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1.
Medicine (Baltimore) ; 100(11): e24894, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725960

RESUMO

OBJECTIVES: Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of RMPP to provide suggestions on prevention and controlling for children. METHODS: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. RESULTS: We conducted a meta-analysis of 15 separate studies. Fever for more than 10 days (odds ratio [OR] 3.965, 95% confidence interval [CI] 2.109-7.456), pleural effusion (OR 6.922, 95% CI 2.058-23.282), extra-pulmonary complications (OR 17.762, 95% CI 11.146-28.305), pulmonary X-ray consolidation ≥2/3 (OR 8.245, 95% CI 1.990-34.153), CRP >40 mg/L (OR 4.975, 95% CI 2.116-11.697) were significantly related to the risk of RMPP. We did not find an association between male sex (OR 0.808, 95% CI 0.548-1.189), LDH >410IU/L (OR 1.033, 95% CI 0.979-1.091) and the risk of RMPP. CONCLUSIONS: Fever for more than 10 days, pleural effusion, extra-pulmonary complications, pulmonary X-ray consolidation≥ 2/3 and CRP >40 mg/L are risk factors for early evaluation of RMPP.


Assuntos
Mycoplasma pneumoniae , Pneumonia por Mycoplasma/etiologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana , Feminino , Febre/microbiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Derrame Pleural/microbiologia , Pneumonia por Mycoplasma/microbiologia , Radiografia , Medição de Risco , Fatores de Risco
2.
Medicine (Baltimore) ; 100(5): e23786, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592835

RESUMO

ABSTRACT: Community acquired-pneumonia (CAP) has varying causative pathogens and clinical characteristics. This study investigated the prevalence of Mycoplasma pneumoniae (M pneumoniae) and evaluated the clinical characteristics in infected hospitalized children by disease severity.From throat swabs of hospitalized children (5 months to 14 years) with CAP collected between November 2017 and May 2018, M pneumoniae and other CAP pathogens were identified using polymerase chain reaction (PCR). Differences in clinical and laboratory test data were compared between severe and mild case groups.Of 333 hospitalized children enrolled, 221/333 (66.4%) tested positive for M pneumoniae and 24/221 (10.9%) patients were (n = 9, aged <5 years vs n = 15, ≥5 years) single infection by PCR, however, only 170/333 (51.1%) patients were presented with M pneumoniae IgM-positive. M pneumoniae detection rate by PCR was higher than by immunoglobulin (IgM) serology. In 123/221 (55.7%) M pneumoniae infected patients, coinfection with bacterial pathogens (n = 61, <5 years vs n = 62, ≥5 years) occurred. Children (aged 3-8 years) had most M pneumoniae infection. Severe M pneumoniae pneumonia (MPP) in children occurred mostly in older age (7 [interquartile ranges {IQR}, 6-8] years; P < .0001), with longer cough days (14 [IQR, 10-19.5] days; P = .002) and hospitalization duration (9.5 [IQR, 7-12.3] days; P < .0001), lower lymphocyte ratio (24.1, [IQR, 20.0-31.1] %; P = .001), higher neutrophils ratio (66.0, [IQR, 60.2-70.3]%; P < .0001), and serum C-reactive protein (CRP) level (3.8, [IQR, 1.3-10.9] mg/L; P = .027).M pneumoniae is the most commonly detected pathogen in CAP. High coinfection prevalence increases diagnosis difficulty by clinically nonspecific characteristics. M pneumoniae detection by PCR with IgM may improve precise and reliable diagnosis of community-acquired MPP.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Infecções Comunitárias Adquiridas/epidemiologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/epidemiologia , Adolescente , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Criança , Pré-Escolar , China/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Lactente , Masculino , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase , Prevalência
3.
Medicine (Baltimore) ; 100(5): e24297, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592875

