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Objective:To investigate the serum levels and clinical significance of Fc fragment of the IgG-binding protein (FCGBP), serum amyloid protein A1 (SAA1), and CXC chemokine ligand 10 (CXCL10) in children with mycoplasma pneumoniae pneumonia (MPP) and their relationship with prognosis.Methods:A prospective study was conducted on 122 children with MPP admitted to the department of pediatrics of the 970th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army from January 2019 to December 2021. According to the severity and prognosis of MPP, they were divided into mild and severe groups, good prognosis group, and poor prognosis group. Forty healthy children who underwent physical examination during the same period were set as the control group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of FCGBP, SAA1, and CXCL10 in each subject, and to compare the differences in serum levels of FCGBP, SAA1, and CXCL10 among different groups. Multivariate logistic regression analysis was used to investigate the influencing factors of poor prognosis in MPP patients. The diagnostic value of individual and combined detection of serum procalcitonin (PCT), FCGBP, SAA1, and CXCL10 for poor prognosis in MPP children by analyzing the receiver operating characteristic (ROC) curve.Results:The levels of serum FCGBP [(115.68±10.57)ng/ml, (78.41±6.73)ng/ml, (12.55±3.25)ng/ml], SAA1 [(34.18±3.72)mg/L, (25.54±2.63)mg/L, (6.74±0.82)mg/L], and CXCL10 [(714.26±55.64)ng/L, (353.74±42.67)ng/L, (106.25±12.92)ng/L] in the severe MPP group were significant higher than those in the mild MPP group and the control group, with statistical significance (all P<0.05). The white blood cell (WBC), neutrophil percentage, C reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, lactate dehydrogenase (LDH), D-dimer (D-D), FCGBP, SAA1, CXCL10 of the children in the poor prognosis group were significantly higher than those in the good prognosis group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that increased PCT ( OR=1.603, 95% CI: 1.190-2.160), FCGBP ( OR=1.757, 95% CI: 1.115-2.770), SAA1 ( OR=1.900, 95% CI: 1.327-2.720) and CXCL10 ( OR=1.704, 95% CI: 1.212-2.397) were independent risk factors for poor prognosis of MPP children (all P<0.05). The combined detection of serum PCT, FCGBP, SAA1, and CXCL10 had a significantly higher diagnostic value for the risk of poor prognosis in children with MPP than a single indicator. Conclusions:The elevated levels of serum FCGBP, SAA1, and CXCL10 in children with MPP are associated with the severity of MPP and are independent risk factors for poor prognosis in MPP patients.
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Objective:To investigate the role of a simple Nomogram model in evaluating the severity of mycoplasma pneumoniae pneumonia (MPP) in adults.Methods:The clinical data of 162 patients with MPP who received treatment in Wenzhou Central Hospital from March 2015 to October 2022 were retrospectively analyzed. These patients were divided into a severe group ( n = 67) and a common group ( n = 95) according to whether they were diagnosed with severe MPP. The clinical data of patients were recorded. Fourteen clinical variables were screened, including age, sex, onset season, fever, heat peak, fever duration, cough duration, white blood cell count, percentage of neutrophils, percentage of lymphocytes, hemoglobin, platelet count, C-reactive protein, and procalcitonin. Multivariate logistic regression analysis of statistically significant variables in univariate analysis was performed. The Nomogram model was constructed with the R language software package (version 3.6.2). The model was verified with a calibration curve and receiver operating characteristic curve. Results:Univariate analysis results showed that in the severe group, the fever peak ( Z = 5.03, P < 0.001) was higher, fever duration ( χ2 = 27.55, P < 0.001), and cough duration ( χ2 = 28.72, P < 0.001) were longer, white cell count ( t = 2.93, P = 0.004), percentage of neutrophils ( t = 9.08, P < 0.001), C-reactive protein ( t = 35.05, P < 0.001), and procalcitonin level ( t = 15.09, P < 0.001) were greater compared with the common group. The percentage of lymphocytes ( t = 1.16, P < 0.001), hemoglobin level ( t = 1.22, P < 0.001), and platelet count ( t = 2.82, P < 0.001) in the severe group were significantly lower than those in the common group. Multivariate logistic regression analysis results showed that heat peak, cough duration, and C-reactive protein were positively correlated with the severity of MPP (all P < 0.05). The percentage of lymphocytes, hemoglobin concentration, and platelet count were negatively correlated with the severity of MPP (all P < 0.05). The establishment and validation results of the Nomogram model showed that the accuracy of the model was good, with a sensitivity of 88.73%, a specificity of 77.61%, and a C-index of 0.904. Conclusion:Heat peak, cough duration, percentage of lymphocytes, platelet count, and C-reactive protein are closely related to the severity of early MPP. A simple Nomogram model can be one of the tools for early assessment of the severity of MPP.
