent dysfunction of alveolar macrophages caused by the high level of the cytokine tumor necrosis factor-α (TNF-α) after mycoplasma infection. Apigenin inhibits the production of TNF-α in variet inflammation associated disease. PURPOSE This study aimed to investigate apigenin's effect on mycoplasma-induced alveolar immune cell injury and the mechanism by which it inhibits TNF-α transcription. METHODS In this study, we performed a mouse model of Mycoplasma hyopneumoniae infection to evaluate the effect of apigenin on reducing mycoplasma-induced alveolar immune cell injury. Furthermore, we carried out transcriptome analysis, RNA interference assay, methylated DNA bisulfite sequencing assay, and chromatin immunoprecipitation assay to explore the mechanism of action for apigenin in reducing TNF-α. RESULTS We discovered that M. hyopneumoniae infection-induced necroptosis in alveolar macrophages MH-S cells and primary mouse alveolar macrophages, which was activated by TNF-α autocrine. Apigenin inhibited M. hyopneumoniae-induced elevation of TNF-α and necroptosis in alveolar macrophages. Apigenin inhibited TNF-a mRNA production via increasing ubiquitin-like with PHD and RING finger domains 1 (Uhrf1)-dependent DNA methylation of the TNF-a promotor. Finally, we demonstrated that apigenin regulated Uhrf1 transcription via peroxisome proliferator activated receptor gamma (PPARγ) activation, which acts as a transcription factor binding to the Uhrf1 promoter and protected infected mice's lungs, and promoted alveolar macrophage survival. CONCLUTSION This study identified a novel mechanism of action for apigenin in reducing alveolar macrophage necroptosis via the PPARγ/ Uhrf1/TNF-α pathway, which may have implications for the treatment of Mycoplasma pneumonia.
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Affiliation(s)
- Xiuzhen Mei
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China; Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Jian Wang
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China; Department of Animal Science, Tibet Agricultural and Animal Husbandry College, Linzhi, China
| | - Chao Zhang
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jiale Zhu
- School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Beibei Liu
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Qingyun Xie
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Ting Yuan
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Yuzi Wu
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Rong Chen
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Xing Xie
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Yanna Wei
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Li Wang
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Guoqing Shao
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Qiyan Xiong
- Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China
| | - Yefen Xu
- Department of Animal Science, Tibet Agricultural and Animal Husbandry College, Linzhi, China.
| | - Zhixin Feng
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China; Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China; Department of Animal Science, Tibet Agricultural and Animal Husbandry College, Linzhi, China.
| | - Zhenzhen Zhang
- College of Veterinary Medicine, Nanjing Agricultural University, Nanjing, China; Institute of Veterinary Medicine, Jiangsu Academy of Agricultural Sciences, Nanjing, China.
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Lee KY. Common immunopathogenesis of central nervous system diseases: the protein-homeostasis-system hypothesis. Cell Biosci 2022; 12:184. [PMCID: PMC9668226 DOI: 10.1186/s13578-022-00920-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022] Open
Abstract
AbstractThere are hundreds of central nervous system (CNS) diseases, but there are few diseases for which the etiology or pathogenesis is understood as well as those of other organ-specific diseases. Cells in the CNS are selectively protected from external and internal insults by the blood–brain barrier. Thus, the neuroimmune system, including microglia and immune proteins, might control external or internal insults that the adaptive immune system cannot control or mitigate. The pathologic findings differ by disease and show a state of inflammation that reflects the relationship between etiological or inflammation-inducing substances and corresponding immune reactions. Current immunological concepts about infectious diseases and infection-associated immune-mediated diseases, including those in the CNS, can only partly explain the pathophysiology of disease because they are based on the idea that host cell injury is caused by pathogens. Because every disease involves etiological or triggering substances for disease-onset, the protein-homeostasis-system (PHS) hypothesis proposes that the immune systems in the host control those substances according to the size and biochemical properties of the substances. In this article, I propose a common immunopathogenesis of CNS diseases, including prion diseases, Alzheimer’s disease, and genetic diseases, through the PHS hypothesis.
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Lee E, Choi I. Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children. Indian J Pediatr 2022; 89:1003-1009. [PMID: 35665905 DOI: 10.1007/s12098-022-04205-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/16/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To elucidate the clinical usefulness of lactate dehydrogenase (LDH) levels in children with Mycoplasma pneumoniae (MP) pneumonia and identify cut-off levels in various clinical conditions. METHODS The study was retrospectively performed in 145 children who were hospitalized with MP pneumonia. Laboratory findings, including LDH levels at admission and clinical features were retrospectively reviewed from patients' electronic medical records. RESULTS The mean age of the study population was 5.9 y, and the mean value of LDH was 809.7 U/L. Poor response to treatment for MP pneumonia, respiratory virus coinfection, severe MP pneumonia, development of postinfectious bronchiolitis obliterans (PIBO) after MP pneumonia, pleural effusion, and oxygen need during illness were significantly associated with serum LDH levels. The cutoff levels of LDH for predicting poor response to treatment for MP pneumonia and respiratory virus coinfection were 1058 U/L [area under the curve (AUC), 0.729] and 803 U/L (AUC, 0.682), respectively. Those for pneumonic lesions involving at least one-third of the total lung volume, prediction of PIBO development, and extrapulmonary manifestations were 1098 U/L (AUC, 0.715), 676 U/L (AUC, 0.714), and 859 U/L (AUC, 0.710), respectively. The cutoff levels for pleural effusion during illness and for the prediction of oxygen need were 894 U/L (AUC, 0.699) and 1114 U/L (AUC, 0.771), respectively. CONCLUSION LDH levels are elevated in diverse clinical conditions in children with MP pneumonia and may be useful in the identification of severe clinical courses of MP pneumonia in children.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea.