RESUMO

RATIONALE: Cardiac thrombus and stroke are rare complications in Mycoplasma pneumoniae infection, which is a common cause of community-acquired pneumonia in children. Early detection and prevention of thrombus in children with M pneumoniae pneumonia is relatively difficult. PATIENT CONCERNS: A 5-year-old boy with severe M pneumoniae pneumonia was referred to our center. During the treatment with sufficient antibiotics, an echocardiography surprisingly revealed a thrombus in the left atrium, with significant changes in D-dimer level and anti-phospholipid antibodies. At day 12 after admission, the patient showed impaired consciousness, aphasia, and reduced limb muscle power. Magnetic resonance angiography (MRA) showed right middle cerebral artery infarction. DIAGNOSES: Cardiac thrombus and stroke associated with M pneumoniae pneumonia. INTERVENTIONS: He was started on aggressive antibiotic therapy and urokinase thrombolytic therapy for 24 hours, continued with low molecular heparin calcium and aspirin along with rehabilitation training. OUTCOMES: On follow up, the D-dimer decreased slowly and echocardiograms showed a steadily decreasing size of thrombus with eventual disappearance at day 22 after admission. His left limb muscle power was improved after rehabilitation for 2 months. LESSONS: Early diagnosis and treatment with multiple modalities maybe useful for improving prognosis of cardiac thrombus and stroke in M pneumoniae pneumonia. Changes in D-dimer level and anti-phospholipid antibodies should be routinely monitored in severe M pneumoniae pneumonia.


Assuntos
Cardiopatias/microbiologia , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/microbiologia , Acidente Vascular Cerebral/microbiologia , Trombose/microbiologia , Antibacterianos/uso terapêutico , Anticorpos Antifosfolipídeos/sangue , Pré-Escolar , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Cardiopatias/sangue , Cardiopatias/tratamento farmacológico , Humanos , Masculino , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/tratamento farmacológico , Prognóstico , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/tratamento farmacológico , Trombose/sangue , Trombose/tratamento farmacológico
4.
Medicine (Baltimore) ; 100(2): e24316, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466220

RESUMO

INTRODUCTION: Mycoplasma pneumoniae (MP) infection in infants is usually overlooked and it might result in important complications if left untreated. MP-induced arthritis is probably the least common extrapulmonary manifestation and frequently leads to delays in the diagnosis. PATIENT CONCERNS: We report the case of a 2-year-old female child admitted in our clinic for prolonged fever (onset 2 weeks before the admission), for which the general practitioner established the diagnosis of acute pharyngitis and recommended antibiotics. But the fever persisted and the patient was referred to a pediatrician. DIAGNOSIS: The laboratory tests revealed leukocytosis with neutrophilia, elevated C-reactive protein and liver cytolysis. The blood and urine cultures, as well as the serological hepatitis B and C, toxoplasmosis, Epstein Barr virus, Rubella, Herpes virus, and cytomegalovirus were negative. The chest X-ray established the diagnosis of pneumonia. The fever persisted for approximately 2 weeks after admission. On the 2nd week of admission, the patient began to experience gait difficulties complaining of pain in the right hip and ankle. The cardiology and pneumology consults revealed no pathological findings. The evolution was favorable after the initiation of Levofloxacin and MP infection was detected as we suspected. Moreover, the ultrasound of the hip revealed a mild joint effusion, while the ankle joint appeared to be normal at ultrasound. Thus, we established the diagnosis of hip and ankle arthritis based on the clinical and ultrasound findings. INTERVENTIONS: Levofloxacin by vein was continued for 5 days, replaced afterwards with clarithromycin orally for 2 weeks. OUTCOMES: The gait difficulties persisted for approximately 5 months from the initial diagnosis, and improved once the titer of immunoglobulin M anti-MP antibodies lowered considerably. After more than 8 months, the patient was completely asymptomatic and the immunoglobulin M anti-MP was close to the normal range. CONCLUSION: The awareness of MP-induced arthritis in children represents the cornerstone in preventing diagnostic delays and initiating the proper treatment.


