1
|
Tang Y, Yang Y, He R, Huang R, Zheng X, Liu C. Pathogens and Pathogenesis in Wheezing Diseases in Children Under 6. Front Oncol 2022; 12:922214. [PMID: 35912246 PMCID: PMC9329614 DOI: 10.3389/fonc.2022.922214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Few studies have comprehensively assessed the roles of cytokine production in wheezing pathogenesis. Therefore, we undertook this study to determine the association between wheezing episodes and cytokines, and to provide further information on this topic. Firstly, we retrospectively collected I176 children, including 122 subjects with first wheezing and 54 subjects with recurrent wheezing, to analyze the etiology and clinical characteristics of children with wheezing diseases. Then, we collected 52 children with wheezing diseases and 25 normal controls to detect the expression of interferon-γ (IFN-γ), interleukin-4 (IL-4), IFN-γ/IL-4, IL-17A, IL-17E, IgE, matrix metalloproteinase-3 (MMP-3), and MMP-9 in serum or plasma. The results showed that boys under 3 years old with history of allergies were more likely to develop wheezing diseases. In our cohort, M. pneumoniae caused a greater proportion of wheezing in children than expected. The expression of IgE [18.80 (13.65-31.00) vs. 17.9 (10.15-21.60)], IL-4 [24.00 (24.00-48.00) vs. 23.00 (9.50-27.00)], IFN-γ [70.59 (41.63-116.46) vs. 49.83 (29.58-81.74)], MMP3 [53.40 (20.02-128.2) vs. 30.90 (13.80-50.95)], MMP9 [148.10 (99.30-276.10) vs. 122.10 (82.20-162.35)], IL-17A [80.55 (54.46-113.08) vs. 61.11 (29.43-93.87)], and IL-17E [1.75 (0.66-2.77) vs. 1.19 (0.488-2.1615)] were significantly increased in the wheezing group (p<0.05) compared to normal controls, while the level of IFN-γ/IL-4 had no significant difference between the two groups (1.24 ± 1.88 vs 0.68 ± 0.74, p>0.05). There was altered cytokine production in children with wheezing diseases which was quite similar to asthma pathogenesis. Sex, age, pathogen infection, and inflammation in our study were also risk factors for wheezing diseases.
Collapse
Affiliation(s)
- Yongjun Tang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Yaxiong Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Ruohui He
- Department of Pharmacy, Ningyuan County of People’s Hospital, Yongzhou, China
| | - Rong Huang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Rong Huang,
| | - Xiangrong Zheng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Chentao Liu
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
2
|
Calmes D, Huynen P, Paulus V, Henket M, Guissard F, Moermans C, Louis R, Schleich F. Chronic infection with Chlamydia pneumoniae in asthma: a type-2 low infection related phenotype. Respir Res 2021; 22:72. [PMID: 33637072 PMCID: PMC7913423 DOI: 10.1186/s12931-021-01635-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Chlamydia pneumoniae and Mycoplasma pneumoniae have been implicated in the pathogenesis of asthma and are responsible for chronic inflammation when host immune system fails to eradicate the bacteria. Method We performed a prospective study on 410 patients who underwent a visit at the asthma clinic of CHU of Liege between June 2016 and June 2018 with serology testing for C. pneumoniae and M. pneumoniae. Results 65% of our asthmatic population had serum IgA and/or IgG towards C. pneumoniae, while only 12.6% had IgM and/or IgG against M. pneumoniae. Compared to seronegative asthmatics, asthmatics with IgA+ and IgG+ against C. pneumoniae were more often male and older with a higher proportion of patients with smoking history. They received higher doses of inhaled corticosteroids (ICS) and displayed lower FEV1/FVC ratio, higher RV/TLC ratio and lower conductance. They had higher levels of fibrinogen, though in the normal range and had lower sputum eosinophil counts. Patients with IgA− and IgG+ against C. pneumoniae were older and had higher blood monocyte counts and alpha-1-antitrypsin levels as compared to seronegative patients. Patients with IgM and/or IgG towards M. pneumoniae were more often males than seronegative asthmatics. In a subpopulation of 14 neutrophilic asthmatics with Chlamydia pneumoniae IgA + /IgG + treated with macrolides, we found a significant decrease in blood neutrophils and normalization of sputum neutrophil count but no effect on asthma quality of life and exacerbations. Conclusion Positive Chlamydia serologic test is more common than positive Mycoplasma serology. Asthmatics with IgA and IgG against C. pneumoniae have more severe disease with increased airway obstruction, higher doses of ICS, more signs of air trapping and less type-2 inflammation.
