Mycoplasma Pneumoniae Pneumonia Research Articles

The Clinical Value of Systemic Immune Inflammation Index (SII) in Predicting the Severity of Hospitalized Children with Mycoplasma Pneumoniae Pneumonia: A Retrospective Study.

The Systemic Immune Inflammation Index (SII), as a novel inflammation biomarker that comprehensively reflects the inflammatory and immune status of the body, has not been reported in studies on Mycoplasma pneumoniae pneumonia (MPP) in children. This study aims to investigate whether SII can serve as an effective indicator for evaluating the condition of MPP. This study recruited a total of 304 hospitalized patients with mycoplasma pneumoniae pneumonia (MPP), including 78 patients with severe MPP (SMPP) and 226 patients with non-SMPP. Univariate analysis using chi-square test, t-test, and Mann-Whitney U-test was conducted to analyze the clinical data of the patients. Logistic regression analysis was employed to identify the main risk factors for SMPP. Receiver operating characteristic curves were plotted to evaluate the potential of using neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic immune response index (SIRI) to predict the severity of MPP. The ROC curve results show that patients with SII values ≥ 699.00 are more likely to develop severe MPP (sensitivity=0.876, specificity=0.987, AUC=0.940), and the predictive value of SII is significantly better than that of NLR, PLR, and SIRI. The results of multivariate logistic regression analysis indicate that SII can serve as a major risk factor for distinguishing non-SMPP from SMPP. This study suggests that SII may be an effective indicator for predicting the severity of MPP in children. SII is more sensitive and specific than NLR, PLR, and SIRI in evaluating the condition of MPP.

Combination of Qingfei Huayu Decoction and Targeted Nursing Care Improves the Clinical Outcomes in Pediatric Patients with Mycoplasma Pneumoniae Pneumonia

To explore the efficacy of the combined use of Qingfei Huayu decoction (QFHYD) and targeted nursing care in pediatric cases of Mycoplasma Pneumoniae pneumonia (MPP). One hundred and twenty pediatric cases of MPP admitted to our hospital from January 2021 to December 2022 were selected and randomly divided into control (n = 60) and experimental (n = 60) groups. The control group (CG) was treated with targeted nursing care in conjunction with conventional Western medicine, while the experimental group (EG) received QFHYD in addition to the CG’s treatment. Clinical efficacy, symptom relief time, and levels of inflammatory markers were recorded. Subsequently, a mouse model of MPP was established to investigate the effects of QFHYD on bacterial load in lung tissues, tissue damage, and the expression of members of the Notch pathway. The symptom relief times for cough, fever, and pulmonary rales were shorter in the EG than in the CG (all P < 0. 001). After treatment, interleukin-6 (IL-6) and IL-8 levels decreased in both groups, with the levels being lower in the EG (both P < 0. 001). Mouse model results showed that both azithromycin alone and in combination with QFHYD could reduce bacterial loads in bronchoalveolar lavage fluid and lung injury scores (all P < 0. 001), with the combination showing more significant effects. Furthermore, western blotting indicated significant reductions in the relative protein levels of Notch1 and Notch2 in mouse lung tissues, with the combination showing more significant effects (all P < 0. 001). In pediatric MPP, the combination of QFHYD and targeted nursing care can significantly enhance clinical efficacy, accelerate symptom relief, and improve the body’s inflammatory state. Based on animal studies, we speculate that the action of QFHYD may be related to the Notch pathway.

Serum IL-17A and IL-6 in paediatric Mycoplasma pneumoniae pneumonia: implications for different endotypes

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.

Construction and Validation of a Nomogram Model to Predict the Severity of Mycoplasma pneumoniae Pneumonia in Children.

