Severe Mycoplasma Pneumoniae Pneumonia Research Articles

Correlation of prognostic values of IL-6 and PCT levels with the severity of pneumonia caused by Mycoplasma pneumoniae in children

Objective: To explore the correlation of interleukin 6 (IL-6) and procalcitonin (PCT) with severity of Mycoplasma pneumoniae pneumonia (MPP) in children and their prognostic value. Methods: One hundred twenty children with MPP and 100 healthy children who underwent physical examination at the Clinical Laboratory Department of Nantong University Maternal and Child Health Hospital from November 2023 to December 2023 were selected as the study subjects, and were divided into the experimental group and the control group. The experimental group was divided into mild MPP group (n=70 ) and severe MPP group (n=50 ) according to the severity of the disease. According to the condition after one course of treatment, separated MPP children into good prognosis group (n=96) and poor prognosis group (n=24). The IL-6 and PCT levels of the experimental/control group before treatment and the good/bad prognosis group after treatment were compared, respectively. The lung function of children with MPP before and after treatment was also examined, and the changes of respiratory rate (RR), tidal volume (VT), expiratory time (Te), peak time (TPTEF), and peak volume (VPTEF) were observed. The correlation between pulmonary function and IL-6, PCT in MPP children was analyzed by Pearson analysis. Receiver operation curve was adopted to analyze the predictive value of IL-6, PCT for poor prognosis. Results: IL-6 and PCT were increased in the severe MPP group compared to the mild MPP group (P<0.001) and tended to decrease in the good prognosis group compared to the poor prognosis group (P<0.001). Fifty-nine of the 70 cases in the good prognosis group were patients with mild MPP, suggesting that patients with mild MPP have a better prognosis. The results of respiratory function showed an increase in RR (P<0.001) and a decrease in VT (P=0.007), TPTEF/Te (P<0.001), VPTEF/VT (P<0.001) in the severe MPP group compared to the mild MPP group. The results of correlation analysis revealed that IL-6, PCT were negatively correlated with VT, TPTEF/Te and VPTEF/VT (P<0.001). ROC curve analysis revealed that IL-6 and PCT co-diagnosis had a better predictive ability for poor prognosis in children with MPP (AUC=0.843). Conclusion: IL-6 and PCT are positively related to the severity of MPP, the combined detection of IL-6 and PCT has certain clinical usefulness to evaluate and assess prognosis of MPP children. doi: https://doi.org/10.12669/pjms.41.5.10448 How to cite this: Bao X, Wang Q, Geng H, Yuan X. Correlation of prognostic values of IL-6 and PCT levels with the severity of pneumonia caused by Mycoplasma pneumoniae in children. Pak J Med Sci. 2025;41(5):1305-1310. doi: https://doi.org/10.12669/pjms.41.5.10448 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A machine learning model for predicting severe mycoplasma pneumoniae pneumonia in school-aged children

ObjectiveTo develop an interpretable machine learning (ML) model for predicting severe Mycoplasma pneumoniae pneumonia (SMPP) in order to provide reliable factors for predicting the clinical type of the disease.MethodsWe collected clinical data from 483 school-aged children with M. pneumoniae pneumonia (MPP) who were hospitalized at the Children's Hospital of Soochow University between September 2021 and June 2024. Difference analysis and univariate logistic regression were employed to identify predictors for training features in ML. Eight ML algorithms were used to build models based on the selected features, and their effectiveness was validated. The area under the curve (AUC), accuracy, five-fold cross-validation, and decision curve analysis (DCA) were utilized to evaluate model performance. Finally, the best-performing ML model was selected, and the Shapley Additive Explanations (SHAP) method was applied to rank the importance of clinical features and interpret the final model.ResultsAfter feature selection, 30 variables remained. We constructed eight ML models and assessed their effectiveness, finding that the CatBoost model exhibited the best predictive performance, with an AUC of 0.934 and an accuracy of 0.9175. DCA was used to compare the clinical benefits of the models, revealing that the CatBoost model provided greater net benefits than the other ML models within the threshold probability range of 34% to 75%. Additionally, we applied the SHAP method to interpret the CatBoost model, and the SHAP diagram was used to visually show the influence of predictor variables on the outcome. The results identified the top six risk factors as the number of days with fever, D-dimer, platelet count (PLT), C-reactive protein (CRP), lactate dehydrogenase (LDH), and the neutrophil-to-lymphocyte ratio (NLR).ConclusionsThe interpretable CatBoost model can help physicians accurately identify school-aged children with SMPP. This early identification facilitates better treatment options and timely prevention of complications. Furthermore, the SHAP algorithm enhances the model's transparency and increases its trustworthiness in practical applications.