| | - Insu Choi
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, 61469, Republic of Korea
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Macrolide versus Non-Macrolide in Combination with Steroids for the Treatment of Lobar or Segmental Mycoplasma pneumoniae Pneumonia Unresponsive to Initial Macrolide Monotherapy. Antibiotics (Basel) 2022; 11:antibiotics11091233. [PMID: 36140012 PMCID: PMC9495205 DOI: 10.3390/antibiotics11091233] [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: 08/25/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022] Open
Abstract
In the last few decades, macrolide-resistant Mycoplasma pneumoniae (MRMP) has been increasing in proportion. This study aimed to evaluate the treatment outcomes of children with lobar or segmental MP pneumonia unresponsive to the initial 3−5-day macrolide therapy, who then switched to either a non-macrolide, macrolide + steroid, or a non-macrolide + steroid regimen, according to the 2019 KSPID and KAPARD guideline during the 2019−2020 Mycoplasma epidemic in South Korea. A total of 190 patients <18 years old were admitted during the study period for MP lobar or segmental pneumonia, and 16.8% (n = 32/190) were responsive to the initial macrolide monotherapy, whereas 83.2% (158/190) were refractory. The median age of the patients was 7 (interquartile range [IQR], 5−9) years old and 46.2% (n = 73/158) were male. The overall treatment success rates of non-macrolide, macrolide + steroid, and non-macrolide + steroid groups were 46.2%, 80.8%, and 100.0%, respectively. Patients in the non-macrolide + steroid group had the shortest fever duration after a regimen change of 1 (IQR, 0−3) day compared with patients in the non-macrolide group and macrolide + steroid group; 2 (IQR, 1−4) days and 2 (IQR, 1−3.3) days (p = 0.004), respectively. Follow-up CRP (ß, 0.169; CI, 0.050−0.287; p = 0.006), macrolide + steroid therapy (ß, −1.694; CI, −2.463−−0.925; p < 0.001), and non-macrolide+ steroid therapy (ß, −2.224; CI, −3.321−−1.127; p < 0.001) were shown to be significantly associated with the duration of fever after admission. To conclude, in patients with severe MP pneumonia that failed to respond to the initial macrolide therapy, a non-macrolide + steroid had the highest treatment success rate and a shorter duration of fever.
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12
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The Diagnostic Value of High-Resolution Computed Tomography Features Combined with Mycoplasma Pneumoniae Ribonucleic Acid Load Detection for Refractory Mycoplasma Pneumonia. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6460865. [PMID: 35601566 PMCID: PMC9095367 DOI: 10.1155/2022/6460865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate the value of high-resolution computed tomography (CT) images and mycoplasma pneumoniae (MP) ribonucleic acid (RNA) load detection in the early diagnosis of refractory mycoplasma pneumoniae (RMP) and provide more methods for the diagnosis and treatment of RMP. Seventy children with MP were divided into the RMP group (H1 group, 31 cases) and the MP group (H2 group, 39 cases) according to pathological findings, and all of them underwent CT scanning. MP-RNA load and genotype distribution were analyzed in both groups, and the diagnostic efficacy of CT combined with MP-RNA load for RMP was calculated. The sensitivity of children in the H1 group to erythromycin (59.17% vs 71.56%) and clarithromycin (53.21% vs 67.03%) was lower than that in the H2 group, and the resistance rate of children in the H1 group to erythromycin (71.43% vs 67.53%) and clarithromycin (64.24% vs 50.37%) was higher than that in the H2 group (P < 0.05); the regression coefficients between lactate dehydrogenase (LDH) and the MPLI value of RMP were −0.064 and −0.413, respectively, which were significantly negatively correlated (P < 0.05); the accuracy (96.5%), sensitivity (92.5%), and specificity (88%) of CT + MP-RNA in the diagnosis of RMP were significantly higher than those of CT alone (91%, 88%, and 82%) and MP-RNA alone (88%, 84.5%, and 74%), which were significantly different (P < 0.05). The results of high MP-RNA load detection can be used as an indicator to predict RMP, and the diagnostic efficacy is significantly improved after combination with high-resolution CT, with high clinical application value.
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13
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Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med 2022; 11:jcm11102824. [PMID: 35628949 PMCID: PMC9144103 DOI: 10.3390/jcm11102824] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Refractory Mycoplasma pneumoniae pneumonia (RMPP) is a severe state of M. pneumoniae infection that has attracted increasing universal attention in recent years. The pathogenesis of RMPP remains unknown, but the excessive host immune responses as well as macrolide resistance of M. pneumoniae might play important roles in the development of RMPP. To improve the prognosis of RMPP, it is mandatory to recognize RMPP in the early stages, and the detection of macrolide-resistant MP, clinical unresponsiveness to macrolides and elevated proinflammatory cytokines might be clues. Timely and effective anti-mycoplasmal therapy and immunomodulating therapy are the main strategies for RMPP.