Collapse
Affiliation(s)
- Doriane Calmes
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium
| | - Pascale Huynen
- Clinical Microbiology, University Hospital of Liege, CHU Sart-Tilman B35, Liège, Belgium
| | - Virginie Paulus
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium
| | - Monique Henket
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium
| | - Françoise Guissard
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium
| | - Catherine Moermans
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium
| | - Renaud Louis
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium
| | - Florence Schleich
- Respiratory Medicine, University Hospital of Liege, CHU Sart-Tilman B35, GIGA I3 Lab, Liège, Belgium.
| |
Collapse
|
3
|
Mycoplasma pneumoniae: Atypical Pathogen in Community Acquired Pneumonia. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.4.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mycoplasma pneumoniae is a one of most common reasons of respiratory tract infections in both adolescents and children with severity ranged from moderate to high. Many facts in the previous years regarding infections were induced via this organism having extra pathogenic mechanisms. Clinically, resistance to macrolide has produced internationally and represents a treatment trouble. Antimicrobial sensitivity checking out techniques have been applied, and novel antibiotics which are effective towards M. pneumoniae are present processing development. That evaluate concentrates on the several trends occurring in the previous quite a few years which beautify the grasp of that microorganism, which is one of the smallest pathogenic bacteria; however, is of extreme medical significance.
Collapse
|
4
|
Liu J, Yang J, Tang X, Li H, Shen Y, Gu W, Zhao S. Homozygous GDF2-Related Hereditary Hemorrhagic Telangiectasia in a Chinese Family. Pediatrics 2020; 146:peds.2019-1970. [PMID: 32669404 DOI: 10.1542/peds.2019-1970] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT) can be clinically diagnosed, but children often lack characteristic features. We report a family with homozygous growth differentiation factor 2 (GDF2)-related HHT diagnosed by genetic testing. A boy aged 5 years and 2 months presented with isolated hypoxemia. He was the product of a consanguineous marriage; his parents were second cousins. Physical examination revealed cyanosis of nail beds and clubbed fingers. Pulse oxygen saturation was 84% to 89%. Lung function, contrast-enhanced lung computed tomography, and noncontrast echocardiography were normal. A pulmonary perfusion scan revealed radioactivity in the brain and bilateral kidney, suggesting the existence of a intrapulmonary shunt. Whole-exome sequencing revealed a homozygous variant [c.1060_1062delinsAG (p.Tyr354ArgfsTer15)] in GDF2, which was found to be inherited from his heterozygous parents. At the age of 8 years, he developed epistaxis, and an angiogram revealed diffuse pulmonary arteriovenous malformations. At the age of 9 years, he was treated with sirolimus, and his condition improved significantly. However, his now 7-year-old sister with the same homozygous variant currently has no symptoms. Physical examinations revealed 1 pinpoint-sized telangiectasia on the chest of his mother and a vascular lesion on the forehead of his sister. Additionally, the patient's father and great-uncle had a history of mild to moderate epistaxis. Mutation in GDF2 is a rare cause of HHT. Ours is the first report of homozygous GDF2-related HHT; in addition, this variant has not been reported previously. In our report, we also confirm variable expressivity, even with the same pathogenic variant in GDF2-related HHT.
