RESUMEN
OBJECTIVE: The aim of this study was to investigate the value of Broncoplasma Insufflation Sign in lung ultrasound signs in assessing the efficacy of bronchoalveolar lavage in severe Mycoplasma pneumoniae pneumonia in children. METHODS: Forty-seven children with severe Mycoplasma pneumoniae pneumonia were treated with medication and bronchial lavage. Laboratory and imaging results were collected, and lung ultrasonography was performed before bronchoalveolar lavage and 1, 3, and 7 days after lavage to record changes in Bronchial Insufflation Sign and changes in the extent of solid lung lesions. Factors affecting the effectiveness of bronchoalveolar lavage were analyzed using logistic regression and other factors. RESULTS: Bronchial Insufflation Sign Score and the extent of lung solid lesions were the factors affecting the effectiveness of bronchoalveolar lavage treatment. The smaller the area of lung solid lesions and the higher the Bronchial Insufflation Sign Score, the more effective the results of bronchoalveolar lavage treatment were, and the difference was statistically significant, with a difference of p < 0.05. The Bronchial Insufflation Sign Score had the highest sensitivity and specificity for the prediction of the efficacy of bronchoalveolar lavage treatment in the first 7 days after the treatment. CONCLUSION: Bronchial Insufflation Sign Score combined with the extent of solid lung lesions can assess the efficacy of bronchoalveolar lavage in the treatment of severe Mycoplasma pneumoniae pneumonia in children; lung ultrasound is a timely and effective means of assessing the efficacy of bronchoalveolar lavage.
Asunto(s)
Lavado Broncoalveolar , Pulmón , Neumonía por Mycoplasma , Ultrasonografía , Lavado Broncoalveolar/métodos , Mycoplasma pneumoniae , Neumonía por Mycoplasma/diagnóstico por imagen , Neumonía por Mycoplasma/terapia , Pulmón/diagnóstico por imagen , Humanos , Femenino , Lactante , Preescolar , Niño , Ultrasonografía/métodos , Resultado del Tratamiento , Insuflación , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: To study the efficacy of bronchoalveolar lavage (BAL) combined with prone positioning in children with Mycoplasma pneumoniae pneumonia (MPP) and atelectasis and its effect on pulmonary function. METHODS: A prospective study was conducted on 94 children with MPP and atelectasis who were hospitalized in Ordos Central Hospital of Inner Mongolia from November 2020 to May 2023. The children were randomly divided into a treatment group and a control group, with 47 children in each group. The children in the treatment group were given conventional treatment, BAL, and prone positioning, and those in the control group were given conventional treatment and BAL. The two groups were compared in terms of fever, pulmonary signs, length of hospital stay, lung recruitment, and improvement in pulmonary function. RESULTS: Compared with the control group, the treatment group had significantly shorter time to improvement in pulmonary signs and length of hospital stay and a significantly higher rate of lung recruitment on day 7 of hospitalization, on the day of discharge, and at 1 week after discharge (P<0.05). Compared with the control group, the treatment group had significantly higher levels of forced vital capacity (FVC) as a percentage of the predicted value, forced expiratory volume (FEV) in 1 second as a percentage of the predicted value, ratio of FEV in 1 second to FVC, forced expiratory flow at 50% of FVC as a percentage of the predicted value, forced expiratory flow at 75% of FVC as a percentage of the predicted value, and maximal mid-expiratory flow as a percentage of the predicted value on the day of discharge and at 1 week after discharge (P<0.05). There was no significant difference in the time for body temperature to return to normal between the two groups (P>0.05). CONCLUSIONS: In the treatment of children with MPP and atelectasis, BAL combined with prone positioning can help to shorten the time to improvement in pulmonary signs and the length of hospital stay and promote lung recruitment and improvement in pulmonary function.
