Necrotizing Pneumonitis Caused by Mycoplasma pneumoniae in Pediatric Patients

Wang, Ruay-Shyang; Wang, Shuo-Yu; Hsieh, Kai‐Sheng; Chiou, Yee-Hsuan; Huang, I-Shen; Cheng, Ming-Feng; Chiou, Christine C.

doi:10.1097/01.inf.0000130074.56368.4b

Cited by 68 publications

(47 citation statements)

References 8 publications

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“…Although M. pneumoniae infection was traditionally thought to be a self-limited process, more and more severe cases even fatal cases of M. pneumoniae infections were reported in recent years (3)(4)(5)(6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

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More Complications Occur in Macrolide-Resistant than in Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia

Zhou

Zhang

Sheng

et al. 2014

Antimicrob Agents Chemother

125

132

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bWe sought to understand the situation of macrolide-resistant genotypes of Mycoplasma pneumoniae, and analyze the relationship between macrolide-resistant genotypes and clinical manifestations of Mycoplasma pneumoniae pneumonia (MPP). Fulllength sequencing of the 23S rRNA gene of M. pneumoniae was performed in 235 nasopharyngeal aspirates (NPAs) from children with MPP. We also retrospectively compared the clinical characteristics of macrolide-resistant (MR) M. pneumoniae infections and macrolide-sensitive (MS) M. pneumoniae infections. A total of 206 patients had point mutations in the M. pneumoniae 23S rRNA gene, and these patients are referred to as MR patients. The remaining 29 patients without point mutations are referred to as MS patients. Among 206 MR patients, 199 (96.6%) had A2063G mutations, 6 had A2063T mutations, and the remaining patients had an A2064G mutation. Among the clinical manifestations, we found that the median fever durations were 8 days (range, 0 to 42 days) and 6 days (0 to 14 days) (P < 0.01), the median hospitalization durations were 8 days (2 to 45 days) and 6 days (3 to 16 days) (P < 0.01), and the median fever durations after macrolide therapy were 5 days (0 to 42 days) and 3 days (0 to 10 days) (P < 0.01), respectively, in the MR and MS groups. We also found that the incidence of extrapulmonary complications in the MR group was significantly higher than that in the MS group (P < 0.05). Moreover, the radiological findings were more serious in the MR group than in the MS group (P < 0.05). The increasing prevalence of MR M. pneumoniae has become a significant clinical issue in the pediatric patients, which may lead to more extrapulmonary complications and severe clinical features and radiological manifestations. Mycoplasma pneumoniae is one of the most prevalent pathogens causing community-acquired respiratory tract infections in children and young adults (1, 2). M. pneumoniae pneumonia (MPP) is usually a benign self-limited disease. However, sometimes it may cause various extrapulmonary complications and progress to a severe life-threatening pneumonia (3-8). These cases might show clinical and radiological deterioration despite of macrolide antibiotic therapy for 7 days or longer (9).Severe M. pneumoniae infections may be related to the occurrence of macrolide-resistant (MR) M. pneumoniae. For children, macrolides are the first-choice agents for M. pneumoniae infections. However, in recent years, many isolates of M. pneumoniae from clinical samples showed resistance to macrolides with a high prevalence of Ͼ90% in China (10). The main mechanism of resistance has been shown to be due to mutations in the domain V of 23S rRNA of M. pneumoniae (10-13). The mutations that induce a high-level of macrolide resistance are an A-to-G transition at position 2063 and an A-to-G transition at position 2064, whereas low-level resistance is induced by an A-to-G transition at position 2617 and A-to-T transition at position 2063 (13). Several studies have indicated that macrolide resistance in M. pneum...

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Section: Discussionmentioning

confidence: 99%

“…M. pneumoniae pneumonia (MPP) is usually a benign self-limited disease. However, sometimes it may cause various extrapulmonary complications and progress to a severe life-threatening pneumonia (3)(4)(5)(6)(7)(8). These cases might show clinical and radiological deterioration despite of macrolide antibiotic therapy for 7 days or longer (9).…”

mentioning

confidence: 99%

More Complications Occur in Macrolide-Resistant than in Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia

Zhou

Zhang

Sheng

et al. 2014

Antimicrob Agents Chemother

125

132

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“…It is characterised by necrosis and liquefaction of lung parenchyma, which is thought to be secondary to ischaemia caused by thrombosis of intrapulmonary vessels and can culminate in pulmonary gangrene [89] of single or multiple lobes [74,90]. Historically, the primary causative pathogen was thought to be S. aureus [91] but S. pneumoniae, particularly serotypes 1, 3 9V and 14 [88,89], is now the predominant cause, although M. pneumoniae [92], methicillin-resistant S. aureus and PVL strains of S. aureus [93] have also been implicated. Diagnosis is usually made on CT, as plain chest radiographs will not accurately demonstrate the typical disruption of normal parenchymal architecture where multiple airor fluid-filled cavities replace the normal lung tissue [90].…”

Section: Necrotising Pneumoniamentioning

confidence: 99%

Complicated pneumonia in children

Pabary

Balfour‐Lynn

2013

BRE

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“…Authors concluded that M. pneumoniae related PPE was milder than that was caused by other organisms, but its course was longer 26 . Massive pleural effusion and empyema secondary to M. pneumoniae infection has been reported as case series or single case reports 5,[27][28][29][30][31][32] . In our study, M. pneumoniae related empyema and PPE were required chest tube drainage and tube thoracostomy with intrapleural fibrinolysis that M. pneumoniae related empyema and PPE might be massive.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of complicated and uncomplicated parapneumonic effusion in children

et al. 2016

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003). Children in the empyema group had significantly more dyspnea symptoms than the children with PPE (p=0.022). Mean fever duration before hospitalization was similar in both groups. Streptococcus pneumoniae and group A streptococcus were the most common causes of empyema. All of the patients were treated with intravenous antibiotics. In addition to medical treatment, tube thoracostomy was performed in 59 of 70 (84.3%) patients in empyema group; 27 (45.8%) of them required intrapleural fibrinolysis also. In the presence of antibiotic treatment failure or in cases with moderate or large pleural effusion with loculations and clinical deterioration; it is necessary to perform drainage of the purulent fluid by tube thoracostomy, to add intrapleural fibrinolytics or to perform video-assisted thoracoscopic surgery (VATS), in order to enhance prompt recovery.

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Necrotizing Pneumonitis Caused by Mycoplasma pneumoniae in Pediatric Patients

Cited by 68 publications

References 8 publications

More Complications Occur in Macrolide-Resistant than in Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia

More Complications Occur in Macrolide-Resistant than in Macrolide-Sensitive Mycoplasma pneumoniae Pneumonia

Complicated pneumonia in children

Evaluation of complicated and uncomplicated parapneumonic effusion in children

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