Collapse
Affiliation(s)
- Jinrong Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health and Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital and Capital Medical University, Xicheng District, Beijing, People's Republic of China; and
| | - Xiaolei Tang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health and Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Huimin Li
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health and Capital Medical University, Xicheng District, Beijing, People's Republic of China;
| | - Yuelin Shen
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health and Capital Medical University, Xicheng District, Beijing, People's Republic of China
| | - Weiyue Gu
- Data and Analysis Center for Genetic Diseases, Beijing Chigene Translational Medicine Research Center Co, Ltd, Tongzhou District, Beijing, People's Republic of China
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health and Capital Medical University, Xicheng District, Beijing, People's Republic of China;
| |
Collapse
|
5
|
Choi YJ, Jeon JH, Oh JW. Critical combination of initial markers for predicting refractory Mycoplasma pneumoniae pneumonia in children: a case control study. Respir Res 2019; 20:193. [PMID: 31443650 PMCID: PMC6706904 DOI: 10.1186/s12931-019-1152-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/05/2019] [Indexed: 01/30/2023] Open
Abstract
Background It is unclear whether the responses of refractory and common Mycoplasma pneumoniae (MP) pneumonia to macrolides differ. Hence, this study aimed to identify biomarkers that may be used to distinguish refractory and common pneumonias caused by MP in children at hospital admission. Methods The study included 123 children divided into five groups according to infection agent and treatment protocol: Group I included those with MP infection without documented viral infection, treated with only macrolides; Group II included those with MP infection without documented viral infection, treated with a combination of macrolides and methylprednisolone; Group III included those with MP infection and documented viral infection, treated with only macrolides; Group IV included those with viral pneumonia without documented MP infection; Group V was the control group composed of admitted children without MP or a documented viral infection. These five groups were further subdivided into Groups A (including Groups I, III, IV, and V) and B (Group II) according to the responses to macrolide treatment. Concentrations of cytokines interleukin 6, interleukin 17, interleukin 18, and tumor necrosis factor-α, and lactate dehydrogenase, and ferritin of all children were evaluated, and these levels were compared among the groups. Statistical comparisons were made using Kruskal Wallis test and Mann-Whitney U test. Results Serum lactate dehydrogenase, interleukin 18, and ferritin concentrations were significantly higher in Group II than in Groups I, III, IV, and V and were significantly higher in Group B than in Group A. When the serum lactate dehydrogenase concentration was 350 IU/L or higher, the sensitivity and specificity for diagnosing refractory MP pneumonia were 73 and 80%, respectively. When the interleukin 18 level was 360 pg/mL or higher, the sensitivity and specificity for diagnosing refractory MP pneumonia were 93 and 70%, respectively. When the ferritin level was 230 pg/mL or higher, the sensitivity and specificity for diagnosing refractory MP pneumonia were 67 and 67%, respectively. Conclusion These results suggest that serum lactate dehydrogenase, interleukin 18, and ferritin constitute the critical combination of biomarkers useful for predicting refractory MP pneumonia in children at hospital admission.
Collapse
Affiliation(s)
- Young-Jin Choi
- Department of Pediatrics, College of Medicine, Hanyang University Guri Hospital, 249-1 Kyomun-Dong, Guri, Kyunggi-Do, Seoul, 471-701, South Korea
| | - Ju-Hee Jeon
- Department of Medicine, Graduate School of Hanyang University, Seoul, South Korea
| | - Jae-Won Oh
- Department of Pediatrics, College of Medicine, Hanyang University Guri Hospital, 249-1 Kyomun-Dong, Guri, Kyunggi-Do, Seoul, 471-701, South Korea.
| |
Collapse
|
6
|
Shi H, Lan L, Lv X, Sun L. Effect of pidotimod combined with azithromycin on children with mycoplasma pneumonia and the expression levels of IL-10 and G-CSF in serum. Exp Ther Med 2019; 18:1800-1806. [PMID: 31410140 PMCID: PMC6676206 DOI: 10.3892/etm.2019.7725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/10/2019] [Indexed: 12/13/2022] Open
Abstract
This study explored the effect of pidotimod combined with azithromycin on children with mycoplasma pneumonia and the expression of interleukin-10 (IL-10) and granulocyte colony-stimulating factor (G-CSF) in serum. The clinical data of 149 children with mycoplasma pneumonia from May 2014 to May 2018 in Zhangqiu District Maternal and Child Health Care Hospital were collected. Among them, 70 children treated with azithromycin sequential therapy were the control group, and 79 children treated with the combination of pidotimod and azithromycin were the observation group. Double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was used to determine the expression levels of IL-10 and G-CSF in serum before and after treatment. Pearson's correlation coefficient was used to analyze the correlation between IL-10 and G-CSF in serum. The total effective rate in the observation group (94.94%) was significantly higher than that in the control group (81.43%) (P<0.05). There was no significant difference in the expression levels of IL-10 and G-CSF between the two groups before treatment (P>0.05). The expression levels of IL-10 and G-CSF in the two groups after treatment were significantly lower than those before treatment (P<0.05). After treatment, the expression levels of IL-10 and G-CSF in serum in the observation group were significantly lower than those in the control group. There was a significant positive correlation between the expression levels of IL-10 and G-CSF before and after treatment in the observation group (P<0.05), and a significant positive correlation between the expression levels of IL-10 and G-CSF before and after treatment in the control group (P<0.05). Compared with sequential treatment with azithromycin alone, pidotimod combined with azithromycin significantly reduced the expression levels of IL-10 and G-CSF in serum of children with mycoplasma pneumonia, improved the curative effect and reduced the occurrence of adverse reactions, which has high application value in clinic.