This study aimed to develop a nomogram model for early prediction of the severe Mycoplasma pneumoniae pneumonia (MPP) in children. A retrospective analysis was conducted on children with MPP, classifying them into severe and general MPP groups. The risk factors for severe MPP were identified using Logistic Stepwise Regression Analysis, followed by Multivariate Regression Analysis to construct the nomogram model. The model's discrimination was evaluated using a receiver operating characteristic curve, its calibration with a calibration curve, and the results were visualized using the Hosmer-Lemeshow goodness-of-fit test. Univariate analysis revealed that age, duration of fever, length of hospital-stay, decreased sounds of breathing, respiratory rate, hypokalemia, and incidence of co-infection were significantly different between severe and general MPP. Significant differences (p < 0.05) were also observed in C-reactive protein, procalcitonin, peripheral blood lymphocyte count, neutrophil-to-lymphocyte ratio, ferritin, lactate dehydrogenase, alanine aminotransferase, interleukin-6, immunoglobulin A, and CD4+ T cells between the two groups. Logistic Stepwise Regression Analysis showed that age, decreased sounds of breathing, respiratory rate, duration of fever (OR = 1.131; 95% CI: 1.060-1.207), length of hospital-stay (OR = 1.415; 95% CI: 1.287-1.555), incidence of co-infection (OR = 1.480; 95% CI: 1.001-2.189), ferritin level (OR = 1.003; 95% CI: 1.001-1.006), and LDH level (OR = 1.003; 95% CI: 1.001-1.005) were identified as risk factors for the development of severe MPP (p < 0.05 in all). The above factors were applied in constructing a nomogram model that was subsequently tested with 0.862 of the area under the ROC curve. Age, decreased sound of breathing, respiratory rate, duration of fever, length of hospital-stay, co-infection with other pathogen(s), ferritin level, and LDH level were the significant contributors for the establishment of a nomogram model to predict the severity of MPP in children.

Integrative study of pulmonary microbiome, transcriptome and clinical outcomes in Mycoplasma pneumoniae pneumonia

BackgroundThis study aimed to investigate the interactions among three core elements of respiratory infection—pathogen, lung microbiome, and host response—and their avocation with the severity and outcomes of Mycoplasma pneumoniae pneumonia (MPP) in children.MethodsWe prospectively collected bronchoalveolar lavage fluid from a cohort of 41 children with MPP, including general MPP (GMPP) and complicated MPP (CMPP), followed by microbiome and transcriptomic analyses to characterize the association among pathogen, lung microbiome, and host response and correlate it with the clinical features and outcomes.ResultsThe lung microbiome of patients with CMPP had an increased relative abundance of Mycoplasma pneumoniae (MP) and reduced alpha diversity, with 76 differentially expressed species. Host gene analysis revealed a key module associated with neutrophil function and several inflammatory response pathways. Patients with a high relative abundance of MP, manifested by a specific lung microbiome and host response type, were more prone to CMPP and had a long imaging recovery time.ConclusionPatients with CMPP have a more disrupted lung microbiome than those with GMPP. MP, lung microbiome, and host response interacts with each other and are closely related to disease severity and outcomes in children with MPP.Graphical

Clinical features of Mycoplasma pneumoniae pneumonia in children without fever

BackgroundMycoplasma pneumoniae (MP) is one of the most common causes of community-acquired pneumonia in children. Most children have fever. In 2021, we found that the proportion of children without fever increased. The aim of this study is to summarize the differences in the clinical characteristics of children with MP pneumonia who are febrile or not, and to raise awareness of children who are not febrile.MethodDemographic information of the children was collected on admission. Clinical manifestations during the course of the disease and the first laboratory, imaging, and pulmonary function tests before discharge were recorded and compared.ResultsFrom August to December, a total of 542 people were included in the study. We found that older children were more likely to have fever. Inflammatory indicators including procalcitonin (P = 0.030), C-reaction protein (P < 0.001), erythrocyte sedimentation rate (P < 0.001), ferritin (P = 0.040) and the rate of atelectasis (P = 0.049) of febrile children were higher in febrile children. However, the elevated lactate dehydrogenase and pulmonary function impairment (P all > 0.05), especially the small airway function impairment, are no lower in afebrile children than in febrile children.ConclusionThe fever rate is lower in younger children, but wheezing is more common. In afebrile children, the impairment of organ and lung function was no less than in febrile children. Therefore, attention should also be paid to children who are not febrile.