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14
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Rhim JW, Kang JH, Lee KY. Etiological and pathophysiological enigmas of severe coronavirus disease 2019, multisystem inflammatory syndrome in children, and Kawasaki disease. Clin Exp Pediatr 2022; 65:153-166. [PMID: 34809418 PMCID: PMC8990954 DOI: 10.3345/cep.2021.01270] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, a novel multisystem inflammatory syndrome in children (MIS-C) has been reported worldwide since the first cases were reported in Europe in April 2020. MIS-C is temporally associated with severe acute respiratory syndrome coronavirus 2 infection and shows Kawasaki disease (KD)-like features. The epidemiological and clinical characteristics in COVID-19, KD, and MIS-C differ, but severe cases of each disease share similar clinical and laboratory findings such as a protracted clinical course, multiorgan involvement, and similar activated biomarkers. These findings suggest that a common control system of the host may act against severe disease insult. To solve the enigmas, we proposed the protein-homeostasis-system hypothesis in that every disease involves etiological substances and the host's immune system controls them by their size and biochemical properties. Also, it is proposed that the etiological agents of KD and MIS-C might be certain strains in the microbiota of human species and etiological substances in severe COVID-19, KD, and MIS-C originate from pathogen-infected cells. Since disease severity depends on the amounts of inflammation-inducing substances and corresponding immune activation in the early stage of the disease, an early proper dose of corticosteroids and/or intravenous immunoglobulin (IVIG) may help reduce morbidity and possibly mortality among patients with these diseases. Corticosteroids are low cost and an analogue of host-origin cortisol among immune modulators. This study's findings will help clinicians treating severe COVID-19, KD, and MIS-C, especially in developing countries, where IVIG and biologics supplies are insufficient.
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Affiliation(s)
- Jung-Woo Rhim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin-Han Kang
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyung-Yil Lee
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea.,Junglock Biomedical Institute, Daejeon, Korea
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15
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Fu X, Yang N, Ji J. Application of CT images based on the optimal atlas segmentation algorithm in the clinical diagnosis of Mycoplasma Pneumoniae Pneumonia in Children. Pak J Med Sci 2021; 37:1647-1651. [PMID: 34712299 PMCID: PMC8520366 DOI: 10.12669/pjms.37.6-wit.4860] [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: 04/09/2021] [Revised: 06/12/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Use of optimal Atlas segmentation algorithm to study the imaging signs of mycoplasma pneumonia with multi-slice spiral CT (HRCT), and to explore the value of HRCT in the diagnosis and efficacy in evaluation of mycoplasma pneumonia in children. Methods The study retrospectively analyzed 72 patients diagnosed with mycoplasma pneumonia in our hospital from January 2017 to January 2019. The imaging data and clinical data of 72 patients were collected. The optimal Atlas segmentation algorithm was used to analyze the characteristics of CT examination, and the value of CT in the diagnosis of mycoplasma pneumonia and the evaluation of curative effect was summarized. Results Among all patients, 37 cases were unilateral lesions, 35 cases were bilateral lesions, 19 cases were in the left upper lobe, 24 cases were in the left lower lobe, 21 cases were in the right upper lobe, 13 cases were in the right middle lobe, 25 The lesion was located in the right lower lobe. The main CT findings of the lesions before treatment were large patchy, spot-shaped shadows, and strip-shaped or ground-glass shadows. After treatment, the main CT findings of the lesions were reduced lesion density and reduced lesion range. Conclusion CT can clearly show the pulmonary lesions of mycoplasma pneumonia, and its unique imaging signs can improve the clinical diagnosis accuracy. In addition, CT scans can evaluate the treatment effect according to the changes in the characteristics of the lesion, which has important value for the evaluation of the effect for clinical diagnosis and efficacy evaluation of mycoplasma pneumonia.
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Affiliation(s)
- Xilin Fu
- Xilin Fu, Attending Physician, Department of Pediatrics, Yiwu Central Hospital, Yiwu, 322000, China
| | - Ningfei Yang
- Ningfei Yang, Attending Physician, Department of Pediatrics, Yiwu Central Hospital, Yiwu, 322000, China
| | - Jianwei Ji
- Jianwei Ji, Attending Physician, Department of Pediatrics, Yiwu Central Hospital, Yiwu, 322000, China
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16
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Chen YC, Hsu WY, Chang TH. Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia. Emerg Infect Dis 2021; 26:1382-1391. [PMID: 32568052 PMCID: PMC7323531 DOI: 10.3201/eid2607.200017] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A high prevalence rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has been reported in Asia. We performed a systematic review and meta-analysis to investigate the effect of macrolide resistance on the manifestations and clinical judgment during M. pneumoniae infections. We found no difference in clinical severity between MRMP and macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections. However, in the pooled data, patients infected with MRMP had a longer febrile period (1.71 days), length of hospital stay (1.61 day), antibiotic drug courses (2.93 days), and defervescence time after macrolide treatment (2.04 days) compared with patients infected with MSMP. The risk of fever lasting for >48 hours after macrolide treatment was also significantly increased (OR 21.24), and an increased proportion of patients was changed to second-line treatment (OR 4.42). Our findings indicate diagnostic and therapeutic challenges after the emergence of MRMP. More precise diagnostic tools and clearly defined treatment should be appraised in the future.
