Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.289
Filtrar
1.
J Int Med Res ; 49(6): 3000605211016376, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34082582

RESUMO

OBJECTIVE: To investigate the prevalence of mutations in domain V of Mycoplasma pneumoniae (MP) 23S ribosomal RNA (rRNA) and the clinical characteristics of pediatric MP pneumonia (MPP) in Nanjing, China. METHODS: Domain V of 23S rRNA was sequenced in MP strains collected from children diagnosed with MPP in Nanjing. Clinical and laboratory data were obtained. RESULTS: Among the 276 MP strains, 255 (92.39%) harbored mutations, primarily A2063G in domain V of MP 23S rRNA. When children were stratified according to the presence or absence of mutations, no significant differences were found in sex, age, the MP DNA load at enrollment, lymphocyte counts, pulmonary complications, immunomodulator levels, fever duration, the duration of fever after macrolide therapy, and hospital stay. The prevalence of refractory MPP in the two groups was similar. Children with refractory MPP exhibited higher MP DNA loads than those with non-refractory MPP. CONCLUSIONS: Despite the high prevalence of the A2063G mutation in domain V of MP 23S rRNA, mutations were not associated with the clinical characteristics of MPP. The MP DNA load significantly differed between refractory and non-refractory MPP.


Assuntos
Pneumonia por Mycoplasma , RNA Ribossômico 23S , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , China/epidemiologia , Farmacorresistência Bacteriana/genética , Humanos , Mutação , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/epidemiologia , RNA Ribossômico 23S/genética
2.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(5): 471-474, 2021 May.
Artigo em Chinês | MEDLINE | ID: mdl-34020736

RESUMO

OBJECTIVE: To evaluate the value of chitinase-like protein YKL-40 in bronchoalveolar lavage fluid (BALF) for predicting refractory Mycoplasma pneumoniae pneumonia (RMPP) in children. METHODS: A total of 50 children with common Mycoplasma pneumoniae pneumonia (MPP) and 22 children with RMPP were enrolled. The two groups were compared in terms of clinical features, laboratory examination results, imaging findings, and YKL-40 levels in BALF. The receiver operating characteristic (ROC) curve was used to evaluate the value of YKL-40 in BALF for predicting RMPP. RESULTS: Compared with the common MPP group, the RMPP group had significantly higher incidence rates of fever, shortness of breath, lung consolidation, and pleural effusion (P < 0.05) and significantly higher serum levels of C-reactive protein and lactate dehydrogenase (P < 0.05). The RMPP group had a significantly higher level of YKL-40 in BALF than the common MPP group (P < 0.05). The ROC curve plotted based on the level of YKL-40 in BALF had an area under the ROC curve of 0.750, a sensitivity of 72.7% and a specificity of 64.0% for predicting RMPP. CONCLUSIONS: There is an increase in the level of YKL-40 in BALF in children with RMPP, and the level of YKL-40 in BALF has a certain value for predicting RMPP.


Assuntos
Quitinases , Pneumonia por Mycoplasma , Líquido da Lavagem Broncoalveolar , Criança , Proteína 1 Semelhante à Quitinase-3 , Humanos , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/diagnóstico
3.
BMJ Case Rep ; 14(4)2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858884

RESUMO

A 9-year-old boy presented to the emergency department of a paediatric hospital with non-painful lesions on his lips and inside his mouth, associated with lip swelling. On examination, his oral mucosa and lips showed numerous blisters with yellowish serofibrinous content and lip oedema. An eye examination revealed bilateral conjunctival injection. Genitalia was unaffected and no other skin lesions were found. He was on day 4 of clarithromycin prescribed for atypical pneumonia caused by Mycoplasma pneumoniae The patient was diagnosed with M. pneumoniae-associated mucositis and was started on topical treatment with fusidic acid and betamethasone, with gradual improvement of the oral lesions.


Assuntos
Mucosite , Pneumonia por Mycoplasma , Criança , Claritromicina/uso terapêutico , Humanos , Masculino , Mucosa Bucal , Mucosite/tratamento farmacológico , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico
4.
BMC Pediatr ; 21(1): 202, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910509

RESUMO

BACKGROUND: Following the outbreak of the COVID-19 pandemic, a change in the incidence and transmission of respiratory pathogens was observed. Here, we retrospectively analyzed the impact of COVID-19 on the epidemiologic characteristics of Mycoplasma pneumoniae infection among children in Chengdu, one of the largest cities of western China. METHOD: M. pneumoniae infection was diagnosed in 33,345 pediatric patients with respiratory symptoms at the Chengdu Women's & Children's Central Hospital between January 2017 and December 2020, based on a serum antibody titer of ≥1:160 measured by the passive agglutination assay. Differences in infection rates were examined by sex, age, and temporal distribution. RESULTS: Two epidemic outbreaks occurred between October-December 2017 and April-December 2019, and two infection peaks were detected in the second and fourth quarters of 2017, 2018, and 2019. Due to the public health response to COVID-19, the number of positive M. pneumoniae cases significantly decreased in the second quarter of 2020. The number of M. pneumoniae infection among children aged 3-6 years was higher than that in other age groups. CONCLUSIONS: Preschool children are more susceptible to M. pneumoniae infection and close contact appears to be the predominant factor favoring pathogen transmission. The public health response to COVID-19 can effectively control the transmission of M. pneumoniae.


