Epidemic characteristics of Mycoplasma pneumoniae infection: a retrospective analysis of a single center in Suzhou from 2014 to 2020

A comparison of diagnostic and therapeutic approaches for Mycoplasma pneumoniae pneumonia in children and adults, during the post-COVID-19 pandemic era

OBJECTIVES

Post-COVID-19, the increasing incidence of adult Mycoplasma pneumoniae pneumonia (MPP) necessitates attention, as it remains understudied due to its low incidence and undefined severity criteria. Therefore, exploring the characteristics of adult MPP and child MPP in terms of clinical diagnosis, treatment, and prognosis is of significant clinical importance. This study investigated the clinical features, severe risk factors, treatment, and prognosis of MPP in children and adults in Hebei, China, following the lifting of COVID-19 lockdown measures, offering insights for the diagnosis and treatment of MPP across age groups.

METHODS

From May 2023 to March 2024, a total of 218 hospitalized MPP patients at the First Hospital of Hebei Medical University were enrolled, with children (≤ 14 years) and adults (≥ 18 years) randomly selected at a 1:1 ratio (109 children and 109 adults). Patient demographics and clinical data were recorded and analyzed to compare the diagnostic and treatment profiles of pediatric and adult MPP patients.

RESULTS

This study revealed that among 218 MPP patients, adult MPP patients differ significantly from child MPP patients in terms of clinical symptoms, the inflammatory response, coagulation status, and organ damage. In addition, C-reactive protein (CRP) (OR, 1.073; 95% CI, 1.032-1.116; P < 0.001) was a severe risk factor for adult MPP, whereas CRP, aspartate transaminase, and potassium (OR: 1.209, 1.124, 31.322; 95% CI: 1.072-1.362, 1.016-1.244, 3.112-315.213; P = 0.008, 0.02, 0.003) were positively associated with the severity of MPP in children. Interestingly, children and adults with MPP received different treatments, and adult MPP patients had shorter hospital stays but poorer lung infection resolution. The positive detection rate of macrolide-resistance genes was 70.8% (34/48). Compared with the macrolide-resistance MPP (MRMPP) subgroup in children (treated with macrolides), the MRMPP subgroup in adults (treated with quinolones) had shorter hospital stays and higher rates of improvement in lung infection (P < 0.05), and the recovery of eosinophil percentage, white blood cell count, neutrophil count and platelet-lymphocyte ratio was better.

CONCLUSION

In short, adult and child MPPs differ significantly in terms of clinical diagnosis, treatment, and prognosis. Early intervention for severe risk factors, monitoring MR genes and managing macrolides can lead to improved prognosis.

Epidemiological trends and serological profiles of respiratory pathogens in Guangzhou: an 11-year retrospective study from 2013 to 2023

Background

Respiratory pathogens pose significant public health challenges globally, particularly in densely populated urban areas. This study aimed to analyze the epidemiological trends of multiple respiratory pathogens in Guangzhou, China, from 2013 to 2023, and investigate associated serological profiles to inform clinical management and public health interventions.

Methods

We conducted a retrospective analysis of 96,927 cases with suspected respiratory infections (SRIs) (defined by fever >37.5 ℃, cough, dyspnea, and/or chest pain) at The First Affiliated Hospital of Guangzhou Medical University. Clinical data were extracted from electronic medical records, and immunofluorescence assays were used to detect immunoglobulin M (IgM) antibodies against nine respiratory pathogens.

Results

Of the cases analyzed, 18.01% (17,454/96,927) tested serologically positive for at least one respiratory pathogen. Mycoplasma pneumoniae (MP) was the predominant pathogen (76.51% of serologically positive cases), followed by parainfluenza viruses (PIVS) (9.75%). The highest serologically positive rate was observed in the 5-14 age group (36.01%). Females exhibited a significantly higher overall serologically positive rate (21.30%) compared to males (15.97%, P<0.001). Serological analysis revealed profiles in confirmed infections, with significantly lower coagulation-related parameters (P<0.001) and some elevated inflammatory markers compared to suspected cases.