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Han HY, Park KC, Yang EA, Lee KY. Macrolide-Resistant and Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia in Children Treated Using Early Corticosteroids. J Clin Med 2021; 10:jcm10061309. [PMID: 33810090 PMCID: PMC8004593 DOI: 10.3390/jcm10061309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
We have found that early corticosteroid therapy was effective for reducing morbidity during five Korea-wide epidemics. We evaluated the clinical and laboratory parameters of 56 children who received early corticosteroid treatment for pneumonia that was caused by macrolide-resistant Mycoplasma pneumoniae (M. pneumoniae) or macrolide-sensitive M. pneumoniae between July 2019 and February 2020. All subjects had dual positive results from a PCR assay and serological test, and received corticosteroids within 24–36 h after admission. Point mutation of residues 2063, 2064, and 2067 was identified in domain V of 23S rRNA. The mean age was 6.8 years and the male:female ratio was 1.2:1 (31:25 patients). Most of the subjects had macrolide-resistant M. pneumoniae (73%), and all mutated strains had the A2063G transition. No significant differences in clinical and laboratory parameters were observed between macrolide-resistant and macrolide-sensitive M. pneumoniae groups that were treated with early dose-adjusted corticosteroids. Higher-dose steroid treatment may be needed for patients who have fever that persists for >48 h or increased biomarkers such as lactate dehydrogenase concentration at follow-up despite a usual dose of steroid therapy.
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Affiliation(s)
- Hye Young Han
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.Y.H.); (K.-Y.L.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea
| | - Ki Cheol Park
- Clinical Research Institute, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 34943, Korea;
| | - Eun-Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.Y.H.); (K.-Y.L.)
- Department of Pediatrics, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea
- Correspondence: ; Tel.: +82-42-220-9540; Fax: +82-42-221-2925
| | - Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Korea; (H.Y.H.); (K.-Y.L.)
- Junglock Biomedical Institute, 127, Yuchun-ro, Jung-gu, Deajeon 34886, Korea
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18
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Meng F, Chen P, Guo X, Li X, Wu Y, Liu W, Jiang F, Liu H, Wang L. Correlations between Serum P2X7, Vitamin A, 25-hydroxy Vitamin D, and Mycoplasma Pneumoniae Pneumonia. J Clin Lab Anal 2021; 35:e23760. [PMID: 33724522 PMCID: PMC8128307 DOI: 10.1002/jcla.23760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Background Identifying new molecular diagnostic markers for Mycoplasma Pneumoniae Pneumonia (MPP) has always been an essential topic since MPP cases have increased every year, especially among children. Here, we examined the correlation between serum level of Purinergic receptor P2X7, vitamin A, and 25‐hydroxy vitamin D (25(OH)D) and the severity of MPP, aiming to identify molecules that have the potential to become diagnostic markers. Methods This study was conducted on 186 cases aged 1–14 (136 MPP and 50 non‐MPP patients). Serum levels of Purinergic receptor P2X7, vitamin A, 25(OH)D, and multiple inflammatory and immune factors were measured, compared, and tested for statistical significance. Results Serum P2X7, tumor necrosis factor‐α (TNF‐α), and interleukin‐1β (IL‐1β) levels were significantly increased in severe MPP patients, while serum vitamin A, 25(OH)D, IgA, and IgG levels were significantly decreased. Conclusion Our results demonstrated a positive correlation between serum P2X7 level and the severity of MPP, and negative correlations between serum levels of vitamin A and 25(OH)D and the severity of MPP, suggesting that high serum levels of P2X7 and low serum levels of vitamin A and 25(OH)D may indicate relatively severer MPP.
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Affiliation(s)
- Fanjun Meng
- Medical Laboratory, Hospital of Cardiovascular and Cerebrovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ping Chen
- Medical Experiment Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaolong Guo
- Medical Experiment Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xiaoru Li
- Department of Laboratory Medicine, Shizuishan Second People's Hospital, Shizuishan, China
| | - Yuexuan Wu
- General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wenen Liu
- Xiangya Hospital of Central South University, Hunan, China
| | - Feng Jiang
- Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Huan Liu
- Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Lixin Wang
- Medical Experiment Center, General Hospital of Ningxia Medical University, Yinchuan, China
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Early Confirmation of Mycoplasma pneumoniae Infection by Two Short-Term Serologic IgM Examination. Diagnostics (Basel) 2021; 11:diagnostics11020353. [PMID: 33672480 PMCID: PMC7923409 DOI: 10.3390/diagnostics11020353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study is to re-evaluate the clinical application of two-times serologic immunoglobulin M (IgM) tests using microparticle agglutination assay (MAA), an enzyme-linked immunosorbent assay (ELISA), and polymerase chain reaction (PCR) assay in diagnosing Mycoplasma pneumoniae (MP) infection. A retrospective analysis of 62 children with MP pneumonia during a recent epidemic (2019–2020) was conducted. The MAA and ELISA immunoglobulin M (IgM) and IgG measurements were conducted twice at admission and around discharge, and MP PCR once at presentation. Diagnostic rates in each test were calculated at presentation and at discharge. The seroconverters were 39% (24/62) of patients tested by MAA and 29% (18/62) by ELISA. At presentation, the diagnostic positive rates of MAA, ELISA, and PCR tests were 61%, 71%, and 52%, respectively. After the second examination, the rates were 100% in both serologic tests. There were positive correlations between the titers of MAA and the IgM values of ELISA. The single serologic IgM or PCR tests had limitations to select patients infected with MP in the early stage. The short-term, paired IgM serologic tests during hospitalization can reduce patient-selection bias in MP infection studies.