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Objective:To evaluate the clinical efficacy of Huzhang Polou Decoction combined with acupoint application in the treatment of children with mycoplasma pneumoniae pneumonia (MPP) complicated with atelectasis.Methods:A total of 105 MPP children with atelectasis and phlegm-heat obstructing lung syndrome in our hospital from August 2019 to March 2022, who met the inclusion criteria, were divided into control group (53 cases) and observation group (52 cases), by random number table method. The control group was given azithromycin sequential therapy on the basis of conventional western medicine treatment, and the observation group was given Huzhang Polou Decoction and acupoint application on the basis of the control group. Both groups were treated for 19 days. TCM syndromes were scored before and after treatment. The FEV1 and peak expiratory flow rate (PEF) were measured by pulmonary function measurement instrument. The CRP was measured by immunoturbidimetry and procalcitonin (PCT) was measured by ELISA. The recovery time of fever, disappearance time of cough and sputum, disappearance time of lung rales, lung recruitment time, and adverse reactions during treatment were recorded, and the clinical efficacy was evaluated.Results:The total effective rate was 96.15% (50/52) in the observation group and 84.91% (45/53) in the control group, and the difference between the two groups was statistically significant ( χ2=3.85, P=0.050). After treatment, the TCM syndrome score of the observation group was significantly lower than that of the control group ( t=22.78, P<0.01). FEV1 [(1.87±0.29) L vs. (1.54±0.28) L, t=5.93] and PEF [(79.82±6.29) L/min vs. (74.32±6.30) L/min, t=4.48] were significantly higher than those in the control group ( P<0.01). The levels of serum CRP [(9.18±2.98) mg/L vs. (12.34±3.00) mg/L, t=5.42] and PCT [(0.60±0.15) ng/L vs. (0.96±0.21) ng/L, t=9.93] were significantly lower than those in the control group ( P<0.01). The recovery time of fever, disappearance time of cough and sputum, disappearance time of lung rale and lung recruitment time in the observation group were significantly earlier than those in the control group ( t=7.27, 6.84, 3.76, 5.87, all Ps<0.01). During treatment, the incidence of adverse reactions was 3.77% (2/53) in the control group and 1.92% (1/52) in the observation group, and there was no significant difference between the two groups ( χ2=0.32, P=0.569). Conclusion:The Huzhang Polou Decoction combined with acupoint application can improve the pulmonary function of children with MPP complicated with atelectasis, reduce the level of serum inflammatory cytokines, improve the clinical efficacy safely.
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Objective:To evaluate the differential expression of blood routine in different types of infection and the diagnostic value of C-reactive protein (CRP), procalcitonin (PT), ferritin (SF) and lactate dehydrogenase (LDH) in bacterial and mycoplasma pneumonia and their early warning value in severe cases.Method:A total of 627 patients, including 176 cases of bacterial pneumonia, 275 cases of mycoplasma pneumonia, 176 cases of viral infection and 180 cases of normal control were collected from May 2018 to December 2019 in children′s Hospital Affiliated to Capital Institute of Pediatrics. The mycoplasma pneumonia group was divided into mild group (151 cases) and severe group (124 cases) according to the results of lavage fluid RNA-examination. All patients received completed blood routine test at the first day of admission, patients in bacteria group and Mycoplasma group received the examination of four inflammatory indicators. The Kruskal-Wallis test was used to analyze the differences in blood routine results between different infection groups, and the differences of inflammatory indexes between bacterial group and Mycoplasma mild and severe group. The receiver operating characteristic (ROC)-curve method was used to analyze the predictive value of inflammatory indexes between different infection groups.Results:There were significant differences in leukocyte count, neutrophil, lymphocyte and monocyte percentage between bacterial pneumonia, mycoplasma pneumonia, viral infection and normal control group ( P<0.05). The differences of four inflammatory indexes in bacterial group, mild Mycoplasma group and severe group were statistically significant ( P<0.05). The rest of the index (CRP, PCT, LDH, SF and white blood cell count) were P<0.05 (CRP: area under curve [AUC] 0.799; PCT: AUC 0.579; LDH: AUC 0.651; SF: AUC 0.854), in mild and severe mycoplasma group, except WBC, by ROC-curves analysis. The AUC value of the area under the curve of CRP and SF is high, and the sensitivity and specificity at the diagnostic critical point are high, which has great diagnostic value (CRP: diagnostic critical point 12.55 mg/L, sensitivity 0.719, specificity 0.755; SF: diagnostic critical point 176.02 μg/L, sensitivity 0.765, specificity 0.960). ROC curve results also showed that of PCT, White blood cell and neutrophil percentage had the diagnostic value in bacterial infection and mycoplasma infection, P<0.05 (PCT: AUC 0.658; leukocyte: AUC 0.804; neutrophil: AUC 0.630). Leukocyte count is the best differential index (diagnostic critical point 9.585×10 9/L, sensitivity 0.778, specificity 0.698), PCT has higher sensitivity at the diagnostic critical point of 0.55 μg/L, but the specificity is slightly lower (diagnostic critical point of 0.55 μg/L, sensitivity 0.862, specificity 0.366). Conclusions:PCT and leukocyte count can be used as the preferred inflammatory indexes to distinguish bacterial and mycoplasma infection. CRP, LDH, PCT and SF can be used as early warning indexes to evaluate severe mycoplasma infection.
