Evaluation on blood coagulation and C-reactive protein level among children with mycoplasma pneumoniae pneumonia by different chest imaging findings

Navigating the outbreak: a comprehensive analysis of pediatric Mycoplasma pneumoniae pneumonia via targeted next-generation sequencing in Wuhan, 2022-2023

This study aims to delineate the epidemiological characteristics and impacts of the Mycoplasma pneumoniae (MP) outbreak, utilizing targeted next-generation sequencing (tNGS) to assess pathogen prevalence and co-infections in pediatric pneumonia cases. Pediatric patients admitted to Wuhan Children's Hospital with pneumonia from 1 October 2022 to 31 October 2023 were included. tNGS was used for comprehensive pathogen detection, including MP and other respiratory pathogens, with additional sequencing of the 23S rRNA gene V region to identify macrolide resistance mutations. This study enrolled 10,223 patients with pneumonia with a positivity rate of 98.4% by targeted next-generation sequencing. Fever (86.4%) and cough (79.3%) were the most common symptoms of Mycoplasma pneumoniae pneumonia (MPP). Lung consolidation (25.8%) was a common imaging feature, and corticosteroid use was noted in 22.5% of MPP patients. MP proved to be the primary pathogen, particularly evident during the MP pandemic, which began in March 2023 and peaked in October with a detection rate of 63.2%. Of the 4,397 MPP cases, 34.5% were sole infections, while 65.6% were co-infections, mostly with viruses. The main causative agents of co-infections were Haemophilus influenzae and Rhinovirus. The macrolide resistance rate was 79.03%. The A2063G mutation in the 23S rRNA V region is the dominant mutation. High-sensitivity C-reactive protein and serum amyloid A were significantly elevated in MPP, while the absolute counts of CD3+T, CD4+T, CD8+T, CD19+B, and NK cells were significantly reduced. This study demonstrates the utility of tNGS in identifying MP co-infections and macrolide resistance and highlights the role of inflammatory markers and lymphocyte subpopulations in differentiating MPP from non-Mycoplasma pneumoniae pneumonia for clinical management.IMPORTANCEOur study is of great scientific value as it provides practical solutions to clinical challenges and supports both clinical decision-making and public health policy. First, it presents new and important insights into the application of targeted next-generation sequencing (tNGS) technology, which enables rapid and accurate pathogen detection and overcomes the limitations of conventional diagnostic methods. Second, the large sample size, focusing specifically on children during a Mycoplasma pneumoniae epidemic, provides valuable epidemiologic data specifically for the Wuhan region. Finally, by integrating rapid tNGS detection with inflammatory markers and lymphocyte subsets, our study demonstrates direct clinical applications that have the potential to improve patient outcomes. This approach highlights the practical utility of our research in enhancing clinical decision-making and contributes important knowledge to the field.

Biomarkers associated with the diagnosis and prognosis of Mycoplasma pneumoniae pneumonia in children: a review

Community-acquired pneumonia (CAP) is a major cause of death in children, and Mycoplasma pneumoniae (MP) is the main pathogen of CAP in children in China. Although Mycoplasma pneumoniae pneumonia (MPP) is usually a self-limiting disease, many children develop multiple complications due to drug resistance or untimely diagnosis and treatment, and may even progress to severe MPP or refractory MPP with a poor prognosis. It is important to explore the value of biomarkers that can be used in clinical practice to assess the severity of pneumonia and assist in clinical decision making. In this article, we searched the literature in the last four years to review the roles of various types of biomarkers in MPP and the associated clinical predictive models, with the aim of helping pediatricians to understand the evaluation indexes related to MPP in children other than microbiology.

Advancing risk factor identification for pediatric lobar pneumonia: the promise of machine learning technologies

Background

Community-acquired pneumonia (CAP) is a prevalent pediatric condition, and lobar pneumonia (LP) is considered a severe subtype. Early identification of LP is crucial for appropriate management. This study aimed to develop and compare machine learning models to predict LP in children with CAP.

Methods

A total of 25 clinical and laboratory variables were collected. Missing data (<2%) were imputed, and the dataset was split into training (60%) and validation (40%) sets. Univariable logistic regression and Boruta feature selection were used to identify significant predictors. Four machine learning algorithms-Logistic Regression (LR), Support Vector Machine (SVM), Extreme Gradient Boosting (XGBoost), and Decision Tree (DT)-were compared using area under the curve (AUC), balanced accuracy, sensitivity, specificity, and F1 score. SHAP analysis was performed to interpret the best-performing model.

