Association of Mycoplasma pneumoniae coinfection with adenovirus pneumonia severity in children

Between the winter of 2018 and the end of 2019, there has been an epidemic of adenovirus infection in southern China, including Zhejiang Province. The number of children suffering from adenovirus pneumonia (AP) has significantly increased. AP can be accompanied by Mycoplasma pneumoniae in children. This study aimed to investigate the association of M. pneumoniae and identify the risk factors for coinfection on hospitalized patients with AP. The patients were classified into two groups by etiologic analysis (single AP and AP with M. pneumoniae coinfection groups). The clinical manifestations, clinical medication, and laboratory and imaging findings of the two groups were compared and analyzed. The coinfection group (n = 125) had a significantly longer duration of fever than the single AP group (n = 171; P = 0.03). Shortness of breath (P = 0.023) and pulmonary imaging findings, such as pulmonary consolidation, atelectasis, pleural effusion, and multilobe lesions (P < 0.05), were more common in the coinfection group. The patients with coinfection had more severe symptoms, significantly longer hospitalization time and an increased proportion of using glucocorticoids and/or immunoglobulin needing oxygen inhalation (P < 0.05). The incidence of AP with M. pneumoniae coinfection is high. The prolonged fever duration and pulmonary imaging findings could be used as prediction factors to predict M. pneumoniae coinfection in children with AP. Patients with AP coinfected with MP may easily develop severe illness. Hence, a reasonable change in the treatment is necessary.

Changes of Host Immunity Mediated by IFN-γ+ CD8+ T Cells in Children with Adenovirus Pneumonia in Different Severity of Illness

The host immunity of patients with adenovirus pneumonia in different severity of illness is unclear. This study compared the routine laboratory tests and the host immunity of human adenovirus (HAdV) patients with different severity of illness. A co-cultured cell model in vitro was established to verify the T cell response in vitro. Among 140 patients with confirmed HAdV of varying severity, the number of lymphocytes in the severe patients was significantly reduced to 1.91 × 109/L compared with the healthy control (3.92 × 109/L) and the mild patients (4.27 × 109/L). The levels of IL-6, IL-10, and IFN-γ in patients with adenovirus pneumonia were significantly elevated with the severity of the disease. Compared with the healthy control (20.82%) and the stable patients (33.96%), the percentage of CD8+ T cells that produced IFN-γ increased to 56.27% in the progressing patients. Adenovirus infection increased the percentage of CD8+ T and CD4+ T cells that produce IFN-γ in the co-culture system. The hyperfunction of IFN-γ+ CD8+ T cells might be related to the severity of adenovirus infection. The in vitro co-culture cell model could also provide a usable cellular model for subsequent experiments.

Influence of the timing of bronchoscopic alveolar lavage on children with adenovirus pneumonia: a comparative study

Background Adenovirus pneumonia is prone to severe clinical and imaging manifestations in children. Bronchoscopic alveolar lavage (BAL) is an important adjunctive therapy for patients with severe imaging findings. The study aimed to evaluate the effect of the timing on the efficacy of bronchoalveolar lavage in children with adenovirus pneumonia. Methods This study included 134 patients with adenovirus pneumonia treated with BAL at Guangzhou Women and Children's Medical Center from January 2019 to January 2020.They were classified into the severe and mild groups. Based on the timing of BAL, each group was divided into the early BAL layer (received BAL within 1–9 days of the illness course) and the late BAL layer (received BAL within 10–14 days of the illness course). The clinical data of patients with different BAL timings were analyzed in two groups. Results Among the 134 patients, 70 were categorized into the mild group and 64 were categorized into the severe group. Of the 134 patients, 42 patients received BAL early (mild group: n = 21 and severe group: n = 21) and 92 patients received BAL later (mild group: n = 49 and severe group: n = 43). In the mild group, the fever and hospital duration were shorter in patients who received BAL early than in those who received BAL later (p < 0.05). However, in the severe group, there were no statistically significant differences in the fever and hospital duration between patients who received BAL early and those who received BAL later. However, the need for mechanical ventilation and the incidence of BAL complications, such as new need for oxygen, were higher in patients who received BAL early than in those who received BAL later in the severe group (p < 0.05). Conclusion For mild adenovirus pneumonia, early BAL may shorten the fever and hospital duration. However, early BAL in severe cases might not shorten the course of the disease or improve prognosis and may even increase the risks of mechanical ventilation and BAL complications.