Diagnostic significance of HRCT imaging features in adult mycoplasma pneumonia: a retrospective study

Mycoplasma pneumoniae pneumonia (MPP) often overlaps with the clinical manifestations and chest imaging manifestations of other types of community-acquired pneumonia (CAP). We retrospectively analyzed the clinical and imaging data of a group of patients with CAP, summarized their clinical and imaging characteristics, and discussed the diagnostic significance of their certain HRCT findings. The HRCT findings of CAP researched in our study included tree-in-bud sign (TIB), ground-glass opacity (GGO), tree fog sign (TIB + GGO), bronchial wall thickening, air-bronchogram, pleural effusion and cavity. The HRCT findings of all cases were analyzed. Among the 200 cases of MPP, 174 cases showed the TIB, 193 showed the GGO, 175 showed the tree fog sign, 181 lacked air-bronchogram. In case taking the tree fog sign and lack of air-bronchogram simultaneously as an index to distinguish MPP from OCAP, the sensitivity was 87.5%, the specificity was 97.5%, the accuracy was 92.5%. This study showed that that specific HRCT findings could be used to distinguish MPP from OCAP. The combined HRCT findings including the tree fog sign and lacked air-bronchogram simultaneously would contribute to a more accurate diagnosis of MPP.

Clinical differences between Mycoplasma pneumoniae pneumonia and Streptococcus pneumoniae pneumonia: a case control study.

Mycoplasma pneumoniae pneumonia (MPP) and Streptococcus pneumoniae pneumonia (SPP) are frequent causes of respiratory tract infection, the aims of the study were to explore the differences in clinical features between children with MPP and those with SPP. This retrospective study included admitted children who were diagnosed with MPP or SPP over 5 years from January 2015 to January 2020. Children with MPP were compared to children with SPP in terms of clinical features. 506 patients with MPP were compared to 311 patients with SPP in terms of clinical differences. The MPP group with a median age of 60 [29-89] months and the SPP group with a median age of 24 [10-40] months. Patients with MPP were older and had a higher occurrence of receiving antibiotics before admission, fever, dry cough, polypnea and diarrhea than patients with SPP (all p < 0.01). Patients with SPP were more likely to have wheezing, cyanosis and irritability (all p < 0.01). Laboratory findings in our study showed that there were significant differences between MPP and SPP patients in mean leucocyte count, neutrophil % (N%), lymphocyte % (L%), ALT levels, AST levels, LDH levels and incidence of accelerated procalcitonin (PCT) (all p < 0.01). Lower age, no dry cough, no polypnea, lower LDH levels, and higher PCT might lead to the diagnosis of SPP. Our study showed that age had a higher accuracy in predicting MPP than LDH levels, with an age >48.5 months shown to be an independent predictive factor for the early evaluation and identification of MPP. In conclusion, patients with MPP and SPP usually present with fever, cough and some nonspecific symptoms. Our study showed that age, dry cough, polypnea, LDH levels, and PCT levels were independent predictive factors associated with MPP and SPP.

Clinical value of monitoring cytokine levels for assessing the severity of mycoplasma pneumoniae pneumonia in children.