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RESUMEN El Mycoplasma pneumoniae es causa frecuente de infecciones del tracto respiratorio superior e inferior en niños y adultos jóvenes, atribuyéndosele hasta un 40 % de los casos de neumonía adquirida en la comunidad. La neumonía por bacterias atípicas ha sido tema de discusión desde su descripción. El diagnóstico de la neumonía adquirida en la comunidad es fundamentalmente clínico. La radiografía de tórax es el patrón oro para confirmarlo, pero no se recomienda de forma rutinaria. En casos graves es necesaria la obtención de imágenes tomográficas. El objetivo de este trabajo es presentar el caso de un paciente con neumonía causada por Mycoplasma pneumoniae adquirida en la comunidad que fue atendido en el Hospital de Cienfuegos. Se trata de un hombre de color de piel blanca, de 51 años de edad, de procedencia urbana, sin hábitos tóxicos, con antecedentes patológicos personales de hipertensión arterial desde hacía tres años, con tratamiento regular; diabetes mellitus tipo 2, con control glucémico mediante dieta, además antecedentes referidos de insuficiencia venosa, el cual se ingresa en el hospital por el diagnóstico de neumonía atípica. Evolucionó hacia la gravedad, pero el adecuado empleo e interpretación de los elementos clínicos e imagenológicos permitió llegar al diagnóstico de neumonía por Mycoplasma pneumoniae, adquirida en la comunidad. Se logró una atención médica adecuada y la recuperación del paciente.
ABSTRACT Mycoplasma pneumoniae is a frequent cause of upper and lower respiratory tract infections in children and young adults, accounting for up to 40% of community-acquired pneumonia cases. The diagnosis of community-acquired pneumonia is primarily clinical. Chest radiography is the gold standard for confirmation, but it is not routinely recommended. In severe cases, tomographic imaging is necessary. The objective of this work is to present the case of a patient with pneumonia caused by Mycoplasma pneumoniae acquired in the community who was treated at the Hospital de Cienfuegos. This is a 51-year-old man of white skin color, of urban origin, without toxic habits, with a personal pathological history of arterial hypertension for three years, with regular treatment; Type 2 diabetes mellitus, with glycemic control through diet, in addition to a referred history of venous insufficiency, which was admitted to the hospital for the diagnosis of atypical pneumonia. It progressed towards severity, but the proper use and interpretation of the clinical and imaging elements allowed the diagnosis of community-acquired pneumonia due to Mycoplasma pneumoniae to be reached. Adequate medical care and recovery of the patient was achieved.
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Objective To explore the association between Vitamin A,E and mycoplasma pneumoniae pneumonia in children.Methods 153 children with mycoplasma pneumoniae pneumonia and 653 health children were selected as cases and controls,respectively.Propensity score matching (PSM) analysis were conducted to reducing confounding bias between groups.Blood samples were collected to test serum levels of vitamin A and E using high performance liquid chromatography (HPLC).Logistic regression was implemented to determine odds ratios (OR) and 95％ confidence intervals (CI) for evaluating the association of mycoplasma pneumoniae pneumonia with the serum levels of Vitamin A and E.Results Mter propensity score matching,the study cohort included 153 cases with mycoplasma pneumoniae pneumonia and 306 health children as controls.Before matching,with age and gender adjusted,logistic regression analysis indicated that higher serum levels of Vitamin A and E led to a lower risk of mycoplasma pneumoniae pneumonia (OR =0.075,95％ CI:0.007-0.815;OR =0.854,95％ CI:0.792-0.986).After matching,higher serum level of Vitamin E had a significantly lower risk of mycoplasma pneumoniae pneumonia (OR =0.877,95％ CI:0.810-0.950).Conclusions The serum levels of Vitamin A didnt have a statistically significant association with mycoplasma pneumoniae pneumonia.However,we observed an obvious association between Vitamin E and mycoplasma pneumoniae pneumonia.Hence Vitamin E clinical monitoring and supplementation are vital for preventing and treating mycoplasma pneumoniae pneumonia.