Clinical analysis of 15 cases of severe Mycoplasma pneumoniae pneumonia complicated by cardiac thrombosis in children

Objective: To investigate the clinical manifestations, therapeutic strategies and prognostic outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by cardiac thrombosis. Methods: This case series study retrospectively analyzed 15 pediatric patients with SMPP complicated by cardiac thrombosis. The patients was recruited from the Department of Pediatric Respiratory Medicine at Shandong Provincial Hospital Affiliated to Shandong First Medical University between July 2018 and January 2025. Comprehensive clinical data and follow-up information were collected. Results: Among the 15 children, 10 were male and 5 were female, and the age of onset was 8.0 (6.3, 10.0) years. All 15 children presented with fever and cough, while additional symptoms included dyspnea in 7 cases, chest pain in 6 cases, hemoptysis in 3 cases, and chest tightness in 1 case. The white blood cell count was 11.7 (9.5, 15.9)×109/L, C-reactive protein was 31.6 (17.5, 64.8) mg/L and lactate dehydrogenase was 548.2 (410.4, 768.3) U/L. A total of 14 children underwent testing for the Mycoplasma pneumoniae drug resistance genes 2063A>G and 2064A>G, of which 13 tested positive. The plasma D-dimer levels of 15 children were 8.77 (7.23, 12.50) mg/L, all of which were higher than normal. Among the 15 children, 5 had decreased activity of anticoagulant proteins (protein C, protein S, antithrombin Ⅲ), and 8 tested positive for antiphospholipid antibodies. Chest CT scans of all 15 children showed pulmonary consolidation and (or) atelectasis, with pleural effusion present in 12 cases. In the 15 children, thrombosis was detected at 14.0 (11.0, 18.0) days after the onset of illness. The locations of cardiac thrombosis included the right ventricle in 9 cases, the right atrium in 5 cases, and the left atrium in 1 case. Additionally, 10 cases had pulmonary vascular embolism, comprising 9 cases of pulmonary artery thrombosis and 1 case of pulmonary vein thrombosis. After anticoagulant treatment, cardiac thrombi disappeared in 10 children. Five children who did not show improvement with anticoagulation underwent surgical thrombectomy. In the follow-up of 15 children, lung imaging basically returned to normal, with no major hemorrhagic events or other adverse events. Conclusions: In children with Mycoplasma pneumoniae pneumonia, the presence of clinical symptoms such as shortness of breath, chest pain and hemoptysis, along with elevated plasma D-dimer levels, should raise suspicion for the possibility of cardiac thrombosis. SMPP complicated by cardiac thrombosis, prognosis is good following anticoagulation or surgical treatment.

Correlation between changes in haemorheology and the HIF-1/EPO pathway in children with Mycoplasma pneumoniae pneumonia

Objective To investigate the possible correlation between changes in haemorheology and the HIF-1/EPO pathway in children with Mycoplasma pneumoniae pneumonia (MPP) to provide new ideas for the early clinical identification of hypercoagulability and reduce the incidence of thrombosis. Methods A total of 205 children with newly diagnosed MPP were selected from our department and divided into a general MPP group (100 patients) and a severe MPP group (105 patients) according to diagnostic criteria. In addition, 30 healthy children were selected as the control group. Routine blood and coagulation function data were collected, and the expression levels of T-cell factors, HIF-1α, EPO and haemorheology were detected. Results The levels of D-dimer, FDP and fibrinogen in the MPP group were significantly greater than those in the control group and more obvious in the severe group than in the general group. Compared with those in the control group, the whole blood viscosity (low, medium, high tangential), plasma viscosity, whole blood low tangential reductive viscosity and erythrocyte aggregation index in the haemorheology of children in the MPP group were significantly greater, and the range of increase in the severe group was greater than those in the general group. The red blood cell (RBC) count and haematocrit (HCT) of children in the MPP group were significantly greater than those in the control group at admission and were more altered in the severe group than in the general group. Moreover, the serum expression levels of TNF-a, IFN-γ, IL-6, IL-8, IL-10, IL-17, HIF-1α and EPO in the MPP group were significantly greater than those in the healthy control group. With the exception of IFN-γ, the cytokines levels in the severe group were significantly greater than those in the general group. The expression level of HIF-1α was significantly correlated with the elevated levels of TNF-a, IL-6 and IL-8. Conclusion Hypercoagulability occurs during the course of MPP in children, especially those with severe disease. The increase in blood viscosity may be an important reason for hypercoagulability, and highly inflammatory cytokines such as TNF-a, IL-6 and IL-8 in children may increase the RBC and HCT levels by activating the HIF-1α/EPO pathway, which may lead to changes in haemorheology and thus participate in the development of hypercoagulability.

