以肺外表现为首发症状的成人肺炎支原体肺炎临床分析

目的提高对以肺外表现为首发症状的成人肺炎支原体肺炎(MMP)临床特点的认识。方法我院110例MMP住院患者,对以肺外表现为首发症状的MPP患者,并对其临床特点进行分析和总结。结果 110例MMP患者中(合并肺外表现54例)以肺外表现为首发症状者26例,占总病例的23.6%。全部患者住院2～7 d后均确诊为MPP,应用大环内酯类抗生素治疗,同时给予针对肺外器官系统损害辅助治疗,107例病愈,死亡3例。结论在MPP中,以肺外表现为首发症状者占有一定比例(23.6%),MP-IgM血清学检测有助于早日确诊,早日获治,避免漏诊、误诊、耽误病情。     

特应性体质儿童肺炎支原体肺炎的临床特点

目的 了解特应性体质儿童肺炎支原体肺炎的临床特点。方法 肺炎支原体肺炎的住院患儿（29天～14岁）164例,按是否存在特应性体质分为特应性体质组（77例）,以及非特应性体质组（87例）。对两组的基本信息、伴随症状体征、实验室指标、肺功能检查结果、胸部CT结果、主要治疗措施、肺外并发症及重症肺炎发生率等临床资料进行回顾性对比分析。结果 特应性体质组患儿住院时间、住院费用、家族过敏史比例、肺部啰音吸收时间、喘息发生率、喘息持续时间、血清总lgE、乳酸脱氢酶、白细胞计数、中性粒细胞绝对值、嗜酸性粒细胞绝对值、中性淋巴细胞比值、IL-6、潮气流速容量阻塞人数、吸氧治疗占比、激素使用占比、激素使用时间、肺外并发症及重症肺炎发生率均高于非特应性体质组（P均<0.05）;但淋巴细胞百分比低于非特应性体质组（P均<0.05）。结论 特应性体质肺炎支原体肺炎较非特应性体质肺炎支原体肺炎患儿病情更严重,治疗需求更高,更易发展为重症肺炎支原体肺炎。     

伴特应质的肺炎支原体肺炎患儿临床特点及相关细胞因子水平变化

目的 探讨合并有特应质的肺炎支原体肺炎患儿临床特点及自身的特应质对疾病严重程度和细胞因子的影响。方法 选取2018年9月至2020年8月上海交通大学医学院附属仁济医院儿科住院的肺炎支原体肺炎(mycoplasma pneumoniae pneumonia, MPP)患儿247例。根据有无特应质分为特应质组和非特应质组,同时根据难治性支原体肺炎(refractory mycoplasma pneumoniae pneumonia, RMPP)诊断标准分为RMPP组和普通型支原体肺炎(general mycoplasma pneumoniae pneumonia, GMPP)组,总结并分析各组临床表现、实验室指标和影像学特点。结果 (1)特应质组大环内酯类药物治疗时间、吸氧人数、住院天数高于非特应质组,特应质组中出现重症的人数及胸腔积液的比例高于非特应质组(8.6%v 1.2%),差异有统计学意义(P<0.05);(2)特应质组中血清IL-6、IL-8水平明显高于非特应质组;在RMPP中,伴特应质者药物治疗时间、氧需求及血清IL-6、IL-8水平也更高,差异有统计学意义(P<0...     

肺炎支原体肺炎74例肺外表现临床分析

目的分析肺炎支原体感染肺外器官受累的临床特征,疗效及预后。方法采用ELSA法检测MP、IgM、IgG阳性的168例及呼吸道细菌培养阴性者儿科临床资料进行回顾性分析。结果 168例中有74例肺外器官受累占44.04%,其中以消化、泌尿、心血管、神经、血液、浆膜腔,分别为50%、32.4%、20.27%、20.27%、6.75%、5.4%。累及1个脏器75.6%.2个脏器16.2%,多个脏器8.1%。全部病例经大环内酯类抗生素治疗半月左右好转。IgM均阳性,IgG37.83%阳性,冷凝集试验阳性率为45.94%。结论 MP感染可引起肺外器官并发症或多脏器受累,临床医生要严密观察,早期诊断及时治疗。     