Assuntos
Artrite Infecciosa/microbiologia , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/microbiologia , Antibacterianos/uso terapêutico , Pré-Escolar , Feminino , Humanos , Levofloxacino/uso terapêutico
5.
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
6.
Biomed Pharmacother ; 133: 110998, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33378995

RESUMO

OBJECTIVE: Mycoplasma pneumoniae (MP) is the only pathogen in the Mycoplasma family that can cause respiratory symptoms, including acute upper respiratory tract infection and bronchitis, which are often attributed to Mycoplasma pneumoniae pneumonia (MPP). MPP is one of the diseases that commonly affects the pediatric respiratory system, but its pathogenesis is unclear. This study investigated the therapeutic effects and mechanisms of Qingxuan Tongluo formula and its main component, curcumin, on MPP. METHODS: A mouse model of MPP was obtained by nasal drip of the MP strain. The effects of Qingxuan Tongluo formula and curcumin on the treatment of MPP were studied. The proteomic profiles of the alveolar lavage fluid of mice in the model group, Qingxuan Tongluo formula group and curcumin group were evaluated by LC-MS/MS. ELISA and immunohistochemistry were used to verify the possible presence of MP infection biomarkers and drug target proteins. RESULTS: Compared with the mice in the model group, the MPP mice in the Qingxuan Tongluo formula group had significantly reduced fever and cough and prolonged the cough incubation period. Moreover, the pulmonary pathology of the MPP mice was significantly improved, and the lung histopathological score was decreased. After treatment with Qingxuan Tongluo formula and curcumin, the functional and pathway abnormalities caused by MP were mainly inhibited. Levels of HSP90AA1, GRP94, ENO1 and PLG expression were verified by ELISA and immunohistochemistry. CONCLUSION: Qingxuan Tongluo formula significantly reduced fevers and cough and prolonged the cough incubation period of MPP mice. Qingxuan Tongluo formula and curcumin significantly improved the pathological changes in lung tissue caused by MP infection. Proteomics analyses indicated that Qingxuan Tongluo formula and curcumin may have therapeutic effects on MPP by regulating energy metabolism, relieving oxidative stress and activating the fibrinolytic system. ENO1 and PLG were found to be potential drug targets.


Assuntos
Curcumina/farmacologia , Medicamentos de Ervas Chinesas/farmacologia , Pulmão/efeitos dos fármacos , Mycoplasma pneumoniae/patogenicidade , Pneumonia por Mycoplasma/tratamento farmacológico , Proteômica , Animais , Líquido da Lavagem Broncoalveolar/química , Modelos Animais de Doenças , Proteínas de Choque Térmico HSP90/metabolismo , Interações Hospedeiro-Patógeno , Pulmão/metabolismo , Pulmão/microbiologia , Pulmão/patologia , Masculino , Glicoproteínas de Membrana/metabolismo , Camundongos Endogâmicos BALB C , Fosfopiruvato Hidratase/metabolismo , Plasminogênio/metabolismo , Pneumonia por Mycoplasma/metabolismo , Pneumonia por Mycoplasma/microbiologia , Pneumonia por Mycoplasma/patologia , Mapas de Interação de Proteínas
7.
Nat Commun ; 11(1): 5188, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33057023

RESUMO

Mycoplasma pneumoniae is a bacterial human pathogen that causes primary atypical pneumonia. M. pneumoniae motility and infectivity are mediated by the immunodominant proteins P1 and P40/P90, which form a transmembrane adhesion complex. Here we report the structure of P1, determined by X-ray crystallography and cryo-electron microscopy, and the X-ray structure of P40/P90. Contrary to what had been suggested, the binding site for sialic acid was found in P40/P90 and not in P1. Genetic and clinical variability concentrates on the N-terminal domain surfaces of P1 and P40/P90. Polyclonal antibodies generated against the mostly conserved C-terminal domain of P1 inhibited adhesion of M. pneumoniae, and serology assays with sera from infected patients were positive when tested against this C-terminal domain. P40/P90 also showed strong reactivity against human infected sera. The architectural elements determined for P1 and P40/P90 open new possibilities in vaccine development against M. pneumoniae infections.