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Objective@#To investigate the effect of methylprednisolone sodium succinate combined with azithromycin in the treatment of severe mycoplasma pneumonia.@*Methods@#From December 2015 to October 2017, a total of 85 children with severe mycoplasma pneumonia in the General Hospital of Gujiao Mining Area were divided into two groups according to the random number table method, 42 cases in the control group were treated with azithromycin, and 43 cases in the observation group were treated with azithromycin+ methylprednisolone sodium succinate.The clinical efficacy, disappearing time of symptoms and signs(fever, cough, pulmonary rales) and the level of serum C reactive protein(CRP) were compared between the two groups.The changes of serum levels of immunoglobulin M(IgM), IgA and IgG in two groups before and after treatment were also statistically analyzed.@*Results@#The total effective rate of the observation group was 93.02%(40/43), which was higher than that of the control group [76.19%(32/42)] (χ2=4.647, P=0.031). The disappearing time of fever, cough and pulmonary rales in the observation group were shorter than those in the control group(t1=4.787, P1=0.000, t2=5.746, P2=0.000, t3=6.418, P3=0.000). After treatment, the serum level of CRP in the observation group was lower than that in the control group(t=16.797, P=0.000). After treatment, the serum levels of IgM, IgA and IgG in the observation group were higher than those in the control group(t1=7.593, P1=0.000, t2=3.583, P2=0.001, t3=10.277, P3=0.000).@*Conclusion@#Methylprednisolone sodium succinate combined with azithromycin can reduce the inflammatory reaction of children with severe mycoplasma pneumoniae, regulate their immunity and promote the recovery of symptoms and signs.Besides, its efficacy is obvious.
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Objective@#To explore the association between Vitamin A, E and mycoplasma pneumoniae pneumonia in children.@*Methods@#153 children with mycoplasma pneumoniae pneumonia and 653 health children were selected as cases and controls, respectively. Propensity score matching (PSM) analysis were conducted to reducing confounding bias between groups. Blood samples were collected to test serum levels of vitamin A and E using high performance liquid chromatography (HPLC). Logistic regression was implemented to determine odds ratios (OR) and 95% confidence intervals (CI) for evaluating the association of mycoplasma pneumoniae pneumonia with the serum levels of Vitamin A and E.@*Results@#After propensity score matching, the study cohort included 153 cases with mycoplasma pneumoniae pneumonia and 306 health children as controls. Before matching, with age and gender adjusted, logistic regression analysis indicated that higher serum levels of Vitamin A and E led to a lower risk of mycoplasma pneumoniae pneumonia (OR=0.075, 95% CI: 0.007-0.815; OR=0.854, 95% CI: 0.792-0.986). After matching, higher serum level of Vitamin E had a significantly lower risk of mycoplasma pneumoniae pneumonia (OR=0.877, 95% CI: 0.810-0.950).@*Conclusions@#The serum levels of Vitamin A didn't have a statistically significant association with mycoplasma pneumoniae pneumonia. However, we observed an obvious association between Vitamin E and mycoplasma pneumoniae pneumonia. Hence Vitamin E clinical monitoring and supplementation are vital for preventing and treating mycoplasma pneumoniae pneumonia.
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Objetivo: Determinar la prevalencia de infección por gérmenes atípicos evaluada mediante la determinación de anticuerpos IgM en casos de neumonía adquirida en la comunidad en pacientes adultos inmunocompetentes atendidos en el Hospital Nacional Hipólito Unanue. Métodos: Se evaluaron a aquellos pacientes adultos inmunocompetentes que acudieron a la emergencia del Hospital Hipólito Unanue con neumonía adquirida en la comunidad entre setiembre del 2008 y enero del 2009. Se tomaron muestras de sangre para realizar serología para Mycoplasma pneumoniae y Chlamydia pneumoniae mediante la detección de niveles de inmunoglobulina M determinados por prueba de ELISA. Resultados:Se reclutaron 85 pacientes. La edad promedio fue de 65,33 ± 21,43 años. Se encontraron 3 casos de pacientes con serología positiva a IgM frente a M. pneumoniae y 1 caso positivo a C. pneumoniae. Los títulos de anticuerpos contra M. pneumoniae tuvieron una correlación altamente significativa con la edad (r=-0,28; p<0,01). se encontró una correlación estadísticamente significativa entre los índices de anticuerpos IgM frente a M. pneumoniae y C. pneumoniae (r=0,29; p<0,01). Conclusión: La infección por gérmenes atípicos no parece ser una condición frecuente en pacientes hospitalizados con diagnóstico de neumonía adquirida en la comunidad. Se deben realizar estudios en poblaciones mayores utilizando serología pareada o estudios moleculares, incluyendo pacientes ambulatorios a fin de definir el rol de patógenos atípicos en casos de neumonía a nivel nacional.
