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.     

肺炎支原体抗体联合超敏C反应蛋白检测在小儿支原体肺炎感染诊断中的临床价值

目的 调查研究小儿支原体肺炎感染患者肺炎支原体抗体(MP-Ab)及超敏C反应蛋白(hs-CRP)水平的变化,探讨肺炎支原体抗体与超敏C反应蛋白联合检测对小儿支原体肺炎感染的临床诊断价值.方法 肺炎支原体肺炎患儿110例,对照儿童120例,均按照《诸福棠实用儿科学》中支原体肺炎诊断标准确诊,两组分别进行MP-Ab、hs-CRP检测,肺炎支原体抗体判定以MP-Ab滴度≥1:160为阳性,超敏C反应蛋白判定以hs-CRP＞ 5mg/L为阳性.通过分析MP-Ab检测法与MP-Ab联合hs-CRP检测法敏感性、特异性差异,探讨MP-Ab联合hs-CRP检测法诊断小儿支原体肺炎感染的临床意义.结果 肺炎支原体肺炎患儿组MP-Ab滴度≥1∶160比率高于正常对照组,肺炎支原体肺炎患儿组hs-CRP高于正常对照组,差异均有统计学意义(P＜0.05);MP-Ab检测法诊断肺炎支原体肺炎的灵敏度为78.2％,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的灵敏度为89.1％,MP-Ab联合hs-CRP检测肺炎支原体肺炎的灵敏度高于MP-Ab检测法,差异有统计学意义(P＜0.05);MP-Ab检测法诊断肺炎支原体肺炎的特异度为94.2％,MP-Ab联合hs-CRP检测法诊断肺炎支原体肺炎的特异度为89.2％,差异无统计学意义(P＞0.05).结论 MP-Ab与hs-CRP联合检测能提高小儿支原体肺炎感染的诊断率,具有较高临床价值.     

儿童肺炎支原体脑炎研究进展

肺炎支原体是儿童社区获得性肺炎的常见致病菌,能引起多种形式的肺外损害.儿童肺炎支原体脑炎是引起神经系统损伤的最常见疾病类型.肺炎支原体脑炎的发病机制仍不清楚,直接侵袭、免疫损伤和神经毒素被认为是可能的发病机制.由于肺炎支原体脑炎具有较高的致死率及神经系统后遗症率,因此提高临床医师对该病的认识,最大限度地避免误诊与漏诊的发生,具有重要意义.     

Macrolide-Resistant Mycoplasma pneumoniae,United States

Macrolide-resistant Mycoplasma pneumoniae (MRMP) is highly prevalent in Asia and is now being reported from Europe. Few data on MRMP are available in the United States. Using genotypic and phenotypic methods, we detected high-level MRMP in 13.2% of 91 M. pneumoniae­–positive specimens from 6 US locations.     

阿奇霉素联合丙种球蛋白治疗小儿支原体肺炎的疗效和安全性分析

目的：分析对比阿奇霉素加丙种球蛋白与单用阿奇霉素治疗小儿支原体肺炎的疗效。方法：将224例支原体肺炎患儿随机分成观察（A）组、对照（B）组各112例,A组予阿奇霉素加丙种球蛋白治疗,B组单用阿奇霉素治疗,观察热退、咳嗽减轻及肺部啰音消失时间,治疗2周后复查胸片,并对结果进行统计学分析。结果：A、B两组均能较好控制症状,治疗2周后X线胸片检查,病灶均基本吸收,疗效差异显著（P＜0.05）,A组在热退时间、咳嗽减轻时间及肺部啰音消失时间上均较B组短,差异不显著（P＞0.05）。结论：丙种球蛋白和阿奇霉素序贯应用治疗小儿支原体肺炎起到了协同作用,较单纯阿奇霉素治疗有效缩短了病程,提高临床疗效,不良反应发生率并未明显增加,值得斟酌应用。     