Assuntos
Adesinas Bacterianas/imunologia , Aderência Bacteriana/imunologia , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/imunologia , Adesinas Bacterianas/isolamento & purificação , Adesinas Bacterianas/ultraestrutura , Microscopia Crioeletrônica , Cristalografia por Raios X , Mycoplasma pneumoniae/isolamento & purificação , Mycoplasma pneumoniae/patogenicidade , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/microbiologia , Domínios Proteicos/imunologia
8.
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
9.
BMC Infect Dis ; 20(1): 534, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698769

RESUMO

BACKGROUND: To analyze the clinical characteristics of Mycoplasma pneumoniae pneumonia with hypoxia in children, and identify the associated risk factors of hypoxia in MPP. METHODS: A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) admitted to our hospital wards from January 2017 to June 2019. They were divided into three groups, namely MPP with hypoxia, refractory Mycoplasma pneumoniae pneumonia (RMPP), and general Mycoplasma pneumoniae pneumonia (GMPP). The clinical features, laboratory findings, imaging, and management were collected and compared in the three groups. RESULTS: The MPP with hypoxia patients (n = 69) had longer disease duration, a higher extra-pulmonary complications rate, and more severe radiological abnormalities (P < 0.05). They also needed more complicated treatments (P < 0.05). Meanwhile, the levels of white blood cell count (WBC), C-reactive protein (CRP), lactic dehydrogenase (LDH), interleukin (IL)-6, ferritin, D-dimer, fibrinogen (FG), alanine aminotransferase (ALT) and the percentage of neutrophils in the MPP with hypoxia group were significantly higher than those in the RMPP group and the GMPP group (P < 0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer, and ALT were contributed to identify the MPP with hypoxia patients. Multivariate logistic regression analysis revealed that ferritin> 174.15 ng/mL, IL-6 > 25.475 pg/ml, and pleural effusion were significantly associated with the incidence of hypoxia in MPP (P < 0.01). CONCLUSION: MPP with hypoxia patients presented more serious clinical manifestations. Ferritin> 174.15 ng/mL, IL-6 > 25.475 pg/ml and pleural effusion were related risk factors for hypoxia in MPP.


Assuntos
Hipóxia/sangue , Hipóxia/complicações , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/complicações , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Interleucina-6/sangue , Contagem de Leucócitos , Masculino , Neutrófilos/metabolismo , Derrame Pleural , Pneumonia por Mycoplasma/microbiologia , Curva ROC , Estudos Retrospectivos , Fatores de Risco
10.
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
11.
BMC Infect Dis ; 20(1): 331, 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32393186

RESUMO

BACKGROUND: IL-6 was associated with the severity of mycoplasma pneumoniae pneumonia (MPP). But the relationship between IL-27 and MPP was unknown. METHODS: Ninety-eight patients with MPP < 14 years old were enrolled in this study and divided into groups by severity (mild cases and severe cases), infection types (MP single infection group and MP mixed infection group) and DNA loads (low MP DNA loads group and high MP DNA loads group), respectively. Fifteen children with foreign bodies in bronchus were also enrolled as control. IL-6 s and IL-27 s in bronchoalveolar lavage fluids (BALFs) from these children were measured by ELISA. RESULTS: There were significant differences in IL-6 s of BALFs from patients between mild cases and severe cases, MP single infection group and MP mixed infection group, and low MP DNA loads group and high MP DNA loads group, respectively (P < 0.05). Compared with IL-6 s of BALFs from control, IL-6 s in BALFs from the 6 patient groups were significantly higher (P < 0.05). IL-27 s in BALFs from MP mixed infection group were significantly lower than those from MP single infection group and control (P < 0.05) respectively. CONCLUSION: IL-6 was firmly associated with MPP and had potential application in clinical practice while IL-27 was not related to MP infection.