Conclusions

This comprehensive study provides crucial insights into the changing landscape of respiratory pathogen infections in Guangzhou over an 11-year period. The predominance of MP, particularly among school-age children and females, highlights the need for targeted interventions. The unexpected coagulation profiles in confirmed infections suggest complex pathophysiological mechanisms that warrant further investigation. These findings have important implications for clinical management, diagnostic approaches, and public health strategies in urban settings.

Comparison of the epidemiological characteristics of mycoplasma pneumoniae infections among children during two epidemics in Wuhan from 2018 to 2024

BACKGROUND

Mycoplasma pneumoniae (M pneumoniae, MP) is a common pathogen causing respiratory tract infections, particularly in children. In 2023, a resurgence of MP epidemics was observed in Wuhan, Hubei Province, China. This study aims to examine the epidemiological trends and clinical characteristics of MP infections among children in Wuhan from 2018 to 2024, providing valuable scientific evidence to guide local prevention strategies.

METHODS

From January 1, 2018, to June 30, 2024, samples were collected from children under 14 years with Acute Respiratory Tract Infections (ARTI) at Renmin Hospital of Wuhan University. MP infections were diagnosed through MP-IgM antibody detection and MP-DNA detection. Results were analyzed and compared across distinct epidemic periods.

RESULTS

Of the 183 626 ARTI children, 57 393 (31.26%) tested positive for MP, with an average age of 4.87 ± 2.99 years and a male-to-female ratio of 1.12:1. The annual positive rates from 2018 to 2024 were 45.92%, 32.23%, 22.84%, 16.22%, 16.26%, and 42.93%, respectively. Across the study period, the highest positive rate was recored in autumn (35.13%, P < 0.05). Two distinct MP outbreaks were identified, in 2018-2019 and 2023. Significant differences were observed between the two outbreaks. The 2018-2019 epidemic peaked in summer, while the 2023 epidemic peaked in November and persisted into February 2024. By age, the 2018-2019 outbreaks predominantly affected pre-school children, whereas the 2023 outbreaks mainly involved school-aged children. In boths outbreaks, girls had higher positive rates. Antibody and DNA testing results followed similar trends.

CONCLUSION

This study highlights the epidemiological trends and clinical characteristics of MP infections in Wuhan from 2018 to 2024, including two distinct outbreaks with differing seasonal patterns. The MP strain in 2023 appeared to predominantly affect older children.The trends observed suggest that MP infections may persist into the winter of 2024. Enhanced surveillance of respiratory pathogens and early diagnosis and prevention of MP infections in children remain critical in this region.

Effect of azithromycin combined with fluticasone propionate aerosol inhalation on immune function in children with chronic cough caused by Mycoplasma pneumoniae infection

This research aimed to describe the effect of azithromycin combined with fluticasone propionate aerosol inhalation on immune function in children with chronic cough caused by Mycoplasma pneumoniae (MP) infection. This study was a retrospective analysis in which 110 children with chronic cough caused by MP infection were divided into two groups based on different treatment methods: 58 cases in the control group treated with azithromycin dry suspension and 52 cases in the intervention group treated with azithromycin dry suspension and fluticasone propionate inhalation aerosol. Lung function, inflammatory factors, immune indicators, laboratory-related indicators, adverse reactions, and therapeutic effects were compared between the two groups. Compared with the pre-treatment period, levels of FEV1, FVC, and PEF increased post-treatment in both groups, with higher levels observed in the intervention group (all P < 0.05). IL-17, IL-6, and IL-10 levels decreased post-treatment in both groups, with the intervention group showing lower levels (all P < 0.05). The levels of IgG, IgA, IgM, CRP, ESR, and PCT decreased in both groups, with the intervention group showing lower levels (all P < 0.05). Higher treatment effectiveness rates were observed in the intervention group compared to the control group (P < 0.05). The incidence of adverse reactions did not differ significantly between the two groups (P > 0.05).

