The treatment role of flexible bronchoscopy (FOB) for pediatric refractory Mycoplasma pneumoniae pneumonia (RMPP) has been well documented. Besides, the application indication of FOB is also studied in patients with general MPP (GMPP), especially in those with large pulmonary lesions. This study was designed to examine the diagnostic value of bronchoscopic features for RMPP.The FOB and bronchoalveolar lavage (BAL) were adopted for pediatric patients who showed clinical and radiograph indications. On the basis of the final diagnosis on discharge, patients were divided into general and refractory MPP groups. The clinical, laboratory, and bronchoscopic imaging features were retrospectively investigated between these 2 groups.From June 2012 to May 2014, a total of 62 RMPP and 101 GMPP patients were treated with therapeutic bronchoscopy. The comparison analysis showed that the CRP, HBDH, LDH were significantly different between RMPP and GMPP groups (all P < .001). In the bronchoscopic imaging, the mucus plug was significantly more commonly seen in the RMPP group (P < .001). Receiver operating characteristic (ROC) analysis revealed that the combined serum, clinical, and FOB imaging data possessed greater specificity and sensitivity than serum and clinical data alone.Our data suggest that the combined serum, clinical, and bronchoscopic imaging data might serve as a promising predictor for early RMPP diagnosis for pediatric patients with large pulmonary lesions.
This study was performed to analyze 22 cases of Mycoplasma pneumoniae pneumonia (MPP) associated with bronchial casts (BCs) in children. Methods: We retrospectively reviewed all cases of MPP in children treated at our institution from November 2015 to December 2016. Demographic information, laboratory parameters, radiologic and fiberoptic bronchoscopy findings, treatment outcomes, and follow-up results were analyzed. Results: Among 161 patients with MPP, 22 had BCs and 139 had no BCs. All BCs occurred in a segmental or subsegmental bronchus and were removed by fiberoptic bronchoscopy. Patients with BCs had a longer duration of fever after admission and higher incidence of refractory MPP. Substantially more children with than without BCs had a high M. pneumoniae load in the bronchoalveolar lavage fluid. All patients with BCs but only 55.4% without BCs were given methylprednisolone in addition to the standard antibiotic treatment. A significantly higher proportion of children with than without BCs received oxygen therapy. After discharge, complete radiological resolution took significantly longer in children with than without BCs. Conclusions: In children with MPP, prompt removal of BCs may be necessary to prevent BC propagation. MPP with BCs is more severe than that without BCs, and treatment and recovery are more difficult.
Mycoplasma pneumoniae (MP) is the most common atypical pathogen that causes respiratory infections in children. Such infections are typically treated by macrolide antibiotics, but the duration of treatment is variable. In this study, we used nested PCR to amplify the 16S rDNA (16S rRNA gene) of MP at different stages of MP pneumonia (MPP) in 100 children who were admitted for lower respiratory tract infections and diagnosed with MPP. Our results indicate that the median duration of MP-DNA positivity was 5 weeks, and 78 % of cases tested positive for 3-6 weeks. Patients with severe disease were positive for MP-DNA for a significantly longer time (median of 6 weeks) than those with mild disease (median of 4 weeks). Thirty-one patients with severe disease who received intravenous immunoglobulin were MP-DNA positive for significantly less time than patients with severe disease who did not receive this treatment. The duration of MP-DNA positivity was prolonged when MP antibody levels were high and treatment was started at a later stage. Therefore, nested PCR can be used for early diagnosis of MP and the duration of MP-DNA reflects the clinical stage of MPP. Early treatment of MPP and the administration of intravenous immunoglobulin during the acute phase of severe MPP shorten the duration of MP-DNA positivity.
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