Assuntos
Líquido da Lavagem Broncoalveolar/imunologia , Interleucina-6/análise , Interleucinas/análise , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/imunologia , Adolescente , Carga Bacteriana/genética , Criança , Pré-Escolar , DNA Bacteriano/genética , Feminino , Humanos , Lactente , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase em Tempo Real
12.
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
13.
Clin Chim Acta ; 503: 76-83, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31926153

RESUMO

The passive particle agglutination (PA) test, once widely used for Mycoplasma pneumoniae (M. pneumoniae) antibody detection, has gradually been replaced by quantitative enzyme-linked immunosorbent assays (ELISA). However, the lack of diagnostic criteria for quantitative ELISA M. pneumoniae-IgG (MP-IgG) and the low positive rates of ELISA M. pneumoniae-IgM (MP-IgM) limit the diagnostic value of ELISA for M. pneumoniae infection in adults. Here, the diagnostic value of quantitative ELISA MP-IgG was evaluated in adults with Mycoplasma pneumoniae pneumonia (MPP). The serum M. pneumoniae antibodies were detected in 162 patients with MPP, 228 patients with community-acquired pneumonia (CAP) with non-Mycoplasma pneumoniae (NMP), and 162 healthy controls by ELISA, using the PA results as the reference standards. For the MP-IgM-/IgG+ subgroup, a single serum MP-IgG level of ≥92.67 RU/mL can be used as a reference criterion for the diagnosis of acute M. pneumoniae infection. At admission, for patients with CAP, the sensitivity and specificity of ELISA MP-IgM positivity for MPP were 18.51% and 99.56%, respectively. MP-IgM positivity combined with MP-IgG ≥ 92.67 RU/mL increased the sensitivity to 40.12% and decreased the specificity to 94.29%. For paired serum samples obtained within seven days, an ELISA MP-IgG concentration change of ≥1.48-fold and MP-IgG ≥ 92.67 RU/mL on day 7 were used as the diagnostic criteria for M. pneumoniae infection. Accordingly, the combination of qualitative MP-IgM detection and quantitative MP-IgG detection by ELISA is valuable for acute MPP diagnosis in adults.


Assuntos
Imunoglobulina G/sangue , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/diagnóstico , Adulto , Anticorpos Antibacterianos/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina M/sangue , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/microbiologia , Sensibilidade e Especificidade
14.
BMC Infect Dis ; 20(1): 79, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992210

RESUMO

BACKGROUND: Mycoplasma pneumoniae is one of the most common causative pathogens of community-acquired pneumonia (CAP), accounting for as many as 30-50% of CAP during peak years. An early and rapid diagnostic method is key for guiding clinicians in their choice of antibiotics. METHODS: The recombinase-aided amplification (RAA) assay is a recently developed, rapid detection method that has been used for the detection of several pathogens. The assays were performed in a one-step single tube reaction at 39° Celsius within 15-30 min. In this study, we established an RAA assay for M. pneumoniae using clinical specimens for validation and commercial real-time PCR as the reference method. RESULTS: The analytical sensitivity of the RAA assay was 2.23 copies per reaction, and no cross-reactions with any of the other 15 related respiratory bacterial pathogens were observed. Compared with the commercial real-time PCR assay used when testing 311 respiratory specimens, the RAA assay obtained 100% sensitivity and 100% specificity with a kappa value of 1. CONCLUSIONS: These results demonstrate that the proposed RAA assay will be of benefit as a faster, sensitive, and specific alternative tool for the detection of M. pneumoniae.


Assuntos
Mycoplasma pneumoniae/genética , Técnicas de Amplificação de Ácido Nucleico/métodos , Pneumonia por Mycoplasma/microbiologia , Recombinases/genética , Adolescente , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
Biomed Res Int ; 2020: 9814916, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31998803