Development of machine learning-based differential diagnosis model and risk prediction model of organ damage for severe Mycoplasma pneumoniae pneumonia in children

Severe Mycoplasma pneumoniae pneumonia (SMPP) poses significant diagnostic challenges due to its clinical features overlapping with those of other common respiratory diseases. This study aims to develop and validate machine learning (ML) models for the early identification of SMPP and the risk prediction for liver and heart damage in SMPP using accessible laboratory indicators. Cohort 1 was divided into SMPP group and other respiratory diseases group. Cohort 2 was divided into myocardial damage, liver damage, and non-damage groups. The models built using five ML algorithms were compared to screen the best algorithm and model. Receiver Operating Characteristic (ROC) curves, accuracy, sensitivity, and other performance indicators were utilized to evaluate the performance of each model. Feature importance and Shapley Additive Explanation (SHAP) values were introduced to enhance the interpretability of models. Cohort 3 was used for external validation. In Cohort 1, the SMPP differential diagnostic model developed using the LightGBM algorithm achieved the highest performance with AUCROC = 0.975. In Cohort 2, the LightGBM model demonstrated superior performance in distinguishing myocardial damage, liver damage, and non-damage in SMPP patients (accuracy = 0.814). Feature importance and SHAP values indicated that ALT and CK-MB emerged as pivotal contributors significantly influencing Model 2’s output magnitude. The diagnostic and predictive abilities of the ML models were validated in Cohort 3, demonstrating the models had some clinical generalizability. The Model 1 and Model 2 constructed by LightGBM algorithm showed excellent ability in differential diagnosis of SMPP and risk prediction of organ damage in children.

Immunological landscape of children with Mycoplasma pneumoniae pneumonia in the post-COVID-19 era reveals distinctive severity indicators

BackgroundThere is a recent global surge in Mycoplasma pneumoniae pneumonia (MPP). However, the key immune factors that contribute to the advancement of the disease remain unknown. Hence, we conducted this study to uncover the immunological profile in children affected by MPP.MethodsThis study enrolled children visiting Children’s Hospital of Fudan University from December 2023 to April 2024, including 34 healthy controls, 51 severe MPP (S-MPP), 27 non-severe MPP (NS-MPP), and 34 non-MPP pneumonia (NMP) cases. Their blood samples were analyzed using flow cytometry, multi-cytokine assays, and antibody detection methods.ResultsCompared with NMP cases, MPP cases displayed higher frequencies of natural killer T cells, classical monocytes, and monocytic myeloid-derived suppressor cells. Notably, both T helper type 1 and activated regulatory T cells were more abundant in MPP cases, particularly in S-MPP, whereas CD8 + T cells displayed an exhaustion phenotype. The proportion of naïve B cells was reduced, while functional B cells, including memory B cells and plasmablasts, increased in S-MPP. 12 out of 95 clinical laboratory indicators and 3 out of 48 cytokines significantly differed between S-MPP and NS-MPP. Finally, we performed logistic and LASSO regression analyses and developed a predictive model for S-MPP that incorporates naïve B cell percentage from flow cytometry, cholinesterase from clinical laboratory tests, and interleukin 18 from the cytokine assay.ConclusionsThese results clarify the immunological features in pediatric MPP cases, and identify novel markers for severe cases, providing insights for early diagnosis and immunological management in affected children.

The value of cytokines in evaluating the efficacy of glucocorticoids in the treatment of severe Mycoplasma pneumoniae pneumonia in children

BackgroundTo investigate the clinical value of inflammatory markers and cytokines at admission in evaluating the efficacy of different doses of glucocorticoids in the treatment of severe Mycoplasma pneumoniae pneumonia (MPP) in children.MethodsA total of 159 children who were hospitalized and diagnosed with severe MPP in our hospital were selected for the study. The patients were divided into three groups according to the dose of glucocorticoid used for severe MPP and the changes in chest imaging data on day 6: the low-dose (1–2 mg/kg/d) effective group (group A), the medium-dose (4–6 mg/kg/d) effective group (group B) and the medium-dose (4–6 mg/kg/d) ineffective group (group C). We compared demographic characteristics, clinical features, and laboratory and imaging findings. ROC curves were used to assess the predictive value of each individual indicator for the efficacy of glucocorticoid treatment for severe MPP.Results(1): The serum CRP, PCT, IL-8, IL-6 and INF-γ levels of the children in Groups A, B and C tended to gradually increase, whereas there was a decreasing trend in the levels of IL-4, IL-2 and IL-10, and the difference was statistically significant. (2): A two-by-two comparison of the laboratory parameters that differed significantly among the three groups of children revealed significant differences in the efficacy of low-dose glucocorticoids in the treatment of severe MPP in terms of the serum CRP, PCT, IL-6 and IL-2 levels. Serum CRP, PCT, IL-6, IL-4, IL-10, and INF-γ levels showed significantly differed in the efficacy of medium-dose glucocorticoids in the treatment of severe MPP. (3): The analysis of receiver operating characteristic curves showed that serum CRP, PCT, and IL-6 had good predictive value in predicting the ineffectiveness of low-dose and medium-dose glucocorticoids in the treatment of severe MPP.ConclusionsSerum CRP, PCT, and IL-6 levels can predict the efficacy of glucocorticoid therapy for severe MPP to a certain extent, or may be useful biomarkers for adjusting glucocorticoid therapy in children with severe MPP.

