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1.
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
2.
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
3.
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 , Síndrome do Desconforto Respiratório do Adulto/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 , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
4.
PLoS One ; 15(3): e0230338, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182283

RESUMO

The aim of this study was to evaluate the diagnostic performance of immunochromatographic tests (ICTs) for the detection of Mycoplasma pneumoniae. Medline/Pubmed, Embase, the Cochrane Library, and ISI Web of Science were searched through June 12, 2019 for relevant studies that used ICTs for the detection of M. pneumoniae infection with polymerase chain reaction (PCR) or microbial culturing as reference standards. Pooled diagnostic accuracy with 95% confidence interval (CI) was calculated using a bivariate random effects model. We also constructed summary receiver operating characteristic curves and calculated the area under the curve (AUC). Statistical heterogeneity was evaluated by χ2 test or Cochrane's Q test. Thirteen studies including 2,235 samples were included in the meta-analysis. The pooled sensitivity and specificity for diagnosing M. pneumoniae infection were 0.70 (95% CI: 0.59-0.79) and 0.92 (95% CI: 0.87-0.95), respectively. The positive likelihood ratio (LR) was 8.94 (95% CI: 4.90-14.80), negative LR 0.33 (95% CI: 0.22-0.46), diagnostic odds ratio 29.20 (95% CI: 10.70-64.20), and AUC 0.904. In subgroup analysis, ICTs demonstrated similar pooled sensitivities and specificities in populations of children only and mixed populations (children + adults). Specimens obtained from oropharyngeal swabs exhibited a higher sensitivity and specificity than those of nasopharyngeal swab. Moreover, pooled estimates of sensitivity and accuracy for studies using PCR as a reference standard were higher than those using culture. The pooled sensitivity and specificity of Ribotest Mycoplasma®, the commercial kit most commonly used in the included studies, were 0.66 and 0.89, respectively. Overall, ICT is a rapid user-friendly method for diagnosing M. pneumoniae infection with moderate sensitivity, high specificity, and high accuracy. This suggests that ICT may be useful in the diagnostic workup of M. pneumoniae infection; however, additional studies are needed for evaluating the potential impact of ICT in clinical practice.


Assuntos
Cromatografia de Afinidade/normas , Testes Diagnósticos de Rotina/normas , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Adulto , Criança , Testes Diagnósticos de Rotina/métodos , Humanos , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/normas , Mycoplasma pneumoniae/imunologia , Orofaringe/microbiologia , Pneumonia por Mycoplasma/imunologia , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase/normas , Curva ROC , Padrões de Referência
5.
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
6.
BMC Infect Dis ; 20(1): 205, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143599

RESUMO

BACKGROUND: The occurrence of segmental/lobar pattern pneumonia (S/L-PP) in children has recently increased. The pathogens of the disease may change for the misuse of antibiotics and the application of vaccines. Therefore, pathogens positive in hospitalized children with S/L-PP and their association with clinical characteristics may have changed. The aim of this study was to analyze the pathogens positive in hospitalized children with S/L-PP and their association with clinical characteristics. METHOD: The current study analyzed the epidemiological and clinical characteristics of pathogens positive in children with S/L-PP under 14 years old at a single hospital between 1st Jan 2014 and 31st Dec 2018 retrospectively. The pathogens were detected by microbial cultivation, indirect immunofluorescence of the kit (PNEUMOSLIDE IgM), Elisa, and/or real-time PCR in the samples of the patients. RESULTS: A total of 593 children with S/L-PP received treatment at a single hospital during the study period by inclusion criteria. Four hundred fifty-one patients were single positive for one pathogen and 83 patients were positive for at least 2 pathogens. Mycoplasma pneumoniae (M.pneumoniae) (72.34%) was the most commonly detected pathogen, followed by Streptococcus pneumoniae (S.pneumoniae) (8.77%). The prevalence of M.pneumoniae in children with S/L-PP increased with time (p < 0.05). The positive rate of M.pneumoniae increased with ages of patients (p < 0.05). M.pneumoniae was statistically associated with the extrapulmonary manifestations while S.pneumoniae was statistically associated with abnormal white blood cells (WBCs) and C reactive proteins (CRPs) (p < 0.05). CONCLUSION: M.pneumoniae was the most positive pathogen in children with S/L-PP. The positive rate of M.pneumoniae in children with S/L-PP increased with time and the ages of children. M.pneumoniae was associated with extrapulmonary manifestations while S.pneumoniae was associated with abnormal WBCs and CRPs.


