The clinical characteristics of corticosteroid-resistant refractory Mycoplasma Pneumoniae pneumonia in children.

Yongdong Yan,Wujun Jiang,Yuzhen Wei,Chuangli Hao

doi:10.1038/srep39929

Yongdong Yan, Wujun Jiang + Show 2 more

Open Access

https://doi.org/10.1038/srep39929

Copy DOI

Journal: Scientific Reports	Publication Date: Dec 1, 2016
Citations: 37	License type: CC BY 4.0

Affiliation: Soochow University, Xuzhou Children Hospital

Abstract

To analyze the clinical characteristics of corticosteroid-resistant refractory Mycoplasma pneumoniae pneumonia (RMPP) and explore the related factors that predict corticosteroid-resistant RMPP. Retrospective analysis of 183 children with RMPP in our hospital admitted between January 1, 2012, and December 31, 2014 was performed. Of the 183 RMPP cases, 36 (19.7%) were corticosteroid-resistant RMPP cases. Corticosteroid-resistant RMPP cases had a longer duration of fever and hospitalization compared with corticosteroid-sensitive RMPP cases (P < 0.05). The radiographic findings of 123 (83.7%) cases of corticosteroid-sensitive RMPP apparently resolved after one week of corticosteroid treatment compared with 4 (11.1%) corticosteroid-resistant RMPP cases that had apparently resolution (P < 0.01). Twenty-four (75%) corticosteroid-resistant RMPP patients who received bronchoscopy had mucus plug formation while none of the corticosteroid-sensitive RMPP patients had mucus plug formation (P < 0.05). Multiple logistic regression analysis showed that duration of fever ≥11 days, percentage of lymphocytes ≤32%, CRP ≥48.73 mg/L and LDH ≥ 545.7 U/L were significant predictors of corticosteroid-resistant RMPP. Patients with corticosteroid-resistant RMPP had more severe presentations and more serious radiological findings. Clinicians might use the parameters of duration of fever, CRP, LDH and proportion of lymphocytes to identify children at higher risk of corticosteroid-resistant RMPP.

Highlights

Mycoplasma pneumoniae is one of the most important pathogens in children and young adults, accounting for 10–40% of community-acquired pneumonia1–4
We retrospectively reviewed and analyzed the medical data of refractory Mycoplasma pneumoniae pneumonia (RMPP) patients and found that corticosteroid-resistant patients had a longer duration of fever, length of hospitalization, and higher incidence of tachypnea, rales and rash
We identified a longer duration of fever, higher levels of CRP and lactate dehydrogenase (LDH), and lower L% as risk factors associated with resistance of RMPP to corticosteroids

Summary

Introduction

Mycoplasma pneumoniae is one of the most important pathogens in children and young adults, accounting for 10–40% of community-acquired pneumonia. Mycoplasma pneumoniae is one of the most important pathogens in children and young adults, accounting for 10–40% of community-acquired pneumonia1–4 It has been observed in many areas of the world that epidemics of M. pneumoniae infections occur every 3–7 years, which increases the rate of morbidity, mortality, as well as the cost of health care in society. We encountered several severe cases of RMPP that were unresponsive to standard doses of corticosteroid and required investigation using fiber optic bronchoscopy. We retrospectively analyzed all children with RMPP over a 3-year period to determine the clinical features, laboratory data, radiological findings and fiber optic bronchoscopic findings of these patients who failure to fully respond to corticosteroid and report our experience of treating these children

Methods

Results

Conclusion