Asunto(s)
Neumonía por Mycoplasma , Atelectasia Pulmonar , Niño , Humanos , Estudios Prospectivos , Mycoplasma pneumoniae , Posición Prona , Atelectasia Pulmonar/terapia , Neumonía por Mycoplasma/terapia , Lavado Broncoalveolar , DimercaprolRESUMEN
OBJECTIVES@#To study the efficacy of bronchoalveolar lavage (BAL) combined with prone positioning in children with Mycoplasma pneumoniae pneumonia (MPP) and atelectasis and its effect on pulmonary function.@*METHODS@#A prospective study was conducted on 94 children with MPP and atelectasis who were hospitalized in Ordos Central Hospital of Inner Mongolia from November 2020 to May 2023. The children were randomly divided into a treatment group and a control group, with 47 children in each group. The children in the treatment group were given conventional treatment, BAL, and prone positioning, and those in the control group were given conventional treatment and BAL. The two groups were compared in terms of fever, pulmonary signs, length of hospital stay, lung recruitment, and improvement in pulmonary function.@*RESULTS@#Compared with the control group, the treatment group had significantly shorter time to improvement in pulmonary signs and length of hospital stay and a significantly higher rate of lung recruitment on day 7 of hospitalization, on the day of discharge, and at 1 week after discharge (P<0.05). Compared with the control group, the treatment group had significantly higher levels of forced vital capacity (FVC) as a percentage of the predicted value, forced expiratory volume (FEV) in 1 second as a percentage of the predicted value, ratio of FEV in 1 second to FVC, forced expiratory flow at 50% of FVC as a percentage of the predicted value, forced expiratory flow at 75% of FVC as a percentage of the predicted value, and maximal mid-expiratory flow as a percentage of the predicted value on the day of discharge and at 1 week after discharge (P<0.05). There was no significant difference in the time for body temperature to return to normal between the two groups (P>0.05).@*CONCLUSIONS@#In the treatment of children with MPP and atelectasis, BAL combined with prone positioning can help to shorten the time to improvement in pulmonary signs and the length of hospital stay and promote lung recruitment and improvement in pulmonary function.
Asunto(s)
Niño , Humanos , Estudios Prospectivos , Mycoplasma pneumoniae , Posición Prona , Atelectasia Pulmonar/terapia , Neumonía por Mycoplasma/terapia , Lavado Broncoalveolar , DimercaprolRESUMEN
BACKGROUND: Early evaluation of severe mycoplasma pneumoniae pneumonia (SMPP) and the prompt utilization of fiberoptic bronchoscopic manipulation can effectively alleviate complications and restrict the progression of sequelae. This study aim to establish a nomogram forecasting model for SMPP in children and explore an optimal early therapeutic bronchoalveolar lavage (TBAL) treatment strategy. METHODS: This retrospective study included children with mycoplasma pneumoniae pneumonia (MPP) from January 2019 to December 2021. Multivariate logistic regression analysis was used to screen independent risk factors for SMPP and establish a nomogram model. The bootstrap method was employed and a receiver operator characteristic (ROC) curve was drawn to evaluate the accuracy and robustness of the model. Kaplan-Meier analysis was used to assess the effect of lavage and hospitalization times. RESULTS: A total of 244 cases were enrolled in the study, among whom 68 with SMPP and 176 with non-SMPP (NSMPP). A prediction model with five independent risk factors: left upper lobe computed tomography (CT) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health assessment (APACHE) II score, bronchitis score (BS), and c-reactive protein (CRP) was established based on the multivariate logistic regression analysis. The ROC curve of the prediction model showed the area under ROC curve (AUC) was 0.985 (95% confidence interval (CI) 0.972-0.997). The Hosmer-Lemeshow goodness-of-fit test results showed that the nomogram model predicted the risk of SMPP well (χ2 = 2.127, P = 0.977). The log-rank result suggested that an early BAL treatment could shorten MPP hospitalization time (P = 0.0057). CONCLUSION: This nomogram model, based on the left upper lobe CT score, SOFA score, APACHE II score, BS, and CRP level, represents a valuable tool to predict the risk of SMPP in children and optimize the timing of TBAL.
