Mycoplasma pneumoniae pneumonia complicated with ARDS: report of 2 cases and review of the literature

Abstract

Objective To analyze and summarize the clinical features of Mycoplasma pneumoniae pneumonia complicated with acute respiratory distress syndrome (ARDS). Methods Two recent cases from Beijing Hospital, together with cases from literature both in China and abroad, were included for analysis. Results Twenty cases of (33±26) years of age were analyzed, among which 8 were male and 12 were female.Major symptoms included fever, cough, expectoration, and shortness of breath.Laboratory findings showed increased white blood cell count in 10 cases (50%), neutrophil percentage in 16 cases (80%), C reactive protein(CRP) levels in 8 cases, as well as procalcitonin(PCT) levels, to a much lesser extent though, in 3 cases.In terms of prognosis, 13 cases were cured (65%), and 7 cases died (35%). Compared with the cured, no significant difference was found in the duration from disease onset to etiological diagnosis in the dead (P>0.05); Nevertheless, the initiation of effective treatment administration was significantly delayed (7±3 days in the cured group, 13±8 days in the death group) in the dead(P<0.05). Fifteen cases (75%) underwent mechanical ventilation (MV), of which 14 were invasive (all deaths experienced invasive MV before death, which accounted for 50% of all invasive cases) and 2 were noninvasive.Corticosteroid therapy were applied in 8 patients (40%), of which 6 cases were cured (effective rate was 75%). The leading antibiotics used targeting M. pneumoniae in the dead group were macrolides. Conclusions M. pneumoniae infection can lead to ARDS, with high mortality in these cases.Unfortunately so far, the etiological diagnosis of M. pneumoniae infection is often delayed.The combined detection of white blood cells, neutrophil classification, CRP and PCT in infectious ARDS patients can contribute to early differentiation of M. pneumoniae infection from bacterial infection.In the settings of ARDS, there is notably greater clinical benefit in early administration of sensitive antibiotics targeting mycoplasma pneumonia rather than the confirmation of the etiological diagnosis.Given the high prevalence of macrolides resistance in M. pneumoniae, fluoroquinolones and tetracyclines can serve as promising options.The usage of corticosteroid therapy may has function to alleviate excessive inflammatory responses in the M. pneumoniae pneumonia complicated with ARDS cases.Respiratory support such as mechanical ventilation is also helpful.Therefore, early treatment is the key prognostic determinant in patients with M. pneumoniae pneumonia complicated with ARDS. Key words: Macrolides; Fluoroquinolones; Corticosteroid; Mechanical ventilation