Is Mycoplasma pneumonia a potential factor for hemoptysis related to pulmonary vascular malformations? A retrospective cohort study of 27 children

Abstract

Background: To summarize characteristics of hemoptysis in children associated with pulmonary vascular malformations, and to identify the pathological mechanism, potentially. Methods: Children were recruited who were diagnosed with hemoptysis for pulmonary vascular malformations without congenital heart disease (CHD). The demographics, history, clinical characteristics, laboratory findings, pathogens testing, imaging outcomes and prognosis were systemically reported. The nonparametric Mann-Whitney U test using SPSS 24.0 was employed to compare the continuous laboratory variables, and Fisher’s exact test was applied for data enumeration. A P-value of <0.05 was considered statistically significant. Results: In sum, 27 children were enrolled in this retrospective study with a medium age of 9.1 years old, among whom 9.1% were in preschool-group, 72.7% in school-group, and 18.2% in adolescent-group. Different hemoptysis degrees were observed from individuals, and the moderate and severe conditions were commonly in elder children. Meanwhile some antecedent symptoms were recorded, mainly cough and fever before hemoptysis occurrence. Pathogens testing indicated proofs for infection of MP in 68.2% patients, and 37.5% were further identified with MP-DNA-PCR. Images revealed interstitial changes in most hemoptysis cases, especially in the inferior lobe of right lung for cases with MP infection, and endovascular contrast detected 24 patients with abnormal bronchial arteries (BAs) causing bronchial artery-pulmonary artery fistula and 3 patients suffered from pulmonary arteriovenous fistula (PAVF). After the transcatheter plug closure, a recurrent hemoptysis occurred in 8 patients suffered from an infection of MP initially, and the OR of clinical worsening in Group 1 where cases were considered with an infection of MP, was 2:1. Conclusions: Pulmonary vascular malformations can be commonly detected in elder children. An infection of MP possibly acts as a potential trigger inducing the rupture of affected vessels, which could take a higher risk of clinical worsening.