Objective: To determine the prevalence of infection due to atypical microorganisms in cases of community-acquired pneumonia in adult inmunocompetent patients seeking attention in the Hospital Nacional Hipolito Unanue. Methods: Adult inmunocompetent patients seeking medical attention in the emergency ward of Hospital Hipolito Unanue with diagnosis of community-acquired pneumonia were evaluated between september 2008 and january 2009. Blood samples were drawn for Mycoplasma pneumoniae and Chlamydia pneumoniae serology, by the detection of M Inmunoglobulin by ELISA technique. Results: We recruited 85 patients. The average age was 65.33 ± 21.43 years. We found 3 cases with positive IgM serology against M. pneumoniae and 1 case positive against C. pneumoniae. The antibody titers against M. pneumoniae had a highly significant correlation with the age (r=-0.28; p<0.01). We also found a statistically significant difference between the titers of antibodies against M. pneumoniae and those correspondent to C. pneumoniae (r=0.29; p<0.01). Conclusion: Infection due to atypical microorganisms doesn't seem to be a frequent condition in inpatients with diagnosis of community-acquired pneumonia. Research in larger populations, including outpatients should be done, in order to define the role of atypical pathogens in cases of pneumonia at a national level.
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Objective@#To investigate the characteristics and drug resistance of pathogenic bacteria of refractory mycoplasma pneumonia in children and the changes of serum interleukin-18 (IL-18) and interleukin-33 (IL-33) levels.@*Methods@#From January 2016 to December 2017, 103 children with refractory mycoplasma infection admitted to the Maternal and Child Health Hospital of Zhoushan were selected in the study.Another 60 healthy subjects in our Hospital from January 2016 to December 2017 were selected as control group.The oropharyngeal secretions were collected in all children with refractory mycoplasma pneumonia, isolated and cultured pathogenic bacteria.Disk diffusion (K-B method) was used to detect the drug resistance of the main pathogens.Enzyme-linked immunosorbent assay was used to determine serum IL-18 and IL-33 levels.@*Results@#The 117 strains of pathogenic bacteria were isolated from 103 children with refractory mycoplasma infection, of which 68 strains (58.12%) were Gram-negative bacilli, 39 strains (33.33%) were Gram-positive cocci, and 10 strains (8.55%) were fungi.Klebsiella pneumoniae was more resistant to cefuroxime than Acinetobacter baumannii to cefuroxime and ceftriaxone.Staphylococcus aureus and Staphylococcus epidermidis were more resistant to erythromycin and penicillin G than other Gram-positive cocci.The levels of serum IL-18 and IL-33 in the study group were higher than those in the control group (all P<0.05).@*Conclusion@#Gram-negative bacilli are the main pathogens of refractory mycoplasma pneumonia in children.The resistant rate of main Gram-negative bacilli to cephalosporins is higher.The resistant rate of main Gram-positive cocci to penicillin G and erythromycin is higher.The levels of serum IL-18 and IL-33 are significantly higher in patients with refractory mycoplasma pneumonia.
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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, χ2=23.222, P<0.01; 14 cases vs. 1 case, χ2=29.326, P<0.01), which more needed to oxygentherapy (18 cases vs. 12 cases, χ2=16.833, P<0.01) and undergo chest drainage (9 cases vs. 4 cases, χ2=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, χ2=29.326, P<0.01). The values of white blood cell (WBC) (23.2 (5.2-67.1)×109/L vs. 9.7 (6.3-18.7)×109/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)×106/L vs. 790 (68-6 920)×106/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, 17.2×109/L, 157 mg/L, 1.505 mg/L, 2 630×106/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.