Assuntos
Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Pneumonia Pneumocócica/diagnóstico , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Proteína C-Reativa/análise , Criança , Criança Hospitalizada , Pré-Escolar , Feminino , Humanos , Lactente , Leucócitos/citologia , Masculino , Pneumonia por Mycoplasma/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Prevalência , Estudos Retrospectivos , Estações do Ano
7.
Zhonghua Er Ke Za Zhi ; 58(1): 25-29, 2020 Jan 02.
Artigo em Chinês | MEDLINE | ID: mdl-31905472

RESUMO

Objective: To improve the diagnosis and therapy of childhood pulmonary thromboembolism (PTE) by analyzing the clinical features of this rare condition. Methods: A total of 8 pediatric patients (4 males, 4 females) with PTE diagnosed in the Children's Hospital of Zhejiang University School of Medicine from March, 2014 to March, 2019 were enrolled. The clinical manifestation, laboratory results, imaging findings, diagnosis and treatment were summarized. Results: Among these 8 cases, aged from 9 hours to 14 years and 10 months. Fever was found in 4 cases, cough aggravation in 4, short of breath in 3, chest pain in 2, abdominal and back pain in one, hemoptysis in 2, cyanosis in 1, and edema of lower extremities in 2. Physical examination found decreased breath sound in 2 cases, phlegm rale in 3, and pleural friction rub in one. Pleural effusion was found in 5 cases by ultrasound. Plasma D-dimer increased in 6 cases (0.66-9.96 mg/L) and hypersensitive C-reactive protein elevated in 5 cases (10.78-78.00 mg/L). Chest enhanced CT showed pulmonary artery or venous filling defects, including pulmonary artery embolism in 7 cases and pulmonary vein embolism in one. The primary disease of these patients included Mycoplasma Pneumoniae pneumonia in 4 cases, nephritis in 2 and postoperative congenital heart disease in 2. Apart from one case who withdrew the treatment and was discharged, the other 7 patients received anticoagulant treatment had good outcome. Conclusions: For children with Mycoplasma pneumoniae pneumonia, immune disorders, long-term hormone therapy, cardiovascular invasive operation or other high-risk factors, PTE should be considered when fever, cough aggravation, short of breath, chest and back pain with pleural effusion are present. Chest enhanced CT scan should be performed as soon as possible, and anticoagulation should be started once the diagnosis is confirmed.


Assuntos
Pneumonia por Mycoplasma/complicações , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Adolescente , Dor no Peito/diagnóstico por imagem , Criança , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Masculino , Derrame Pleural , Pneumonia por Mycoplasma/diagnóstico , Embolia Pulmonar/complicações , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
BMC Infect Dis ; 19(1): 1045, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823740

RESUMO

BACKGROUND: An increased number of refractory mycoplasma pneumoniae (MP) pneumonia (MPP) cases have been reported. However the duration of MP infection in lower airway and the course of anti-MP treatment remains unclear. METHODS: We retrospectively reviewed the medical records of 94 MPP children. Patients were classified into two groups. The long-term group (Group LT) was defined as bronchoalveolar lavage fluid (BALF) remained MP-positive by PCR after 30 days of the disease course. The non-long-term group (Group NLT) was defined as BALF became MP-negative by PCR within 30 days of disease and patients who only needed one bronchoscopy lavage therapy. MP loads, clinical outcomes were analyzed along with other clinical measurements. RESULTS: The average levels of inflammatory markers such as C reactive protein and lactate dehydrogenase in Group LT were significantly higher than those in Group NLT. Airway and lung damage in Group LT were more severe than Group NLT. 28 patients developed necrotizing pneumonia and 8 patients developed pulmonary embolism in Group LT. Mean maximum MP loads in BALF were 107.46 ± 0.93 and 104.86 ± 0.93 in Groups LT and NLT, respectively. There was persistent MP DNA in Group LT, even lasted for 120 days. One severe MPP patient in Group LT had MP-associated bloodstream infection. After 3 months of follow-up, chest imaging revealed incomplete absorption of pulmonary consolidation in 33 patients of Group LT [including 13 airway obliterans (AO) patients] and in 7 patients of Group NLT (including 2 AO patients). CONCLUSION: MP loads of BALF were associated with the subsequent duration of MP DNA in lower airway. High MP loads and persistent long-term MP DNA in lower airway were associated with severity of pediatric MPP.


