IntroductionIncidence of severe M. pneumoniae pneumonia (SMPP) reported in China has been increasing over the last decade. We aimed to evaluate the clinical features of pediatric SMPP with pulmonary complications, according to laboratory tests and chest radiographic resolution patterns.Material and MethodsWe retrospectively reviewed 93 SMPP patients between January 2016 and February 2019, and grouped them by pneumonia pattern: pulmonary complications (63 patients) and extensive lung lesions without pulmonary complications (30 patients).ResultsSMPP patients with pleural effusion (medium or large) and necrotizing pneumonia showed longer duration of fever, high serum value of lactate dehydrogenase (LDH), d‐dimer, and LDH to albumin ratio (LAR). LAR and d‐dimer were associated with moderate or massive pleural effusion, and d‐dimer was associated with lung necrosis. The average time of radiographic resolution in the pulmonary complication group was 12 weeks, while those with elevated d‐dimer were significantly more likely to have longer time for radiographic clearance.ConclusionWe conclude that M. pneumoniae pneumonia in patients with pleural effusion (medium or large) or lung necrosis was more severe than those without pulmonary complications. LAR and d‐dimer might be used as parameters to identify children susceptible to pleural effusion (medium or large) or lung necrosis, and longer time for radiographic clearance among pediatric patients of SMPP.
Background: Congenital bronchobiliary fistula (CBBF) is a rare disease with abnormal connection between the biliary tract and the bronchus. The misdiagnosis rate of CBBF is high, delayed surgery may induce poor outcome. Case presentation: We reported a girl with CBBF who was confirmed via bronchoscopy and chest computed tomography (CT). The girl was 7-month-old admitted to the hospital with “recurrent pneumonia”. Bilirubin crystallization detection was positive in the bronchoalveolar lavage fluid (BALF). CT images showed the abnormal traffic between the biliary tract and the right main bronchus, the girl was diagnosed with CBBF and recovered after surgical operation. Literature search: A total of 27 cases were collected, 14 (51.8%) cases were diagnosed in the neonatal period, 9 (33.3%) patients were diagnosed in infancy. CBBF was more common in female (19/27, 70.3%). The specific manifestations were bilious sputum (24/27, 88.9%) and bilious vomiting (7/27, 22.2%). Recurrent pneumonia (9/27, 33.3%) was common clinical manifestations. The most abnormal fistula originates different location around the carina was right main bronchus (21/27, 77.8%). There were 23(85.2%) cases recovered after surgical operation and 4(14.8%) cases with severe comorbidities/complications died. Conclusions: CBBF should be suspected in infants with bilious sputum. Bronchoscopy plays crucial role in preoperative evaluation and postoperative follow-up. With early diagnosis and surgery, the prognosis is quite well for CBBF patients without severe biliary malformation and/or severe postoperative complications.
Background Incidence of severe M. pneumoniae pneumonia (SMPP) reported in China was increasing in the last decade. We aimed to evaluate clinical features in pediatric SMPP with pulmonary complications according to laboratory test and chest radiographic resolution patterns.Methods We retrospectively reviewed 93 SMPP patients between January 2016 and December 2018, and they were grouped by pneumonia pattern: pulmonary complication group (63 patients) and extensive lung lesion without pulmonary complication group (30 patients).Results SMPP patients of pleural effusion and necrotizing pneumonia showed longer fever duration, high serum value of lactic dehydrogenase (LDH), D-dimer and LDH to albumin ratio (LAR). LAR and D-dimer were associated with moderate and massive pleural effusion,and D-dimer was associated with lung necrosis. The average time of radiographic resolution in pulmonary complication group was 12 weeks, and those with elevated D-dimer were significantly more likely to have longer time to radiographic clearance.Conclusions M. pneumoniae pneumonia patients with pleural effusion or lung necrosis were more severe than those without pulmonary complication, LAR and D-dimer might be used as parameters to identify susceptible children of pleural effusion or lung necrosis and longer time to radiographic clearance among patients with SMPP.
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