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

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Yongdong Yan ◽  
Yuzhen Wei ◽  
Wujun Jiang ◽  
Chuangli Hao
2019 ◽  
Vol 8 (5) ◽  
pp. 632-639 ◽  
Author(s):  
Miaomiao Lin ◽  
Lifeng Shi ◽  
Airong Huang ◽  
Dongshi Liang ◽  
Lisha Ge ◽  
...  

2020 ◽  
Author(s):  
yaoyao ling ◽  
Tongqiang Zhang ◽  
Zhenli Zhu ◽  
Jiao Tian ◽  
yongsheng xu ◽  
...  

Abstract BACKGROUND: Analyze the clinical characteristics of Fulminant Mycoplasma pneumoniae pneumonia (FMPP), and explore the related factors predicting FMPP. METHODS: A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our Hospital from January 2017 to June 2019. The clinical features, laboratory data and radiological findings were compared between the FMPP group, refractory Mycoplasma pneumoniae pneumonia (RMPP)group and general Mycoplasma pneumoniae pneumonia (GMPP) group. RESULTS: FMPP patients (n=69) had more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings(P<0.05). And the days of fever and the days in hospital were longer, and FMPP patients also need more complicated treatments(P<0.05). Meanwhile, the levels of white blood cell count(WBC) ,C-reactive protein(CRP), lactic dehydrogenase (LDH), interleukin (IL)-6,ferritin, D-dimer, fibrinogen(FG),alanine aminotransferase(ALT) and the percentage of neutrophils in the FMPP group were significantly higher than those in the RMPP group and the GMPP group (both P<0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer and ALT were contributed to identify FMPP patients. Multivariate logistic regression analysis showed that ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion had significant predictive effects on the early diagnosis of FMPP (P<0.01). Conclusion: FMPP patients presented more serious clinical manifestations. Ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion were high risk factors for FMPP.


2020 ◽  
Author(s):  
Zhenli Zhu ◽  
Tongqiang Zhang ◽  
Wei Guo ◽  
Yaoyao Ling ◽  
Jiao Tian ◽  
...  

Abstract Objective: To observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia(RMPP)under different doses, to summarize the clinical characteristics of children treated with glucocorticoid pulse therapy.Methods: The clinical data of 125 children with RMPP hospitalized in Tianjin Children's Hospital from September 2018 to October 2019 were retrospectively analyzed. They were divided into two groups according to the dose of hormone. Group I was given conventional dose methylprednisolone 2mg/kg/day (<200mg/day) (n=81), and group II was treated with methylprednisolone pulse therapy ≥200mg/day(n=44). Compare the clinical manifestations, laboratory findings, and imaging between the two groups of children, and use meaningful related indicators as ROC curves to find reference indicators for pulse therapy.Results: (1)The age and weight of the group II were greater than the group I(P<0.05). (2) The symptoms of group II were more serious than group I, with higher incidence of hypoxemia, longer fever, longer hospital stays, higher incidence of extrapulmonary complications, and more severe radiological findings (P<0.05). (3)The more severe the disease was, the higher hormone amount,use rate of gamma globulin,use rate of bronchoscopy , and incidence of plastic bronchitis (P<0.05)were.(4) WBC, CRP, LDH, FER, D-D dimer, APTT, TT, PCT, IL-6 and the percentage of neutrophils in peripheral blood in Group II were higher than those in Group I(P<0.05). Moreover, the lymphocyte percentage level in group II was lower than that in group I(P<0.05). (5) In ROC curve analysis, CRP, LDH, FER, and neutrophils of leukocyte classification were independent related factors that could be used as valuable predictors of methylprednisolone pulse therapy for RMPP in children. The cut-off values were CRP 44.45 mg/L, LDH 590 IU/L, FER 411 ng/L, and neutrophils in leukocyte classification were 73.75%, respectively.Conclusions: Conventional dose methylprednisolone can improve the clinical symptoms and imaging findings of most children with RMPP rapidly. However, CRP 44.45 mg/L, LDH 590 IU/L, FER 411 ng/L, neutrophil 73.75%, lung consolidation and pleural effusion were found in RMPP patients, which should be treated with pulse dose of methylprednisolone in time to reduce the incidence of severe RMPP and the occurrence of severe sequelae.