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Mycoplasma pneumoniae , Neumonía por Mycoplasma , Niño , Humanos , Estudios Retrospectivos , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/terapia , Lavado Broncoalveolar , Nomogramas , PronósticoRESUMEN
PURPOSE: To explore the effectiveness of flexible bronchoscopy in pediatric Mycoplasma pneumoniae pneumonia (MPP). METHODS: This retrospective cohort study included children with MPP admitted between 2016 and 2019 in Shanghai. Tracheobronchial manifestations, etiologic findings, therapeutic effect, and health-economic indicators were assessed in bronchoscopy (plus bronchoalveolar lavage (BAL)) and non-bronchoscopy group. We used propensity-score matching and multivariable logistic regression to investigate the effect of bronchoscopy and BAL on disease recovery. RESULTS: In 900 children with MPP, 24/278 (8.6%) of those who underwent bronchoscopy had sputum plugs. Coinfection rate was four-fold enhanced by BAL (19.6% vs. 4.5%, p < 0.01) in patients with severe MPP (SMPP) and nearly doubled (10.8% vs. 5.9%, p = 0.03) in those without SMPP, compared with no BAL. Total of 224 (24.9%) patients had multilobar consolidation; after BAL, a significantly shorter lesion-resolution duration was observed on imaging (OR: 0.2, 95% CI: 0.0-0.7). However, longer fever duration (OR: 2.8, 95% CI: 1.7-4.8), hospital stay (OR: 3.1, 95% CI: 1.9-5.1), and higher costs were found in the bronchoscopy group than in the non-bronchoscopy group. CONCLUSIONS: Through BAL, coinfection may explain one-fifth of causes for SMPP. Bronchoscopy with BAL may increase the detection rate of pathogen and resolve pulmonary lesions in patients with multilobar consolidation. IMPACT: Flexible bronchoscopy with bronchoalveolar lavage is of great assistance in the timely detection of coinfection, sputum plug and inflammatory polyps in children with Mycoplasma pneumoniae pneumonia (MPP), and improves the recovery of lung damage in MPP patients with multilobar consolidation. This study provides new insights into the indications of flexible bronchoscopy for the diagnosis and treatment of pediatric patients with MPP.
Asunto(s)
Coinfección , Neumonía por Mycoplasma , Humanos , Niño , Mycoplasma pneumoniae , Estudios Retrospectivos , China , Neumonía por Mycoplasma/complicaciones , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/terapiaAsunto(s)
Eritrocitos/patología , Hemoglobinuria Paroxística/etiología , Neumonía por Mycoplasma/complicaciones , Adulto , Hemoglobinuria Paroxística/diagnóstico , Hemoglobinuria Paroxística/patología , Hemoglobinuria Paroxística/terapia , Humanos , Inmunoglobulina M/análisis , Masculino , Mycoplasma pneumoniae/aislamiento & purificación , Fagocitosis , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/patología , Neumonía por Mycoplasma/terapiaRESUMEN
BACKGROUND: In recent years, the incidence rate of children with severe Mycoplasma pneumoniae pneumonia (SMPP) is increasing, which poses a great threat to children's life and safety. There are some limitations in the existing drugs for the treatment of SMPP, and the supplementary and alternative therapy of SMPP plays an irreplaceable role in the treatment of this disease. This study will evaluate the efficacy and safety of various complementary and alternative therapies for SMPP by means of mesh meta-analysis. In order to provide the basis for clinical rational use. METHODS: Two researchers will independently and comprehensively searched the Cochrane Central controlled trials registry, Cochrane Library, PubMed, web of science, EMBASE, CNKI, and Wanfang database to collect randomized controlled trials (RCT) studies on complementary and alternative therapies for SMPP. And the relevant references included in the systematic review/meta-analysis are screened. The retrieval time limit is from the establishment of the database to November 2020. We will use Revman 5.3 software for meta-analysis and use grade to grade the quality of evidence in the net meta-analysis (NMA). RESULTS: The aim of this study was to compare the efficacy and safety of different complementary and alternative therapies in the treatment of SMPP, with a view to evaluating and ranking different interventions. CONCLUSION: The supplement and replacement therapy of SMPP can improve the clinical efficacy, relieve the clinical symptoms, improve the quality of life of children, and reduce adverse reactions, which can provide strong support for the rational use of clinicians. INPLASY REGISTRATION NUMBER: INPLASY2020110079.