RESUMO

Background: Extensive studies have focused on the diagnosis and treatment of Mycoplasma pneumoniae infection; however, rare studies investigated the posttreatment conditions. We analyzed the carrying status of M. pneumoniae in the respiratory tract of children before and after treatment. Methods: Ninety-two children with M. pneumoniae pneumonia were included in this study. Clinical data were obtained from each patient, and pharyngeal swab sampling was performed at preliminary diagnosis and discharge. Real-time PCR and dilution quantitative culture were utilized to determine the DNA quantification and number of viable M. pneumoniae from samples collected upon preliminary diagnosis and discharge. Results: All the 92 cases showed DNA positivity upon preliminary diagnosis, serum IgM antibody was detected in 80 patients, and positivity of M. pneumoniae culture was observed in 82 cases. Upon discharge, the M. pneumoniae nucleotide and culture positivity were detected in 87 and 49 cases, respectively. The content of viable M. pneumoniae was 10-104 CCU/mL and 10-102 CCU/mL in the preliminary diagnosis samples and discharge samples, respectively. Conclusions: Real-time PCR was rapid and effective for the qualitative diagnosis of M. pneumoniae at the early stage, but it cannot be used to evaluate the prognosis of patients with M. pneumoniae infection. Quantitative analysis for M. pneumoniae DNA could not directly reflex the viable strain content.


Assuntos
Anticorpos Antibacterianos/sangue , Imunoglobulina M/sangue , Mycoplasma pneumoniae , Faringe/microbiologia , Pneumonia por Mycoplasma , Reação em Cadeia da Polimerase em Tempo Real , Adolescente , Criança , Pré-Escolar , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Feminino , Humanos , Masculino , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/crescimento & desenvolvimento , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/genética , Pneumonia por Mycoplasma/microbiologia
17.
Microb Pathog ; 139: 103863, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712120

RESUMO

Mycoplasma pneumoniae (M. pneumoniae) is a small bacterium characterized by the absence of cell wall. It is a human pathogen causing upper and lower respiratory infections, both in adults and children. However, it is also considered to be implicated in the pathogenesis of several types of extra-respiratory diseases, including some gastrointestinal disorders. The liver involvement in children during or after M. pneumoniae infections is analyzed and discussed in this review. Through a systematic literature search, it is evidenced that M. pneumoniae is not infrequently associated with alteration of liver function, but rarely causes acute and severe hepatitis in children. M. pneumoniae should be considered as an unusual cause of acute hepatitis in children, whenever the most common hepatotropic viruses have been excluded. The pathogenesis of M. pneumoniae-related hepatitis is likely to be immune-mediated: both the innate and adaptive immune responses may play a fundamental role. However, the exact pathological mechanisms have to be elucidated yet. Further clinical studies are needed in order to understand the actual relevance of this microorganism in liver disease and its pathogenesis.


Assuntos
Hepatite/complicações , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/microbiologia , Doença Aguda , Criança , Bases de Dados Factuais , Gastroenteropatias/complicações , Hepatite/imunologia , Hepatite/microbiologia , Humanos , Fígado , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/imunologia
18.
Pediatr Infect Dis J ; 39(3): 177-183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31738328

RESUMO

BACKGROUND: Mycoplasma pneumoniae pneumonia is generally a self-limiting disease, but it can develop into severe Mycoplasma pneumoniae pneumonia (SMPP). Immunologic mechanisms are thought to play an important role in the pathogenesis of SMPP. Therefore, the use of systemic glucocorticoids may have beneficial effects. However, to date, the use of glucocorticoid therapy in SMPP is limited to small case series, and the glucocorticoid dosage for children with SMPP has not been established. METHODS: Here, we used a meta-analysis method to collect data from randomized control trials of different doses of methylprednisolone in SMPP to assess the safety and efficacy of treatment with low- versus high-dose methylprednisolone in children with SMPP. RESULTS: We included 13 Chinese randomized control trials that included 1049 children. The high- and low-dose groups were comprised of 524 and 525 children, respectively. The high-dose group was significantly more effective than the low-dose group in clinical efficacy [risk ratio = 1.30, 95% confidence interval (CI) (1.23, 1.38), P < 0.05]. In addition, compared with low-dose methylprednisolone, high-dose methylprednisolone significantly shortened hospital stays and antipyretic therapy, pulmonary rales disappearance, cough disappearance and pulmonary shadow absorption times. There was no significant difference in adverse events between the high- and low-dose groups: risk ratio= 0.85, 95% CI (0.53, 1.36), P > 0.05. CONCLUSIONS: We conclude that high-dose methylprednisolone is effective in the treatment of SMPP without increasing the incidence of adverse reactions.


