An analysis of 20 clinical cases of refractory mycoplasma pneumonia in children

Abstract

Background: Refractory mycoplasma pneumonia (RMPP) is one of the important pathogens of community-acquired pneumonia (CAP) in children. Its treatment is difficult. The aims of this study were to analyze the clinical manifestations, diagnosis, and treatment of 20 cases of RMPP in children in order to provide a reference for the diagnosis and treatment of RMPP. Methods: The clinical data of 20 patients with RMPP admitted to the Pediatrics Department of the First Affiliated Hospital of Guangzhou Medical University in the recent three years were retrospectively analyzed.The clinical data of 36 patients with common mycoplasma pneumonia in the same period were compared.The clinical manifestations, laboratory examinations, and imaging characteristics of RMPP were discussed.Intrapulmonary and extrapulmonary complications and treatment were also analyzed in order to provide assistance in the diagnosis and treatment of RMPP.Results: There were significant differences between the refractory group and the general group in terms of heat duration, hospitalization time, hypoxemia, lung rales, CRP, ESR, PCT, LDH, ALT, PLT, WBC, D dimer and other laboratory examinations, intrapulmonary and extrapulmonary complications, and treatment (all P<0.05). There was no significant difference in the age, sex, and wheezing between the two groups (P>0.05).Conclusions: Long duration of fever, tachycardia, and lung rale protrusion may be the clinical characteristics of RMPP. Unilateral pulmonary shadow and atelectasis should be paid more attention, which may be a high-risk factor for the development of RMPP. The inflammation index of RMPP cases increased and there were many complications inside and outside the patients' lungs. It was necessary to give enough macrolides to fight the infection by using Glucocorticoid and Intravenous immunoglobulin reasonably while liver, heart, and fiberoptic bronchoscopy was completed to improve the effectiveness of the diagnosis and treatment.

A Lung Ultrasound-Based Nomogram for the Prediction of Refractory Mycoplasma pneumoniae Pneumonia in Hospitalized Children

“…Our study confirmed that consolidation size corrected for BSA remained an independent risk factor for RMPP and entered the prediction model. Several studies confirmed 7,12,26 that unilateral pulmonary solidity or atelectasis was the most critical risk factor for developing RMPP, which was consistent with our findings. Musolino et al 35 showed that 63.6% of patients with complicated pneumonia had a lung consolidation size ≥5 cm in LUS.…”

“…As macrolide-unresponsive RMPP continues to emerge, only drugs such as minocycline or fluoroquinolones are available for treatment; however, the safety of these two classes of drugs in children remains to be studied. 25 Zhai et al 26 found that the course of antibiotics for RMPP was significantly longer than that for children with CMPP, requiring two or even longer infusion courses. Because RMPP has an overwhelming immune response and is prone to extrapulmonary complications such as mycoplasma encephalopathy, liver injury, myocardial injury, glucocorticoid, immunoglobulin, liver-protecting, and heart-protecting drugs are also used…”

Clinical Significance of Pleural Effusion in Mycoplasma pneumoniae Pneumonia in Children

“…MP infections present as cyclic epidemics every 3–7 years, depending on the geographic location [ 2 ]. MP infection is considered a benign or self-limiting disease; however, the prevalence of refractory MP pneumonia, characterized by persistent fever and/or disease progression despite appropriate treatment with antibiotics and immunomodulators, has been increasing [ 3 , 4 , 5 ]. The prevalence of macrolide-resistant MP (MRMP) pneumonia has also been increasing [ 6 ].…”

Chinese Herbal Medicine for the Treatment of Children and Adolescents With Refractory Mycoplasma Pneumoniae Pneumonia: A Systematic Review and a Meta-Analysis

“…However, after being treated by macrolide antibiotics for no less than 7 days, some children and adolescents still show severe symptoms and/or progressively worsening radiological findings, which can be diagnosed as refractory M. pneumoniae pneumonia (RMPP) ( Chen et al, 2015 ). Compared to common M. pneumoniae pneumonia (MPP), RMPP commonly presented with persistent or repeated high fever, severe cough, multiple complications involving atelectasis, pleural effusion, myocarditis, hemolytic anemia, encephalitis, and even multiple organ dysfunction, damaging the health of children and adolescents ( Zhai et al, 2020 ). In recent years, the incidence of RMPP has gradually increased, especially in Asia ( Guo et al, 2020 ; Lee et al, 2020 ), which is becoming a critical issue for pediatricians.…”