Analysis of Clinical Characteristics and Risk Factors of Severe Adenovirus Pneumonia in Children

Objective: To analyze the clinical characteristics of adenovirus pneumonia (ADVP) in children and explore risk factors for severe ADVP.Methods: Clinical data from 7,008 hospitalized children with community-acquired pneumonia and 211 with ADVP were retrospectively analyzed between July 2014 and June 2019. Eighty-six patients were diagnosed with severe pneumonia, and related risk factors were analyzed.Results: ADVP accounts for 3.01% (211/7008) of CAP in hospitalized children. Among 211 patients, 167 (64.9%) children aged 1–5 years old, and the onset was in winter and spring for 126 (59.7%) children. All patients had cough, and 116 (92.8%) patients with mild cases and 82 (95.4%) patients with severe cases had varying degrees of fever. The duration of fever in the severe ADVP group and mild ADVP group was 7.3 and 5.4 days, respectively. The average hospital stays were 9.8 and 5.8 days, respectively. There was no significant difference in the levels of WBC and ESR between the two groups, but the levels of N%, CRP, PCT and LDH in children with severe ADVP were significantly higher than those in the mild ADVP group. The univariate analysis showed that there were significant differences between the severe ADVP group and the mild ADVP group in ≥7 days of fever and high IgE (P &lt; 0.05). There was no significant difference in sex, age, onset season, mycoplasma infection, bacterial infection between the two groups (P &gt; 0.05). The multivariate logistic analysis showed that ≥7 days of fever and high IgE were independent risk factors for severe ADVP (P &lt; 0.05).Conclusions: Children with severe ADVP have long fever duration, a strong inflammatory response and immune function disturbance. Fever duration (≥7 days) and high IgE were independent risk factors for severe ADVP.

Risk Factors for the Development of Hemophagocytic Lymphohistiocytosis in Children With Severe Adenovirus Pneumonia: A Single-Center Retrospective Study

Objective: To investigate and analyze the relevant risk factors for hemophagocytic lymphohistiocytosis (HLH) in children with severe adenovirus pneumonia (SAP).Methods: A retrospective study of children with SAP was performed in 30 cases developing HLH and 94 cases not developing HLH from December 2018 to August 2019. The binary logistic regression analysis was used to identify risk factors that were significantly associated with the development of HLH after the univariate analysis, and the receiver operating characteristic (ROC) curve was performed to find out the cut-off value for the significant relevant factors.Results: Two factors were associated with the development of HLH, which were the length of fever (OR = 1.331, 95%CI: 1.002–1.769) and triglycerides (TG) (OR = 17.345, 95%CI: 1.358–221.538). The cut-off value of the length of fever was 12.5 days, and the cut-off value of TG was 3.02 mmol/L.Conclusion: Children with SAP who had a duration of fever over 12.5 days and the TG level over 3.02 mmol/L are more likely to develop HLH.

Bronchitis obliterans after severe pneumonia in children: a review of 34 cases

Background: This study aimed to describe the clinical characteristics, pathogeny and bronchoscopic findings of 34 children with bronchitis obliterans after severe pneumonia. Methods: Thirty-four children diagnosed with bronchitis obliterans were retrospectively studied at the Children’s Hospital of Chongqing Medical University in China between January, 2014 and October, 2020. The clinical manifestations, pathogeny, lung computed tomography imaging and bronchoscopic findings of the 34 children were reported. Results: In children with bronchitis obliterans, repeated coughing, fever, wheezing, tachypnea, and lung rales were common clinical manifestations. Mycoplasma pneumoniae (M. pneumoniae) was the most common etiologic agent, followed by adenovirus. The CT scan images included uneven lung inflation(12/34), lung consolidation( 27/34), pulmonary atelectasis(23/34), and pleural effusion(22/34). All children underwent flexible bronchoscopy, and major types of airway findings were identified: mucosal congestion, luminal longitudinal folds, mucosal erosion or necrosis, hyperplastic changes, sputum emboli, bronchiectasis and obliterative-like lesions. Conclusion: In conclusion, severe M. pneumoniae pneumonia and adenovirus pneumonia appeared to have a higher risk of development of bronchitis obliterans. Bronchoscopy can be used as the main criterion for the diagnosis of bronchitis obliterans. Bronchoscopy interventional treatment is an effective measure to quickly recanalize the occluded lumen, but there is a risk of recurrence after treatment. Children with severe pneumonia should undergo regular follow-up and bronchoscopy to detect possible lumen occlusion in time.