Assuntos
DNA Bacteriano/metabolismo , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Líquido da Lavagem Broncoalveolar/microbiologia , Broncoscopia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Pulmão/microbiologia , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença
9.
BMC Infect Dis ; 19(1): 966, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718584

RESUMO

BACKGROUND: Among pediatric patients hospitalized for Mycoplasma pneumoniae pneumonia (MPP), the risk factors for 90-day readmission after discharge is undefined. METHODS: We conducted a retrospective observational study of patients <14 years of age who were discharged with a diagnosis of MPP between January 2016 and February 2017. We collected clinical, laboratory and radiographic variables at the time of initial admission. We assessed pneumonia-related readmission within 90-day after discharge. Risk factors independently associated with rehospitalization were identified using multiple logistic regression models. RESULTS: Of the 424 MPP hospitalizations, 48 (11.3%) were readmitted within 90 days and were mainly diagnosed with pneumonia. Patients with younger age or coinfection with influenza A were more likely to be readmitted. In addition, compared with children without readmission, the readmission ones showed different clinical and laboratory characteristics at the index hospital admission. Multiple logistic regression analysis identified age (OR 0.815, 95%CI 0.706-0.940) and body temperature (OR 0.659, 95%CI 0.518-0.839) were significantly associated with lower risk of 90-day readmission. Coinfection with influenza was independently associated with a greater likelihood of 90-day readmission (OR 4.746, 95%CI 1.191-18.913). CONCLUSIONS: Readmission after MPP are common and is related to patients' age, body temperature and influenza A coinfection during initial hospital stay, indicating potential targets could be noticed to reduce the rehospitalization after pediatric MPP.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Pneumonia por Mycoplasma/diagnóstico , Adolescente , Fatores Etários , Idoso , Criança , Pré-Escolar , Coinfecção/diagnóstico , Coinfecção/microbiologia , Coinfecção/virologia , DNA Bacteriano/metabolismo , Feminino , Humanos , Lactente , Influenza Humana/diagnóstico , Modelos Logísticos , Masculino , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/isolamento & purificação , Alta do Paciente , Pneumonia por Mycoplasma/patologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
10.
Pediatr Infect Dis J ; 38(10): 1015-1019, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568140

RESUMO

BACKGROUND: The use of bacterial multiplex polymerase chain reaction (PCR) in children with suspected pertussis sometimes yields unexpected positive results for Mycoplasma pneumoniae. We aimed to evaluate the clinical significance of positive M. pneumoniae results in this population. METHODS: Retrospective cohort of consecutive patients with suspected pertussis tested with a bacterial multiplex PCR (including Bordetella pertussis and M. pneumoniae) between June 2015 and March 2017. Medical records were reviewed to compare demographics, clinical presentations and outcomes of patients positive for M. pneumoniae with those positive for B. pertussis and those with negative results, using multivariable logistic regression. RESULTS: A total of 1244 patients were included as follows: 56 (4.5%) with M. pneumoniae, 116 (9.3%) with B. pertussis and 1029 (82.7%) with negative results. Mean age was respectively 4.8 years, 6.5 years and 2.8 years (P < 0.05). Children with M. pneumoniae were less likely to present with cardinal symptoms of pertussis such as paroxysmal cough [adjusted odds ratio (OR): 0.19, 95% confidence interval (CI): 0.08-0.40) but were more likely to have fever (adjusted OR: 10.53, 95% CI: 3.54-39.49) and other nonspecific respiratory symptoms compared with children with B. pertussis. Children with M. pneumoniae had very similar clinical presentations to those with a negative PCR, but were more likely to have radiologically confirmed pneumonia (adjusted OR: 5.48, 95% CI: 2.96-9.99) and were less likely to be diagnosed with a concomitant viral infection (adjusted OR: 0.32, 95% CI: 0.07-0.99). CONCLUSIONS: In children with suspected pertussis, the detection of M. pneumoniae is clinically relevant. However, the impact of this finding on patients' outcome is still unclear.