Development and Evaluation of a Nomogram for Predicting Pulmonary Embolism in Children With Severe Mycoplasma pneumoniae Pneumonia.

To construct a nomogram utilizing pediatric severe Mycoplasma pneumoniae pneumonia (SMPP) risk factors for pulmonary embolism (PE), facilitating the clinical identification and management of high-risk patients and reducing the excessive use of CT pulmonary angiography (CTPA). This was a retrospective analysis conducted between August 2021 and March 2024. We identified 35 children with SMPP complicated by PE, forming the PE group. A control group of 70 age- and sex-matched children with SMPP without PE was randomly selected at a 1:2 ratio. Clinical, laboratory, and CT findings were compared between the groups. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to develop a scoring model using a nomogram. The model's performance was assessed via the receiver operating characteristic curve (ROC), fivefold cross-validation, calibration curve, and clinical decision curve analysis. LASSO regression and multivariate logistic regression analyses revealed that D-dimer, neutrophil ratio, time to admission, pleural effusion, and necrotizing pneumonia were independent risk factors for PE in patients with SMPP. A nomogram prediction model was established based on the aforementioned independent risk factors. The area under ROC curve was 0.900. Fivefold cross-validation results further confirmed the model's stability. The calibration curve revealed good agreement between the predicted and actual probabilities of PE caused by SMPP, and the decision curve demonstrated that the nomogram model had a higher clinical net benefit. The nomogram serves as a predictive tool to aid in early intervention for pediatric patients with SMPP at high risk for PE, while minimizing unnecessary CTPA and overtreatment in low-risk patients.

Risk factors for hypoxemia in children with severe Mycoplasma pneumoniae pneumonia

To study the risk factors for hypoxemia in children with severe Mycoplasma pneumoniae pneumonia (SMPP). A retrospective collection of clinical data from children diagnosed with SMPP at the Third Affiliated Hospital of Zhengzhou University from June to December 2023 was conducted. The patients were categorized into hypoxemia and non-hypoxemia groups. Logistic regression analysis was used to assess the risk factors for hypoxemia, and receiver operating characteristic (ROC) curve analysis was employed to analyze the diagnostic performance of various indicators. A total of 113 children with SMPP were included. Univariate logistic regression analysis showed that ferritin, aspartate aminotransferase, creatinine, creatine kinase isoenzyme, lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, immunoglobulin G, complement C3, complement C4, age, extrapulmonary complications, and a chest computed tomography (CT) scan showing a bronchiolitis pattern were significant factors for hypoxemia in children with SMPP (P<0.05). Multivariate logistic regression analysis revealed that elevated ferritin levels, presence of extrapulmonary complications, and a bronchiolitis pattern on lung CT were independent risk factors for hypoxemia in these patients (P<0.05). The ROC curve analysis indicated that the combination of these three indicators for predicting hypoxemia had a sensitivity of 71.9%, a specificity of 95.1%, and an area under the curve of 0.888 (95%CI: 0.809-0.968). In children with SMPP, when there are elevated ferritin levels, a bronchiolitis pattern on chest CT, and the presence of extrapulmonary complications, there should be a high level of vigilance for the potential development of hypoxemia.

Clinical features of intracardiac thrombotic complication in patients with severe Mycoplasma pneumoniae pneumonia

BackgroundIntracardiac thrombus (ICT) is the rarest yet most severe complication of severe Mycoplasma pneumoniae pneumonia (SMPP) in children. This study aims to elucidate the clinical characteristics of patients with SMPP-related ICT.MethodsWe retrospectively enrolled 68 children with SMPP (18 cases of ICT, 50 cases of non-ICT) who were admitted from January 2014 to January 2024. We compared their demographic data, clinical symptoms, laboratory tests, imaging findings, treatment strategies, and prognoses. Additionally, we summarized data from 33 confirmed SMPP-related ICT cases reported in 12 references.ResultsIn our cohort, the ICT group exhibited higher incidences of tachypnea, chest pain, inflammation, and elevated D-dimer levels. They also presented more severe radiological findings and had longer hospital stays compared to the non-ICT group. The chordae tendineae-attached was the most common type (61.1%). Pathological examinations revealed ICT sizes ranging from 480 to 31,500 mm³. A favorable prognosis was observed in 94.4% of ICT patients. Clinical features did not significantly differ between various ICT types. In the overall cohort (51 cases), the right ventricle was the predominant location (68.6%). Notably, 66.7% of patients had concurrent extracardiac thrombosis, with pulmonary thrombosis being the most common subtype (41.2%).ConclusionsThe clinical characteristics of SMPP-related ICT are non-specific, often coexisting with severe pulmonary lesions and significantly elevated inflammatory markers. All ICT types were chordae tendineae or wall-attached, rather than mobile. These findings suggest that an inflammation storm induced by SMPP may play a significant role in the pathogenesis of in situ thrombosis within the heart and major blood vessels.