Results

A total of 278 patients with CAP were included in this study, of whom 65 were diagnosed with LP. The XGBoost model demonstrated the best performance with an AUC of 0.880 (95% CI: 0.807-0.934) in the training set and 0.746 (95% CI: 0.664-0.843) in the validation set. SHAP analysis identified age, CRP, CD64 index, lymphocyte percentage, and ALB as the top five predictive factors.

Conclusion

The XGBoost model showed superior performance in predicting LP in children with CAP. The model enabled early diagnosis and risk assessment of LP, thereby facilitating appropriate clinical decision-making.

Mycoplasma pneumoniae pneumonia in children

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen that causes community-acquired pneumonia in children. The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases. Complications may occur, such as necrotizing pneumonia and respiratory failure. Extrapulmonary complications, including encephalitis, myocarditis, nephritis, hepatitis, or even multiple organ failure, can also arise. In this editorial, we discuss the clinical implications of the significant findings from the article "Serum inflammatory markers in children with M. pneumoniae pneumonia and their predictive value for mycoplasma severity" published by Wang et al. They reported that measuring lactic dehydrogenase, interleukin-6 levels, and D-dimer effectively predicts refractory M. pneumoniae pneumonia cases.

Exploring high-risk factors for the prediction of severe mycoplasma pneumonia in children

Background

As one of the most common causes of community-acquired pneumonia in children, the prevalence of mycoplasma pneumonia (MPP) has long been underestimated. This study aimed to analyze children's severe MPP (SMPP) by examining laboratory characteristics and identifying high-risk factors.

Methods

Clinical data from 447 hospitalized children with MPP were retrospectively analyzed. Patients were categorized into ordinary MPP and SMPP groups. Initial laboratory results on admission were compared between groups, and risk factors for SMPP were assessed using receiver operating characteristic (ROC) and logistic regression analyses.

Results

Children with SMPP exhibited significantly higher levels of neutrophils, neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and lactate dehydrogenase (LDH), along with lower lymphocyte, albumin (ALB), and prealbumin (PAB) levels compared to the ordinary MPP group (all P<0.05). SMPP children also had a higher incidence of multiple pathogens (P<0.05). ROC analysis identified cutoff values for ESR, LDH, IL-6, CRP, neutrophil percentage, and NLR, with corresponding areas under the curve (AUCs) indicating their predictive values for SMPP. A combined analysis of these factors yielded an AUC of 0.732 (P<0.05). Multivariate logistic regression confirmed ESR >35.50 mm/h, LDH >360.50 U/L, IL-6 >20.28 pg/mL, and CRP >9.74 mg/L as independent high-risk factors for SMPP (P<0.05).

Conclusions

ESR, LDH, IL-6, CRP, neutrophil percentage, and NLR are valuable predictors for early identification of SMPP in children. These findings provide essential insights for clinical management aimed at assessing and intervening in prognosis.

Murine exosomal miR-30a aggravates cardiac function after acute myocardial infarction via regulating cell fate of cardiomyocytes and cardiac resident macrophages

After acute myocardial infarction (AMI), intercellular communication is crucial for maintaining cardiac homeostasis and patient survival. Exosomes secreted by cardiomyocytes serve as carriers for transporting microRNA(miRNAs), participating in intercellular signaling and the regulation of cardiac function. This study aims to investigate the role of exosomal microRNA-30a(miR-30a) during AMI and its underlying mechanisms. AMI was induced by permanent ligation of the left anterior descending (LAD) artery in C57BL/6 mice. The expression of miR-30a in mice was respectively enhanced and inhibited by administering agomiR-30a and antagomiR-30a. Using HL-1 cardiomyocytes and RAW264.7 macrophages for in vitro experiments, HL-1 cardiomyocytes were cultured under hypoxic conditions to induce ischemic injury. Following isolation and injection of exosomals, a variety of validation methods were utilized to assess the expression of miR-30a, and investigate the effects of enriched exosomal miR-30a on the state of cardiomyocytes. After AMI, the level of exosomal miR-30a in the serum of mice significantly increased and was highly enriched in cardiac tissue. Cardiomyocytes treated with agomiR-30a and miR-30a-enriched exosomes exhibited inhibition of cell autophagy, increased cell apoptosis, mice showed an larger myocardial infarct area and poorer cardiac function. Exosomes released from hypoxic cardiomyocytes transferred miR-30a to cardiac resident macrophages, promoting the polarization into pro-inflammatory M1 macrophages. In conclusion, murine exosomal miR-30a exacerbates cardiac dysfunction post-AMI by disrupting the autophagy-apoptosis balance in cardiomyocytes and polarizing cardiac resident macrophages into pro-inflammatory M1 macrophages. Modulating the expression of miR-30a may reduce cardiac damage following AMI, and targeting exosomal miR-30a could be a potential therapeutic approach for AMI.