Assuntos
Bordetella pertussis/isolamento & purificação , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/complicações , Coqueluche/complicações , Adolescente , Animais , Bordetella pertussis/genética , Criança , Pré-Escolar , Coinfecção/diagnóstico , Feminino , Humanos , Lactente , Masculino , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Estudos Retrospectivos , Coqueluche/diagnóstico
11.
BMC Infect Dis ; 19(1): 835, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601192

RESUMO

BACKGROUND: Increasing number of hospitalized children with community acquired pneumonia (CAP) is co-detected with Mycoplasma pneumoniae (Mp). The clinical characteristics and impact of Mp co-detected with other bacterial and/or viral pathogens remain poorly understood. The purpose of this study was to evaluate the demographic and clinical features of CAP children with Mp mono-detection and Mp co-detection. METHODS: A total of 4148 hospitalized children with CAP were recruited from January to December 2017 at the Children's Hospital of Hebei Province, affiliated to Hebei Medical University. A variety of respiratory viruses, bacteria and Mp were detected using multiple modalities. The demographic and clinical features of CAP children with Mp mono-detection and Mp co-detection were recorded and analyzed. RESULTS: Among the 110 CAP children with Mp positive, 42 (38.18%) of them were co-detected with at least one other pathogen. Co-detection was more common among children aged ≤3 years. No significant differences were found in most clinical symptoms, complications, underlying conditions and disease severity parameters among various etiological groups, with the following exceptions. First, prolonged duration of fever, lack of appetite and runny nose were more prevalent among CAP children with Mp-virus co-detection. Second, Mp-virus (excluding HRV) co-detected patients were more likely to present with prolonged duration of fever. Third, patients co-detected with Mp-bacteria were more likely to have abnormal blood gases. Additionally, CAP children with Mp-HRV co-detection were significantly more likely to report severe runny nose compared to those with Mp mono-detection. CONCLUSION: Mp co-detection with viral and/or bacterial pathogens is common in clinical practice. However, there are no apparent differences between Mp mono-detection and Mp co-detections in terms of clinical features and disease severity.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Bactérias/isolamento & purificação , Líquido da Lavagem Broncoalveolar/microbiologia , Criança , Criança Hospitalizada , Pré-Escolar , Infecções Comunitárias Adquiridas/microbiologia , DNA Bacteriano/metabolismo , Feminino , Humanos , Lactente , Masculino , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/microbiologia , Prevalência , Estudos Prospectivos , Vírus/isolamento & purificação
12.
Pediatr Dermatol ; 36(6): 929-931, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31576583

RESUMO

We present two pediatric cases of recurrent mucositis associated with influenza B infection, both in patients with prior episodes of Stevens-Johnson syndrome (SJS) due to Mycoplasma. Influenza B is an uncommon cause of both rash and mucosistis and SJS.


Assuntos
Exantema/virologia , Influenza Humana/diagnóstico , Mucosite/virologia , Pneumonia por Mycoplasma/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Adolescente , Conjuntivite Viral/virologia , Feminino , Humanos , Imunoglobulina M/sangue , Vírus da Influenza B/isolamento & purificação , Masculino , Mycoplasma pneumoniae/imunologia
13.
Am J Respir Crit Care Med ; 200(7): e45-e67, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573350

RESUMO

Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/tratamento farmacológico , Adulto , Assistência Ambulatorial , Antígenos de Bactérias/urina , Hemocultura , Infecções por Chlamydophila/diagnóstico , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/metabolismo , Técnicas de Cultura , Quimioterapia Combinada , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Infecções por Haemophilus/metabolismo , Hospitalização , Humanos , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Legionelose/metabolismo , Macrolídeos/uso terapêutico , Infecções por Moraxellaceae/diagnóstico , Infecções por Moraxellaceae/tratamento farmacológico , Infecções por Moraxellaceae/metabolismo , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/metabolismo , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/metabolismo , Pneumonia Estafilocócica/diagnóstico , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/metabolismo , Radiografia Torácica , Índice de Gravidade de Doença , Escarro , Estados Unidos , beta-Lactamas/uso terapêutico
14.
Respir Res ; 20(1): 193, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443650

