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Abstract
BackgroundIt 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.MethodsThe 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.ResultsSerum 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.ConclusionThese 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.
Highlights
It is unclear whether the responses of refractory and common Mycoplasma pneumoniae (MP) pneumonia to macrolides differ
Previous studies have shown that serum Lactate dehydrogenase (LDH) levels are increased in patients with refractory MP pneumonia, including children requiring steroid therapy. [5, 11,12,13,14,15,16] We propose that LDH can be used as an initial indicator of refractory MP pneumonia, further studies are necessary to confirm the usefulness of serum LDH level as an indicator of severity and the need for steroid therapy in MP pneumonia
We found that the levels of serum LDH, Interleukin 18 (IL-18), and ferritin were increased only in the refractory MP group, indicating that these are relevant biomarkers for diagnosing refractory MP pneumonia
Summary
It is unclear whether the responses of refractory and common Mycoplasma pneumoniae (MP) pneumonia to macrolides differ. In MP pneumonia, the host’s cell-mediated immunity plays a key role in the development of pulmonary lesions. Studies of immunocompromised hosts suggest that T cells play a role in the pathogenesis of mycoplasma infection. This is further supported by an apparent correlation between the development of a delayed hypersensitivity skin reaction to MP infection and the severity of disease. [6, 7] In some cases of MP pneumonia, an active host immune response promoting the release of cytokines and a T-helper (Th)-1-mediated immune response may contribute to severe pulmonary injury. MP pneumonia may be related to mononuclear cell infiltration into the airway, which is mainly composed of CD4+ T cells, contributing to substantial amplification of the immune response and subsequent injury to the lung parenchyma. [8,9,10]
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