Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults

Miyashita, Naoyuki; Kawai, Yasuhiro; Inamura, Norikazu; Tanaka, Takaaki; Akaike, Hiroto; Teranishi, Hideto; Wakabayashi, Tokio; Nakano, Takashi; Ouchi, Kazunobu; Okimoto, Niro

doi:10.1016/j.jiac.2014.10.008

Cited by 64 publications

(66 citation statements)

References 28 publications

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“…[25][26][27][28] Although there is no case-control study on the benefit of steroids in refractory M. pneumoniae pneumonia, it is believed that early steroid therapy might prevent disease progression and reduce disease morbidity without adverse reactions. 29,30 However, it is impossible to initiate steroids early for all M. pneumoniae infections because most of them are self-limited, and there is no evidence to support the use of systemic steroids in community-acquired pneumonia due to other pathogens. 31 In addition, an epidemiological investigation showed that there is no apparent risk factor for refractory M. pneumoniae pneumonia 32 ; therefore, predicting this illness at an early stage may improve the prognosis of M. pneumoniae infection, as this might help identify subjects for trials of early steroid administration.…”

Section: Discussionmentioning

confidence: 99%

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

et al. 2015

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BACKGROUND: Corticosteroids have been used for refractory Mycoplasma pneumoniae pneumonia and have beneficial effects. The aim of this study was to identify the biomarkers for predicting refractory M. pneumoniae pneumonia in a timely fashion to initiate steroid therapy. METHODS: This was a prospective cohort study of children with M. pneumoniae pneumonia admitted to the Children's Hospital of Fudan University from September 2012 to August 2013. Lactate dehydrogenase (LDH) and other laboratory tests, including complete blood counts, C-reactive protein, erythrocyte sedimentation rate (ESR), alanine aminotransferase, aspartate aminotransferase, ␣-hydroxybutyrate dehydrogenase (HBDH), creatine kinase, and creatine kinase MB, were performed on admission. Based on the definition of refractory M. pneumoniae pneumonia, subjects were divided into 2 groups: refractory M. pneumoniae pneumonia and usual M. pneumoniae pneumonia.The diagnostic values of laboratory findings were analyzed. RESULTS: In total, 653 subjects were enrolled, including 300 in the refractory pneumonia group and 353 in the usual pneumonia group. There was no significant difference in sex distribution between the 2 groups. The average age in the refractory M. pneumoniae pneumonia group was greater than that in the usual M. pneumoniae pneumonia group. Compared with the usual pneumonia group, the refractory pneumonia group showed significantly higher levels of C-reactive protein, serum LDH, serum HBDH, serum alanine aminotransferase, serum aspartate aminotransferase, and neutrophils and higher ESRs. Logistic regression showed that age, LDH, and ESR were the significant factors in predicting refractory M. pneumoniae pneumonia. In addition, LDH and HBDH were strongly correlated, and receiver operating characteristic curve analysis showed that the area under the curve of LDH was 0.718 with a cutoff of 379 IU/L, that of ESR was 0.683 with a cutoff of 32.5 IU/L, and that of HBDH was 0.691 with a cutoff of 259.5 IU/L. CONCLUSIONS: Serum LDH can be used as a biomarker to predict refractory M. pneumoniae pneumonia at the early stage of hospitalization.

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Section: Discussionmentioning

confidence: 99%

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

et al. 2015

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“…However, corticosteroids may have a desirable effect on MPP by down-regulating cell-mediated immunity. Clinical evidence supporting this hypothesis has been reported by several groups (2,3,6,7). Although about half of previously reported patients with fulminant MPP were treated with methylprednisolone pulse therapy probably following typical ARDS (6), the optimal dose and duration of steroid therapy remain unclear.…”

Section: Discussionmentioning

confidence: 83%

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report

Takahashi

Shinohara

et al. 2016

J. Thorac. Dis.

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Sporadic patients with acute respiratory distress syndrome (ARDS) caused by Mycoplasma pneumoniae have been reported. However, knowledge about the pathophysiology and pharmacological treatment of this condition is insufficient. Moreover, the pulmonary vascular permeability in ARDS related to M. pneumoniae infection has not been reported. We report a case of ARDS caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability, which was successfully treated using low-dose short-term hydrocortisone, suggesting that pulmonary infiltration in ARDS caused by Mycoplasma pneumoniae does not match the criteria of permeability edema observed in typical ARDS.

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“…All patients had positive results for MP immunoglobulin M (IgM) antibody in sera and for MP DNA by polymerase chain reaction (PCR) in throat swabs on admission. Patients with RMPP were defined as follows: (i) prolonged fever for 7 days or more and (ii) increasing cough and infiltrates in chest radiograph despite administration of appropriate antibiotics (20). Five patients were defined as NRMPP.…”

Section: Methodsmentioning

confidence: 99%

iTRAQ-based Quantitative Proteomics Study in Patients with Refractory <i>Mycoplasma pneumoniae</i> Pneumonia

Song

Xie

et al. 2017

Jpn J Infect Dis

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Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults

Cited by 64 publications

References 28 publications

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report

iTRAQ-based Quantitative Proteomics Study in Patients with Refractory <i>Mycoplasma pneumoniae</i> Pneumonia

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