RESUMO

BACKGROUND: It is unclear whether the responses of refractory and common Mycoplasma pneumoniae (MP) pneumonia to macrolides differ. Hence, this study aimed to identify biomarkers that may be used to distinguish refractory and common pneumonias caused by MP in children at hospital admission. METHODS: The study included 123 children divided into five groups according to infection agent and treatment protocol: Group I included those with MP infection without documented viral infection, treated with only macrolides; Group II included those with MP infection without documented viral infection, treated with a combination of macrolides and methylprednisolone; Group III included those with MP infection and documented viral infection, treated with only macrolides; Group IV included those with viral pneumonia without documented MP infection; Group V was the control group composed of admitted children without MP or a documented viral infection. These five groups were further subdivided into Groups A (including Groups I, III, IV, and V) and B (Group II) according to the responses to macrolide treatment. Concentrations of cytokines interleukin 6, interleukin 17, interleukin 18, and tumor necrosis factor-α, and lactate dehydrogenase, and ferritin of all children were evaluated, and these levels were compared among the groups. Statistical comparisons were made using Kruskal Wallis test and Mann-Whitney U test. RESULTS: Serum lactate dehydrogenase, interleukin 18, and ferritin concentrations were significantly higher in Group II than in Groups I, III, IV, and V and were significantly higher in Group B than in Group A. When the serum lactate dehydrogenase concentration was 350 IU/L or higher, the sensitivity and specificity for diagnosing refractory MP pneumonia were 73 and 80%, respectively. When the interleukin 18 level was 360 pg/mL or higher, the sensitivity and specificity for diagnosing refractory MP pneumonia were 93 and 70%, respectively. When the ferritin level was 230 pg/mL or higher, the sensitivity and specificity for diagnosing refractory MP pneumonia were 67 and 67%, respectively. CONCLUSION: These results suggest that serum lactate dehydrogenase, interleukin 18, and ferritin constitute the critical combination of biomarkers useful for predicting refractory MP pneumonia in children at hospital admission.


Assuntos
Biomarcadores/análise , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Ferritinas/sangue , Hospitalização , Humanos , Lactente , Interleucina-18/sangue , L-Lactato Desidrogenase/sangue , Masculino , Metilprednisolona/uso terapêutico , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia Viral/diagnóstico , Valor Preditivo dos Testes , Valores de Referência
15.
Zhonghua Er Ke Za Zhi ; 57(8): 625-630, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352749