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Objective@#To observe the clinical effect of the Compound herba houttuyniae mixture combined with azithromycin for the children with macrolide-resistant mycoplasma pneumoniae(MRMPP) and investigate the bi-directional control mechanism of inflammatory response.@*Methods@#A total of 60 patients with MRMPP were randomly divided into control group and observation group of 30 patients each by random number table. Patients in control group took azithromycin, while patients in observation group took azithromycin and compound herba houttuyniae mixture. Both groups were treated 21 days.@*Results@#The total effective rate of observation group was 86.67%, while the control group was 56.67%, and the difference was statistical significance (χ2=5.253, P=0.022). The duration of fever (1.2 ± 0.3 d vs. 3.7 ± 2.2 d, t=6.293), cough (7.5 ± 2.3 d vs. 14.9 ± 3.7 d, t=9.232) in the observation group were significantly better than those in the control group (P<0.01). The serum concentrations of IL-6 (14.69 ± 8.26 pg/ml vs. 8.41 ± 5.26 pg/ml, t=3.512), IL-10 (6.23 ± 1.79 pg/ml vs. 3.47 ± 2.18 pg/ml, t=5.359), IL-17 (5.61 ± 2.77 pg/m vs. 2.09 ± 1.53 pg/ml, t=6.093) in the observation group were significantly decreased than the control group (P<0.01). There were fewer cases of gastrointestinal adverse events in the treatment group than in the control group (3 vs. 11 cases; χ2=4.565, P<0.05) and the number of abnormal liver function (2 vs. 9 cases; χ2=4.007, P<0.05).@*Conclusions@#Compound herba houttuyniae mixture combined with azithromycin could improve the clinical symptoms and signs, and shorten the symptoms duration and reduce the side reaction.
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Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children with mycoplasmmapneumonia infection.Methods The clinical data of 15 children with MERS diagnosed in our hospital were analyzed retrospectively.Results Among the 15 cases,there were 5 males and 10 females.The onset age ranged from 2 years old to 11 years old.All the 15 cases were onset of acute infection.8 cases were onset of vomiting,diarrhea and other gastrointestinal symptoms.2 cases were onset of respiratory tract infection such as cough.8 cases were accompanied by fever.15 cases were accompanied by convulsions.2 cases were onset of consciousness disturbance.All 15 children underwent lumbar puncture and routine cerebrospinal fluid tests were in normal range.Electroencephalogram examination was abnormal in 13 children,showing slow activity in each lead.The cranial MRI examination of the onset of 4-6 d suggested that the lesions of the corpus callosum were characterized by high signal intensity of DWI sequence.Etiological examination of 15 children showed mycoplasma pneumoniae (MP)-IgM or-Ab positive.In 10 children,the MRI of the corpus callosum was completely restored to normal after 7-12 d.15 children were treated with anti-infection and azithromycin orally,but not with propofol or hormone.They were discharged after 4-14 days of hospitalization.All 10 children were reexamined with MRI at 7-12 days intervals.Conclusions Minor encephalitis/encephalopathy associated with reversible corpus callosum pressure in children with mycoplasma pneumoniae infection is characterized by mild encephalitis or encephalopathy.The imaging of the corpus callosum is reversible and has a good prognosis.
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Objective To study the cytokine levels of TNF-α, IFN-γ, IL-2, IL-4, IL-6 and IL-10 in bronchoalveolar lavage fluid (BALF) in children with mycoplasma pneumoniae pneumonia (MPP). Methods Clinical data of 90 patients with MPP (MPP group), who were admitted to Tianjin Children's Hospital from January to December 2017, were collected in this study. The 90 cases were divided into group A1 (<7 days), group A2 (7-14 d) and group A3 (15-30 d) according to the course of disease on admission, with 30 cases in each group. Children who were without MPP and needed bronchoscopy examination or treatment at the same time were used as the control group (B group). The expression levels of cytokines (TNF-α, IFN-γ, IL-2, IL-4, IL-6 and IL-10) were detected by enzyme-linked immunoassay (ELISA). Results The serum and BALF levels of TNF-α, IFN-γ, IL-2, IL-4, IL-6 and IL-10 increased significantly in A group compared with those in B group (P<0.05). The highest levels of cytokines (TNF-α, IFN-γ and IL-2) were found in Group A1. The highest levels of cytokines (IL-4 and IL-6) were found in Group A2. Conclusion The levels of TNF-α, IFN-γ and IL-2 are increased significantly in the disease course of < 7 days. In the disease course of 7 to 14 days, the IL-4 and IL-6 are elevated significantly. Our data suggest that these cytokines may be involved in the pathogenesis of MPP.