Assuntos
Pneumonia por Mycoplasma , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Mycoplasma pneumoniae , Pandemias , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/epidemiologia , Estudos Retrospectivos
5.
BMC Pediatr ; 21(1): 90, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607971

RESUMO

BACKGROUND: Due to the lack of a sensitive, specific and rapid detection method, aetiological diagnosis of pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae, MP) is a constantly challenging issue. This retrospective study aimed to compare the diagnostic methods for Mycoplasma pneumoniae in children and evaluate their values. METHODS: From November 2018 to June 2019, 830 children with community-acquired pneumonia were selected from the Department of Respiratory Medicine, Shanghai Children's Medical Center. On the first day of hospitalization, sputum, throat swab and venous blood samples were collected to analyse MP-IgM (particle agglutination, PA), MP-IgM (immune colloidal gold technique, GICT), MP-DNA, MP-RNA (simultaneous amplification and testing, SAT) and MP-DNA (real-time polymerase chain reaction, RT-PCR). RESULTS: Among these 830 children, RT-PCR showed that the positive rate was 36.6% (304/830), in which the positive rate of macrolide resistance (A2063G mutation) accounted for 86.2% of cases (262/304). Using RT-PCR as the standard, MP-RNA (SAT) had the highest specificity (97.5%), and MP-IgM (PA) had the highest sensitivity (74.0%) and Youden index (53.7%). If MP-RNA (SAT) was combined with MP-IgM (PA), its Kappa value (0.602), sensitivity (84.2%), specificity (78.7%) and Youden index (62.9%) were higher than those of single M. pneumoniae detection. CONCLUSIONS: Our research indicated that a combination of MP-RNA (SAT) plus MP-IgM (PA) might lead to reliable results as an early diagnostic method for children with clinical manifestations of Mycoplasma pneumoniae pneumonia.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia por Mycoplasma , Antibacterianos , Criança , China , Infecções Comunitárias Adquiridas/diagnóstico , Farmacorresistência Bacteriana , Humanos , Macrolídeos , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Estudos Retrospectivos
7.
BMC Infect Dis ; 21(1): 67, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441105

RESUMO

BACKGROUND: Recently, many cases of pneumonia in children with Mycoplasma pneumoniae infection have been shown to have varying degrees of intrabronchial mucus plug formation. The clinical, laboratory, radiological characteristics, and treatment of patients with Mycoplasma infection are analyzed in this study. The risk factors for M. pneumoniae pneumonia (MPP) mucus plug formation in children are explored, and a risk factor scoring system is established. METHODS: MPP patients treated with bronchoscopy were retrospectively enrolled in the study from February 2015 to December 2019. The children were divided into a mucus plug group and a control group according to the presence or absence of mucus plug formation. The clinical, laboratory, radiological characteristics, and treatment of the two groups of children were compared. Univariate and multivariate logistic regression models were used to identify the risk factors for MPP mucus plug formation. The receiver operating characteristic (ROC) curve was drawn to evaluate the regression model and establish the MPP mucous plug risk factor scoring system. RESULTS: A univariate analysis showed that the children in the mucous group were older and had a longer fever duration, longer hospital stay, higher fever peak, more cases of wheezing symptoms and allergies, and azithromycin or corticosteroids were administered later. In addition, neutrophil, C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (DD), sputum MP-DNA copy number, and total immunoglobulin A (IgA) levels were higher, while prealbumin (PA) levels were lower. The ROC curve analysis showed that children with MPP had PA ≤144.5 mg/L, had used corticosteroids during the course of the illness of ≥4.5 days, CRP ≥12.27 mg/L, an LDH ≥ 462.65 U/L, and there was a possibility of intra-airway mucus formation. The independent risk factors were scored according to their odds ratio (OR) value. Among the 255 children with MPP, the high-risk group had 44 (83.02%) mucus plugs out of 53; the middle-risk group had 35 (34.3%) mucus plugs out of 102; and the low-risk group had 11 (11%) mucus plugs out of 100. CONCLUSIONS: PA levels, timing of corticosteroid use (use in the first few days), CRP levels, and LDH levels were independent risk factors for MPP mucus plug formation. This provides a basis for the early identification of MPP in children combined with mucus plug formation.