Clinical Value of Coagulation Function Indicators in Children with Severe Pneumonia

Objective

This study aimed to probe the changes in coagulation function-related indicators (prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D), and fibrinogen degradation product (FDP)) in severe pneumonia and their clinical significance.

Methods

The levels of coagulation function indicators of all the children were measured within 24 hours of admission. Pearson correlation analysis was utilized to analyze the correlation between PT, APTT, FIB, D-D, FDP and PCIS in children with severe pneumonia. The ROC curve was drawn to assess the power of PT, APTT, FIB, D-D and FDP in diagnosing severe pneumonia and predicting the prognosis of severe pneumonia. A logistic regression analysis was implemented to analyze the factors influencing the prognosis of children with severe pneumonia.

Results

PT, APTT, FIB, FDP, and D-D in the critically severe pneumonia and the extremely severe pneumonia groups were higher versus the common pneumonia group (P < 0.05). FDP and D-D levels in children with severe pneumonia were negatively correlated with PCIS. PT, APTT, FIB, FDP, and D-D of children in the poor prognosis group were higher compared with those in the good prognosis group (P < 0.05). Further logistic regression analysis unveiled that FDP and APTT were influential factors impacting the prognosis of severe pneumonia.

Conclusion

The levels of D-D, FDP, FIB, APTT, and PT in severe pneumonia are increased. Detecting the contents of coagulation function indicators can help clinical judgment of the changes in the condition of severe pneumonia and evaluate prognosis.

New Insights into the Epidemiological Characteristics of Mycoplasma pneumoniae Infection before and after the COVID-19 Pandemic

Mycoplasma pneumoniae (M. pneumoniae), a prevalent respiratory pathogen affecting children and adolescents, is known to trigger periodic global epidemics. The most recent significant outbreak commenced in the first half of 2023 and reached its peak globally during the autumn and winter months. Considering the worldwide repercussions of the COVID-19 pandemic, it has become increasingly essential to delve into the epidemiological characteristics of M. pneumoniae both before and after the pandemic. This review aims to provide a comprehensive analysis of the key features of M. pneumoniae epidemics in the pre-and post-COVID-19 contexts, including but not limited to shifts in the susceptible population, the molecular genotypes of the pathogen, the clinical manifestations, and potential new trends in drug resistance. Additionally, we will introduce the latest advancements in the diagnosis of M. pneumoniae.

[Value of calprotectin S100 A8/A9 in predicting the severity of Mycoplasma pneumoniae pneumonia in children]

OBJECTIVES

To investigate the role of calprotectin S100 A8/A9 complex in evaluating the condition of children with severe Mycoplasma pneumoniae pneumonia (SMPP).

METHODS

A prospective study was conducted among 136 children with Mycoplasma pneumoniae pneumonia (MPP) and 30 healthy controls. According to the severity of the condition, the children with MPP were divided into mild subgroup (40 children) and SMPP subgroup (96 children). The levels of S100 A8/A9 complex and related inflammatory factors were compared between the MPP group and the healthy control group, as well as between the two subgroups of MPP. The role of S100 A8/A9 in assessing the severity of MPP was explored.

RESULTS

The MPP group had a significantly higher level of S100 A8/A9 than the healthy control group, with a significantly greater increase in the SMPP subgroup (P<0.05). The multivariate logistic regression analysis showed that the increases in serum C reactive protein (CRP) and S100A8/A9 were closely associated with SMPP (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that the combined measurement of serum S100 A8/A9 and CRP had an area under the ROC curve of 0.904 in predicting SMPP, which was significantly higher than the AUC of S100 A8/A9 or CRP alone (P<0.05), with a specificity of 0.718 and a sensitivity of 0.952.