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20
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Huang X, Li D, Liu F, Zhao D, Zhu Y, Tang H. Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2021; 21:14. [PMID: 33407216 PMCID: PMC7787414 DOI: 10.1186/s12879-020-05700-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/09/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP). METHOD A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n = 306) and a RMPP group (n = 124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP. RESULTS (1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P < 0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P < 0. 05). D-D had the highest predictive power for RMPP (P < 0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P < 0.01). CONCLUSION Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.
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Affiliation(s)
- Xia Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yifan Zhu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Heng Tang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China.
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Abstract
The major pathogens that cause atypical pneumonia are Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Community-acquired pneumonia (CAP) caused by M. pneumoniae or C. pneumoniae is common in children and presents as a relatively mild and self-limiting disease. CAP due to L. pneumophila is very rare in children and progresses rapidly, with fatal outcomes if not treated early. M. pneumoniae, C. pneumoniae, and L. pneumophila have no cell walls; therefore, they do not respond to β-lactam antibiotics. Accordingly, macrolides, tetracyclines, and fluoroquinolones are the treatments of choice for atypical pneumonia. Macrolides are the first-line antibiotics used in children because of their low minimum inhibitory concentrations and high safety. The incidence of pneumonia caused by macrolide-resistant M. pneumoniae that harbors point mutations has been increasing since 2000, particularly in Korea, Japan, and China. The marked increase in macrolide-resistant M. pneumoniae pneumonia (MRMP) is partly attributed to the excessive use of macrolides. MRMP does not always lead to clinical nonresponsiveness to macrolides. Furthermore, severe complicated MRMP responds to corticosteroids without requiring a change in antibiotic. This implies that the hyper-inflammatory status of the host can induce clinically refractory pneumonia regardless of mutation. Empirical macrolide therapy in children with mild to moderate CAP, particularly during periods without M. pneumoniae epidemics, may not provide additional benefits over β-lactam monotherapy and can increase the risk of MRMP.
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Affiliation(s)
- Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University of Medicine, Seoul, Korea
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22
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Lee E, Young Lee Y. Risk factors for the development of post-infectious bronchiolitis obliterans after Mycoplasma pneumoniae pneumonia in the era of increasing macrolide resistance. Respir Med 2020; 175:106209. [PMID: 33186845 DOI: 10.1016/j.rmed.2020.106209] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prevalence of macrolide-resistant Mycoplasma pneumoniae (MP) pneumonia has been rapidly increased. MP pneumonia is a risk factor for the development of post-infectious bronchiolitis obliterans (PIBO). The aim of the present study was to identify the risk factors for the development of PIBO after MP pneumonia in the era of increasing macrolide resistance of MP. MATERIALS AND METHODS This retrospective study enrolled 150 children with a mean age of 6.0 years admitted to the hospital due to MP pneumonia between May 2019 and February 2020 at a tertiary hospital. The clinical, radiologic, and laboratory data were obtained using retrospective chart review. RESULTS Eighteen children (12%) were diagnosed with PIBO after MP pneumonia. PIBO was diagnosed after a mean duration of 100.0 days (range, 6-268 days) from symptom onset. The respiratory virus co-infection (adjusted odds ratio [aOR], 4.069; 95% confidence interval [95% CI], 1.224-13.523), adenovirus co-infection (aOR, 5.607; 95% CI, 1.801-17.454), longer duration between symptom onset and admission (aOR, 1.150; 95% CI, 1.020-1.298), higher levels of serum lactate dehydrogenase (LDH) at the time of admission (aOR, 1.001; 95% CI, 1.000-1.003), and poor response to stepwise treatment increased the risk for development of PIBO after MP pneumonia. However, macrolide resistance of MP was not associated with development of PIBO after MP pneumonia. CONCLUSION The present study suggests that respiratory virus co-infection, including adenovirus, poor response to the treatment of MP pneumonia, and higher levels of serum LDH, but not macrolide resistance of MP, are risk factors of PIBO after MP pneumonia.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Yun Young Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea
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Lee KY. The solution on enigmas in COVID-19: the protein-homeostasis-system hypothesis. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.7.366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Infectious diseases, including coronavirus disease 2019 (COVID-19), are representative, of which etiology is known in all human diseases. However, many enigmas persist in relation to COVID-19, including different clinical phenotypes and incubation periods across individuals, species-specificity, appearance of cytokine storm and lymphopenia, and the mechanism of damage to organ cells. Current immunological concepts have limitations to explain these unsolved issues. Meanwhile, results of clinical, pathological, and animal studies have suggested that the virus itself is not a direct cause of acute injury to the lung or other organ cells. For better understanding of COVID-19, a presumed immunopathogenesis of COVID-19 is presented under the protein-homeostasis-system hypothesis; every disease, including COVID-19, has associated etiological substances, and the host immune system controls these diverse substances according to the size and biochemical property. These etiological substances, inducing inflammation and subsequent tissue injury, are smaller substances derived from virus-infected cells. Initially acting nonspecific adaptive immune reaction with cytokine imbalance may be responsible for target cell injury. Furthermore, substances from initial target cell injury and secondary bacterial invasion can induce further inflammation if released from local or systemic circulation. COVID-19 patients with pneumonia show hypercytokinemia with lymphocytopenia corresponding to the severity of pneumonia at early stages. Thus, early immune-modulator treatment, including corticosteroids and intravenous immunoglobulin, has an immunological rationale. It could help reduce the morbidity and possibly mortality of older patients with underlying conditions.