Assuntos
Brônquios/fisiopatologia , Broncoscopia/métodos , Muco/metabolismo , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/fisiopatologia , Pneumonia por Mycoplasma/cirurgia , Corticosteroides/uso terapêutico , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Febre , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Lactente , L-Lactato Desidrogenase/sangue , Tempo de Internação , Modelos Logísticos , Masculino , Neutrófilos/metabolismo , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Pré-Albumina/análise , Curva ROC , Estudos Retrospectivos , Fatores de Risco
8.
BMC Infect Dis ; 21(1): 126, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509121

RESUMO

BACKGROUND: To observe the effect of corticosteroids in the treatment of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) under different doses, to summarize the clinical features 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. Compare the clinical features, laboratory findings, and imaging between the two groups, and use meaningful related indicators as ROC curves to find reference indicators for pulse therapy. RESULTS: (1) The median age of the group II was older than that of the group I(P < 0.05). (2) We found more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings in group II, which needed oxygen more often, higher the hormone, higher usage rate of gamma globulin, higher usage rate of bronchoscopy, and higher incidence of plastic bronchitis(P < 0.05). (3) 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). (4) 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 CRP44.45 mg/L, LDH590IU/L, FER411ng/L, and neutrophils in leukocyte classification were 73.75%, respectively. CONCLUSION: CRP ≥ 44.45 mg/L, LDH ≥ 590 IU/L, FER ≥ 411 ng/L, neutrophil≥73.75%, lung consolidation, and pleural effusion may be predictors that guide the treatment of RMPP with pulse dose of GC.


Assuntos
Glucocorticoides/administração & dosagem , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/tratamento farmacológico , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/patologia , Pulsoterapia , Curva ROC , Recidiva , Estudos Retrospectivos , Fatores de Risco
9.
BMC Infect Dis ; 21(1): 14, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407216

RESUMO

BACKGROUND: The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP). METHOD: A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n = 306) and a RMPP group (n = 124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP. RESULTS: (1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P < 0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P < 0. 05). D-D had the highest predictive power for RMPP (P < 0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P < 0.01). CONCLUSION: Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/diagnóstico , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Modelos Logísticos , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Neutrófilos/patologia , Derrame Pleural/etiologia , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/microbiologia , Estudos Retrospectivos , Fatores de Risco
10.
Rev Iberoam Micol ; 38(1): 16-18, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33500209

RESUMO

BACKGROUND: Patients with severe viral pneumonia are likely to receive high-dose immunomodulatory drugs to prevent clinical worsening. Aspergillus species have been described as frequent secondary pneumonia agents in severely ill influenza patients receiving steroids. COVID-19 patients admitted to Intensive Care Unit (ICU) are receiving steroids as part of their treatment and they share clinical characteristics with other patients with severe viral pneumonias. COVID-19 patients receiving steroids should be considered a putative risk group of invasive aspergillosis. CASE REPORT: We are reporting a SARS-CoV-2/Aspergillus section Fumigati coinfection in an elderly intubated patient with a history of pulmonary embolism treated with corticosteroids. The diagnosis was made following the ad hoc definitions described for patients admitted to ICU with severe influenza, including clinical criteria (fever for 3 days refractory to the appropriate antibiotic therapy, dyspnea, pleural friction rub, worsening of respiratory status despite antibiotic therapy and need of ventilator support), a radiological criterion (pulmonary infiltrate) and a mycological criterion (several positive galactomannan tests on serum with ratio ≥0.5). In addition, Aspergillus section Fumigati DNA was found in serum and blood samples. These tests were positive 4 weeks after the patient was admitted to the ICU. The patient received voriconazole and after two month in ICU his respiratory status improved; he was discharged after 6 weeks of antifungal treatment. CONCLUSIONS: Severely ill COVID-19 patients would be considered a new aspergillosis risk group. Galactomannan and Aspergillus DNA detection would be useful methods for Aspergillus infection diagnosis as they allow avoiding the biosafety issues related to these patients.