To investigate the clinical relevance of cytokine levels in assessment of the severity of mycoplasma pneumoniae pneumonia (MPP) in children. A retrospective study was conducted on 150 pediatric cases of MPP admitted to a local hospital in China from November 1, 2022 to October 31, 2023. These MPP cases were divided into mild (n=100) and severe (n=50) groups according to the severity of the disease. Cytokine levels, including Interferon-γ (IFN-γ), Tumor Necrosis Factor-α (TNF-α), C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-2 (IL-2), and D-Dimer (D-D), were compared between the two groups. The diagnostic efficacy of each cytokine in assessing the severity of MPP was analyzed through Receiver Operating Characteristic (ROC) curves, and correlation between cytokine levels and disease severity was assessed using Pearson's correlation coefficient. The IL-2 level was significantly lower, while TNF-α, IL-6, and IFN-γ levels were significantly higher in the severe group compared to the mild group (all P<0.05). TNF-α, IFN-γ, IL-2, IL-6, CRP, and D-D were identified as factors influencing the severity of MPP (all P<0.05). The ROC curve analysis showed that the areas under the curve (AUCs) of TNF-α, IL-2, IL-6, IFN-γ, CRP, and D-D were 0.864, 0.692, 0.874, 0.949, 0.814, and 0.691, respectively (all P<0.001), indicating their diagnostic value in assessing the severity of MPP. There exists a positive correlation between IL-2 and the percentage of normal lung density on Computed Tomography (CT) scan (P<0.05), while TNF-α, IL-6, IFN-γ, CRP, and D-D showed negative correlations with the percentage of normal lung density (P<0.05). Cytokines such as TNF-α, IL-2, IL-6, IFN-γ, CRP, and D-D are aberrantly expressed in children with MPP and are associated with the severity of the disease. These cytokines have high diagnostic value and can serve as reference indicators for clinical, especially prognostic assessment of the severity of (pediatric) MPP.

Azithromycin Effectiveness in Children with Mutated Mycoplasma Pneumoniae Pneumonia.

Mycoplasma pneumoniae (MP) is highly resistant to macrolides in China. However, macrolides still exhibit clinical effectiveness in some macrolide-resistant patients. We tend to explore azithromycin effectiveness in Mycoplasma pneumoniae pneumonia (MPP) children with A2063/2064G mutation. This retrospective observational cohort study was conducted at the Children's Hospital of the Chongqing Medical University. Children with macrolide-resistant mutations (A2063/2064G) diagnosed as MPP were retrospectively enrolled. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to evaluate and identify independent risk factors for treatment failure (progress to refractory Mycoplasma pneumoniae pneumonia [RMPP]) in macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) children with the A2063/2064G mutation. One hundred fifty-five children were retrospectively enrolled. More than 20% (36/155, 23.23%) of patients experienced defervescence within 3 days of azithromycin treatment. RMPP was diagnosed in 54 patients (54/155, 34.84%) and the incidence of RMPP during hospitalization was 22.72 per 1000 person-days. Logistic regression analysis showed that lactate dehydrogenase (LDH) ≥ 399 (U/L) was an independent risk factor for RMPP (odds ratio [OR] 4.66, 95% confidence interval [CI] 1.31-17.10, P=0.017). During the year followed, RMPP patients had a significantly higher incidence of bronchiolitis obliterans and bronchiectasis than non-RMPP patients (16.67% vs 1.98%, P=0.001; 9.26% vs 0.00%, P=0.005, respectively). Azithromycin was effective in children with MPP with the A2063/2064G mutation. For MUMPP children with A2063/2064G mutation, children with LDH ≥ 399 (U/L) had significant higher risk for progression to RMPP, and should consider to be treated with alternative antibiotics (eg tetracyclines, and fluoroquinolones).

Involvement of the TGF-β pathway in epithelialmesenchymal transition promoted by the pulmonary microenvironment in Mycoplasma pneumoniae pneumonia