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Objective To investigate the changes of levels of exhaled nitric oxide and the clinical signifi -cance in children with Mycoplasma pneumoniae pneumonia ( MPP).Methods From June 2014 to March 2017,95 children with MPP and 64 children with bronchial pneumonia in Jinshan Branch of The Sixth People ＇s Hospital of Shanghai were collected,32 healthy children were enrolled as controls.According to the imaging examination,patients with MPP were further grouped into lobar pneumonia group,bronchopneumonia group and interstitial pneumonia group.FeNO and lung function were measured in all children.Results The level of FeNO in the MPP group was (7.25 ±3.41) ppb,which was lower than that in the non -MPP group and control group [(11.24 ±3.52) ppb,(10.51 ±4.23)ppb](t＝5.82,5.77,all P＜0.01).The level of FeNO between the non -MPP group and control group had no statistically significant difference (P＞0.05).The FEV1,FEV1/FVC%,FEF25%-75% of the MPP group[(66.23 ±13.21),(84.62 ±6.73),(58.65.±19.43)]were lower than those of the control group and non -MPP group[(91.81 ±11.36),(93.80 ±8.91),(86.80 ±20.71);(85.43 ±10.32),(90.18 ±11.35),(74.73 ± 17.91)](t＝4.35,3.62,4.78;4.56,7.12,5.06,all P＜0.01).The FEV1,FEV1/FVC%,FEF25%-75% of the non-MPP group[(85.43 ±10.32),(90.18 ±11.35),(74.73 ±17.91)]were lower than those of the control group [(91.81 ±11.36),(93.80 ±8.91),(86.80 ±20.71)] ( t＝2.12,3.05,2.53,all P＜0.05).The level of FeNO among the lobar pneumonia group,bronchopneumonia group and interstitial pneumonia group had no statistically significant difference ( all P ＞0.05 ).In the MPP group,the FEV1,FEV1/FVC%,FEF25% -75% were not associated with FeNO level(r＝-0.15,P＞0.05;r＝-0.06,P＞0.05;r＝0.07,P＞0.05).Conclusion The level of FeNO in children with MPP is lower,and the level of FeNO is not significantly correlated with the parameters of lung function,and FeNO can be used as an inflammatory marker to evaluate the correlation between MP infection and airway inflammation.
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Objective To evaluate the clinical efficacy of phlegm and nourishing Yin combined with glucocorticoids in the treatment of refractory Mycoplasma pneumoniae pneumonia in children .Methods 134 children with Mycoplasma pneumonia were divided into control group and observation group according to the random number , 67 cases in each group .The control group were given hydrocortisone ,and the observation group received phlegm and nourishing Yin combined with glucocorticoid .After intervention ,the clinical data and the improvement of the clinical symptoms of the two groups were compared .Results There was no statistically significant difference in antipyretic time between the two groups(P>0.05).The time of cough relief,the absorption time of lung rales,the disappearance time of pleural effusion of the observation group were (3.61 ±1.13) d,(6.52 ±1.90) d and (7.02 ±2.10) d, respectively,which were significantly shorter than those of the control group [(4.89 ±2.18)d,t=2.920,P=0.021;(8.24 ±2.75)d,t=3.108,P=0.000;(9.26 ±2.38)d,t=5.027,P=0.000].There were no statistically signifi-cant differences in the total white blood cell count ,C-reactive protein and erythrocyte sedimentation rate between the two groups(all P>0.05).The percentage of lymphocytes in the observation group [(55.25 ±4.91)％] was signifi-cantly higher than that in the control group [(50.16 ±4.83)％,t=2.597,P=0.037].The effective treatment rate in the observation group was 97.01％,which was significantly higher than 83.58％in the control group (χ26.849,P=0.009).Conclusion Heat phlegm and nourishing Yin combined with glucocorticoid can not only effectively improve the patients'clinical symptoms , improve the proportion of lymphocyte , but also can improve the overall efficacy of children,it is worthy of clinical promotion .
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Objective To understand the pathogenic epidemiological status quo among populations with respiratory tract infectious in Nanjing area.Methods The IgM antibody detection reagent kit against 9 kinds of respiratory tract pathogen was used to conduct the IgM antibody detection in 25 057 patients with respiratory tract infection in the Affiliated Nanjing Hospital of Nanjing Medical University,Affiliated Children's Hospital of Nanjing Medical University and Nanjing General Hospital of Nanjing Military Region from May 2013 to April 2015.Results A total of 8 575 cases(34.22％) of pathogen positive were detected out,in which Pneumonia mycoplasma (MP) antibody had the highest positive rate (23.77％);followed by respiratory syncytial virus (RSV,5.19 ％),adenovirus (ADV,4.56 ％),Parainfluenza virus type 1,2 and 3 (PIVS,4.02 ％) and influenza B virus (INFB,2.28％).The seasonal distribution of RSV,ADV and PIVS was significant and had high onset in winter and spring,but low onset in summer and autumn.Infants and young children had maximal positive cases in preschool period,which were 5 274 cases;as a whole,MP IgM antibody positive rate was gradually decreased with the age increase.Conclusion MP is the main pathogen causing respiratory tract infections in Nanjing area,followed by RSV.The pathogenic infection has a correlation with the age group,moreover which demonstrates the seasonal epidemic trend.