Assuntos
Aspergillus fumigatus/isolamento & purificação , /tratamento farmacológico , Coinfecção/diagnóstico , Imunocompetência , Imunossupressores/efeitos adversos , Aspergilose Pulmonar Invasiva/complicações , Metilprednisolona/efeitos adversos , /isolamento & purificação , Acetaminofen/uso terapêutico , Idoso , Anti-Infecciosos/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , /terapia , Coinfecção/microbiologia , Coinfecção/terapia , Coinfecção/virologia , Terapia Combinada , Diagnóstico Diferencial , Quimioterapia Combinada , Enoxaparina/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Imunossupressores/uso terapêutico , Intubação Intratraqueal , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/microbiologia , Aspergilose Pulmonar Invasiva/terapia , Masculino , Mananas/sangue , Metilprednisolona/uso terapêutico , Nasofaringe/virologia , Pneumonia por Mycoplasma/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Respiração Artificial , Staphylococcus aureus/isolamento & purificação , Traqueia/microbiologia
11.
Pediatr. catalan ; 80(4): 163-167, oct.-dic. 2020. tab, graf
Artigo em Catalão | IBECS | ID: ibc-200120

RESUMO

FONAMENT: Mycoplasma pneumoniae I Chlamydophila pneu-moniae són agents causals freqüents de la pneumònia adquirida a la comunitat (PAC) en pediatria, I les tècniques com la reacció en cadena de la polimerasa (PCR) poden facilitar-ne el diagnòstic etiològic precoç, adequant l'antibioteràpia emprada. OBJECTIU: Descriure l'ús d'aquesta tècnica en el maneig ambulatori dels pacients pediàtrics amb PAC que acudeixen a urgències. MÈTODE: Estudi observacional, retrospectiu I descriptiu de pacients pediàtrics diagnosticats de PAC a urgències amb maneig ambulatori. RESULTATS: De 67 pacients, el 32,8% va obtenir un resultat positiu per a bacteris atípics. El percentatge de resultats positius en <4 anys va ser del 10,0% I en ≥4 anys del 42,6% (p = 0,021). Van rebre antibiòtic empíric a l'alta 49 pacients dels 67 (73,1%): 31 macròlids, 12 betalactàmics I 6 ambdós. Amb el resultat de la PCR, per resultat negatiu es van retirar els macròlids a 25 dels 37 als quals se'ls havia pautat (67,6%) I es va pautar a 10 dels 22 casos positius que no els estaven rebent (45,5%). CONCLUSIONS: La PCR de bacteris atípics facilita el diagnòstic microbiològic ràpid I l'adequació de l'antibioteràpia, i, sobretot, evita l'excés de tractament amb macròlids a les urgències pediàtriques


FUNDAMENTO: Mycoplasma pneumoniae y Chlamydophila pneumoniae son agentes causales frecuentes de la neumonía adquirida en la comunidad (NAC) en pediatría, y las técnicas como la reacción en cadena de la polimerasa (PCR) pueden facilitar su diagnóstico etiológico precoz, adecuando la antibioterapia utilizada. OBJETIVO: Describir el uso de esta técnica en el manejo ambulatorio de los pacientes pediátricos con NAC que acuden a urgencias. MÉTODO: Estudio observacional, retrospectivo y descriptivo de pacientes pediátricos diagnosticados de NAC en urgencias manejados ambulatoriamente. RESULTADOS: De 67 pacientes, el 32,8% obtuvo resultado positivo para bacterias atípicas. El porcentaje de resultados positivos en <4 años fue del 10,0% y en ≥4 años de 42,6% (p = 0,021). Recibieron antibiótico empírico 49 pacientes de los 67 (73,1%): 31 macrólidos, 12 betalactámicos y 6 ambos. Con el resultado de la PCR, por resultado negativo se retiraron los macrólidos a 25 de los 37 a los que se les había pautado (67,6%) y se pautó a 10 de los 22 casos positivos que no los estaban recibiendo (45,5%). CONCLUSIONES: La PCR de bacterias atípicas facilita el diagnóstico microbiológico rápido y la adecuación de la antibioterapia, evitando sobre todo el exceso de tratamiento con macrólidos en urgencias


BACKGROUND: Mycoplasma pneumoniae and Chlamydophila pneu-moniae are frequent causative agents of community-acquired pneumonia (CAP) in children. Techniques such as the polymerase chain reaction (PCR) can facilitate early diagnosis and adequacy of antibiotic therapy. OBJECTIVE: To describe the use of this test in the ambulatory management of children with CAP seen in the emergency room. METHOD: Observational, retrospective and descriptive study of children diagnosed with CAP in the emergency room and managed as outpatients. RESULTS: Sixty-seven patients were recruited and 22 (32.8%) had a positive PCR for atypical bacteria. The percentage of positive results in children <4 years was 10.0% and it was 42.6% in children ≥4 years (p = 0.021). Forty-nine (73.1%) patients received antibiotic treatment: 31 received macrolides, 12 beta-lactams and 6 both. The results of the PCR test resulted in discontinuation of macrolide treatment in 25 of 37 patients (67.6%) after a negative PCR test and in its prescription to 10 of the 22 (45.5%) positive cases that were not receiving it. CONCLUSIONS: The use of PCR for atypical bacteria in the emergency department facilitates rapid microbiological diagnosis and the adequacy of antibiotic therapy, avoiding over-treatment with macrolides