姜黄素对肺炎支原体感染肺炎幼鼠抗炎作用及机制初步探讨

目的基于NF-κB途径探讨姜黄素对肺炎支原体感染肺炎幼鼠抗炎作用及机制初步探讨。方法选取50只SPF级BALB/c小鼠随机分为五组,分别为空白对照组(A组)、模型组(B组)、姜黄素高剂量组(C组),姜黄素中剂量组(D组)和姜黄素低剂量组(E组),模型组及姜黄素治疗组采用肺炎支原体标准株滴鼻法进行建模,HE染色观察肺脏病理组织学变化;免疫组化染色测定肺组织中NF-κB p65阳性细胞的积分光密度;采用Western blot实验检测肺组织中NF-κB p65蛋白表达变化;使用ELISA法检测IL-6、IL-8和TNF-α水平。结果模型组小鼠肺组织病理改变明显,姜黄素高剂量组小鼠肺组织与模型组相比,小鼠肺泡结构比较完整,肺泡与气管结构清晰,炎细胞明显减少,姜黄素中剂量组对小鼠有一定的治疗效果,姜黄素低剂量组小鼠和模型组小鼠比较并无明显差异;与空白对照组相比,模型组小鼠肺组织中NF-κB p65的IOD值、NF-κB p65蛋白表达和支气管灌洗液中IL-6、IL-8和TNF-α表达明显升高(P<0.01),与模型组小鼠相比,姜黄素高剂量组和姜黄素中剂量组小鼠肺组织中NF-κB p65的IOD值、NF-κB p65蛋白表达和支气管灌洗液中IL-6、IL-8和TNF-α表达明显降低(P<0.01)。与模型组小鼠相比,姜黄素低剂量组与模型组小鼠肺组织中NF-κB p65的IOD值、NF-κB p65蛋白表达和支气管灌洗液中IL-6、IL-8和TNF-α表达相比差异无统计学意义(P>0.05)。结论姜黄素可改善肺炎支原体感染幼鼠症状且能够抑制炎症因子,其机制可能是通过抑制NF-κB通路的激活,表明姜黄素可作为治疗肺炎支原体感染的潜在药物。     

患儿呼吸道感染肺炎支原体分布及药敏分析

目的了解患儿呼吸道感染肺炎支原体(Mp)培养阳性率及药敏特点,为临床诊断及治疗提供依据。方法对2013年2月-2013年7月1 023例呼吸道感染患儿送检标本进行Mp培养及药敏试验,数据采用SPSS13.0统计软件进行处理。结果 1 023例呼吸道感染患儿送检标本Mp培养阳性354例,阳性率为34.6%;其中急性支气管炎Mp培养阳性率最高,达65.0%,其次是上呼吸道感染和毛细支气管炎,阳性率分别为50.0%和45.9%,其他呼吸道疾病Mp培养阳性率为20.0%~40.0%,上呼吸道感染和肺炎患儿Mp阳性率比较,差异有统计学意义(P<0.01);Mp对多西环素敏感率最高为99.2%,对大环内酯类药物的敏感性相对较低,对罗红霉素、红霉素的敏感率分别为68.6%、66.1%。结论对发病初期患儿及早做Mp培养及药敏,做到早发现、早诊断、早治疗,避免并发症的发生,并根据药敏试验结果选择合理的抗菌药物。     