CONCLUSIONS

S100 A8/A9 is closely associated with the severity of MPP, and the combination of S100 A8/A9 with CRP is more advantageous for assessing the severity of MPP in children.

Efficacy and inflammatory levels (IL-6, IL-10) of adjuvant application of vitamin-A in the treatment of pediatric Mycoplasma pneumoniae pneumonia: a systematic review and meta-analysis

Objective

The purpose of this study is to evaluate the efficacy of Vitamin A (VitA) as an adjuvant therapy for pediatric Mycoplasma Pneumoniae Pneumonia (MPP) through meta-analysis, and to investigate its impact on inflammation levels (IL-6, IL-10), in order to explore the role of VitA in pediatric MPP.

Methods

Using a systematic literature search method, relevant research literature is searched, and RCT studies that meet the requirements are selected based on preset inclusion and exclusion criteria. Then, a quality evaluation was conducted on the included literature, and meta-analysis was used to calculate the combined effect values of mortality rate, hospital stay, lung rale disappearance time, cough duration, fever duration, IL-6 and IL-10 levels, and heterogeneity analysis was conducted. The levels of IL-6 and IL-10 represent the inflammatory levels in pediatric MPP patients, and exploring their changes has significant implications for the anti-inflammatory effect of treatment.

Results

A total of 10 RCT studies were included, with a total sample size of 1,485, including 750 cases in the control group and 735 cases in the observation group. The meta-analysis results of this study showed that there was a significant difference in the total clinical efficacy of using VitA adjuvant therapy compared to the control group without VitA [OR = 3.07, 95%CI = (2.81, 4.27)], P < 0.05. However, there was no significant difference in the adverse reaction rate between the use of VitA as an adjuvant therapy and the control without VitA [OR = 1.17, 95%CI = (0.61, 2.27)], P > 0.05. At the same time, the hospitalization time [MSD = -0.86, 95% CI = (-1.61, -0.21)], lung rale disappearance time [MSD = -0.78, 95%CI = (-1.19,-0.51)], cough duration [MSD = -1.07, 95%CI = (-1.41, -0.71)], and fever duration [MSD = -0.47, 95%CI = (-0.72, -0.23)] using VitA as an adjuvant treatment were obviously lower. In addition, the meta-analysis outcomes also showed that the use of VitA adjuvant therapy can significantly reduce IL-6 [MSD = -1.07, 95%CI = (-1.81, -0.27)] and IL-10 [MSD = -0.13, 95%CI = (-0.31, 0.12)] levels. This indicates that the application of VitA in pediatric MPP also has the effect of reducing inflammatory response.

Conclusion

Based on the meta-analysis results, VitA adjuvant therapy can significantly improve the clinical symptoms of pediatric MPP patients, shorten hospitalization time, promote the disappearance of lung rales, and alleviate cough and fever symptoms. In addition, VitA adjuvant therapy can effectively reduce inflammation levels, indicating its potential role in inhibiting inflammatory responses. In clinical practice, VitA adjuvant therapy for pediatric MPP can be promoted as a potential treatment option.

Changes in coagulation markers in children with Mycoplasma pneumoniae pneumonia and their predictive value for Mycoplasma severity

BACKGROUND

This study investigates the correlation between coagulation levels and the severity of Mycoplasma pneumoniae pneumonia (MPP) in children. In addition, the study analyses the predictive value of coagulation abnormalities in MPP combined with necrotising pneumonia (NP).

METHODS

A total of 170 children with MPP who underwent treatment between June 2021 and February 2022 were selected for this study. The study population was divided into groups according to the severity of the disease to compare differences in the incidence of coagulation abnormalities between the groups. The participants were also divided into groups according to imaging manifestations to compare the differences in coagulation function among the different groups. All data information was processed for statistical analysis using SPSS Statistics 25.0 and GraphPad Prism 7.0 statistical analysis software.

RESULTS

The incidence of coagulation abnormalities in the children in the severe MPP (SMPP) group was significantly higher than that in the normal MPP (NMPP) group (P < 0.05). The multi-factor logistic regression analysis revealed that the D-dimer level is an independent risk factor for the development of NP in SMPP (P < 0.05). The receiver operating characteristic curve analysis revealed statistically significant differences (P < 0.05) in D-dimer, fibrinogen degeneration products (FDP), neutrophils, lactate dehydrogenase and serum ferritin for predicting SMPP combined with NP. Bronchoscopic manifestations of coagulation indicators (D-dimer and FDP levels) were significantly higher in the mucus plug group than in the non-mucus plug group, while the activated partial thromboplastin time levels were lower in the former than in the latter (P < 0.05).