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Comunitárias Adquiridas/microbiologia , Serviços Médicos de Emergência , Pneumonia Bacteriana/microbiologia , Reação em Cadeia da Polimerase , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Chlamydophila pneumoniae/genética , Infecções por Chlamydophila/diagnóstico , Estudos Retrospectivos , Estações do Ano
12.
Zhonghua Er Ke Za Zhi ; 58(8): 635-639, 2020 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-32842383

RESUMO

Objective: To investigate the spectrum of pathogenic agents in pediatric patients with acute respiratory infections (ARI) during the outbreak of coronavirus infectious diseases 2019 (COVID-19). Methods: Three groups of children were enrolled into the prospective study during January 20 to February 20, 2020 from Capital Institute of Pediatrics, including children in the exposed group with ARI and epidemiological history associated with COVID-19 from whom both pharyngeal and nasopharyngeal swabs were collected, children in the ARI group without COVID-19 associated epidemiological history and children in the screening group for hospital admission, with neither COVID-19 associated epidemiological history nor ARI. Only nasopharyngeal swabs were collected in the ARI group and screening group. Each group is expected to include at least 30 cases. All specimens were tested for 2019-nCoV nucleic acid by two diagnostic kits from different manufacturers. All nasopharyngeal swabs were tested for multiple respiratory pathogens, whilst the results from the ARI group were compared with that in the correspondence periods of 2019 and 2018 used by t or χ(2) test. Results: A total of 244 children were enrolled into three groups, including 139 males and 105 females, the age was (5±4) years. The test of 2019-nCoV nucleic acid were negative in all children, and high positive rates of pathogens were detected in exposed (69.4%, 25/36) and ARI (55.3%, 73/132) groups, with the highest positive rate for mycoplasma pneumoniae (MP) (19.4%, 7/36 and 17.4%, 23/132, respectively), followed by human metapneumovirus (hMPV) (16.7%, 6/36 and 9.8%, 13/132, respectively). The positive rate (11.8%, 9/76) of pathogens in the screening group was low. In the same period of 2019, the positive rate of pathogens was 83.7% (77/92), with the highest rates for respiratory syncytial virus (RSV) A (29.3%, 27/92), followed by influenza virus (Flu) A (H1N1) (19.6%, 18/92) and adenovirus (ADV) (14.1%, 13/92), which showed significant difference with the positive rates of the three viruses in 2020 (RSV A: χ(2)=27.346, P<0.01; FluA (H1N1): χ(2)=28.083, P<0.01; ADV: χ(2)=7.848, P=0.005) . In 2018, the positive rate of pathogens was 61.0% (50/82), with the highest rate for human bocavirus (HBoV) (13.4%, 11/82) and followed by ADV (11.0%, 9/82), and significant difference was shown in the positive rate of HBoV with that in 2020 (χ(2)=6.776, P=0.009). Conclusions: The infection rate of 2019-nCoV is low among children in Beijing with no family clustering or no close contact, even with epidemiological history. The spectrum of pathogens of ARI in children during the research period is quite different from that in the previous years when the viral infections were dominant. MP is the highest positively detected one among the main pathogens during the outbreak of COVID-19 in Beijing where there is no main outbreak area.


Assuntos
Surtos de Doenças , Metapneumovirus/isolamento & purificação , Mycoplasma pneumoniae/isolamento & purificação , Infecções por Paramyxoviridae/diagnóstico , Infecções Respiratórias/diagnóstico , Pequim/epidemiologia , Betacoronavirus , Criança , Pré-Escolar , Coronavirus , Infecções por Coronavirus , Feminino , Humanos , Lactente , Vírus da Influenza A Subtipo H1N1 , Masculino , Metapneumovirus/patogenicidade , Mycoplasma pneumoniae/patogenicidade , Pandemias , Infecções por Paramyxoviridae/epidemiologia , Pediatria , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/epidemiologia , Pneumonia Viral , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia
13.
Medicine (Baltimore) ; 99(28): e21128, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664140

RESUMO

RATIONALE: Fulminant macrolide-resistant Mycoplasma pneumoniae pneumonia (MPP) has seldom been reported, and cases of MPP usually show rapid improvement after fluoroquinolones or tetracyclines addition. The purpose of this case report is to highlight the importance of proper selection of antibiotics for treatment of severe MPP and increase awareness concerning the emergence of fluoroquinolone-resistant MPP. PATIENT CONCERNS: A case of severe life-threatening pneumonia in a 26-year-old man with high fever and cough was non-responsive to azithromycin and fluoroquinolones. DIAGNOSES: The patient was diagnosed with MPP based on the test results of bronchoalveolar lavage using real-time quantitative PCR method. INTERVENTIONS: Tigecycline was given to the patient after azithromycin and fluoroquinolones failed. OUTCOMES: The patients fever subsided within the first day of tigecycline therapy. He showed rapid symptom resolution and improvement in lung infiltration after 4 days of tigecycline therapy. LESSONS: The case suggests that fulminant MPP should be timely treated with proper antibiotics, and the possible emergence of fluoroquinolone-resistant MPP should be of concern.