Collapse
Affiliation(s)
- Hongxing Shi
- Department of Pediatrics, Zhangqiu District Maternal and Child Health Care Hospital, Jinan, Shandong 250200, P.R. China
| | - Limin Lan
- Department of Pharmacy, Yantaishan Hospital, Yantai, Shandong 264000, P.R. China
| | - Xianghong Lv
- Department of Pediatrics, The Affiliated Central Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China
| | - Lizhi Sun
- Department of Medical Laboratory Diagnosis Center, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| |
Collapse
|
7
|
Abstract
The airways are under continuous assault from aerosolized bacteria and oral flora. The bacteria present in the airways and gastrointestinal tract of neonates promote immune maturation and protect against asthma pathogenesis. Later bacterial infections and perturbations to the microbiome can contribute to asthma pathogenesis, persistence, and severity.
Collapse
Affiliation(s)
- Michael Insel
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, University of Arizona College of Medicine - Tucson, 1501 North Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA
| | - Monica Kraft
- Department of Medicine, College of Medicine Tucson, Asthma and Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona College of Medicine - Tucson, 1501 North Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA.
| |
Collapse
|
8
|
Xiao Z, Jiang Y, Gao X, Lin S, Lin Y, Liu X, Tan D, Jiang Z. Comparison of the ameliorative effects of Qingfei Tongluo formula and azithromycin on Mycoplasma pneumoniae pneumonia. J Nat Med 2017; 71:685-692. [PMID: 28664473 DOI: 10.1007/s11418-017-1098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/29/2017] [Indexed: 11/29/2022]
Abstract
Mycoplasma pneumoniae pneumonia (MPP) is a common disease in children. Qingfei Tongluo formula (QTF) has been used for the treatment of MPP clinically, but the therapeutic effect remains unclear compared to conventional treatments with Western medicines. Therefore, the aim of this study was to assess changes in the expression levels of relevant factors associated with microcirculation after MPP and to compare the therapeutic effect of QTF with that of azithromycin (AZM) on experimental mice with MPP. A total of 174 children admitted with clinical diagnoses of pneumonia (80 MPP and 94 non-MPP) were used to identify differences in the expression patterns of factors in the microcirculation using an enzyme-linked immunosorbent assay. A BALB/c mouse model of MPP infection was established to determine the therapeutic effect of QTF. The results showed that the expression level of thrombomodulin (TM), vascular endothelial growth factor (VEGF), d-dimer (D-D), interleukin (IL)-6, and IL-10 were upregulated after MPP both clinically in children and in the mouse model. After 3 days of therapy, the amount of total MPP DNA decreased, especially in the mid- and high-dose QTF treatment groups. The expression levels of VEGF, IL-6, and IL-10 also decreased in response to treatment with QTF or AZM. However, there was no influence on D-D levels. QTF treatment also decreased TM expression. In conclusion, QTF treatment inhibited the progression of MPP, reduced vascular permeability, and improved pulmonary microcirculation more effectively than conventional treatment with Western medicine.