Asunto(s)
Terapias Complementarias/métodos , Neumonía por Mycoplasma/terapia , Niño , Humanos , Metaanálisis como Asunto , Revisiones Sistemáticas como Asunto , Resultado del TratamientoRESUMEN
ABSTRACT: Mycoplasma pneumoniae (MP) is an atypical bacterial pathogen that typically causes mild respiratory symptoms. Rarely, MP is associated with acute respiratory distress syndrome, a condition marked by widespread inflammation in the lungs that often requires invasive support. We report a case of severe acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation in an otherwise healthy adolescent because of MP.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Mycoplasma pneumoniae/efectos de los fármacos , Neumonía por Mycoplasma/terapia , Síndrome de Dificultad Respiratoria/microbiología , Síndrome de Dificultad Respiratoria/terapia , Antibacterianos/uso terapéutico , Niño , Voluntarios Sanos , Humanos , Masculino , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/patogenicidad , Neumonía por Mycoplasma/diagnóstico por imagen , Neumonía por Mycoplasma/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: Plastic bronchitis (PB) is a rare, variable, and potentially fatal disease. This study aimed to assess the efficacy of fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) in treating children with PB. METHODS: In total, 15 children with PB, between 2012 and 2020, were enrolled in our study. Within 12 hours of admission, FOB and BAL were performed and reviewed under local anesthesia and sedation. Before and after FOB, clinical findings and chest imaging were evaluated. RESULTS: Regarding the onset of symptoms before FOB, all cases had prominent cough for 7.00 ± 4.55 days, and 14 had persistent high fever. In total, 13 cases had complete obstruction from bronchial casts, consistent with consolidated lesions; 2 had partial airway obstruction. Within 3 days, complete resolution was revealed in nine cases. Overall, six cases underwent repeated FOB (range, 2-3 times) for persistent atelectasis and airway obstruction. Except for two cases with type 2 PB, cast histology confirmed type 1 PB for all cases. Only eight children had minor intra- and post-procedure complications. Reverse transcription-polymerase chain reaction for Mycoplasma pneumoniae in sputum and BAL samples were positive in 13 cases. Next-generation sequencing of the BAL samples was positive for adenovirus and Human parainfluenza virus in one case, respectively. During 1 month to 7 years of follow-up, no patient developed PB recurrence, asthmatic attacks, or chronic cough. CONCLUSIONS: Early FOB and BAL were effective in alleviating clinical findings, atelectasis, and airway obstruction. Serial FOB could be performed in patients with recurrent symptoms.
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Bronquitis/terapia , Lavado Broncoalveolar , Broncoscopía/métodos , Neumonía por Mycoplasma/terapia , Niño , Preescolar , Femenino , Tecnología de Fibra Óptica , Humanos , Lactante , Masculino , Mycoplasma pneumoniaeRESUMEN
INTRODUCTION: The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only two cases of Chlamydia pneumoniae have been reported in a large US study so far. METHODS: In the present report, we describe a series of seven patients where co-infection with C. pneumoniae (n = 5) or M. pneumoniae (n = 2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. RESULTS AND CONCLUSION: An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.
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COVID-19/diagnóstico , COVID-19/virología , Neumonía por Clamidia/diagnóstico , Neumonía por Clamidia/microbiología , Coinfección , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/microbiología , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/terapia , Neumonía por Clamidia/epidemiología , Neumonía por Clamidia/terapia , Comorbilidad , Manejo de la Enfermedad , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Neumonía por Mycoplasma/epidemiología , Neumonía por Mycoplasma/terapia , Estudios Retrospectivos , Ciudad de Roma/epidemiología , Evaluación de Síntomas , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To evaluate the natural history and ophthalmologic morbidity of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and propose a treatment algorithm. DESIGN: Retrospective, interventional case series. METHODS: Retrospective chart review of all MIRM patients examined by the department of ophthalmology at a tertiary children's hospital. Diagnosis was established clinically concomitant with either positive Mycoplasma pneumoniae IgM or PCR testing from January 1, 2010, until December 31, 2019. The main outcome measures were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention. RESULTS: There were 15 patients (10 male and 5 female) aged 10.9 ± 4.2 years who had primary episodes of MIRM; of those, 4 had multiple episodes. All patients required topical steroid treatment, 3 required amniotic membrane transplantation, and 1 patient underwent placement of a sutureless biologic corneal badage device. There were no patients who suffered visual loss, but 1 was left with mild symblephara near the lateral canthus in each eye and 2 others had scarring of the eyelid margins and blepharitis. CONCLUSIONS: The ocular morbidity is significantly less in MIRM than in other closely related syndromes such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. However, these patients still require close observation and a low threshold for intervention to avoid permanent ophthalmic sequelae and possible blindness.