Comparison of thromboelastographic profiles and clinical characteristics in children with severe Mycoplasma pneumoniae pneumonia.

This study aimed to compare Thromboelastographic (TEG) profiles and clinical characteristics between severe Mycoplasma pneumoniae (MP) pneumonia patients with normal and abnormal TEG parameters. The clinical data of 133 children with severe MP pneumonia were retrospectively analyzed. Patients were divided into normal (n = 76) and abnormal (n = 57) TEG groups. Demographic characteristics, clinical manifestations, laboratory findings, imaging features, bronchoscopy results, treatment, complications, and outcomes were compared between groups. The abnormal TEG group (42.9%) had longer fever duration (median: 8.5 vs. 7.0 days, P < 0.001) and hospital stay (median: 11.5 vs. 10.0 days, P = 0.003). They also showed higher levels of C-reactive protein (median: 30.2 vs. 20.1 mg/L, P < 0.001), lactate dehydrogenase (median: 334.5 vs. 276.0 U/L, P = 0.001), and D-dimer (median: 1.2 vs. 0.5 μg/ml, P < 0.001). HRCT revealed more lobar consolidation or multilobar involvement (36.8% vs. 18.4%, P = 0.016), and bronchoscopy showed more mucous plug obstruction (28.1% vs. 10.5%, P = 0.008) in the abnormal TEG group. TEG parameters indicated a hypercoagulable state with shorter R time (P < 0.001), shorter K time (P < 0.001), and higher MA (P = 0.003). The abnormal TEG group had higher incidences of coagulopathy (P < 0.001), cardiac involvement (elevated cardiac enzymes: 36.8% vs. 17.1%, P = 0.009; pericardial effusion: 10.5% vs. 1.3%, P = 0.017), and plastic bronchitis (P = 0.006). They also required longer azithromycin courses (median: 15 vs. 14 days, P = 0.026). Children with severe MP pneumonia and abnormal TEG profiles have more severe clinical manifestations, higher inflammatory markers, more extensive lung involvement, and a higher incidence of complications. TEG may help identify high-risk patients and guide management in severe MP pneumonia.

The impact of atopy on the clinical characteristics of mycoplasma pneumoniae pneumonia in pediatric patients

Mycoplasma pneumoniae (MP) is one of the pathogens that cause community-acquired pneumonia in children. Atopic diseases are also common in children. However, the impact of atopy on Mycoplasma pneumoniae pneumonia (MPP) in children is still unclear. The purpose of this study is to analyze the impact of atopy on the clinical characteristics of MPP in children, and provide a diagnosis and treatment plan. A total of 489 children hospitalized for MPP in our hospital from June 2023 to December 2023 were selected. They were divided into an atopic group (n = 172) and a non-atopic group (n = 317) based on whether they had atopy or not. Clinical data, treatment regimens, and laboratory indicators were compared between the two groups. Eosinophil count, lactate dehydrogenase and IgE levels were higher in the atopic group than in the non-atopic group. Additionally, neutrophil percentage, procalcitonin levels were lower in the atopic group than in the non-atopic group (P < 0.05). The proportion of bronchiolitis type on lung imaging was higher in the atopic group, and there was a higher incidence of severe pneumonia compared to the non-atopic group (P < 0.05). Atopy may lead to severe MPP and bronchiolitis-type MPP. Therefore, the treatment and prognosis of these children should be given more attention.

Clinical characteristics of Mycoplasma pneumoniae pneumonia with airway involvement in children.

Mycoplasma pneumoniae pneumonia (MPP) with chest computed tomography (CT) findings showing airway involvement as the main manifestation has begun to be noted and increasingly reported. This type of MPP has different clinical features and may progress to bronchiolitis obliterans (BO). Early recognition and treatment are helpful for reducing sequelae. To investigate the clinical characteristics of MPP patients with airway involvement and provide guidance for clinical recognition of this type. Data from children diagnosed with MPP were collected. Forty-one patients were assigned to the airway group according to chest CT, and 114 patients were assigned to the air space group. The clinical data of the two groups were compared and analyzed. The children in the airway group were younger, and the prevalence of wheezing, pulmonary moist rales, and allergic background in the airway group was greater. The prevalence of severe MPP, the proportions of neutrophils, C-reactive protein, and D-dimer were lower in the airway group than in the air space group. Significantly more patients had lung involvement in both airways in the airway group. No cases of BO were found in the airway group. Mycoplasma pneumoniae-associated airway involvement mostly occurs in young children, especially in atopic individuals. Patients with this type of pneumonia are prone to have clinical wheezing and pulmonary moist rales. The airway group included relatively few severe cases, but more patients had involvement of both lungs. Whether the patients in the airway group had a greater chance of developing BO needs further investigation.

Biomarkers associated with the diagnosis and prognosis of Mycoplasma pneumoniae pneumonia in children: a review.