Collapse
Affiliation(s)
- Zhen Xiao
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China.
| | - Yonghong Jiang
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China
| | - Xuan Gao
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China
| | - Shuzhu Lin
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China
| | - Yan Lin
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China
| | - Xiuxiu Liu
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China
| | - Dan Tan
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China
| | - Zhiyan Jiang
- Department of Pediatric, Longhua Hospital, Shanghai University of TCM, 725 South Wan-Ping Road, Shanghai, 200032, China.
| |
Collapse
|
9
|
Changes in the Levels of Interleukin-17 Between Atopic and Non-atopic Children with Mycoplasma pneumoniae Pneumonia. Inflammation 2017; 39:1871-1875. [PMID: 27531365 DOI: 10.1007/s10753-016-0422-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
As previous study showed that Mycoplasma pneumoniae (MP) induced a cellular immune response associated with interleukin-17 (IL-17), we designed this study to explore IL-17 in MP pneumonia patients with atopic sensitization and 144 patients were evaluated and divided into three groups: atopic MP pneumonia group (n = 38), non-atopic MP pneumonia group (n = 74), and atopic non-MP pneumonia group (n = 32). Serum IL-17 was measured at admission acute phase and at recovery phase. We found IL-17 levels only in the atopic MP pneumonia group that were significantly higher at recovery phase than at acute phase, and its levels were also higher in the atopic MP pneumonia group than the other two groups at clinical recovery phase. In addition, acute asthma attack was higher in the atopic MP pneumonia group. Therefore, IL-17 should be related with asthma and it can be a good marker warning an acute asthma attack in atopic MP pneumonia. Necessary measures can be taken as prevention.
Collapse
|
10
|
Fan Q, Gu T, Li P, Yan P, Chen D, Han B. Roles of T-cell Immunoglobulin and Mucin Domain Genes and Toll-like Receptors in Wheezy Children with Mycoplasma pneumoniae Pneumonia. Heart Lung Circ 2016; 25:1226-1231. [DOI: 10.1016/j.hlc.2016.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/03/2016] [Accepted: 03/28/2016] [Indexed: 02/04/2023]
|
11
|
Inhibitory effects of atractylone on mast cell-mediated allergic reactions. Chem Biol Interact 2016; 258:59-68. [DOI: 10.1016/j.cbi.2016.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/10/2016] [Accepted: 08/18/2016] [Indexed: 12/18/2022]
|
12
|
Serum cytokine profile contributes to discriminating M. pneumoniae pneumonia in children. Cytokine 2016; 86:73-78. [DOI: 10.1016/j.cyto.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/14/2016] [Accepted: 07/24/2016] [Indexed: 01/18/2023]
|
13
|
Abstract
Chronic bacterial infection is implicated in both the development and severity of asthma. The atypical bacteria Mycoplasma pneumoniae and Chlamydophila pneumoniae have been identified in the airways of asthmatics and correlated with clinical features such as adult onset, exacerbation risks, steroid sensitivity, and symptom control. Asthmatic patients with evidence of bacterial infection may benefit from antibiotic treatment directed towards these atypical organisms. Examination of the airway microbiome may identify microbial communities that confer risk for or protection from severe asthma.
Collapse
|
14
|
Parrott GL, Kinjo T, Fujita J. A Compendium for Mycoplasma pneumoniae. Front Microbiol 2016; 7:513. [PMID: 27148202 PMCID: PMC4828434 DOI: 10.3389/fmicb.2016.00513] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/29/2016] [Indexed: 12/11/2022] Open
Abstract
Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, “walking” pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review.
Collapse
Affiliation(s)
- Gretchen L Parrott
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| |
Collapse
|
15
|
Wu SH, Chen XQ, Kong X, Yin PL, Dong L, Liao PY, Wu JM. Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast. World J Pediatr 2016; 12:88-95. [PMID: 25846070 DOI: 10.1007/s12519-015-0024-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/26/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The influence of Mycoplasma pneumoniae (MP) infection on bronchiolitis remains unclear. Additionally, reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive. METHODS Children with respiratory syncytial virus (RSV)-induced bronchiolitis were divided into two groups: RSV+MP group and RSV group. Each group was randomly divided into two subgroups: one received routine and placebo treatment, while the other received routine and montelukast treatment for 9 months. The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded. Blood parameters were determined. RESULTS Patients in the RSV+MP group exhibited an older average age, fever, more frequent flaky and patchy shadows in chest X-rays, more frequent extrapulmonary manifestations, and longer hospital stays compared with patients in the RSV group. Additionally, higher baseline blood eosinophil counts, eosinophil cationic protein (ECP), total immunoglobulin E (IgE), interleukin (IL)-4, IL-5, IL-4/interferon-γ ratios, leukotriene (LT) B4, and LTC4, and lower baseline lipoxin A4 (LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group. Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months. This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts, ECP and total IgE, as well as the montelukast-dependent recovery in T helper (Th) 1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis. CONCLUSIONS RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection. Add-on therapy with montelukast for 9 months was beneficial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.