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Amnios/trasplante , Exantema/microbiología , Infecciones Bacterianas del Ojo/microbiología , Enfermedades de los Párpados/microbiología , Glucocorticoides/uso terapéutico , Mucositis/microbiología , Mycoplasma pneumoniae/aislamiento & purificación , Neumonía por Mycoplasma/microbiología , Adolescente , Niño , ADN Bacteriano/genética , Exantema/diagnóstico , Exantema/terapia , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/terapia , Enfermedades de los Párpados/diagnóstico , Enfermedades de los Párpados/terapia , Femenino , Estudios de Seguimiento , Humanos , Inmunoglobulina M/sangre , Masculino , Mucositis/diagnóstico , Mucositis/terapia , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/inmunología , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/terapia , Reacción en Cadena de la Polimerasa , Estudios Retrospectivos , Agudeza Visual/fisiologíaRESUMEN
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is spreading at a rapid pace, and the World Health Organization declared it as pandemic on 11 March 2020. Mycoplasma pneumoniae is an "atypical" bacterial pathogen commonly known to cause respiratory illness in humans. The coinfection from SARS-CoV-2 and mycoplasma pneumonia is rarely reported in the literature to the best of our knowledge. We present a study in which 6 of 350 patients confirmed with COVID-19 were also diagnosed with M. pneumoniae infection. In this study, we described the clinical characteristics of patients with coinfection. Common symptoms at the onset of illness included fever (six [100%] patients); five (83.3%) patients had a cough, shortness of breath, and fatigue. The other symptoms were myalgia (66.6%), gastrointestinal symptoms (33.3%-50%), and altered mental status (16.7%). The laboratory parameters include lymphopenia, elevated erythrocyte sedimentation rate, C-reactive protein, lactate dehydrogenase, interleukin-6, serum ferritin, and D-dimer in all six (100%) patients. The chest X-ray at presentation showed bilateral infiltrates in all the patients (100%). We also described electrocardiogram findings, complications, and treatment during hospitalization in detail. One patient died during the hospital course.
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COVID-19/fisiopatología , Hipertensión/fisiopatología , Mycoplasma pneumoniae/patogenicidad , Neumonía por Mycoplasma/fisiopatología , SARS-CoV-2/patogenicidad , Adulto , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , COVID-19/diagnóstico por imagen , COVID-19/mortalidad , COVID-19/terapia , Coinfección , Comorbilidad , Tos/fisiopatología , Disnea/fisiopatología , Fatiga/fisiopatología , Femenino , Fiebre/fisiopatología , Humanos , Hipertensión/diagnóstico por imagen , Hipertensión/mortalidad , Hipertensión/terapia , Linfocitos/patología , Linfocitos/virología , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Mycoplasma pneumoniae/efectos de los fármacos , Neumonía por Mycoplasma/diagnóstico por imagen , Neumonía por Mycoplasma/mortalidad , Neumonía por Mycoplasma/terapia , Estudios Retrospectivos , SARS-CoV-2/efectos de los fármacos , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Hiperferritinemia/diagnóstico , Hiperferritinemia/microbiología , Mycoplasma pneumoniae , Neumonía por Mycoplasma/diagnóstico , Vasculitis/diagnóstico , Vasculitis/microbiología , Adolescente , Femenino , Humanos , Hiperferritinemia/terapia , Neumonía por Mycoplasma/complicaciones , Neumonía por Mycoplasma/terapia , Vasculitis/terapiaRESUMEN
BACKGROUND: Radiologic evaluation of children with Mycoplasma pneumoniae is important for diagnosis and management. OBJECTIVE: To investigate the correlation between chest radiographic findings and the clinical features in children with Mycoplasma pneumoniae pneumonia. MATERIALS AND METHODS: This study included 393 hospitalized children diagnosed with M. pneumoniae pneumonia between January 2000 and August 2016. Their clinical features and chest radiographs were reviewed. Radiographic findings were categorized and grouped as consolidation group (lobar or segmental consolidation) and non-consolidation group (patchy infiltration, localized reticulonodular infiltration, or parahilar peribronchial infiltration). RESULTS: Lobar or segmental consolidation (37%) was the most common finding, followed by parahilar or peribronchial infiltration (27%), localized reticulonodular infiltration (21%) and patchy infiltration (15%). The consolidation group was more frequently accompanied by pleural effusions (63%), compared to the non-consolidation group (16%). Compared with patients in the non-consolidation group, those in the consolidation group were associated with a significantly higher rate of hypoxia, tachypnea, tachycardia, extrapulmonary manifestations, prolonged fever, and longer periods of anti-mycoplasma therapy and hospitalization. Lobar or segmental consolidation was significantly more frequent in children ≥5 years old (44%) compared with children 2-5 years old (34%) and <2 years old (13%). Parahilar peribronchial infiltration was significantly more frequent in children <2 years old (56%) compared with children 2-5 years old (32%) and ≥5 years old (18%). CONCLUSION: The chest radiographic findings of children with M. pneumoniae pneumonia correlate well with the clinical features. Consolidative lesions were frequently observed in older children and were associated with more severe clinical features.