小儿肺炎支原体肺炎肺外合并症38例分析

肺炎支原体肺炎(MPP)是儿科较常见的一种感染性疾病。1989年5月～1999年1月,我们收治肺炎支原体肺炎106例,其中发生肺外并发症者38例。现报告如下。一般资料:本组男21例,17例;年龄1～14岁。本组38例MPP均符合小儿内科学第3版诊断标准,血冷凝集实验>1:32,或咽刷支原体聚合酶链反应(PCR)阳性,伴有肺外器官系统的临床及实验室改变。肺外合并症表现及治疗:1消化系统表现者13例:6例恶心呕吐,肝区痛,肝大,AST、ALT增高。4例左上腹痛,B超提示胰腺肿大,尿淀粉酶增高。无明显定位体征腹痛3例。均经应用红霉素、护肝药物等治疗痊愈。2心血管系…     

肺炎支原体感染肺外表现156例

目的分析肺炎支原体（MP）感染肺外器官受损的临床特征、疗效及预后。方法采用ELISA检测MP—IgM、IgG．对阳性的298例患儿临床资料进行回顾性分析。结果289例中156例肺外器官受累,占52．35％,其中以消化、泌尿、心血管系统及浆膜腔积液多见。结论MP感染可以引起机体多系统损害,部分患儿可同时有2种以上的器官受累,少数以肺外表现为首发症状,故对不能完全以细菌、病毒感染解释的多脏器受累的呼吸道感染,应考虑到MP感染的可能,以免误诊、漏诊。     

儿童肺炎支原体肺炎的病理及影像学表现特点

肺炎支原体肺炎(mycoplasma pneumoniae pneumonia,MPP)是我国儿童社区获得性肺炎中最常见的类型,早期识别危重症病例、合理救治、减少后遗症是MPP诊治的关键。MPP发病机制在于肺炎支原体对呼吸道的直接损伤和宿主异常免疫应答,病理表现包括肺气道及肺间质炎、塑形性支气管炎、肺泡炎性渗出、坏死性肺炎、肺栓塞及胸腔积液等。影像学对MPP病情严重程度判断和预后评估有重要作用。MPP影像学表现主要有塑形性支气管炎、树芽征、小叶中心结节、树雾征、肺实变、肺坏死、肺栓塞、胸腔积液等。其中,肺坏死和肺栓塞是诊断重症MPP的重要指征。肺坏死临床症状以持续高热和C反应蛋白明显升高为特点。肺栓塞表现包括胸痛和/或咯血、D-二聚体升高和血性胸腔积液。本文结合相关研究进展,通过图文解析MPP影像学表现、相关的发病机制及病理表现,总结各影像学征象与MPP临床特点的关系,旨在提高儿科医生和放射科医生对儿童MPP的认识。     

儿童肺炎支原体肺炎及其肺外并发症

肺炎支原体（Mycoplasma PneumoniaeMP）是儿童社区获得性肺炎的主要病原之一。MP约占小儿肺炎病原的10～30％以上。文献报道MP感染率9．6％～66．7％不等。MP引起的呼吸系统病变,临床表现多样,自轻型的上呼吸道感染、咽炎、扁桃体炎、中耳炎、支气管炎到严重的致死性肺炎,还可通过免疫机制和／或直接侵犯肺外脏器,引起多系统、多器官的肺外并发症如脑膜炎、心肌炎、肾炎和免疫性溶血性贫血等,部分病例可遗留慢性咳嗽和神经系统后遗症,严重危害儿童健康。     

258例儿童支原体肺炎临床及并发症分析

目的探讨肺炎支原体肺炎（Mycoplaama pneumoniae pneumonia,MPP）临床、肺外并发症和诊治。方法对258例确诊为MPP患儿临床、并发症进行总结和分析。结果发病多集中在学龄儿童,5～10岁111例（43％）,发热180例（69．8％）,持续性干咳136例（52．7％）,161例（62．4％）肺部可闻及干罗音,胸片呈斑点状阴影117例,呈阶段性肺炎69例,呈间质性损害42例,表现肺门影增浓28例,外周血白细胞总数大多正常（86．8％）,血红蛋白低于正常值63例,82例（31．8％）有肺外并发症,多脏器损害13例（5．0％）,198例静脉使用红霉素,后改阿奇霉素口服治疗,164例痊愈。结论MPP好发学龄儿童,其肺外并发症也较常见,红霉素、阿奇霉素序贯治疗安全、疗效满意。     

Thromboembolic complications of Mycoplasma pneumoniae pneumonia in children

Background

Thromboembolism is less common in children than in adults, but it is frequently associated with Mycoplasma pneumoniae infection in many cases. This study aimed to investigate the clinical characteristics of pediatric M. pneumoniae pneumonia complicated with thromboembolism.