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Lee KY, Rhim JW, Kang JH. Immunopathogenesis of COVID-19 and early immunomodulators. Clin Exp Pediatr 2020; 63:239-250. [PMID: 32664709 PMCID: PMC7374000 DOI: 10.3345/cep.2020.00759] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is spreading globally. Although its etiologic agent is discovered as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), there are many unsolved issues in COVID-19 and other infectious diseases. The causes of different clinical phenotypes and incubation periods among individuals, species specificity, and cytokine storm with lymphopenia as well as the mechanism of damage to organ cells are unknown. It has been suggested that in viral pneumonia, virus itself is not a direct cause of acute lung injury; rather, aberrant immune reactions of the host to the insults from viral infection are responsible. According to its epidemiological and clinical characteristics, SARS-CoV-2 may be a virus with low virulence in nature that has adapted to the human species. Current immunological concepts have limited ability to explain such unsolved issues, and a presumed immunopathogenesis of COVID-19 is presented under the proteinhomeostasis-system hypothesis. Every disease, including COVID-19, has etiological substances controlled by the host immune system according to size and biochemical properties. Patients with severe pneumonia caused by SARS-CoV-2 show more severe hypercytokinemia with corresponding lymphocytopenia than patients with mild pneumonia; thus, early immunomodulator treatment, including corticosteroids, has been considered. However, current guidelines recommend their use only for patients with advanced pneumonia or acute respiratory distress syndrome. Since the immunopathogenesis of pneumonia may be the same for all patients regardless of age or severity and the critical immune-mediated lung injury may begin in the early stage of the disease, early immunomodulator treatment, including corticosteroids and intravenous immunoglobulin, can help reduce morbidity and possibly mortality rates of older patients with underlying conditions.
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Affiliation(s)
- Kyung-Yil Lee
- The Catholic University of Korea College of Medicine, Seoul, Korea
- Junglock Biomedical Institute, Daejeon, Korea
| | - Jung-Woo Rhim
- The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin-Han Kang
- The Catholic University of Korea College of Medicine, Seoul, Korea
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Lee KY, Rhim JW, Kang JH. Early preemptive immunomodulators (corticosteroids) for severe pneumonia patients infected with SARS-CoV-2. Clin Exp Pediatr 2020; 63:117-118. [PMID: 32272008 PMCID: PMC7170790 DOI: 10.3345/cep.2020.00290] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kyung-Yil Lee
- The Catholic University of Korea College of Medicine, Seoul, Korea.,Junglock Biomedical Institute, Daejeon, Korea
| | - Jung-Woo Rhim
- The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin-Han Kang
- The Catholic University of Korea College of Medicine, Seoul, Korea
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Meta-analysis of the Clinical Efficacy and Safety of High- and Low-dose Methylprednisolone in the Treatment of Children With Severe Mycoplasma Pneumoniae Pneumonia. Pediatr Infect Dis J 2020; 39:177-183. [PMID: 31738328 DOI: 10.1097/inf.0000000000002529] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia is generally a self-limiting disease, but it can develop into severe Mycoplasma pneumoniae pneumonia (SMPP). Immunologic mechanisms are thought to play an important role in the pathogenesis of SMPP. Therefore, the use of systemic glucocorticoids may have beneficial effects. However, to date, the use of glucocorticoid therapy in SMPP is limited to small case series, and the glucocorticoid dosage for children with SMPP has not been established. METHODS Here, we used a meta-analysis method to collect data from randomized control trials of different doses of methylprednisolone in SMPP to assess the safety and efficacy of treatment with low- versus high-dose methylprednisolone in children with SMPP. RESULTS We included 13 Chinese randomized control trials that included 1049 children. The high- and low-dose groups were comprised of 524 and 525 children, respectively. The high-dose group was significantly more effective than the low-dose group in clinical efficacy [risk ratio = 1.30, 95% confidence interval (CI) (1.23, 1.38), P < 0.05]. In addition, compared with low-dose methylprednisolone, high-dose methylprednisolone significantly shortened hospital stays and antipyretic therapy, pulmonary rales disappearance, cough disappearance and pulmonary shadow absorption times. There was no significant difference in adverse events between the high- and low-dose groups: risk ratio= 0.85, 95% CI (0.53, 1.36), P > 0.05. CONCLUSIONS We conclude that high-dose methylprednisolone is effective in the treatment of SMPP without increasing the incidence of adverse reactions.