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Niño Hospitalizado/estadística & datos numéricos , Mycoplasma pneumoniae/fisiología , Neumonía por Mycoplasma/diagnóstico por imagen , Tórax/diagnóstico por imagen , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Neumonía por Mycoplasma/terapia , RadiografíaAsunto(s)
Mycoplasma pneumoniae/aislamiento & purificación , Neumonía por Mycoplasma/diagnóstico , Antibacterianos/uso terapéutico , Niño , Femenino , Humanos , Pulmón/diagnóstico por imagen , Moxifloxacino/uso terapéutico , Gravedad del Paciente , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/etiología , Neumonía por Mycoplasma/complicaciones , Neumonía por Mycoplasma/terapia , Radiografía Torácica , Respiración ArtificialRESUMEN
RATIONALE: Concurrent or sequential coinfections of Legionella pneumophila and Mycoplasma pneumoniae have been reported in the past though infrequently. Distinguishing a true co-infection from cross reactivity is often challenging as the diagnosis is mostly dependent on serological testing. PATIENT CONCERNS: A 77-year-old male presented with worsening dyspnea, cough with yellow sputum, diarrhea and fever of 2-days duration. Patient had history of chronic obstructive pulmonary disease (COPD) on home oxygen, bronchiectasis, rheumatoid arthritis (on methotrexate and leflunomide), treated pulmonary tuberculosis and 30-pack-year smoking. Chest X-ray showed bilateral interstitial changes with left lower lobe infiltrate. On day 5, his urine antigen for L pneumophila serogroup 1 was reported positive. The following day his serum M pneumoniae IgM antibody titers were reported elevated at 6647âU/mL. Patient was started on antibiotics and placed on non-invasive positive pressure ventilation. DIAGNOSIS: The patient was diagnosed with possible Legionella and Mycoplasma co-infection. OUTCOMES: Sputum Mycoplasma polymerase chain reaction (PCR) and serum cold agglutinins were obtained on day 6 and later reported negative. He was treated with azithromycin for 10 days with clinical improvement. LESSONS: Serological testing alone is an indirect measure with poor sensitivity and specificity and has its own limitations. Urine antigen detection confirms L pneumophila serogroup 1 infection in a patient with suggestive symptoms. However, diagnosis of M pneumonia should be based on combination of tests including serology and PCR to confirm true co-infection.
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Legionelosis/complicaciones , Neumonía por Mycoplasma/complicaciones , Anciano , Antibacterianos/uso terapéutico , Bronquiectasia , Coinfección , Humanos , Inmunoglobulina M/inmunología , Incidencia , Legionella pneumophila/aislamiento & purificación , Legionelosis/terapia , Masculino , Mycoplasma pneumoniae/inmunología , Ventilación no Invasiva , Neumonía por Mycoplasma/terapia , Reacción en Cadena de la Polimerasa , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Radiografía Torácica , Sensibilidad y Especificidad , Fumar/epidemiologíaRESUMEN
Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. The pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.