肺炎支原体肺炎患儿口咽部常见细菌及临床意义北大核心CSCD

目的:了解肺炎支原体肺炎(MPP)患儿口咽部常见细菌及临床意义。方法:回顾性分析。选取中国医科大学附属盛京医院小儿呼吸内科2016年12月至2017年6月住院治疗的134例MPP患儿为研究对象,选取同期同医院42例健康儿童为健康对照组。采用荧光定量聚合酶链反应Taqman探针法检测入组儿童口咽部常见细菌[肺炎链球菌(SP)、卡他莫拉杆菌(CTA)、流感嗜血杆菌(HI)]。首先比较MPP患儿及健康儿童口咽部细菌检出情况,再将134例MPP患儿根据年龄(<1岁、1~<3岁、3~<6岁及6~14岁)、有无细菌检出[肺炎支原体(MP)、MP+细菌]及检出菌种不同(MP+SP、MP+CTA及MP+HI)进行分组比较。采用秩和检验及 χ^(2)检验对相关临床资料进行分析。 结果:134例MPP患儿检出细菌79例(58.96%),42例健康儿童检出细菌17例(40.48%),差异有统计学意义( χ^(2)=4.404, P<0.05)。与MP组相比,MP+细菌组外周血中白细胞(WBC)水平[8.5(6.7,12.0)×10^(9)/L比7.8(5.8,9.3)×10^(9)/L, Z=-2.232]、C反应蛋白(CRP)水平[19.2(7.2,35.0) mg/L比8.4(3.4,24.6) mg/L, Z=-2.810]、乳酸脱氢酶(LDH)水平[286(244,365) U/L比250(210,302) U/L, Z=-2.474]及大叶性肺炎比例[40.51%(32/79例)比18.18%(10/55例), χ^(2)=7.510]、胸腔积液比例[13.92%(11/79例)比3.64%(2/55例), χ^(2)=3.917]、难治性肺炎支原体肺炎(RMPP)比例[34.18%(27/79例)比18.18%(10/55例), χ^(2)=4.151]均较高;总热程[10(7,12) d比8(6,10) d, Z=-2.706]及抗生素使用时间[16(13,19) d比12(9,16) d, Z=-3.747]均较长,差异均有统计学意义(均 P<0.05)。MP+SP组外周血中WBC高于MP+HI组[12.20(7.80,17.30)×10^(9)/L比6.75(5.37,9.44)×10^(9)/L],差异有统计学意义( Z=11.574, P<0.05);MP+SP组[56.67%(17/30例)]大叶性肺炎发生率高于MP+CTA组[0(0/3例)]和MP+HI组[18.75%(3/16例)],差异有统计学意义( χ^(2)=9.770, P<0.05)。 结论:MPP患儿口咽部更易发生细菌定植或感染,当WBC、CRP及LDH均明显升高,影像表现为大片实变影或有胸腔积液时,提示可能混合细菌感染,热程更长,难治性MPP比例增高,且常见的混合细菌为SP。     

Correlations between Serum P2X7, Vitamin A, 25‐hydroxy Vitamin D,and Mycoplasma Pneumoniae Pneumonia

BackgroundIdentifying new molecular diagnostic markers for Mycoplasma Pneumoniae Pneumonia (MPP) has always been an essential topic since MPP cases have increased every year, especially among children. Here, we examined the correlation between serum level of Purinergic receptor P2X7, vitamin A, and 25‐hydroxy vitamin D (25(OH)D) and the severity of MPP, aiming to identify molecules that have the potential to become diagnostic markers.MethodsThis study was conducted on 186 cases aged 1–14 (136 MPP and 50 non‐MPP patients). Serum levels of Purinergic receptor P2X7, vitamin A, 25(OH)D, and multiple inflammatory and immune factors were measured, compared, and tested for statistical significance.ResultsSerum P2X7, tumor necrosis factor‐α (TNF‐α), and interleukin‐1β (IL‐1β) levels were significantly increased in severe MPP patients, while serum vitamin A, 25(OH)D, IgA, and IgG levels were significantly decreased.ConclusionOur results demonstrated a positive correlation between serum P2X7 level and the severity of MPP, and negative correlations between serum levels of vitamin A and 25(OH)D and the severity of MPP, suggesting that high serum levels of P2X7 and low serum levels of vitamin A and 25(OH)D may indicate relatively severer MPP.     

Outbreak of Mycoplasma pneumoniae at a military academy

In 2019,an outbreak of Mycoplasma pneumoniae (M.pneumoniae) occurred at a military academy in China.The attack rate (10.08％,60/595) was significantly different among the units.High-intensity training and crowded environments to which cadets are exposed are the high risk factors for the outbreak of M.pneumoniae.In-time prevention and control measures effectively controlled the spread of the epidemic.