2020 ◽  
Author(s):  
Lianfu Cao ◽  
Haijiao Lin ◽  
Hongjun Yu ◽  
Yongji Wang

Abstract Background: To analyze the relationship between granulocyte-macrophage colony-stimulating factor (GM-CSF) and high mobility group box 1 (HMGB1) level in alveolar lavage fluid with the clinical characteristics and prognosis of children refractory mycoplasma pneumoniae pneumonia (MPP), so as to provide reliable targets for clinical diagnosis and treatment. Methods: A total of 106 children diagnosed with MPP and prepared for bronchoalveolar lavage therapy were selected in this study, which were divided into 2 groups according to clinical diagnosis: those showing clinical and radiological deterioration despite appropriate antibiotic therapy for ≥7 days were classified into refractory MPP group (n=47), while the others were classified into non-refractory MPP group (n=59). The data of physical examination, treatment and outcome were collected. In addition, the GM-CSF and HMGB1 levels in alveolar lavage fluid during each bronchoalveolar lavage therapy were detected by ELISA kits. Results: There was no significant difference in age, sex, course of fever, the highest temperature, WBC, L, PLT, ALT, AST, CK-MB, D-D, CK, IgG, IgA, IgM, C3, and C4 between refractory MMP group and non-refractory MMP group on admission (P>0.05). The levels of N, CRP, PCT, and LDH in refractory MPP group were higher than those in non-refractory MPP group, the difference had statistical significance (P<0.05). Both GM-CSF and HMGB1 levels were positively correlated with traditional indicators N, CRP, PCT and LDH (r=0.611-0.785, P<0.05). ROC analysis results showed that CRP, GM-CSF and HMGB1 had predictive value for refractory MPP attack (AUC=0.636, 0.657, 0.651, P<0.05). Logistic regression analysis results showed GM-CSF and HMGB1 were independent factors for refractory MPP (B>1.0, P<0.05). ROC analysis results showed that GM-CSF and HMGB1 at 2nd bronchoalveolar lavage therapy had predictive value for long hospital stay (>28 d) and poor prognosis of refractory MPP (AUC=0.782-0.825, P < 0.05). Conclusion: The level of GM-CSF and HMGB1 in alveolar lavage fluid is closely related to the occurrence and development of refractory MPP, which can be used as an auxiliary indicator for clinical diagnosis and prognosis evaluation, and has certain guiding significance for its clinical treatment.


2019 ◽  
Vol 21 (10) ◽  
pp. 749-754 ◽  
Author(s):  
Chen Yuan ◽  
Fang-Mei Min ◽  
Yin-Jie Ling ◽  
Gang Li ◽  
Hong-Zhou Ye ◽  
...  

Aim: To analyze the clinical characteristics and antibiotic resistance of Mycoplasma pneumoniae pneumonia (MP) in Chinese patients, providing valuable information for the management of patients with MP. Methods: A total of 120 children who were hospitalized in The First Hospital of Huzhou between January and December 2016 for respiratory tract infection due to M. pneumoniae were enrolled in this study. Infection with M. pneumoniae was confirmed by ELISA for M. pneumoniae antibody, PCR, and throat culture. Antibiotic resistance was measured from the minimum inhibitory concentrations (MICs) of antibiotics. The 23S rRNA gene of M. pneumoniae was also examined for mutations using DNA sequencing. Patients with MP were classified into antibiotic resistance (n = 98) and no resistance (n = 20) groups. For the 98 patients showing antibiotic resistance, they were further stratified into subgroups based on the antibiotics initially prescribed: azithromycin or erythromycin (n = 78) and cephalosporin or penicillin (n = 20). Clinical characteristics were compared between the patient groups. Results: Antibiotic resistance group presented significantly longer febrile days compared to the no resistance group (P = 0.007). The number of febrile days after macrolide treatment was also longer in antibiotic resistance group than in no resistance group (P = 0.042). MP patients initially treated with azithromycin or erythromycin showed a longer average duration of respiratory symptoms (P = 0.046) and had a fever for more days after macrolide treatment (P = 0.009) compared to those received cephalosporin or penicillin. The average white blood cell count of patients treated with azithromycin or erythromycin was nearly half of those treated with cephalosporin or penicillin (P < 0.001). Nearly 90% of the resistant M. pneumoniae strains showed A to G substitution at position 2063 of the 23S rRNA gene. Conclusion: The clinical characteristics and antibiotic resistance of MP were analyzed in 120 Chinese patients. DNA sequencing revealed a highly prevalent A2063G mutation in the 23S rRNA gene.


Medicine ◽  
2020 ◽  
Vol 99 (19) ◽  
pp. e19987
Author(s):  
Yinle Lan ◽  
Shuxian Li ◽  
Dehua Yang ◽  
Junfen Zhou ◽  
Yingshuo Wang ◽  
...  

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