Assuntos
Anti-Inflamatórios/administração & dosagem , Metilprednisolona/administração & dosagem , Mycoplasma pneumoniae/efeitos dos fármacos , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/microbiologia , Anti-Inflamatórios/efeitos adversos , Criança , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Tempo de Internação , Metilprednisolona/efeitos adversos , Pneumonia por Mycoplasma/diagnóstico , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação de Sintomas , Resultado do Tratamento
19.
J Clin Lab Anal ; 34(1): e23032, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31628684

RESUMO

BACKGROUND: Respiratory viruses, such as influenza viruses, initially infect the upper airways but can manifest as severe lower respiratory tract infections in high-risk patients with significant morbidity and mortality. For syndromic diagnosis, several multiplex nucleic acid amplification tests have been developed for clinics, of which SureX 13 Respiratory Pathogen Multiplex Kit (ResP) can simultaneously detect 13 pathogens directly from airway secretion specimens. The organisms identified are influenza virus A, influenza virus A pdmH1N1 (2009), influenza virus A H3N2, influenza virus B, adenovirus, boca virus, rhinovirus, parainfluenza virus, coronavirus, respiratory syncytial virus, human metapneumovirus, Mycoplasma pneumoniae, and Chlamydia. METHODS: This study provides performance evaluation data of this assay by comparing with pathogen-specific PCRs from oropharyngeal swab samples. RESULTS: Ten pathogens were detected in this assay, of which rhinovirus, adenovirus, and influenza virus A pdmH1N1 (2009) were the most common. The overall agreement between the ResP and the comparator tests was 93.8%. The ResP demonstrated 86.5% agreement for positive results and 97.8% agreement for negative results. CONCLUSION: The ResP assay demonstrated a highly concordant performance comparing with pathogen-specific PCRs for detection of respiratory pathogens in oropharyngeal swabs from outpatients and could aid in the diagnosis of respiratory infections in a variety of clinical scenarios.


Assuntos
Assistência Ambulatorial/métodos , Reação em Cadeia da Polimerase Multiplex/métodos , Orofaringe/virologia , Pneumonia por Mycoplasma , Pneumonia Viral , Adenoviridae/genética , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Vírus da Influenza A/genética , Masculino , Pessoa de Meia-Idade , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/microbiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , RNA Viral/análise , RNA Viral/genética , Rhinovirus/genética , Adulto Jovem
20.
Eur J Clin Microbiol Infect Dis ; 39(2): 257-263, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31655931

RESUMO

The aim of this study was to assess which Mycoplasma pneumoniae genotypes were present in Moscow during the years 2015-2018 and whether the proportion between detected genotypes changed over time. We were also interested in the presence of macrolide resistance (MR)Mycoplasma pneumoniae. We performed multilocus variable-number tandem-repeat (VNTR) analysis (MLVA), SNP typing, and mutation typing in the 23S rRNA gene from 117 M. pneumoniae clinical isolates. Our analysis suggests two major MLVA types: 4572 and 3562. In 2017-2018, MLVA type 4572 gradually became predominant. In general, the SNP type range is the same as described earlier for European countries. The analysis of MR mutations showed that 7% of the isolates had an A2063G mutation in the 23S rRNA gene with no isolates carrying an A2064G mutation. In 2017-2018, MLVA type 4572 (SNP type 1) begins to spread in Moscow, which was widespread globally, especially in Asian countries. SNP typing of our sample showed higher discriminatory power than MLVA typing.


Assuntos
Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/epidemiologia , Pneumonia por Mycoplasma/microbiologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , História do Século XXI , Humanos , Macrolídeos/farmacologia , Testes de Sensibilidade Microbiana , Moscou/epidemiologia , Tipagem de Sequências Multilocus , Mycoplasma pneumoniae/classificação , Mycoplasma pneumoniae/efeitos dos fármacos , Pneumonia por Mycoplasma/história , Polimorfismo de Nucleotídeo Único , Vigilância em Saúde Pública , RNA Ribossômico 23S/genética
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