Community-acquired pneumonia (CAP) is a major cause of death in children, and Mycoplasma pneumoniae (MP) is the main pathogen of CAP in children in China. Although Mycoplasma pneumoniae pneumonia (MPP) is usually a self-limiting disease, many children develop multiple complications due to drug resistance or untimely diagnosis and treatment, and may even progress to severe MPP or refractory MPP with a poor prognosis. It is important to explore the value of biomarkers that can be used in clinical practice to assess the severity of pneumonia and assist in clinical decision making. In this article, we searched the literature in the last four years to review the roles of various types of biomarkers in MPP and the associated clinical predictive models, with the aim of helping pediatricians to understand the evaluation indexes related to MPP in children other than microbiology.

Clinical characteristics and risk factors for Mycoplasma pneumoniae pneumonia in children

BackgroundMycoplasma pneumoniae (M. pneumoniae) is one of the most common pathogens of community-acquired pneumonia (CAP) in children. Although Mycoplasma pneumoniae pneumonia (MPP) is considered a self-limiting disease, severe MPP (SMPP) occurs in some cases. This study aims to analyze clinical features of MPP and to explore predictive indicators in the early stage of M. pneumoniae infection.MethodsWe retrospectively enrolled patients with MPP and non-MPP (NMPP) hospitalized to the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from 2023 to 2024. A total of 757 children with CAP were divided into MPP group and NMPP group. Patients with MPP included SMPP group and mild MPP (MMPP) group. Demographic and clinical characteristics as well as laboratory and imaging tests were deemed to be baseline data within 24 h after admission. We compared differences between MPP group and NMPP group as well as SMPP group and MMPP group. To exclude the impacts of age and gender, analysis of covariance and Logical regression was used to account for the baseline differences in the probability between MPP group and NMPP group, SMPP group and MMPP group. Logistic regression analysis was used to screen markers as potential early clinical predictors. ROC curves were applied to estimate the diagnostic and predictive value of different indicators for SMPP group.ResultsAmong the 757 cases of CAP, 464 cases were MPP group and 226 cases were SMPP group. There were significant differences in hospital stay and fever duration between the MPP and NMPP groups. Compared to NMPP group, MPP group exhibited higher levels of platelet count (PLT), heparin-binding protein (HBP), erythrocyte sedimentation rate (ESR), immunoglobulin G (IgG) (P &amp;lt; 0.05). The levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum ferritin (SF), prothrombin time (PT), fibrinogen (Fg), interleukin-5 (IL-5) and Gamma interferon (IFN-γ) were significantly increased in SMPP group compared to MMPP group. PT, Fg, SF, IL-5 and IFN-γ were independent risk factors for SMPP group. Significantly, IL-5 and IFN-γ served as reliable predictive indices of SMPP.ConclusionsNotable differences were observed in both clinical characteristics and serum inflammatory markers between the MPP group and the NMPP group, as well as between the SMPP group and the MMPP group. Consequently, PT, Fg, SF, IL-5 and IFN-γ hold the potential to be employed as efficacious predictors for SMPP.

Investigation of T lymphocyte subsets in children with Mycoplasma pneumoniae pneumonia.

This study aims to characterize the majority of immune cell subsets in peripheral blood mononuclear cells in children with Mycoplasma pneumoniae pneumonia (MPP) by a 21-color flow cytometry panel. Patients who met the predetermined eligibility criteria for pneumonia diagnosis were recruited for the research study. Multi-color flow cytometry was conducted on the peripheral blood mononuclear cells of each patient group, which were then subjected to dimensionality reduction and cluster analysis. In our study, the proportion of activated CD4 + T cell and naïve CD8 + T in children with MPP was higher than that of children with non-MPP, and the proportion of CD8 + T cell and central memory CD8 + T cell in MPP children was lower. Central memory CD4 + T cell and activated CD4 + T cell in the severe MPP were higher than those in the mild MPP. The highest proportions of CD8 + T cell, CD8 + Tn cell, activated CD8 + T cell, and total activated T cell were observed in the pulmonary consolidation-mucous group when compared to the pulmonary consolidation-necrosis and bronchiolitis groups. In the pulmonary consolidation-necrosis group, the proportions of central memory CD4 + T cell and T helper 17 cell were higher than those in pulmonary consolidation-mucous and bronchiolitis groups. In the bronchiolitis group, the percentages of CD4 + T cell, naïve CD4 + T cell, and T helper 2 cell were higher than those in pulmonary consolidation-mucous and the pulmonary consolidation-necrosis groups. The T lymphocyte subsets were different among various groups, offering new insights into the immune system of pediatric patients with Mycoplasma pneumoniae pneumonia.