Assuntos
Azitromicina/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Fluoroquinolonas/farmacologia , Mycoplasma pneumoniae/efeitos dos fármacos , Pneumonia por Mycoplasma/tratamento farmacológico , Tigeciclina/uso terapêutico , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Brochothrix , Humanos , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/microbiologia , Tomografia Computadorizada por Raios X
14.
BMC Infect Dis ; 20(1): 367, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448200

RESUMO

BACKGROUND: Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community acquired pneumonia (CAP). Establishing an early diagnosis of M. pneumoniae pneumonia in patients with acute respiratory distress syndrome (ARDS) may have important therapeutic implications. METHODS: We describe diagnosis and management of M. pneumoniae pneumonia induced ARDS in a case series of adults and youth hospitalized with radiographically confirmed CAP prospectively enrolled in an observational cohort study in two university teaching hospitals, from November 2017 to October 2019. RESULTS: In all 10 patients, early and rapid diagnosis for severe M. pneumoniae pneumonia with ARDS was achieved with polymerase chain reaction (PCR) or metagenomic next-generation sequencing (mNGS) testing of samples from the lower respiratory tract or pleural effusion. The average PaO2/FiO2 of all patients was 180 mmHg. Of the 10 cases, 4 cases had moderate ARDS (100 mmHg ≤ PaO2/FiO2 < 200 mmHg) and 3 cases had severe ARDS (PaO2/FiO2 < 100 mmHg). High flow nasal cannula (HFNC) was applied in all patients, though only two patients were sufficiently supported with HFNC. Invasive mechanical ventilation (IMV) was required in 5 patients. High resistance (median 15 L/cmH2O/s) and low compliance (median 38 ml/cmH2O) was observed in 4 cases. In these 4 cases, recruitment maneuvers (RM) were applied, with 1 patient demonstrating no response to RM. Prone positioning were applied in 4 cases. Two cases needed ECMO support with median support duration of 5.5 days. No patient in our case series received corticosteroid therapy. All patients were survived and were discharged from hospital. CONCLUSIONS: Early and rapid diagnosis of severe M. pneumoniae pneumonia with ARDS can be achieved with PCR/mNGS tests in samples from the lower respiratory tract or pleural effusion. In our case series, half of M. pneumoniae pneumonia induced ARDS cases were adequately supported with HFNC or NIV, while half of cases required intubation. RM and prone position were effective in 30% of intubated cases, and 20% needed ECMO support. When early anti-mycoplasmal antibiotics were given together with sufficient respiratory support, the survival rate was high with no need for corticosteroid use.


Assuntos
Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/diagnóstico , Respiração Artificial/métodos , /microbiologia , Doença Aguda , Adolescente , Adulto , Cânula , Diagnóstico Precoce , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Hospitais Universitários , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Adulto Jovem
15.
Medicine (Baltimore) ; 99(19): e19987, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384451

RESUMO

This study aimed to investigate the inner linkage and mechanism of Mycoplasma pneumoniae (MP) infection and Kawasaki disease (KD), as well as the risk factors of outcome in this cohort of patients.A retrospective study was performed in 210 patients diagnosed with KD complicated with community acquired pneumonia (CAP) in Children's Hospital, Zhejiang University School of Medicine from January 2014 to December 2017. They were divided into two groups based on MP infection: MP infection group (n = 97) and non-MP infection group (n = 113). We compared the variables of these two groups based on medical records.The MP infection group had higher ESR than the non-MP infection group. During hospitalization, the non-MP infection group had higher levels of WBC during hospital, LDH, PCT, and lower HB when compared to the MP infection group. No differences were found in the hs-CRP level, N%, PLT, ALT, CKMB, and cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) between MP and non-MP infection group. Likewise, no difference was found in fever duration or hospital stays between them. Totally 19 patients in the infection group had CAA with a rate of 19.59%; and 27 (23.89%) patients had CAA in the non-MP infection group. Unfortunately, no difference was found in CAA rate between the two groups.MP infection may occur simultaneously in children with Kawasaki disease. KD patients with MP infection tended to occur in older population. MP infection may not increase the risk of CAA, which still needs further large-scaled studies to confirm. Clinicians should be alert to KD patients with high level of ESR. MP should be screened and early treatment with macrolides should be given timely.