Methods

Hospitalized patients with M. pneumoniae pneumonia complicated by thromboembolism were enrolled from January 2012 to December 2021 in Beijing Children's Hospital, Capital Medical University, China. The data on clinical manifestations, laboratory tests, and treatment were evaluated.

Results

A total of 49 cases were enrolled, with a mean age of 7.9 years old, including 27 boys and 22 girls. Consolidation of pulmonary lobe or segment was observed in 95.9% (47/49) of the cases, whereas interstitial change was found only in two patients; 85.7% (42/49) of patients had pleural effusion. Pulmonary vascular thromboembolism was most common in 35 patients, whereas 13 cases had thromboembolism of multiple anatomic sites. The levels of C-reaction protein, lactate dehydrogenase, and erythrocyte sedimentation rate were all increased, with a mean value of 54.08 ± 52.27 g/L, 451.12 ± 218.76 U/L, 43.40 ± 29.43 mm/h, respectively. Blood coagulation test showed that all 49 patients had elevated D-dimer values (median 3.81 ng/ml, range, 0.34–48 ng/ml) and normal PT. aPTT.LA was positive in 74.3% (26/35) of the cases. aCL-IgM was positive in 66.7% (26/39) of the cases. aβ2GPI-IgM was positive in 79.4% (27/34) of the cases. The prognosis was generally good in this group.

Conclusion

Pulmonary arteriovenous thromboembolism is the most common thromboembolism complicated in MPP, and cerebral artery embolism and cardiac thrombosis are common in extrapulmonary thromboembolism. In the cases of MPP with thromboembolic complications, pulmonary consolidation with pleural effusion is the main characteristic. About two thirds of the cases are positive for antiphospholipid antibodies.     

Epidemiology and clinical manifestations of children with macrolide‐resistant Mycoplasma pneumoniae pneumonia in Taiwan

Mycoplasma pneumoniae accounts for 10–30% of community‐acquired pneumonia (CAP) in children. This study reveals the epidemiology and clinical manifestations of children with macrolide‐resistant (ML^r) M. pneumoniae pneumonia in Taiwan. Respiratory tract specimens were collected from children hospitalized with CAP for evaluation via PCR followed by DNA sequencing for several point mutations related to the ML^r character. Of the 412 specimens collected during the study period, 60 (15%) were positive for M. pneumoniae, 14 (23%) of which presented point mutation (all A2063G) in 23S rRNA. Clinical symptoms and chest X‐ray findings between the ML^s and ML^r groups were not significantly different. However, the ML^r group had longer mean duration of fever after azithromycin treatment (3.2 days vs. 1.6 days, P = 0.02) and significantly higher percentage of changing antibiotics for suspected ML^r strain (42% vs. 13%, P = 0.04). Although 58% of children in the ML^r group did not receive effective antibiotics, all children were discharged without sequelae. In conclusion, 15% of CAP in children is caused by M. pneumoniae and the macrolide‐resistance rate is 23% in Taiwan. Despite ineffective antibiotics, children with ML^r M. pneumoniae pneumonia recover completely. Pediatr Pulmonol. 2013; 48:904–911. © 2012 Wiley Periodicals, Inc.     