RESUMO

Objective: To compare the characteristics of Mycoplasma pneumoniae necrotizing pneumonia (MPNP) and bacterial necrotizing pneumonia (BNP), and explore the biomarkers for differentiation of MPNP from BNP. Methods: A retrospective, observational study of 52 necrotizing pneumonia (NP) cases who were hospitalized in our hospital from January 2008 to December 2017 was conducted. According to the pathogen causing NP, patients were divided into two groups, BNP and MPNP, and the clinical manifestations, laboratory data, imaging findings, hospital course and prognosis between these groups were analyzed. Results: This study enrolled 19 boys and 33 girls, and the median ages of patients were 4.4 (0.1-13.8) years old. Of the totally of 52 NP patients, 19 were in the BNP group (9 boys and 10 girls), 33 were in the MPNP group (10 boys and 23 girls). The mean age of MPNP patients was much older than that of BNP patients (5.2 (2.3-13.2) years vs. 1.8 (0.1-13.8) years, Z=-0.128, P<0.01). The number of patients with tachypnea and pleural effusion septation were significantly higher in BNP patients than those in MPNP patients (15 cases vs. 4 cases, χ(2)=23.222, P<0.01; 14 cases vs. 1 case, χ(2)=29.326, P<0.01), which more needed to oxygentherapy (18 cases vs. 12 cases, χ(2)=16.833, P<0.01) and undergo chest drainage (9 cases vs. 4 cases, χ(2)=5.829, P=0.022); while the number of patients required bronchoalveolar lavage was higher in MPNP patients than that in BNP patients (5 cases vs. 32 cases, χ(2)=29.326, P<0.01). The values of white blood cell (WBC) (23.2 (5.2-67.1)×10(9)/L vs. 9.7 (6.3-18.7)×10(9)/L, Z=-4.855, P<0.01), procalcitonin (PCT) (3.69 (0.23-90.15) mg/L vs. 0.28 (0.02-1.44) mg/L, Z=-3.207, P=0.001), C reactive protein (CRP) (160 (94-220) mg/L vs. 90 (5-134) mg/L, Z=-4.337, P<0.01), interleukin (IL)-10 (11.7 (4.2-401.5) ng/L vs. 4.8 (2.0-23.4) ng/L, Z=-2.278, P=0.023), pleural fluid cell count (5 200 (120-50 000)×10(6)/L vs. 790 (68-6 920)×10(6)/L, Z=-3.125, P=0.002), pleural fluid lactic dehydrogenase (LDH) (3 990 (589-29 382) U/L vs. 2 211 (673-3 993) U/L, Z=-2.488, P=0.013) in BNP group were significantly higher than those in MPNP group; while the values of pleural fluid glucose(0.43 (0.03-18.00) mmol/L vs. 5.95 (4.27-7.87) mmol/L, Z=-2.795, P=0.005), serum tumor necrosis factor (TNF)-α (2.3 (1.0-2.8) ng/L vs. 2.6 (1.3-109.2) ng/L, Z=-2.113, P=0.035) and interferon (IFN)-γ (4.8 (2.6-7.7) ng/L vs. 11.9 (2.9-154.6) ng/L, Z=-2.455, P=0.014) were lower in BNP group than those in MPNP group. Meanwhile, the mean time from the onset of symptoms to the discovery of necrotic lesions was longer in MPNP group than that in BNP group ((20.6±6.4) days vs. (14.6±6.2) days, t=3.029, P=0.004). After treatments, all patients were discharged without death, WBC and PCT recovered more quickly in MPNP group than those in BNP group (12 (0-24) days vs. 0 (0-23) days, Z=-4.484, P<0.01; 10 (5-15) days vs. 0 (0-23) days, Z=-3.244, P=0.001). As to prognosis, 34 cases were followed up, and the results showed that patients recovered without surgical intervention, and chest lesions were resolved within 3.0 (1.0-8.0) months, and the time to necrosis disappearance was similar in the BNP group and MPNP greup (3.0 (1.0-8.0) months vs. 3.0 (1.0-8.0) months, Z=-0.128, P=0.001). In receiver operator characteristic curve analysis, the cut-off values for the age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose were set at 2.4 years of age, 17.2×10(9)/L, 157 mg/L, 1.505 mg/L, 2 630×10(6)/L and 3.73 mmol/L, respectively. Conclusions: NP is found to be severe and prolonged, yet, reversible through proper therapy, such as rational antibiotics application. The age, WBC, CRP, PCT, pleural fluid cell count and pleural fluid glucose could be used as biomarkers to differentiate MPNP from BNP in children.


Assuntos
Mycoplasma pneumoniae , Necrose/patologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia Necrosante/diagnóstico , Adolescente , Antibacterianos/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pneumonia por Mycoplasma/microbiologia , Pneumonia Necrosante/microbiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
16.
BMC Infect Dis ; 19(1): 616, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299916

