Four cases of lung abscess related to Mycoplasma pneumoniae infection / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the clinical characteristics of pediatric Mycoplasma pneumoniae (MP)complicated with lung abscess.Methods Data of 4 cases suffering from pulmonary abscess associated with MP from Jan.2000 to Jun.2011,including manifestations,imaging,laboratory examinations and therapies,were collected and analyzed.Related literatures were reviewed.Results Two female and 2 male cases were included in this study.The age ranged from 3 to 6 years old,and all patients had a history of acute onset,severe cough and little sputum.Three cases had remittent fever,and 3 cases had fixed small and medium-sized blisters sound in the lung.The levels of MP antibody M (MP-IgM) in the serum were higher than 1160 and sputum fluorescence quantitative-mycoplasma pneumonia (FQ-MP DNA) tests were positive in 4 patients.The white blood cells (WBC),polymorphonuclear leukocyte (PMN),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR) in 3 cases were significantly higher than the normal level,and the FQ-MP DNA tests in the bronchoalveolar lavage fluid (BALF) were positive in 3 cases.The FQ-MP DNA in both blood and chest water were positive in 1 case.Cultures of sputum,blood,chest water,BALF and procalcitionin tests were negative,except for 1 case with positive sputum culture of Branhamellacatarrhalis.The imaging examinations on admission of 4 cases strongly suggested that the interstitial and parenchymal lung disease and subsequently appeared the different sized cystic shadow,liquid fiat cystic shadow,thickened wall empty tissue image during the course of 5 to 20 days.All cases were sequentially treated with azithromycin after full erythromycin,3 cases received intravenous glucocorticoid,1 case received intravenous gamma globulin.The bronchial mucosal hyperemia and edema,submucosal scattered small nodules,pathological changes of bronchial sticky phlegm jam were observed in 3 cases by flexible bronchoscopy.After 3 to 5 days of admission,all patients' temperature returned to normal,the cough was reduced,and the characteristics of the lung were gradually improved.After 3 to 4 weeks,the chest radiograph showed that most pneumonia was absorbed.The 6 to 18 month follow-up indicated that absorption was good.The upper left lung limited atelectasis was found in 1 case.Conclusions Pulmonary abscess is a rare complication of MP.The major clinical manifestations are high fever,significantly higher levels of blood WBC,PMN,CRP and ESR,and high density of shadow in chest Xray.The regular dose of erythromycin doesn't work well.However,the prognosis is good after conservative therapy with the sufficient macrolide antibiotics with glucocorticoid and immunoglobulin.