Mycoplasma pneumoniae (MP), one of the smallest prokaryotic microorganisms capable of independent survival, causes respiratory tract infections and various extrapulmonary diseases. Mycoplasma pneumoniae pneumonia (MPP) is the most significant clinical manifestation, often leading to complications such as atelectasis and pulmonary fibrosis. We explored the role of the pulmonary microenvironment in regulating epithelial-mesenchymal transition (EMT) in MPP patients with atelectasis. Transcriptome sequencing revealed significant upregulation of pathways including transforming growth factor beta (TGF-?), tumor protein 53 (P53), protein kinase Hippo, Ras-proximate- 1 or Ras-related protein 1 (Rap1), and members of class O forkhead box proteins (FoxO) in cells exposed to bronchoalveolar lavage fluid (BALF) from MPP patients with atelectasis. Among these, the TGF-? pathway exhibited the most pronounced changes in gene expression. Further analysis confirmed that BALF from these patients induced EMT in human bronchial epithelial cells and mouse lung tissues and that TGF-? receptor kinase inhibitor (TRKI) effectively reversed this process. In conclusion, the pulmonary microenvironment in MPP patients with atelectasis promotes EMT in the lungs, with TGF- ? playing a key role in this process. This may represent a crucial mechanism contributing to pulmonary fibrosis, underscoring the need to focus on the pulmonary microenvironment and TGF-?-targeted therapies for the prevention and management of pulmonary fibrosis in these patients.

Study on red blood cell distribution width in children with severe Mycoplasma pneumoniae pneumonia.

Background: This study aimed to investigate the clinical value of the red blood cell distribution width (RDW) in severe Mycoplasma pneumoniae pneumonia (MPP). Methods: A total of 185 children with diagnosed severe MPP were included. The patients' case records and laboratory examination data were analyzed retrospectively. The children were grouped into quartiles based on RDW. Results: Univariate analysis revealed that RDW was significantly correlated with the Pediatric Risk of Mortality (PRISM) III score, Sepsis-Related Organ Failure Assessment score, incidence of invasive intubation and 30-day in-hospital mortality. After adjustment for the severity of illness, multivariate analysis revealed that the PRISM III score and RDW were factors independently associated with 30-day in-hospital mortality. Conclusion: This study revealed that RDW could be correlated with the long-term prognosis and severity of severe MPP.

Efficacy and safety of Lianhua Qingwen granule combined with azithromycin for mycoplasma pneumoniae pneumonia in children: a systematic review with meta-analysis and trial sequential analysis.

Lianhua Qingwen (LHQW) granule, a botanical drug preparation, is frequently utilized as an adjuvant treatment for mycoplasma pneumoniae pneumonia (MPP). Nevertheless, the clinical efficacy and safety of this treatment remain uncertain. This study aims to evaluate the efficacy and safety of LHQW granule combined with azithromycin (AZM) in treating MPP in children. To identify all randomized controlled trials (RCTs) of LHQW granule plus AZM, a search was conducted in eight Chinese and English databases (CNKI, Wan Fang, VIP, Sinomed, PubMed, Embase, Web of Science, and Cochrane Library) from their inception until 25 December 2023. Meta-regression and subgroup analysis were employed to investigate heterogeneity. Sensitivity analysis and trial sequential analysis (TSA) were conducted to assess the robustness of the findings. Additionally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was utilized to evaluate the quality of evidence. A total of 15 RCTs involving 1909 participants were included in this study. The meta-analysis results indicated combination therapy of LHQW granule and AZM is significant different from AZM alone in both efficacy and safety, which are specifically observed in the following outcomes: response rate (RR = 1.17, 95% CI: 1.12 to 1.22, p < 0.01), antipyretic time (MD = -1.32, 95% CI: -1.66 to -0.98, p < 0.01), cough disappearance time (MD = -1.76, 95% CI: -2.47 to -1.05, p < 0.01), pulmonary rale disappearance time (MD = -1.54, 95% CI: -2.06 to -1.02, p < 0.01), c-reactive protein (CRP) (MD = -5.50, 95% CI: -6.92 to -4.07, p < 0.01), procalcitonin (PCT) (MD = -0.31, 95% CI: -0.38 to -0.24, p < 0.01), interleukin 6 (IL-6) (MD = -5.97, 95% CI: -7.39 to -4.54, p<0.01), tumor necrosis factor α (TNF-α) (MD = -5.74, 95% CI: -7.44 to -4.04, p < 0.01), forced vital capacity (FVC) (SMD = 0.48, 95% CI: 0.34 to 0.62, p < 0.01), forced expiratory volume in the first second (FEV1) (SMD = 0.55, 95% CI: 0.44 to 0.67, p < 0.01), FEV1/FVC (SMD = 0.49, 95% CI: 0.32 to 0.67, p < 0.01), CD4+ T lymphocyte (CD4+) (MD = 4.04, 95% CI: 3.09 to 4.98, p < 0.01), CD8+ T lymphocyte (CD8+) (MD = -3.32, 95% CI: 4.27 to 2.38, p < 0.01) and adverse events (RR = 0.65, 95% CI: 0.43 to 0.96, p < 0.01). The combination therapy of LHQW granule and AZM may be a better strategy to treat MPP in children. However, the clinical efficacy and safety of LHQW granule require further validation. https://www.crd.york.ac.uk/PROSPERO/.