Assuntos
Sedimentação Sanguínea , Cardiopatias , Macrolídeos/administração & dosagem , Síndrome de Linfonodos Mucocutâneos , Pneumonia por Mycoplasma , Antibacterianos/administração & dosagem , Pré-Escolar , China/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Comorbidade , Citocinas/sangue , Intervenção Médica Precoce/métodos , Feminino , Cardiopatias/etiologia , Cardiopatias/prevenção & controle , Humanos , Lactente , Contagem de Leucócitos/métodos , Contagem de Leucócitos/estatística & dados numéricos , Masculino , Síndrome de Linfonodos Mucocutâneos/sangue , Síndrome de Linfonodos Mucocutâneos/complicações , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/epidemiologia , Estudos Retrospectivos , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
17.
Zhonghua Er Ke Za Zhi ; 58(5): 403-407, 2020 May 02.
Artigo em Chinês | MEDLINE | ID: mdl-32392957

RESUMO

Objective: To explore the value of nucleic acid detection methods in pharyngeal swabs in the etiological diagnosis of Mycoplasma pneumoniae (MP) infection in children. Methods: Four hundred and fifty-four (male 210, female 244) children with pneumonia in Department of Pulmonology, Children's Hospital of Zhejiang University School of Medicine were enrolled from July, 2018 to October, 2018. Pharyngeal swabs and venous blood were obtained on the first or the second day after hospitalization. Fluorescence detection quantitative amplification of DNA, thermostatic amplification of RNA, MP culture and MP-IgM were used to detect MP simultaneously. MP infection is diagnosed if MP culture is positive or the two of the other three methods are positive. Pharyngeal swabs were acquired and detected using fluorescence quantitative amplification of DNA, thermostatic amplification of RNA and MP culture again for children with confirmed MP infection before discharge. The detection rates and quantitative changes of the three methods were compared, and χ(2) test was used for comparison among groups. Results: A total of 454 hospitalized children with pneumonia were included in this study. The detection rates of fluorescence quantitative amplification of DNA, thermostatic amplification of RNA, MP culture and MP-IgM IgM were 43.6% (198/454), 43.2% (196/454), 40.0% (180/454) and 30.6% (139/454) respectively. The difference of detection rates of the four methods was statistically significant (χ(2)=20.8, P<0.05),but no significant difference between the detection rates of fluorescence quantitative amplification of DNA and thermostatic amplification of RNA was found (χ(2)=0.018, P=0.900). They both had higher detection rates than MP-IgM or MP culture. MP infection is diagnosed if MP culture is positive or the two of the other three methods are positive, and two hundred and nine children were diagnosed as MP infection. In the second test of MP infection in 209 children before discharge, the positive rate of MP culture was 67.5% (141/209), with 39.4% (13/33) changed from negative to positive, and 27.3% (48/176) changed from positive to negative. The positive rate of thermostatic amplification of RNA was 82.3% (172/209), with 16.2% (31/191) turned from positive to negative, and 66.7% (12/18) turned from negative to positive. The positive rate of fluorescence quantitative amplification of DNA was 67.0% (140/209), with 52.9% (18/34) cases changed from negative to positive, and 30.3% (53/175) cases changed from positive to negative. MP-DNA load decreased in 141 cases (67.5%) and increased in 68 cases (32.5%) in the second test among the positive samples tested by fluorescence quantitative amplification of DNA. The detection rates of the four methods in the non-severe group and the severe group were similar, and the differences among the groups were not statistically significant (all P>0.05). In the second test, the proportion of changing from negative to positive in the severe group was higher than that in the non-severe group, but only the difference in the thermostatic amplification of RNA was statistically significant (P=0.038) and the cases of changing from negative to positive of thermostatic amplification of RNA in the severe group and non-severe group are 7 and 5 respectively. Conclusions: The methods of pharyngeal swab nucleic acid detection have high sensitivity and application value in the etiological diagnosis of acute MP infection in children. The results of fluorescence quantitative amplification of DNA and thermostatic amplification of RNA are highly consistent, and they are both more advantageous than MP-IgM. Repeated testing in the acute phase is helpful to find MP infection children whose first test is negative. The load of MP-DNA did not decrease in some children in the acute stage after antibiotic treatment.