Predicting the severity of mycoplasma pneumoniae pneumonia in pediatric and adult patients: a multicenter study

The purpose of this study is to develop a nomogram model for early prediction of the severe mycoplasma pneumoniae pneumonia (SMPP) in Pediatric and Adult Patients. A retrospective analysis was conducted on patients with MPP, classifying them into SMPP and non-severe MPP (NSMPP) groups. A total of 550 patients (NSMPP 374 and SMPP 176) were enrolled in the study and allocated to training, validation cohorts. 278 patients (NSMPP 224 and SMPP 54) were retrospectively collected from two institutions and allocated to testing cohort. The risk factors for SMPP were identified using univariate analysis. For radiomic feature selection, Spearman’s correlation and the least absolute shrinkage and selection operator (LASSO) were utilized. Logistic regression was used to build different models, including clinical, imaging, radiomics, and integrated models (combining clinical, imaging, and radiomics features selected). 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. Thirteen clinical features and fourteen imaging features were selected for constructing the clinical and imaging models. Simultaneously, a set of twenty-five radiomics features were utilized to build the radiomics model. The integrated model demonstrated good calibration and discrimination in the training cohorts (AUC, 0.922; 95% CI: 0.900, 0.942), validation cohorts (AUC, 0.879; 95% CI: 0.806, 0.920), and testing cohorts (AUC, 0.877; 95% CI: 0.836, 0.916). The discriminatory and predictive efficacy of the clinical model in testing cohorts increased further after clinical and radiological features were incorporated (AUC, 0.849 vs. 0.922, P = 0.002). The model demonstrated exemplary predictive efficacy for SMPP by leveraging a comprehensive set of inputs, encompassing clinical data, quantitative and qualitative radiological features, along with radiomics features. The integration of these three aspects in the predictive model further enhanced the performance of the clinical model, indicating the potential for extensive clinical applications.

Clinical characteristics and predictive factors for plastic bronchitis in children with severe Mycoplasma pneumoniae pneumonia

Objective: To explore the clinical characteristics and predictive factors for plastic bronchitis (PB) in children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: A retrospective cohort enrolled children with a clinical diagnosis of SMPP who were treated at the Department of Respiratory Medicine of Tianjin Children's Hospital Machang District from January 1, 2018, to October 31, 2023. According to the bronchoscopy and pathological examination results, the patients were divided into 142 cases in the PB group and 274 cases in the non-PB group. The clinical manifestations, laboratory data, imaging findings, and treatments were analyzed.Mann-Whitney U test and Chi-square test were used to analyze the differences between the two groups, and multivariate Logistic regression was used to analyze the risk factors. The receiver operating characteristic (ROC) curve was used to explore the predictive value of PB in SMPP. Results: Among 416 SMPP children, there were 197 males and 219 females; PB group 142 cases, non-PB group 274 cases, the age of disease onset was (6.9±2.9) years and (6.6±2.8) years in the PB group and the non-PB group respectively. The incidence of wheezing symptoms, hypoxemia, heat peak >40 ℃, the duration of fever, neutrophil-lymphocyte ratio, mean platelet volume, C-reactive protein, procalcitonin, interleukin-6, alanine transaminase, aspartate aminotransferase and ferritin were higher in the PB group (16 cases (11.3%) vs. 15 cases (5.5%), 14 cases (9.9%) vs. 12 cases (4.4%), 57 cases (40.1%) vs. 67 cases (24.5%), 10 (8, 12) vs. 9 (8, 12) d, 6.1 (4.1, 13.1)×109 vs. 5.0 (3.7, 6.8)×109/L, 10.2 (9.6, 10.8) vs. 9.4 (8.9, 10.1) fl, 33.4 (16.0, 67.5) vs. 23.0 (10.4, 56.1) mg/L, 0.24 (0.12, 0.48) vs. 0.16 (0.09, 0.31) μg/L, 39.9 (25.1, 81.4) vs. 31.3 (18.3, 59.3) ng/L, 16.0 (12.0, 29.0) vs. 14.0 (10.0, 24.3) U/L, 38.5 (28.0, 52.5) vs. 33.0 (25.0, 44.0) U/L, 233 (136, 488) vs. 156 (110, 293) μg/L, χ2=4.55, 4.79, 11.00, Z=2.25, 4.00, 6.64, 2.76, 2.98, 3.09, 2.22, 2.62, 4.18, all P<0.05). Multivariate Logistic regression analysis showed that the dyspnea (OR=2.97, 95%CI 1.35-6.55, P=0.007), the diminution of respiration (OR=2.40, 95%CI 1.27-4.52, P=0.006), neutrophil-lymphocyte ratio (NLR) (OR=2.07, 95%CI 1.71-2.51, P<0.001), lactate dehydrogenase (LDH) (OR=1.01, 95%CI 1.00-1.01, P<0.001), mean platelet volume/platelet count (MPV/PLT) (OR=1.39, 95%CI 1.13-1.71, P=0.002), pleural effusion (OR=2.23, 95%CI 1.21-4.13, P=0.011),≥2/3 lobe consolidation (OR=1.84, 95%CI 1.04-3.00, P=0.039) and atelectasis (OR=1.98, 95%CI 1.02-3.48, P=0.044) were independent predictors of PB in children with SMPP. ROC curve analysis showed that the cut-off values for NLR, LDH and MPV/PLT in the diagnosis of PB were 2.79 (sensitivity 0.89, specificity 0.69, area under the curve (AUC)=0.86, P<0.001), 474 U/L (sensitivity 0.63, specificity 0.65, AUC=0.70, P=0.003) and 0.04 (sensitivity 0.75, specificity 0.53, AUC=0.68, P=0.005) respectively. Children in the PB group had longer hospital stays and corticosteroid treatment course than those in the non-PB group, the proportion of children in the PB group who received bronchoscopy treatment twice or more was higher (9 (8, 12) vs. 8 (6, 10) d, 7 (5, 8) vs. 6 (5, 7) d, 128 cases (90.1%) vs. 218 cases (79.6%), 106 cases (74.7%) vs. 54 cases (19.7%), Z=6.70, 5.06, χ2=7.48, 119.27, all P<0.05). Conclusions: The dyspnea, respiration diminution, NLR level elevation (>2.79) and pleural effusion were predictive factors for PB in children with SMPP. This provides a basis for the early identification of PB in children with SMPP.