Neutrophil-to-lymphocyte ratio as a predictor of poor outcomes of Mycoplasma pneumoniae pneumonia.

Mycoplasma pneumoniae pneumonia (MPP) may lead to varioussignificantoutcomes,suchas necrotizing pneumonia(NP) and refractory MPP (RMPP). We investigated the potential of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with MPP. This was a prospective study of patients with MPP who were admitted to our hospital from 2019 to 2021. Demographic and clinical data were collected from patient records and associated with the development of NP and RMPP and other outcome measures. Of the 1,401 patients with MPP included in the study, 30 (2.1%) developed NP. The NLR was an independent predictor of NP (odds ratio 1.153, 95% confidence interval 1.022-1.300, P=0.021). The probability of NP was greater in patients with a high NLR (≥1.9) than in those with a low NLR (<1.9) (P<0.001). The NLR was also an independent predictor of RMPP (odds ratio 1.246, 95% confidence interval 1.102-1.408, P<0.005). Patients with a high NLR were more likely to develop NP and RMPP and require intensive care, and had longer total fever duration, longer hospital stays, and higher hospitalization expenses than those with a low NLR (all P<0.005). The NLR can serve as a predictor of poor prognosis in patients with MPP. It can predict the occurrence of NP, RMPP, and other poor outcomes. The use of this indicator would allow the simple and rapid prediction of prognosis in the early stages of MPP, enabling the implementation of appropriate treatment strategies.

Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes

BackgroundThe imaging findings of Mycoplasma pneumoniae pneumonia (MPP) vary; however, few studies have focused on the relationship of imaging classification with clinical manifestations and outcomes. ObjectiveTo prospectively investigate whether chest imaging classification in Mycoplasma pneumoniae pneumonia (MPP) is associated with its clinical features and outcomes. MethodsA total of 1,401 hospitalized children with MPP were enrolled from January 2019 to December 2021. Imaging findings were categorized as bronchopneumonia and consolidation/atelectasis according to X-ray, and bronchopneumonia, consolidation/atelectasis, bronchiolitis, and mosaic pattern according to computed tomography (CT). Clinical characteristics and outcomes of patients with different imaging classifications were prospectively analyzed based on electronic medical records. ResultsBronchopneumonia was the most common finding (59.6%), while consolidation/atelectasis was the most severe group. Clinical manifestations and laboratory indicators for the consolidation/atelectasis group included serious abnormalities. Further, outcomes of the patients were worse, including having longer total durations of fever and hospitalization, greater hospitalization expenses, and a higher likelihood of developing refractory MPP, necrotizing pneumonia, and bronchiolitis obliterans (BO) in this group. The incidence of bronchiolitis, a disease characterized by a high prevalence of fever, moist rales, and an atopic constitution, tended to increase after the coronavirus disease pandemic and predisposed patients to BO. A mosaic pattern occurred in allergic and young individuals, with wheezing as the main manifestation, with patients having relatively mild symptoms and good outcomes. ConclusionDifferent imaging classifications have different clinical features and clinical outcomes; thus, formulating an imaging-based classification system is of great clinical value.

