Two patients with Mycoplasma pneumoniae pneumonia progressing to acute respiratory distress syndrome

Mycoplasma pneumoniae pneumonia is one of the most prevalent community-acquired pneumonias in pediatric patients. It commonly presents with mild respiratory symptoms and is well controlled by macrolide antibiotics. Rarely, it can progress to acute respiratory distress syndrome (ARDS) despite appropriate antibiotic therapy, and systemic corticosteroids and quinolone antibiotics are required. We recently treated 2 patients who presented with M. pneumoniae pneumonia with ARDS. Case 1: A 17-year-old girl was admitted with pneumonia that showed no response to antibiotics and progressed to ARDS, which required initiation of mechanical ventilation therapy. The patient was negative for M. pneumoniae IgM; but positive for, M. pneumoniae. After treatment with methylprednisolone and levofloxacin, rapid improvement was observed in both clinical manifestations and chest radiographic findings. Two days after discontinuing a 5-day methylprednisolone treatment regimen, she developed fever, and investigations revealed an elevated C-reactive protein level; this necessitated additional methylprednisolone treatment. Subsequently, she showed complete recovery with no sequelae. Case 2: A 14-year-old girl was admitted with M. pneumoniae pneumonia with ARDS that required mechanical ventilation therapy. She showed a IgM titers against M. pneumoniae of 1:320. After treatment with antibiotics and methylprednisolone, she recovered and was discharged at 48 admission days; however, mild dyspnea persisted. The chest computed tomography showed multiple bronchiectasis areas. After 15 days, because of aggravated dyspnea, she was readmitted and adminis-tered methylprednisolone pulse therapy. Despite 3 courses of methylprednisolone pulse therapy, she still showed mild dyspnea.

Clinical Evaluation of Macrolide-resistant Mycoplasma pneumoniae Infections in Pediatric Japanese Patients.

Background: In recent years, an increase in Mycoplasma pneumoniae infections among children has become a social issue in Japan. Methods: During a 2-year collection period (2011-2012), we evaluated trends during the first and second halves of both years. Only patients with positive rapid antigen detection test results (ImmunoCard Mycoplasma: Meridian Bioscience, Inc Cincinnati, OH, USA) were included. The evaluation items included the patient number, sex, radiography findings, white blood cell (WBC) count, C-reactive protein (CRP) level, and clinical macrolide-resistance rate. Results: The patient number increased significantly during the latter halves of the years. The macrolide-resistance rate also increased during the same periods. A similar trend was observed with respect to radiography findings but not with respect to the WBC count and CRP level. Conclusions: It is important to monitor the macrolide-resistance trends in case of Mycoplasma pneumoniae infections in children.

Advance on macrolide-resistant Mycoplasma pneumoniae infection / 国际儿科学杂志

Macrolide(Ma) resistance has been spreading for more than 13 years worldwide accompanying Ma widely used for anti-mycoplasma pneumoniae (Mp)infection,and has been rapidly increasing.Prevalence of Ma resistance has been higher in Asia than in Europe and America.More than 10 positions of Mp mutation were found.Of them A2058G in domain V of 23S ribosomal RNA gene is frequently found in Europe and America,and A2063G is found dominant in Asia.Different position points of Mp mutation are related with different Ma resistance.Real time PCR for detecting Mp and its mutation position directly from bronchoalveolar lavage fluid is the most accurate method.Treatment with minocycline and garenoxacin for Ma-resistant Mp infection are known most effective.

Therapeutic and antimicrobial efficacy of macrolides,minocycline, and tosufloxacin against macrolide-resistant mycoplasma pneumoniae pneumonia in pediatric patients / 中国生化药物杂志

Objective To observe the differences in the therapeutic efficacies of macrolides,minocycline,and tosufloxacin against macrolide-resistant Mycoplasma pneumoniae(MRMP).Methods A total of 188 children with M.pneumoniae pneumonia confirmed by culture and PCR were analyzed.Of these,150 patients had a strain with an MR gene and 134 had one with an A-to-G mutation at position 2063 of M.pneumoniae 23S rRNA domain V.Azithromycin(n=27),clarithromycin(n=23),tosufloxacin(n=62),or minocycline(n=38)was used for definitive treatment of patients with MR M.pneumoniae.Among the 188 patients,the other 38 patients with macrolide-sensitive Mycoplasma pneumonia (MSMP)were grouped into azithromycin(n =16)and clarithromycin groups(n =22)for observing whether there is differences with respect to efficacy under parallel treatment between patients with MRMP and MSMP. Results Defervescence within 48 h after the initiation of antibiotic therapy was observed in 41%of the patients in the azithromycin group,48% of those in the clarithromycin group,69% of those in the tosufloxacin group,and 87% of those in the minocycline group.The average number of days of fever after the administration of antibiotic treatment was lower in the minocycline and tosufloxacin groups than in the macrolide groups(azithromycin and clarithromycin groups).The decrease in the M.pneumoniae burden,as estimated by the number of DNA copies,after 48 to 96 h of treatment was more rapid in patients receiving minocycline(P=0.016)than in those receiving tosufloxacin(P=0.049),azithromycin(P=0.273),or clarithromycin(P=0.107).Conclusion We found that the clinical and bacteriological efficacies of macrolides against MR M.pneumoniae pneumonia was low.Our results indicated that minocycline rather than tosufloxacin can be considered the first-choice drug for the treatment of M.pneumoniae pneumonia in children aged >8 years.