RESUMO

BACKGROUND: The point mutations in 23S rRNA gene of Mycoplasma pneumoniae (M. pneumoniae) can lead to high-level resistance to macrolides. This study aimed to evaluate allele-specific real-time PCR (ASPCR) to detect the resistance-related mutations located at positions A2063G and A2064G of 23S rRNA gene. METHODS: We detected 178 pharyngeal swab specimens and calculated the proportions of resistant and sensitive quasispecies using ASPCR assays. ASPCR assays can detect down to 10 copies of 23S rRNA gene and achieved sensitivities of < 0.1% for A2063G and A2064G. We also compared the findings of ASPCR with the results of nested PCR with sequencing. RESULTS: Of 178 samples, 164 were found to have M. pneumoniae including 90.85% (149/164) samples with macrolide-resistant M. pneumoniae (MRMP) quasispecies by ASPCR, while 153 were found to be M. pneumoniae-positive including 71.90% (110/153) samples with MRMP quasispecies by nested PCR with sequencing. Of the 164 M. pneumoniae-positive samples, 61.59% (101/164) had the mixed population of wild-type and mutant M. pneumoniae, and 56.44% (57/101) of the latter contained the mutations at low frequency (≤50%). CONCLUSION: ASPCR indicated that sensitive and resistant quasispecies coexisted in most of the M. pneumoniae positive samples. The ASPCR was a highly sensitive, accurate and rapid method for detecting the macrolide resistance-associated mutations and it could provide earlier and more drug-resistant information for M. pneumoniae research and the clinical therapy.


Assuntos
Farmacorresistência Bacteriana/genética , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , RNA Ribossômico 23S/metabolismo , Reação em Cadeia da Polimerase em Tempo Real/métodos , Antibacterianos/uso terapêutico , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Feminino , Humanos , Macrolídeos/uso terapêutico , Mycoplasma pneumoniae/isolamento & purificação , Faringe/microbiologia , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologia , Mutação Puntual , RNA Ribossômico 23S/genética , Reprodutibilidade dos Testes
18.
J Infect Chemother ; 25(12): 1007-1011, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31227380

RESUMO

Using the hospital records, we retrospectively assessed whether urinary ß2 microglobulin/creatinine ratio (UBCR) and lactate dehydrogenase (LD) values could be used to estimate the severity of Mycoplasma pneumoniae-associated lower respiratory tract infection (MP-LRTI). We studied 48 patients with MP-LRTI (median age, 7.5 years; range, 3-14 years) admitted to Kagoshima City Hospital and examined the relationships of the UBCR or LD values with fever and pulmonary tissue damage (hypoxemia and severity assessments on chest radiographs). Patients were assigned to four groups based on whether they had fever and/or hypoxemia. Patients with high fever showed significantly higher UBCR values than those without (P < 0.05), whereas those with hypoxemia showed higher LD values than those without (P = 0.001). The maximum body temperature on admission was closely associated with the UBCR but not with LD levels. In chest radiography assessments, LD levels were significantly higher in patients with severe than mild or moderate MP-LRTI. A cut-off LD level of 530 IU/L showed a very high sensitivity (100%) and specificity (93%). Although UBCR values were higher in patients with severe MP-LRTI, the differences were not statistically significant. Our study shows that the UBCR is associated with body temperature, whereas LD levels may serve as an index of pulmonary tissue damage in children with MP-LRTI.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Hipóxia/diagnóstico , L-Lactato Desidrogenase/sangue , Pneumonia por Mycoplasma/diagnóstico , Microglobulina beta-2/urina , Adolescente , Biomarcadores/sangue , Biomarcadores/urina , Temperatura Corporal , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/urina , Creatinina/urina , Feminino , Humanos , Hipóxia/microbiologia , Hipóxia/urina , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/microbiologia , Pneumonia por Mycoplasma/urina , Radiografia , Estudos Retrospectivos
19.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(2): 203-207, 2019 Apr 28.
Artigo em Chinês | MEDLINE | ID: mdl-31060675