Role of prednisolone treatment in severe Mycoplasma pneumoniae pneumonia in children

Mycoplasma pneumoniae pneumonia (MP) is responsible for 10-40% of cases of pediatric community-acquired pneumonia. Occasionally, progression to severe pneumonia occurs despite appropriate antibiotic therapy. We retrospectively evaluated the effect of prednisolone in 15 children with MP whose clinical and radiographic course worsened despite broad-spectrum antibiotics, including appropriate macrolides. The mean ( +/- SD) age was 6.1 +/- 1.9 years, and 10 were boys. All children had received macrolides at presentation, but they had persistent fever and progressively worsening radiographic findings. In addition to broad-spectrum antimicrobial therapy, we added prednisolone (1 mg/kg for 3-7 days, then tapered over 7 days) on day 6 (+/-1.5 days) of admission. Fourteen children became afebrile within 24 hr, and their clinical status and radiographic findings improved over several days. The white blood cell count at presentation was 7,500 +/- 2,000/mm3, with a proportion demonstrating lymphopenia (lymphocyte differential, 19.7 +/- 5.7%). In conclusion, corticosteroid treatment appeared to be temporally associated with clinical and radiographic improvement, and may be helpful for reducing morbidity in children with macrolide-nonresponsive severe MP. Further studies may be warranted.     

脉冲振荡法与常规通气法检测儿童肺炎支原体肺炎肺功能

目的为进一步了解儿童肺炎支原体肺炎(Mycoplasma pneumoniae pneumonia)肺功能的改变,并探讨脉冲振荡法(Impulse oscillation method,IOS)与常规通气法的相关性。方法选取血清MPIgM阳性的住院肺炎患儿39例作为观察组,同时选择同时期门诊健康体检的健康儿童35例作为对照组,对两组受试儿童进行IOS及常规通气肺功能检测。结果 1两组常规通气肺功能VCMAX%、FVC%、FEV1%、PEF%、MEF75%、MEF50%、MEF25%比较差异有统计学意义(P0.05),观察组明显低于对照组;2两组IOS肺功能Z5%、R5%、R20%、Fres比较差异有统计学意义(P0.05),观察组明显高于对照组。3两种检测方法相关性分析及多元线性逐步回归分析发现R5对VCMAX、FVC影响显著。结论 1 MPP患儿肺大、中、小气道通气功能下降,以小气道通气功能下降为主;2 MPP患儿气道阻力增高,以小气道阻力增高为主;肺的顺应性较健康儿童差;3两种检测方法有良好相关性,气道阻力对最大肺活量、用力肺活量起反向作用。     

五指山地区儿童肺炎支原体感染流行特点及与气候因素相关性研究

目的 探讨五指山地区儿童急性呼吸道肺炎支原体(MP)感染流行特点及与气候因素的关系。方法 检测2015年1月至2016年12月门诊和住院的1 597例呼吸道感染患儿血清肺炎支原体特异性IgM(MP-IgM),同时收集同期的气象资料,采用多元线性回归分析研究 MP-IgM 检出率与气候因素的相关性。结果 MP-IgM总检出率为25.05%; 0~1 岁、~3 岁、~6 岁、> 6 岁患儿的 MP-IgM 阳性率分别为6.70%、30.80%、36.90% 和43.40%;男性 27.54%,女性阳性率21.78%; 春、夏、秋、冬四季阳性率分别为22.95%、35.91%、28.89% 和17.07%;以上年龄、性别、季节的差异均有统计学意义(P< 0.01)。月平均气温、月总雨量与 MP-IgM 检出率呈正相关(P=0.001)。结论 MP为五指山地区儿童呼吸道感染主要病原体之一,学龄前儿童及学龄期儿童为易感人群,不同季节MP感染率不同,夏秋季节为高发期,高气温、高雨量是促进 MP感染流行的主要气候因素。     

A retrospective study of azithromycin and ceftizoxime for the management of children with Mycoplasma pneumoniae pneumonia

The aim of this study was to compare the clinical efficacy of azithromycin and ceftizoxime (AC) and erythromycin and amoxicillin/sulbactam (EAS) in the treatment of children with Mycoplasma pneumoniae pneumonia (MPP).In this retrospective study, a total of 92 eligible children with MPP were included, and they were divided into a treatment group (n = 46) and a control group (n = 46). All patients were treated with intravenous ambroxol, and nebulized inhalation of budesonide and terbutaline. In addition, patients in the treatment group received AC. Patients in the control group underwent EAS. All patients in both groups were treated for a total of 10 days. Outcomes consist of erythrocyte sedimentation rate, C-reactive protein, serum lactate dehydrogenase, and interleukin 6, fever clearance time, time of cough disappearance, time of rale disappearance, time of signs disappeared by X-ray, and adverse events. All outcomes were measured after 10-day treatment.After treatment, patients who received AC exerted better improvements in erythrocyte sedimentation rate (P < .01), C-reactive protein (P < .01), serum lactate dehydrogenase (P < .01), interleukin 6 (P < .01), fever clearance time (P < .01), time of cough disappearance (P < .01), time of rale disappearance (P < .01), and time of signs disappeared by X-ray (P < .01), than those in patients who received EAS. In addition, there were not significant differences in adverse events between 2 groups.The results of this study showed that AC may benefit more than EAS for the children with MPP.     