Clinical features and risk factors of plastic bronchitis caused by Mycoplasma pneumoniae pneumonia in children

BackgroundWe analyzed the clinical characteristics of children with plastic bronchitis (PB) caused by Mycoplasma pneumoniae (MP) and explored its risk factors.MethodsWe prospectively analyzed clinical data of children with MP pneumonia (MPP) treated with fiberoptic bronchoscopy (FB). Patients were classified into a PB and non-PB group. General information, clinical manifestations, laboratory tests, results of computed tomography scan, and FB findings were compared between groups. We conducted statistical analysis of risk factors for developing PB.ResultsOf 1169 children who had MPP and were treated with FB, 133 and 1036 were in the PB and non-PB groups, respectively. There were no significant differences in sex, age, and incident season between groups (P > 0.05). The number of children in the PB group decreased during the COVID-19 pandemic. Compared with children in the non-PB group, those in the PB group had longer duration of hospitalization, increased levels of neutrophil (N), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH), alanine transaminase (ALT) and aspartate transaminase (AST); lower levels of lymphocyte (L) and platelet (PLT); and higher incidence of lack of appetite, decreased breath sounds, single lobar infiltrate, pleural effusion, pericardial effusion, mucosal erosion and/or necrosis, and bronchial embolization. L levels and pleural effusion were identified as risk factors in multivariate logistic regression.ConclusionsChildren with PB caused by MPP had a strong and local inflammatory response. L levels and pleural effusion were independent risk factors of PB with MPP in children. Our findings will help clinicians identify potential PB in pediatric patients for early and effective intervention.

Epidemiological and Genetic Characteristics of Mycoplasma pneumoniae Pneumonia after the Outbreak of COVID-19

Abstract Objective Mycoplasma pneumoniae pneumonia (MPP) accounts for a major part of community-acquired pneumonia in children, and we performed this study to investigate the epidemiological and genetic characteristics of MPP after the outbreak of COVID-19. Methods A total of 15,538 throat swab samples were collected from inpatients with respiratory tract infections from January 2021 to December 2021. All specimens were detected by real-time reverse transcriptase polymerase chain reaction (RT-PCR). The P1 gene of Mycoplasma pneumoniae (MP) in positive samples was amplified and sequenced. Results From January 2021 to December 2021, a total of 15,538 children with acute respiratory tract infection were tested by real-time RT-PCR in our study, including 9,056 boys and 6,482 girls. Overall, 469 (3.0%, 469/15,538) tested positive for MP, with 266 (2.9%, 266/9,056) males and 203 (3.1%, 203/6,482) females (p = 0.48). The positive rates of MP infection in &lt; 1 year old, 1 to 3 years old, 3 to 5 years old, 5 to 7 years old, and &gt;7 years old groups were 1.31% (85/6,474), 1.87% (64/3,423), 3.65% (95/2,601), 8.02% (127/1,583), and 6.72% (98/1,458), respectively. The homology analysis of the P1 gene of 24 MP positive samples showed that the nucleotide sequence consistency was up to 91.2 to 99.3%. Conclusion After the outbreak of COVID-19, positive detection rate was the highest from 5 to 7 years old among children with MPP, and the genotype of MP in Hangzhou, China area was focused on P1 subtype, type I.

Changes in coagulation markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for Mycoplasma severity

BackgroundThis 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).MethodsA 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.ResultsThe 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).ConclusionThe 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.