Collapse
Affiliation(s)
- Sheng-Hua Wu
- Department of Pediatrics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Xiao-Qing Chen
- Department of Pediatrics, Jiangsu Maternity and Children Healthcare Hospital, Nanjing, 210036, China
| | - Xia Kong
- Department of Pediatrics, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China
| | - Pei-Ling Yin
- Department of Pediatrics, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China
| | - Ling Dong
- Department of Pediatrics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Pei-Yuan Liao
- Department of Pediatrics, Central Hospital of Tengzhou, Tengzhou, 277500, China
| | - Jia-Ming Wu
- Department of Pediatrics, Qidong People's Hospital, 753 Central Jianghai Road, Qidong, 226200, China
| |
Collapse
|
16
|
Guo L, Liu F, Lu MP, Zheng Q, Chen ZM. Increased T cell activation in BALF from children with Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol 2015; 50:814-9. [PMID: 25157471 DOI: 10.1002/ppul.23095] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 05/07/2014] [Accepted: 05/27/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVE The mechanisms of Mycoplasma pneumoniae induced lung inflammation are not clearly understood yet. This study investigated whether activated T cells in the airway contributed to the pulmonary inflammation in patients with severe Mycoplasma pneumoniae pneumonia (MPP). METHODS BALF were collected in all 45 patients with MPP (MPP, n = 45), including mild (Mild, n = 20) and severe (Severe, n = 25) group. BALF in 20 of all 25 severe cases with MPP at the recovery stage (Rec-severe, n = 20) were collected again. The control group consisted of 20 patients with airway foreign body aspiration (Con., n = 20). CD3+ T cells, CD69+, HLA-DR+, CD25+ on CD3+ T cells in BALF were determined by flow cytometry. Levels of IL-6, IL-10 in BALF were determined by ELISA, and percentage of neutrophils was counted. RESULTS A significant increased percentage of neutrophils and levels of IL-6 and IL-10, decreased percentage of CD3+ T cells, increased expressions of CD69+, HLA-DR+ or CD25+ on CD3+ T cells were observed in children with MPP compared with the control group (P < 0.05 or 0.01). Compared to mild group, the percentage of neutrophils, CD3+ CD25+, IL-6, and IL-10 were increased in children with severe MPP (P < 0.01 or 0.05). Compared to acute stage, an increased percentage of CD3+ T cells, decreased percentage of neutrophils and IL-6 level, and expressions of CD3+ CD69+ or CD3+ CD25+ were observed at the recovery stage in children with severe MPP (P < 0.01 or 0.05). CONCLUSIONS Increased activation of T cell in BALF may play an important role in the inflammatory response of acute and severe MPP. IL-6 may predict the severity and prognosis and provide a better assessment for patient care. However, the underlying mechanism awaits further detailed investigations.
Collapse
Affiliation(s)
- Li Guo
- Department of Rheumatology Immunology & Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Fang Liu
- Department of Respiratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.,Taizhou Nursing School, 100 Chennan Huaxi Rd, Linhai, 317000, Zhejiang, China
| | - Mei-Ping Lu
- Department of Rheumatology Immunology & Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.,Department of Respiratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Qi Zheng
- Department of Rheumatology Immunology & Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zhi-Min Chen
- Department of Respiratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| |
Collapse
|
17
|
Shao L, Cong Z, Li X, Zou H, Cao L, Guo Y. Changes in levels of IL-9, IL-17, IFN-γ, dendritic cell numbers and TLR expression in peripheral blood in asthmatic children with Mycoplasma pneumoniae infection. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:5263-5272. [PMID: 26191227 PMCID: PMC4503099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
Mycoplasma pneumoniae (MP) infection in children with asthma resulted in a more severe allergic state compared with a non-MP infected group. The infection rate of children with asthma was higher than that of the other groups, suggesting that being asthmatic may be a predisposing factor for MP infection and that the infection itself is an important co-factor in the disease progression of asthma. The number of dendritic cells (DCs) and the expression of TLR2 and TLR4 were compared in 22 asthmatic patients with MP infection, 22 asthmatic patients without MP infection, and 17 normal children as controls. The percentages of DCs in the peripheral blood of the three groups showed significant differences between asthmatic children with MP infection and controls, and asthmatic children without MP and controls (P<0.05), whereas no difference was found between asthmatic children with and without MP infection. The asthmatic children with MP infection group showed increased expression of TLR-2 and TLR-4 on DCs (P<0.01). Asthmatic patients infected with MP showed that DCs and TLRs (TLR-2, TLR-4) might play an important role in asthma pathogenesis with MP infection. The cytokines produced by the T-cell subsets in asthmatic children with MP infection showed a significant increase in IL-9 (P<0.01) and a decrease in IFN-γ (P<0.05) levels post-MP infection, while the IL-17 level remained stable (P>0.05), indicating a shift towards Th1/Th9 in the presence of MP infection.