Predictive value of immune-related parameters in severe Mycoplasma pneumoniae pneumonia in children.

The severity of Mycoplasma pneumoniae pneumonia (MPP) is strongly correlated with the extent of the host's immune-inflammatory response. In order to diagnose the severity of MPP early, this study sought to explore the predictive value of immune-related parameters in severe MPP (sMPP) in admitted children. We performed a database analysis consisting of patients diagnosed at our medical centers with MPP between 2021 and 2023. We included pediatric patients and examined the association between complete blood cell count (CBC), lymphocyte subsets and the severity of MPP. Binary logistic regression was performed to identify the independent risk factors of sMPP. Receiver operating characteristic (ROC) curves were used to estimate discriminant ability. A total of 245 MPP patients were included in the study, with 131 males and 114 females, median aged 6.0 [interquartile range (IQR), 4.0-8.0] years, predominantly located in 2023, and accounted for 64.5%. Among them, 79 pediatric patients were diagnosed as sMPP. The parameters of CBC including white blood cell (WBC) counts, neutrophil counts, monocyte counts, platelet counts, and neutrophil-to-lymphocyte ratio (NLR), were higher in the sMPP group (all P<0.05). The parameters of lymphocyte subsets including CD3+ T cell ratio (CD3+%) and CD3+CD8+ T cell ratio (CD3+CD8+%), were lower in the sMPP group (all P<0.05). And CD3-CD19+ B cell ratio (CD3-CD19+%) was higher in the sMPP group. Logistic regression analysis showed that age, CD3-CD19+%, and monocyte counts were identified as independent risk factors for the development of sMPP (all P<0.001). The three factors were applied in constructing a prediction model that was tested with 0.715 of the area under the ROC curve (AUC). The AUC of the prediction model for children aged ≤5 years was 0.823 and for children aged >5 years was 0.693. The predictive model formulated by age, CD3-CD19+%, and monocyte counts may play an important role in the early diagnosis of sMPP in admitted children, especially in children aged ≤5 years.

Analysis of the Efficacy of Erythromycin Cyclic 11,12-Carbonate Combined with Azithromycin in the Treatment of Severe Mycoplasma Pneumoniae Pneumonia in Children and its Effect on Cytokines

Introduction: Mycoplasma Pneumoniae Pneumonia (MPP) is an inflammation of the lungs caused by Mycoplasma pneumoniae infection. Macrolide antibiotics are the therapeutic agents of choice for MPP. This study aimed to explore the efficacy of erythromycin cyclic 11,12-carbonate combined with azithromycin in treating children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: 84 children with SMPP treated at Hubei Maternal and Child Health Hospital between February 2021 and December 2021 were randomly divided into two groups. The control group was treated with intravenous azithromycin and then changed to oral azithromycin. The experimental group was treated with intravenous azithromycin and then switched to oral erythromycin cyclic 11,12-carbonate. The clinical efficacy, symptom improvement, inflammatory levels, and cytokine levels before and after treatment were compared, and the occurrence of adverse reactions was recorded. Results: The overall effective rate of treatment in the experimental group was significantly higher than that in the control group (P&lt;0.05). The time to the disappearance of clinical symptoms and length of hospitalization of the experimental group was significantly shorter than that of the control group (P&lt;0.05). After treatment, inflammatory levels and cytokine levels of the experimental group were significantly lower than those of the control group (P&lt;0.05). There was no difference in the incidence of adverse reactions between the two groups (P&gt;0.05). Conclusion: Erythromycin cyclic 11,12-carbonate combined with azithromycin in the treatment of children with SMPP had significant efficacy, superior to azithromycin monotherapy, which could effectively improve immune function and clinical symptoms.