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Antibacterianos/uso terapéutico , Mycoplasma pneumoniae , Derrame Pleural/etiología , Neumonía por Mycoplasma/tratamiento farmacológico , Azitromicina/uso terapéutico , Ceftriaxona/uso terapéutico , Progresión de la Enfermedad , Drenaje , Femenino , Humanos , Omán , Oseltamivir/uso terapéutico , Derrame Pleural/complicaciones , Neumonía por Mycoplasma/terapia , Adulto JovenRESUMEN
Mycoplasma pneumoniae is a significant cause of pneumonia in school-aged children and young adults. We report a case of neonatal M. pneumoniae pneumonia in a preterm child manifesting in the first hours of life. Vertical transmission was demonstrated by the detection of M. pneumoniae in inflamed placental tissue indicating chorioamnionitis.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Mycoplasma pneumoniae/aislamiento & purificación , Neumonía por Mycoplasma/congénito , Neumonía por Mycoplasma/transmisión , Corioamnionitis/microbiología , ADN Bacteriano/aislamiento & purificación , Femenino , Humanos , Recién Nacido , Masculino , Placenta/microbiología , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/terapia , Embarazo , Radiografía TorácicaRESUMEN
Objective: To investigate the efficacy of bronchoalveolar lavage (BAL) and its influence factors in the treatment of Mycoplasma pneumoniae pneumonia (MPP) with atelectasis. Methods: A retrospective case control study was performed on hospitalized MPP patients with atelectasis and received BAL in the Department of Pulmonology, Children's Hospital Zhejiang University School of Medicine from January 1, 2015 to July 31, 2017. Fever relieved in 48 hours and chest imaging improved in one week after BAL were considered effective. Clinical data, including age, sex, blood routine tests, lactate dehydrogenase (LDH), cytokines, complications, fever duration before BAL, course of disease before BAL, sputum plug, atelectasis area and its CT values of atelectasis site were collected. Student's t test, Mann-Whitney U test, or chi square test were used. Results: (1) A total of 163 patients were enrolled, including 69 boys and 94 girls, with the ratio of 1â¶1.36. Their ages ranged from 6 months to 12.6 years. (2) On the day of bronchoscope, 113 patients still had fever. They were divided into effective group (n=66) and ineffective group (n=47) according to whether fever was relieved in 48 hours after BAL. The effective group were found to have less sputum plug compared with the ineffective group (33% (22/66) vs. 57% (27/47), χ(2)=6.499, P=0.011). The other factors such as sex, age, fever duration before BAL, course of disease before BAL, C reactive protein (CRP), LDH, IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, atelectasis area and CT value showed no significant difference between the two groups (all P>0.05). (3)A total of 122 cases had chest imaging after BAL. According to chest imaging improvement, they were divided into effective group (n=81) and ineffective group (n=41). The effective group showed lower CT value ((58±9) vs. (63±8) HU, t=-2.436, P=0.017), IL-6 and IL-10 (M(Q(1), Q(3))) (21.0 (1.9, 48.4) vs. 36.4(21.8, 93.6), 4.9 (3.7, 9.6) vs. 7.7 (4.4, 12.0) ng/L, Z=-2.387,-2.009, P=0.017, 0.045). Sex, age, fever duration before BAL, course of disease before BAL, CRP, LDH, IL-2, IL-4, TNF, IFN-γ, atelectasis area showed no significant differences between the two groups (all P>0.05). (4) Patients were divided into sputum plug group (57 cases) and non sputum plug group (106 cases) according to bronchoscopic findings. The sputum plug group showed higher LDH, CRP, IL-6, IFN-γ, incidence of pleural effusion and extrapulmonary complications (585(433, 833) vs. 369 (312, 588) U/L, 42 (19, 103) vs. 25 (12, 45) mg/L, 38.8 (22.1, 71.3) vs. 20.7 (9.2, 48.3) ng/L, 33.1 (13.5, 89.3) vs. 12.7 (6.5, 33.6) ng/L, 73.7% (42/57) vs. 52.8% (56/106), 40.4% (23/57) vs. 17.0% (18/106)), with statistically significant differences (Z=-4.865,-3.435,-3.098,-3.704, χ(2)= 0.010, 0.001, all P<0.01) . Additionally, fewer patients showed fever relief within 48 hours after BAL in the cases with sputum plug cases compared those without sputum plug (44.9% (22/49) vs. 68.8% (44/64), χ(2)= 0.011, P=0.009). Fewer patients showed chest imaging improvement within one week after BAL in the cases with sputum plug compared with those without sputum plug, but did not show significant difference (56.5% (26/46) vs. 72.4% (55/76), χ(2)=0.073, P=0.056). Conclusions: BAL has some therapeutic effect on fever or atelectasis in MPP children complicated with atelectasis. Chest imaging improvement or fever relief may be hampered by sputum plug, increased IL-6 or IL-10.