The clinical significance of macrolide resistance in pediatric Mycoplasma pneumoniae infection during COVID-19 pandemic.

Background: Mycoplasma pneumoniae (MP) is a commonly occurring pathogen causing community-acquired pneumonia (CAP) in children. The global prevalence of macrolide-resistant MP (MRMP) infection, especially in Asian regions, is increasing rapidly. However, the prevalence of MRMP and its clinical significance during the COVID-19 pandemic is not clear. Methods: This study enrolled children with molecularly confirmed macrolide-susceptible MP (MSMP) and MRMP CAP from Beijing Children's Hospital Baoding Hospital, Capital Medical University between August 2021 and July 2022. The clinical characteristics, laboratory findings, chest imaging presentations, and strain genotypes were compared between patients with MSMP and MRMP CAP. Results: A total of 520 hospitalized children with MP-CAP were enrolled in the study, with a macrolide resistance rate of 92.7%. Patients with MRMP infection exhibited more severe clinical manifestations (such as dyspnea and pleural effusion) and had a longer hospital stay than the MSMP group. Furthermore, abnormal blood test results (including increased LDH and D-dimer) were more common in the MRMP group (P<0.05). Multilocus variable-number tandem-repeat analysis (MLVA) was performed on 304 samples based on four loci (Mpn13-16), and M3562 and M4572 were the major types, accounting for 74.0% and 16.8% of the strains, respectively. The macrolide resistance rate of M3562 strains was up to 95.1%. Conclusion: The prevalence of MRMP strains in hospitalized CAP patients was extremely high in the Baoding area, and patients infected with MRMP strains exhibited more severe clinical features and increased LDH and D-dimer. M3562 was the predominant resistant clone.

Kawasaki disease shock syndrome complicated with bilateral lung consolidation in a child: A case report.

INTRODUCTION: Kawasaki disease (KD) is a systemic inflammatory disease. Standard imaging features of KD include interstitial and lobular inflammatory lesions in the lungs, while KD shock syndrome (KDSS), complicated with substantial consolidation and atelectasis in the lung, is rarely reported. PATIENTS CONCERNS: Herein, we report a single case of a 5-year-old female patient who manifested KDSS on the seventh day of the course of KD. Chest enhanced computed tomography indicated large-area consolidation in the lower lobes of the bilateral lungs. DIAGNOSIS: The patient was diagnosed with KDSS complicated with non-infective lung consolidation. INTERVENTIONS: The patient received human intravenous immunoglobulin (2 g/kg) and aspirin (30-50 mg/kgd), methylprednisolone, a vasoactive agent, and albumin. Infective factors were excluded. OUTCOMES: The consolidation in the lower lobe of the bilateral lungs was completely recovered after 3 days of treatment. CONCLUSIONS: Children with KDSS may present with pulmonary lesions such as substantial consolidation and atelectasis; thus, infective factors should be excluded. If there is no etiological evidence, antibiotics should be used with caution.