Collapse
Affiliation(s)
- Li Shao
- Department of Allergy, Renji Hospital Shanghai Jiaotong University School of MedicineShanghai 200127, China
| | - Zhijie Cong
- Department of Renji Clinic School, Renji Hospital Shanghai Jiaotong University School of MedicineShanghai 200127, China
| | - Xiaoli Li
- Department of Pediatrics, Renji Hospital Shanghai Jiaotong University School of MedicineShanghai 200127, China
| | - Hanbing Zou
- Department of Molecular Biology Central Lab, Renji Hospital Shanghai Jiaotong University School of MedicineShanghai 200127, China
| | - Lanfang Cao
- Department of Pediatrics, Renji Hospital Shanghai Jiaotong University School of MedicineShanghai 200127, China
| | - Yinshi Guo
- Department of Allergy, Renji Hospital Shanghai Jiaotong University School of MedicineShanghai 200127, China
| |
Collapse
|
18
|
Gilbert SR, Camara J, Camara R, Duffy L, Waites K, Kim H, Zinn K. Contaminated open fracture and crush injury: a murine model. Bone Res 2015; 3:14050. [PMID: 26273534 PMCID: PMC4472147 DOI: 10.1038/boneres.2014.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/16/2014] [Accepted: 12/27/2014] [Indexed: 12/27/2022] Open
Abstract
Modern warfare has caused a large number of severe extremity injuries, many of which become infected. In more recent conflicts, a pattern of co-infection with Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus has emerged. We attempted to recreate this pattern in an animal model to evaluate the role of vascularity in contaminated open fractures. Historically, it has been observed that infected bones frequently appear hypovascular, but vascularity in association with bone infection has not been examined in animal models. Adult rats underwent femur fracture and muscle crush injury followed by stabilization and bacterial contamination with A. baumannii complex and methicillin-resistant Staphylococcus aureus. Vascularity and perfusion were assessed by microCT angiography and SPECT scanning, respectively, at 1, 2 and 4 weeks after injury. Quantitative bacterial cultures were also obtained. Multi-bacterial infections were successfully created, with methicillin-resistant S. aureus predominating. There was overall increase in blood flow to injured limbs that was markedly greater in bacteria-inoculated limbs. Vessel volume was greater in the infected group. Quadriceps atrophy was seen in both groups, but was greater in the infected group. In this animal model, infected open fractures had greater perfusion and vascularity than non-infected limbs.