Construction of a predictive model for performing bronchoalveolar lavage in children with Mycoplasma pneumoniae pneumonia and pulmonary consolidation

To investigate the risk factors for performing bronchoalveolar lavage (BAL) in children with Mycoplasma pneumoniae pneumonia (MPP) and pulmonary consolidation, and to construct a predictive model for performing BAL in these children. A retrospective analysis was performed for the clinical data of 202 children with MPP who were hospitalized in the Department of Pediatrics, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, from August 2019 to September 2022. According to whether BAL was performed, they were divided into BAL group with 100 children and non-BAL group with 102 children. A multivariate logistic regression analysis was used to identify the risk factors for performing BAL in MPP children with pulmonary consolidation. Rstudio software (R4.2.3) was used to establish a predictive model for performing BAL, and the receiver operator characteristic (ROC) curve, C-index, and calibration curve were used to assess the predictive performance of the model. The multivariate logistic regression analysis demonstrated that the fever duration, C-reactive protein levels, D-dimer levels, and presence of pleural effusion were risk factors for performing BAL in MPP children with pulmonary consolidation (P<0.05). A nomogram predictive model was established based on the results of the multivariate logistic regression analysis. In the training set, this model had an area under the ROC curve of 0.915 (95%CI: 0.827-0.938), with a sensitivity of 0.826 and a specificity of 0.875, while in the validation set, it had an area under the ROC curve of 0.983 (95%CI: 0.912-0.996), with a sensitivity of 0.879 and a specificity of 1.000. The Bootstrap-corrected C-index was 0.952 (95%CI: 0.901-0.986), and the calibration curve demonstrated good consistency between the predicted probability of the model and the actual probability of occurrence. The predictive model established in this study can be used to assess the likelihood of performing BAL in MPP children with pulmonary consolidation, based on factors such as fever duration, C-reactive protein levels, D-dimer levels, and the presence of pleural effusion. Additionally, the model demonstrates good predictive performance.

Recognition of refractory Mycoplasma pneumoniae pneumonia among Myocoplasma pneumoniae pneumonia in hospitalized children: development and validation of a predictive nomogram model

BackgroudThe current diagnostic criteria for refractory Mycoplasma pneumoniae pneumonia (RMPP) among Mycoplasma pneumoniae Pneumonia (MPP) are insufficient for early identification, and potentially delayed appropriate treatment. This study aimed to develop an effective individualized diagnostic prediction nomogram for pediatric RMPP.MethodsA total of 517 hospitalized children with MPP, including 131 with RMPP and 386 without RMPP (non-RMPP), treated at Lianyungang Maternal and Child Health Care Hospital from January 2018 to December 2021 were retrospectively enrolled as a development (modeling) cohort to construct an RMPP prediction nomogram. Additionally, 322 pediatric patients with MPP (64 with RMPP and 258 with non-RMPP, who were treated at the Affiliated Hospital of Xuzhou Medical University from June 2020 to May 2022 were retrospectively enrolled as a validation cohort to assess the prediction accuracy of model. Univariable and multivariable logistic regression analyses were used to identify RMPP risk factors among patients with MPP. Nomogram were generated based on these risk factors using the rms package of R, and the predictive performance was evaluated based on receiver operating characteristic (ROC) curves and using decision curve analysis (DCA).ResultsMultivariate analysis revealed five significant independent predictors of RMPP among patients with MPP: age (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.08–1.33, P = 0.038), fever duration (HR 1.34, 95%CI 1.20–1.50, P < 0.001), lymphocyte count (HR 0.45, 95%CI 0.23–0.89, P = 0.021), serum D-dimer (D-d) level (HR 1.70, 95%CI 1.16–2.49, P = 0.006), and pulmonary imaging score (HR 5.16, 95%CI 2.38–11.21, P < 0.001). The area under the ROC curve was 90.7% for the development cohort and 96.36% for the validation cohort. The internal and external verification calibration curves were almost linear with slopes of 1, and the DCA curve revealed a net benefit with the final predictive nomogram.ConclusionThis study proposes a predictive nomogram only based on five variables. The nomogram can be used for early identification of RMPP among pediatric patients with MPP, thereby facilitating more timely and effective intervention.