Assuntos
DNA Bacteriano/análise , Técnicas de Amplificação de Ácido Nucleico/métodos , Pneumonia por Mycoplasma/diagnóstico , Anticorpos Antibacterianos/sangue , Criança , Feminino , Hospitalização , Humanos , Imunoglobulina M/sangue , Masculino , Mycoplasma pneumoniae , Faringe/microbiologia , Sensibilidade e Especificidade
19.
Arch Dis Child ; 105(9): 891-895, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32269038

RESUMO

BACKGROUND: Acute chest syndromes (ACS) may be associated with upper respiratory tract infections, but the epidemiology of viral and intracellular respiratory pathogens in children with sickle cell disease (SCD) is not precisely known. The aim of this study was to describe the epidemiology of viral and intracellular respiratory pathogens in children with SCD presenting with fever and/or ACS. MATERIALS AND METHODS: An observational, prospective, single-centre cohort study with nested case-control analysis was conducted on children with SCD admitted from October 2016 to October 2017 for fever and/or ACS to the paediatric department of Robert Debré university hospital, Paris, France. They were screened for 20 respiratory pathogens by a multiplex PCR in the nasopharynx (FilmArray). RESULTS: We included 101 children. M/F sex ratio of 0.45. The median age was 3.2 years (IQR: 1.4-8.2). At least one pathogen was isolated in 67 patients (67%). The most frequent viruses were as follows: rhinovirus (n=33), adenovirus (n=14), respiratory syncytial virus (n=13) and parainfluenza viruses (n=11). Mycoplasma pneumoniae was detected in one case. Twenty-three (23%) presented with or developed ACS. A nested case-control analysis was performed, after pairing ACS with non-ACS children for age and inclusion period. There was no statistical association between any viral detection or multiple viral infection, and ACS (p=0.51) even though parainfluenza viruses were twice as common in ACS. CONCLUSIONS: Viral detection in febrile children with SCD is frequent, but its association with ACS was not demonstrated. In this study, M. pneumoniae was rare in young children with SCD experiencing ACS.


Assuntos
Síndrome Torácica Aguda/etiologia , Anemia Falciforme/complicações , Síndrome Torácica Aguda/microbiologia , Síndrome Torácica Aguda/virologia , Adenoviridae , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/etiologia , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase Multiplex , Mycoplasma pneumoniae , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/etiologia , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/etiologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/etiologia , Estudos Prospectivos , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/etiologia , Vírus Sinciciais Respiratórios , Rhinovirus
20.
BMC Infect Dis ; 20(1): 186, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111168

RESUMO

BACKGROUND: The presentation of clinical leptospirosis has been historically associated with animal workers, slaughterhouse workers and medical veterinarians. This association has shifted to be related to flooding events and outdoor activities; few cases are related to high-risk factors found in immunosuppressed patients. Scarcely a handful of cases have serological evidence of immune response against Leptospira serovar Bratislava representing serogroup Australis, a serovar associated with poor reproductive performance in swine and horses, and recently with cats. CASE PRESENTATION: Herein, we describe a rare clinical presentation of disseminated Leptospira infection in an immunosuppressed 65-year-old woman. She was admitted to the emergency room with fever, bacteraemia, bilateral uveitis and pulmonary involvement. The patient denied outdoor activities; she only had wide exposure to faeces and urine from cats living in her home. Her medical history included idiopathic thrombocytopenic purpura (ITP) diagnosed at the age of 18. She did not respond to medical treatment, and a splenectomy was performed. At age 60, she was diagnosed with Chronic Myeloid Leukemia (CML), and was treated with a tyrosine kinase inhibitor (TKI) -Imatinib. The patient voluntarily discontinued the treatment for the last 6 months. After extensive workup, no microorganisms were identified by the commonly used stains in microbiology. The diagnosis was performed through dark-field microscopy, microagglutination test (MAT), Leptospira genus-specific PCR, the IS1500 PCR for identification of pathogenic species, and 16S based sequencing for the genus identification. CONCLUSION: Immunosuppressed patients may acquire uncommon infections from ubiquitous microorganisms. In this case, serology evidence of exposure to Leptospira serovar Bratislava by MAT and the presence of the Leptospira genus were identified. It should be on mind for the diagnosis in otherwise healthy patients, and thoroughly search on splenectomised patients exposed to animals. Additionally, this report highlights the usefulness of PCR for diagnosis of this potentially life-threatening illness.


Assuntos
Bacteriemia/diagnóstico , Leptospirose/diagnóstico , Idoso , Bacteriemia/microbiologia , DNA Bacteriano/metabolismo , Feminino , Humanos , Hospedeiro Imunocomprometido , Leptospira/genética , Leptospira/isolamento & purificação , Leptospirose/microbiologia , Pneumonia por Mycoplasma/diagnóstico , Insuficiência Respiratória/diagnóstico , Esplenectomia , Tórax/diagnóstico por imagem , Uveíte/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...