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Yang EA, Lee KY. Are alternative antibiotics needed for antibiotic-nonresponsive Mycoplasma pneumoniae pneumonia? Clin Exp Pediatr 2020; 63:44-45. [PMID: 32066227 PMCID: PMC7029668 DOI: 10.3345/kjp.2019.00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Eun-Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Pediatrics, The Catholic University of Korea Daejeon St. Mary's Hospital, Daejeon, Korea
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Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators. Med Sci (Basel) 2020; 8:medsci8010006. [PMID: 31991843 PMCID: PMC7151587 DOI: 10.3390/medsci8010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 01/18/2023] Open
Abstract
Despite advances in its prevention, pneumonia remains associated with high morbidity, mortality, and health costs worldwide. Studies carried out in the last decade have indicated that more patients with community-acquired pneumonia (CAP) now require hospitalization. In addition, pneumonia management poses many challenges, especially due to the increase in the number of elderly patients with multiple comorbidities, antibiotic-resistant pathogens, and the difficulty of rapid diagnosis. In this new call to action, we present a wide-ranging review of the information currently available on CAP and offer some reflections on ways to raise awareness of this disease among the general public. We discuss the burden of CAP and the importance of attaining better, faster microbiological diagnosis and initiating appropriate treatment. We also suggest that closer cooperation between health professionals and the population at large could improve the management of this largely preventable infectious disease that takes many lives each year.
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Liu J, He R, Wu R, Wang B, Xu H, Zhang Y, Li H, Zhao S. Mycoplasma pneumoniae pneumonia associated thrombosis at Beijing Children's hospital. BMC Infect Dis 2020; 20:51. [PMID: 31948402 PMCID: PMC6966865 DOI: 10.1186/s12879-020-4774-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background With the increase of awareness of mycoplasma pneumoniae pneumonia (MPP), we found thrombosis in severe MPP (SMPP) was not rare. The aim of the study was to investigate the clinical characteristics, treatment, and long-term prognosis of MPP-associated thrombosis. Methods We retrospectively reviewed the medical records of 43 children with MPP-associated thrombosis between January 2013 and June 2019 at Beijing Children’s Hospital. The results of blood coagulation studies, autoimmune antibody, thrombophilia screening, contrast-enhanced lung computed tomography, echocardiography, and blood vessel ultrasonography were analyzed, as were treatment outcomes. Results Forty-two patients were diagnosed with SMPP. D-dimer was higher than 5.0 mg/L in 58.1% (25/43) of patients. The mean D-dimer level was 11.1 ± 12.4 mg/L. Anticardiolipin-IgM was positive in 60.0% of patients, β2-glycoprotein-IgM in 64.0%, and lupus anticoagulant in 42.1%. Chest imaging revealed pulmonary consolidation with lobe distribution in all patients (2/3–1 lobe in 10 patients, > 1 lobe in 29 patients). In our experience, thrombosis can occur in a vessel of any part of the body, and it can be initially detected as late as 31 days after disease onset. Thrombosis in the brain and abdomen can occur early, at 5 days after disease onset. Pulmonary vessels were the most commonly involved sites in the current study, and accordingly chest pain was the most common symptom (32.6%), followed by neurological symptoms (14.0%) and abdominal pain (9.3%). Thirty-five percent of patients were asymptomatic with regard to thrombosis. All patients underwent anticoagulant therapy, and thrombus absorption took > 3 months in most patients. All patients were followed until October 2019, at which time 41 were asymptomatic and 2 had mild recurrent cough. Conclusions SMPP with pulmonary consolidation (> 2/3 lobe) was the most strongly associated risk factor for thrombosis. Thrombosis-associated symptoms may be subtle, even absent. Elevated D-dimer, specifically > 11.1 mg/L (even > 5.0 mg/L), would assist in the early diagnosis of thrombosis. The long-term prognosis of thrombosis was good after timely administration of anticoagulant therapy.
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Affiliation(s)
- Jinrong Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, NO.56, Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Ruxuan He
- Department of Respiratory Medicine, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, NO.56, Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.,Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Runhui Wu
- Hematology Oncology Center, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Bei Wang
- Department of Radiology, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, Beijing, 100045, China
| | - Hui Xu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, NO.56, Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Yue Zhang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, NO.56, Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Huimin Li
- Department of Respiratory Medicine, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, NO.56, Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Centre for Children's Health, Capital Medical University, NO.56, Nanlishi Road, Xicheng District, Beijing, 100045, People's Republic of China.