RESUMO

Objective To explore the clinical value of one-step visualization loop-mediated isothermal amplification(LAMP)in the detection of Mycoplasma pneumoniae(Mp). Methods One-step visualized LAMP,polymerase chain reaction(PCR),and enzyme-linked immunosorbent assay(ELISA)were used to simultaneously detect 108 clinical Mp specimens in children,which included 73 cases of Mp infection diagnosed by PCR and 35 cases of other chronic/acute respiratory tract infections.On the first day of admission,one-step visualization LAMP,PCR(fluorimetric method),and ELISA were used to test the throat swab and serum sample obtained from the same patient,and the Kappa value was calculated.The consistence between LAMP and PCR and that between LAMP and ELISA were compared.On the fifth day of admission,40 patients were resampled and the findings of these three tests on the first day and on the fifth day were compared. Results One-step visualization LAMP had a sensitivity of 100% and a specificity of 94.3%,whereas ELISA had a sensitivity of 65.8% and a specificity of 82.9%.The ratio of Kappa camparing one-step visualization LAMP and PCR was 0.956 and the ratio of Kappa camparing one-step visualization LAMP and ELISA was 0.38.The number of positive specimens detected by LAMP was higher than that by ELISA on the first day. Conclusions One-step visualization LAMP has excellent sensitivity and specificity in detecting early acute Mp infection.It has high consistency with PCR and can be applied to detect Mp.


Assuntos
Mycoplasma pneumoniae/isolamento & purificação , Técnicas de Amplificação de Ácido Nucleico , Pneumonia por Mycoplasma/diagnóstico , Criança , Ensaio de Imunoadsorção Enzimática , Humanos , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade
20.
Ital J Pediatr ; 45(1): 61, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088519

RESUMO

BACKGROUND: Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. Recent studies demonstrated that the incidence of severe or fatal M. pneumoniae was gradually increasing, which may be related to the excessive inflammation. However, the exact pathogenesis of excessive inflammation in Mycoplasma pneumoniae pneumonia(MPP) is still unclear. This study aimed to reveal the role of miR-29c/B7-H3/Th17 axis in children with MPP. METHODS: Children hospitalized in Respiratory Department during Jan. 2014 to Dec. 2015 were enrolled. All children enrolled was confirmed with MP infection using real-time PCR and ELISA. Children were excluded if they were co-infected with other pathogens. A total of 52 children with MPP and 26 controls were enrolled. miR-29c expression in monocytes of children with MPP was determined by real-time PCR and soluble B7-H3 (sB7-H3) and IL-17 were determined by ELISA, and explore their clinical significance. miR-29c overexpression and silencing technology and luciferase reporter assay were performed to confirm whether B7-H3 is the direct target of miR-29c. The levels of transcription factor ROR-γt in CD4+ T cells and cytokine IL-17A in supernatant were detected after stimulated by different concentrations of B7-H3 fusion protein in vitro. RESULTS: Of all 52 children with MPP, the mean age of the children were 77 ± 33 months, and 23 cases were male accounting for 44.2%. Nineteen cases had pleural effusion accounting for 36.5%. Children with MPP had significantly lower level of miR-29c and higher level of sB7-H3 and IL-17 compared to controls (both P < 0.05). The level of miR-29c significantly increased during convalescent phase compared to that of acute phase while sB7-H3 and IL-17 significantly decreased during convalescent phase (both P < 0.05). There was a positive correlation between the level of sB7-H3 and IL-17 in children with MPP during acute-stage (r = 0.361,P = 0.009). Children with MPP combined with pleural effusion had significantly higher level of sB7-H3 compared to those without pleural effusion (9952.3 ± 3065.3 vs. 7449.7 ± 2231.5, pg/ml), and the levels of sB7-H3 was positively correlated with the number of days of fever. The level of miR-29c was negatively correlated with M. pneumoniae specific IgG, IgM level. High concentrations of B7-H3(15µg/ml) could enhance ROR-γt expression and increase IL-17A. Functional studies based on luciferase reporter assay and immunofluorescence staining suggested that B7-H3 is the direct target of miR-29c, and miR-29c silencing or overexpression could up- or down-regulate the expression of B7-H3 in THP-1 cells. CONCLUSIONS: The axis of miR-29c/B7-H3/Th17 plays a vital role in children with MPP through excessive inflammation. miR-29c and B7-H3 may be the new target for the prevention and treatment of MPP, and may be the novel and potential biomarkers for the assessment of prognosis.


Assuntos
Antígenos B7/metabolismo , Interleucina-17/metabolismo , MicroRNAs/metabolismo , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/metabolismo , Estudos de Casos e Controles , Pré-Escolar , Infecções Comunitárias Adquiridas , Feminino , Humanos , Lactente , Masculino , Pneumonia por Mycoplasma/etiologia
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