Collapse
Affiliation(s)
- Shawn R Gilbert
- Department of Surgery, University of Alabama at Birmingham , AL USA
| | | | | | - Lynn Duffy
- Departments of Pathology, University of Alabama at Birmingham , AL USA
| | - Ken Waites
- Departments of Pathology, University of Alabama at Birmingham , AL USA
| | - Hyunki Kim
- Department of Radiology, University of Alabama at Birmingham , AL USA
| | - Kurt Zinn
- Department of Radiology, University of Alabama at Birmingham , AL USA
| |
Collapse
|
19
|
Shin JE, Cheon BR, Shim JW, Kim DS, Jung HL, Park MS, Shim JY. Increased risk of refractory Mycoplasma pneumoniae pneumonia in children with atopic sensitization and asthma. KOREAN JOURNAL OF PEDIATRICS 2014; 57:271-7. [PMID: 25076972 PMCID: PMC4115068 DOI: 10.3345/kjp.2014.57.6.271] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/12/2013] [Accepted: 01/02/2014] [Indexed: 01/26/2023]
Abstract
Purpose A nationwide outbreak of Mycoplasma pneumoniae pneumonia (MP) refractory to macrolide antibiotics occurred in Korea during 2011. Steroid therapy has been reported to be both efficacious and well tolerated in pediatric patients with refractory MP. We compared clinical features and laboratory characteristics between children with refractory MP requiring steroid treatment and those with macrolide-responsive MP and evaluated the risk factors associated with refractory MP. Methods We investigated 203 children who were admitted to our institution with MP from June to November 2011. Refractory MP was defined by persistent fever over 38.3℃ with progressive pulmonary consolidation or pleural effusion despite administration of appropriate macrolide antibiotics for 5 days or longer after admission. Steroid therapy was initiated on the fifth day after admission for refractory cases. Results There were 26 patients with refractory MP requiring steroid therapy. The mean duration of steroid therapy was 5.4 days and most of the patients were afebrile within 24 hours after initiation of steroid therapy. The prevalence of refractory MP was higher in patients with pleural effusion, lobar pneumonia affecting more than 2 lobes, higher levels of serum lactate dehydrogenase, increased oxygen requirements, and longer duration of hospitalization. Atopic sensitization and history of asthma were also associated with refractory MP after adjusting for age and gender. Conclusion Children with refractory MP had more severe pneumonia. Atopic sensitization and history of asthma may be risk factors for refractory MP requiring steroid therapy in Korean children.
Collapse
Affiliation(s)
- Jeong Eun Shin
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bo Ram Cheon
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Won Shim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Deok Soo Kim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae Lim Jung
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Soo Park
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Kim JH, Cho TS, Moon JH, Kim CR, Oh JW. Serial Changes in Serum Eosinophil-associated Mediators between Atopic and Non-atopic Children after Mycoplasma pneumoniae pneumonia. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:428-33. [PMID: 25229000 PMCID: PMC4161684 DOI: 10.4168/aair.2014.6.5.428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/27/2013] [Accepted: 01/06/2014] [Indexed: 01/22/2023]
Abstract
Purpose Mycoplasma pneumoniae pneumonia (MP) is associated with the exacerbation, timing, and onset of asthma. The goal of this study was to elucidate the impact of MP on eosinophil-related hyper-reactive amplification in atopic children. Methods We studied 48 patients with MP (26 atopic, 22 non-atopic), between 3 and 12 years of age. Serial changes in blood eosinophil counts, serum interleukin-5 (IL-5), and serum eosinophil cationic protein (ECP) levels were measured in atopic and non-atopic children with MP upon admission, recovery, and at 2 months post-recovery. Serum IL-5 and ECP levels were measured by enzyme-linked immunosorbent assays; eosinophil counts were measured using an autoanalyzer. Results Serial changes in serum IL-5, ECP, and total eosinophil counts were significantly higher in atopic patients, relative to non-atopic controls (P≤0.001). Serum IL-5 and ECP levels were significantly higher in atopic patients at all three time points tested, while eosinophil counts were higher in the clinical recovery and follow-up phases, but not in the acute phase. Furthermore, among atopic patients, serum ECP levels were significantly higher in the recovery and follow-up phases than in the acute phase. Conclusions The present study demonstrated significant differences in eosinophil counts, serum IL-5, and serum ECP levels between atopic and non-atopic children with MP at admission, recovery, and 2 months after clinical recovery. These outcomes are suggestive of eosinophil-related hyperreactivity in atopic children, with this status maintained for at least 2 months after MP.
Collapse
Affiliation(s)
- Joo-Hwa Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Shik Cho
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Hwa Moon
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Oh JW. The efficacy of glucocorticoid on macrolide resistant Mycoplasma pneumonia in children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 6:3-5. [PMID: 24404386 PMCID: PMC3881397 DOI: 10.4168/aair.2014.6.1.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 11/26/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Hong SJ. The Role of Mycoplasma pneumoniae Infection in Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:59-61. [PMID: 22379599 PMCID: PMC3283794 DOI: 10.4168/aair.2012.4.2.59] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 11/20/2022]
Affiliation(s)
- Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|