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Mărginean CO, Meliţ LE, Simu I, Săsăran MO. The Association Between Mycoplasma pneumoniae and Chlamydia pneumoniae, a Life-Threatening Condition in Small Children-A Case Report and a Review of the Literature. Front Pediatr 2020; 8:558941. [PMID: 33240829 PMCID: PMC7683434 DOI: 10.3389/fped.2020.558941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/26/2020] [Indexed: 12/28/2022] Open
Abstract
Mycoplasma pneumoniae (MP) and Chlamydia pneumoniae (CP) are two atypical pathogens that may result in mild, moderate or severe acute respiratory infections. We report the case of a 2 years and 9-month-old male child admitted with prolonged fever, dry cough, and shortness of breath for which he underwent symptomatic treatment. The laboratory tests showed leukocytosis with neutrophilia, anemia, and elevated inflammatory biomarkers and the thoracic radiography revealed pleural effusion raising the suspicion of inferior right pneumonia. Although we the initial evolution was favorable being treated with 3rd class cephalosporin and Oxacillin, on the 8th day of admission the fever and the acute phase reactants levels increased as well as the quantity of the pleural effusion, requiring surgical drainage. We ruled out lung tuberculosis, but we identified positive IgM for both MP and CP. Based on these findings we changed the antibiotic therapy on Levofloxacin for 10 days with favorable evolution. MP and CP are two atypical pathogen that are difficult to be diagnosed due to their slow-growing pattern. Despite their self-limiting feature, the association between them might carry a vital risk in small children, especially in the lack of a proper and timely diagnosis.
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Affiliation(s)
- Cristina Oana Mărginean
- Department of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Lorena Elena Meliţ
- Department of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Iunius Simu
- Department of Radiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
| | - Maria Oana Săsăran
- Department of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Târgu Mureş, Romania
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High Mycoplasma pneumoniae loads and persistent long-term Mycoplasma pneumoniae DNA in lower airway associated with severity of pediatric Mycoplasma pneumoniae pneumonia. BMC Infect Dis 2019; 19:1045. [PMID: 31823740 PMCID: PMC6905005 DOI: 10.1186/s12879-019-4667-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background An increased number of refractory mycoplasma pneumoniae (MP) pneumonia (MPP) cases have been reported. However the duration of MP infection in lower airway and the course of anti-MP treatment remains unclear. Methods We retrospectively reviewed the medical records of 94 MPP children. Patients were classified into two groups. The long-term group (Group LT) was defined as bronchoalveolar lavage fluid (BALF) remained MP-positive by PCR after 30 days of the disease course. The non-long-term group (Group NLT) was defined as BALF became MP-negative by PCR within 30 days of disease and patients who only needed one bronchoscopy lavage therapy. MP loads, clinical outcomes were analyzed along with other clinical measurements. Results The average levels of inflammatory markers such as C reactive protein and lactate dehydrogenase in Group LT were significantly higher than those in Group NLT. Airway and lung damage in Group LT were more severe than Group NLT. 28 patients developed necrotizing pneumonia and 8 patients developed pulmonary embolism in Group LT. Mean maximum MP loads in BALF were 107.46 ± 0.93 and 104.86 ± 0.93 in Groups LT and NLT, respectively. There was persistent MP DNA in Group LT, even lasted for 120 days. One severe MPP patient in Group LT had MP-associated bloodstream infection. After 3 months of follow-up, chest imaging revealed incomplete absorption of pulmonary consolidation in 33 patients of Group LT [including 13 airway obliterans (AO) patients] and in 7 patients of Group NLT (including 2 AO patients). Conclusion MP loads of BALF were associated with the subsequent duration of MP DNA in lower airway. High MP loads and persistent long-term MP DNA in lower airway were associated with severity of pediatric MPP.
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Li J, Sun L, Wu X, Guo Y, Jiao W, Xiao J, Xu B, Shen A. Early Diagnosis of Mycoplasma pneumoniae in Children: Simultaneous Amplification and Testing (SAT) Is the Key. Front Pediatr 2019; 7:441. [PMID: 31709210 PMCID: PMC6824142 DOI: 10.3389/fped.2019.00441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/10/2019] [Indexed: 01/27/2023] Open
Abstract
Objective: The effective diagnosis of Mycoplasma pneumoniae (MP) pneumonia (MPP) in children has been hampered by the difficulty of achieving an early diagnosis. The simultaneous amplification and testing (SAT) has the potential for early diagnosis of MP in children. Methods: Of the 1,180 children enrolled in this study, 169 were MPP antibody (Ab) seroconversion positive, 641 showed MPP positivity with a single Ab test, and 370 were MPP negative. Sera and pharyngeal swabs were collected for antibody testing and SAT detection, respectively, on admission. When the samples were Ab negative, the paired -Ab test was requested for MP 7 days later. Results: Using the Ab results as the diagnostic standard, the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for SAT were 72.8, 95.1, 97.0, and 61.5%, respectively. SAT had superior diagnostic value in the MPP group who had undergone Ab seroconversion (sensitivity: 82.2%; NPV: 92.1%) and in the short-course group also (sensitivity: 81.0%; NPV: 81.3%). Good agreement was observed between SAT and the paired-Ab results (kappa value = 0.79; P < 0.001), but there was a lack of consistency between SAT and the single-Ab test results on admission (kappa value = 0.54, P < 0.001). Conclusions: SAT is a rapid, sensitive, and specific method for MP diagnosis in pediatric patients. Our results indicate its value as an effective diagnostic tool for detecting MPP at the initial stage of an infection.
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Affiliation(s)
- Jieqiong Li
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lin Sun
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xirong Wu
- Department of Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yan Guo
- Department of Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weiwei Jiao
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jing Xiao
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Baoping Xu
- Department of Respiratory Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Adong Shen
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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