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Objective To understand the pathogenic epidemiological status quo among populations with respiratory tract infectious in Nanjing area.Methods The IgM antibody detection reagent kit against 9 kinds of respiratory tract pathogen was used to conduct the IgM antibody detection in 25 057 patients with respiratory tract infection in the Affiliated Nanjing Hospital of Nanjing Medical University,Affiliated Children's Hospital of Nanjing Medical University and Nanjing General Hospital of Nanjing Military Region from May 2013 to April 2015.Results A total of 8 575 cases(34.22％) of pathogen positive were detected out,in which Pneumonia mycoplasma (MP) antibody had the highest positive rate (23.77％);followed by respiratory syncytial virus (RSV,5.19 ％),adenovirus (ADV,4.56 ％),Parainfluenza virus type 1,2 and 3 (PIVS,4.02 ％) and influenza B virus (INFB,2.28％).The seasonal distribution of RSV,ADV and PIVS was significant and had high onset in winter and spring,but low onset in summer and autumn.Infants and young children had maximal positive cases in preschool period,which were 5 274 cases;as a whole,MP IgM antibody positive rate was gradually decreased with the age increase.Conclusion MP is the main pathogen causing respiratory tract infections in Nanjing area,followed by RSV.The pathogenic infection has a correlation with the age group,moreover which demonstrates the seasonal epidemic trend.
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Objective To compare the sensitivity and specificity of dot immunogold method (DIM) and particle agglutination (PA) for the diagnosis of mycoplasma pneumoniae (MP) infection. Methods The 190 serum specimens of 113 children with mycoplasmal pneumonia (infection group) and 50 serum specimens of 50 health children (health group) were tested for MP by PA and DIM- A and B. Results In infection group, the positive rates of DIM- A and B were 82.63% (157/190) and 84.74%(161/190), and there was no statistical difference (χ2 = 0.31, P>0.05); the positive rate of PA (titer ≥1:160) was 70.00%(133/190), the positive rate of PA was significantly lower than that in DIM-A and B, and there were statistical differences (P0.05); the positive of PA was 8.00% (4/50), the positive rate of PA was significantly lower than that in DIM- A and B, and there were statistical differences (P<0.05 or<0.01). Conclusions Compared with the PA, DIM has low sensitivity and poor specificity for clinical diagnosis. DIM is not suitable for clinical diagnosis of MP infection.
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Objective To explore the heme oxygenase-1 (HO-1) content of carbon monoxide (CO) levels and clinical significance of Mycoplasma pneumoniae infection in children.Methods 219 cases of mycoplasma pneumonia from October 2013 to June 2015 in our hospital were divided into two groups,which were non-asthmatic group (156 cases) and wheezing group (63 cases),and the wheezing group were divided into two groups according to the presence or absence of hypoxemia and mild asthmatic group (39 cases) and severe asthmatic group (24 cases).HO-1 content in the blood was measured by enzyme-linked immunosorbent assay,using dual-wavelength spectrophotometric determination of hemoglobin oxygen percentage of broken (COHb％),analysis of the differences between the groups.Results Children with blood COHb content wheezing group were (2.59 ± 0.40)％ and HO-1 levels were (1 813.24 ± 28.34)ng/L and non-respite group were significantly increased,it had significant differences between the two groups (P＜ 0.05).Group of children with severe wheezing COHb content were (3.63 ± 0.45)％ and HO-1 levels were (2 594.34±23.94)ng/L and mild wheezing group were significantly increased,it had significant differences between the two groups (P＜0.05).Positive correlation between blood COHb content and HO-1 levels were significantly (r=0.733,P＜0.05).Conclusion Mycoplasma pneumoniae infection in children with wheezing blood COHb content and HO-1 levels were significantly increased,and with wheezing exacerbation and showed an increasing trend,suggesting that CO and HO-1 may be involved in Mycoplasma pneumoniae infection in children in the pathogenesis of wheezing,should lead to clinical attention.