CONCLUSION

The degree of elevated D-dimer and FDP levels was positively correlated with the severity of MPP, with elevated serum D-dimer levels (> 3.705 mg/L) serving as an independent predictor of MPP combined with NP in children.

Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children

BACKGROUND

To compare the demographic and clinical features, laboratory and imaging findings in mycoplasma pneumoniae pneumonia (MPP) children with non-MPP (NMPP) children and general MPP (GMPP) children with refractory MPP (RMPP) children and analysis the relationship with the severity of disease.

METHODS

The study included 265 children with MPP and 230 children with NMPP in the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University from 2020 to 2021. The children with MPP included RMPP (n = 85) and GMPP (n = 180). Demographic and clinical characteristics, laboratory and imaging findings of all children were measured as baseline data within 24 h after admission and the differences between MPP and NMPP, RMPP and GMPP patients were compared. ROC curves were used to evaluate the diagnostic and predictive value of different indicators for RMPP.

RESULTS

Fever duration and hospital stay in children with MPP were longer than those with NMPP. The number of patients with imaging features of pleural effusion, lung consolidation and bronchopneumonia in MPP group was significantly higher than that in NMPP group. Compared with NMPP group, the levels of C-reactive protein (CRP), procalcitonin (PCT), serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), lactic dehydrogenase (LDH), prothrombin time (PT), fibrinogen (FIB) and D-dimer and inflammatory cytokines (interleukin [IL]-6, IL-8, IL-10 and IL-1β) in MPP group were significantly higher (P < 0.05). The clinical symptoms and pulmonary imaging findings were more severe in RMPP group. The levels of white blood cell (WBC), CRP, PCT, SAA, ESR, alanine aminotransferase (ALT), LDH, ferritin, PT, FIB, D-dimer and inflammatory cytokines in RMPP group were higher than those in GMPP group. There was no significant difference in the level of lymphocyte subsets between the RMPP and GMPP group. IL-6, IL-10, LDH, PT, D-dimer and lung consolidation were independent risk factors for RMPP. IL-6 levels and LDH activity were good predictors of RMPP.

CONCLUSION

In conclusion, there were differences in clinical characteristics and serum inflammatory markers between MPP group and NMPP group, RMPP group and GMPP group. IL-6, IL-10, LDH, PT and D-dimer can be used as predictive indicators for RMPP.

Special Issue: Advances in SARS-CoV-2 Infection

Coronavirus Disease 2019 (COVID-19) is a life-threatening disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus which was first reported in late 2019 in China, from where it then spread worldwide [...].

Role of Intracellular Pulmonary Pathogens during SARS-CoV-2 Infection in the First Pandemic Wave of COVID-19: Clinical and Prognostic Significance in a Case Series of 1200 Patients

Background: Since 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) has caused millions of deaths worldwide and is the second most serious pandemic after the Spanish flu. Despite SARS-CoV-2 infection having a dominant effect on morbidity and life-threatening outcomes, the role of bacterial co-infection in patients with COVID-19 is poorly understood. The present study aimed to verify the existence of bacterial co-infections and their possible role as cofactors worsening COVID-19-related clinical manifestations. Methods: All patients with suspected SARS-CoV-infection, hospitalised in COVID-19 wards at the Sant'Anna University Hospital of Ferrara, were retrospectively included in this single-centre study and their specific bacterial serologies were assessed. Univariate and logistic regression analyses were performed. Results: A total of 1204 individual records were retrieved. Among them, 959 were excluded because of a negative nasopharyngeal swab or missing data; of the eligible 245 patients, 51 were co-infected. Compared to patients with SARS-CoV-2 infection alone, those with Chlamydia pneumoniae or Mycoplasma pneumoniae co-infections had worse respiratory/radiological features and more intensive care unit admissions. However, the co-infection did not result in a higher mortality rate. Conclusions: The present study, comparing clinical, laboratory and radiological findings between patients with COVID-19 vs. those with co-infections (C. pneumoniae or M. pneumoniae) showed that, on admission, these features were worse in co-infected patients, although the mortality rate did not differ between the two groups.