Arthritis associated with Mycoplasma pneumoniae in a pediatric patient: A case report

Introduction:Mycoplasma pneumoniae (MP) infection in infants is usually overlooked and it might result in important complications if left untreated. MP-induced arthritis is probably the least common extrapulmonary manifestation and frequently leads to delays in the diagnosis.Patient concerns:We report the case of a 2-year-old female child admitted in our clinic for prolonged fever (onset 2 weeks before the admission), for which the general practitioner established the diagnosis of acute pharyngitis and recommended antibiotics. But the fever persisted and the patient was referred to a pediatrician.Diagnosis:The laboratory tests revealed leukocytosis with neutrophilia, elevated C-reactive protein and liver cytolysis. The blood and urine cultures, as well as the serological hepatitis B and C, toxoplasmosis, Epstein Barr virus, Rubella, Herpes virus, and cytomegalovirus were negative. The chest X-ray established the diagnosis of pneumonia. The fever persisted for approximately 2 weeks after admission. On the 2nd week of admission, the patient began to experience gait difficulties complaining of pain in the right hip and ankle. The cardiology and pneumology consults revealed no pathological findings. The evolution was favorable after the initiation of Levofloxacin and MP infection was detected as we suspected. Moreover, the ultrasound of the hip revealed a mild joint effusion, while the ankle joint appeared to be normal at ultrasound. Thus, we established the diagnosis of hip and ankle arthritis based on the clinical and ultrasound findings.Interventions:Levofloxacin by vein was continued for 5 days, replaced afterwards with clarithromycin orally for 2 weeks.Outcomes:The gait difficulties persisted for approximately 5 months from the initial diagnosis, and improved once the titer of immunoglobulin M anti-MP antibodies lowered considerably. After more than 8 months, the patient was completely asymptomatic and the immunoglobulin M anti-MP was close to the normal range.Conclusion:The awareness of MP-induced arthritis in children represents the cornerstone in preventing diagnostic delays and initiating the proper treatment.     

吸入布地奈德混悬液辅治小儿支原体肺炎的疗效观察

目的研究阿奇霉素静脉滴注联合布地奈德混悬液雾吸治疗肺炎支原体肺炎（MPP）的疗效观察。方法 2007年1月至2008年3月在吴江市第一人民医院儿科病房住院并确诊为MPP的患儿150例为研究对象,随机分为治疗组、对照组。对照组按传统治疗方案予静脉滴注阿奇霉素抗感染;治疗组在上述综合治疗基础上,加用布地奈德混悬液吸入治疗,观察所有入组患儿临床症状、体征消失及住院时间。结果在缓解发热、咳嗽及住院时间方面,两组差异具有统计学意义（P〈0.01）;在肺部湿啰音吸收方面治疗组好于对照组,但两组相比差异无统计学意义;肺部X线影像恢复时间两组相比差异无统计学意义（P〉0.05）。结论阿奇霉素静滴抗感染联合布地奈德混悬液雾吸,较单用阿奇霉素静滴治疗在缓解临床症状方面具有较显著疗效,且方法简便,患儿依从性好,可在基层医院推广。     

Adult community-acquired pneumonia caused by macrolide resistant Mycoplasma pneumoniae

A 28-year-old woman with community-acquired pneumonia was treated with sulbactam/ampicillin and clarithromycin, but failed to show any improvement after 4 days. The antibiotic regimen was changed to pazufloxacin and rapid clinical improvement was seen. Mycoplasma pneumoniae was identified as the causative agent, and adenine (A) to guanine (G) mutation at position 2063 in domain V of the 23S rRNA was noted in the isolate. The minimum inhibitory concentration of macrolide antibiotics, including clarithromycin, of this isolate was greatly elevated.