CONCLUSION

Azithromycin dry suspension combined with fluticasone propionate aerosol inhalation in children with chronic cough due to MP infection reduces inflammatory factors, improves immune function, and enhances treatment efficacy.

WHAT IS KNOWN

• The addition of oral azithromycin has demonstrated significant efficacy in treating cough caused by chronic respiratory disease, and inhaling fluticasone propionate has a more significant systemic impact than other corticosteroids.

WHAT IS NEW

• Azithromycin dry suspension combined with fluticasone propionate aerosol inhalation in children with chronic cough due to MP infection reduces inflammatory factors, improves immune function, and enhances treatment efficacy.

Epidemiological and clinical characteristics of hospitalized pediatric patients with Mycoplasma pneumoniae pneumonia before and after the COVID-19 pandemic in China: a retrospective multicenter study

BACKGROUND

In China many respiratory pathogens stayed low activities amid the COVID-19 pandemic due to strict measures and controls. We here aimed to study the epidemiological and clinical characteristics of pediatric inpatients with Mycoplasma pneumoniae pneumonia (MPP) after the mandatory COVID-19 restrictions were lifted, in comparison to those before the COVID-19 pandemic.

METHODS

We here included 4,296 pediatric patients with MPP, hospitalized by two medical centers in Jiangsu Province, China, from January 2015 to March 2024. Patients were divided into the pre-COVID (n = 1,662) and post-COVID (n = 2,634) groups. Their baseline characteristics, laboratory test results and radiological patterns were separately assessed and compared between the two groups to determine the substantial changes in the disease profile of MPP after the COVID-19 pandemic.

RESULTS

Epidemiological results suggested a higher annual incidence of MPP after the COVID-19 pandemic when the outbreak reached a peak in October, two months delayed in seasonality compared to that in the pre-COVID era. For pediatric patients with MPP, there was no difference in their median ages, gender ratios, and severe case percentages between the two groups, where most patients were younger than 14 years old. With significance, the post-COVID group had more occurrences of cough and expectoration and higher incidences of influenza A/B virus (IAV/IBV) co-infection than the pre-COVID group. Many hematological parameters and radiological features between the two groups displayed alteration, but comparatively there demonstrated no worsened severity in hospitalized children with MPP after COVID-19 pandemic. Concurrently, the post-COVID group was administered with fewer antibiotics but more corticosteroids for effective treatment than the pre-COVID group.

CONCLUSION

Through the COVID-19 pandemic, the epidemiological and clinical characteristics of pediatric patients with MPP differed, but there was no evident change in the disease severity. After the COVID-19 pandemic, the increased incidence of IAV/IBV co-infection may contribute to the differences in clinical symptoms and hematological profiles, while the adding usage of corticosteroids might treat more effectively.

Construction and validation of a nomogram model to predict bronchiolitis Mycoplasma pneumoniae pneumonia in children

After the cancellation of COVID-19 epidemic control measures in 2023, cases of pediatric bronchiolitis caused by Mycoplasma pneumoniae (MP) have been reported successively, with some children experiencing residual bronchiolitis obliterans (BO). Currently, the diagnosis of bronchiolitis Mycoplasma pneumoniae pneumonia (MPP) primarily relies on high-resolution computed tomography (HRCT). To establish a predictive model for bronchiolitis MPP, a retrospective analysis was conducted. The patients were randomly divided into a training cohort and a validation cohort. The nomogram model was constructed in the training cohort. Finally, the differential, calibration, and clinical applicability of the prediction model were evaluated using both the training and validation cohorts. Logistic stepwise regression analysis identified age, atopy, wheezing, hypoxemia, and pleural effusion as independent predictors of bronchiolitis MPP. These factors were used to construct a nomogram model. This nomogram model serves as a useful tool for predicting the risk of bronchiolitis MPP, which may facilitate individualized early intervention.

Risk factors for complications of Mycoplasma pneumoniae pneumonia in hospitalized children in China: a systematic review and meta-analysis

BACKGROUND

Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory disease in children. Some patients may develop long-term respiratory issues such as chronic cough and wheezing due to complications. These complications increase the health burden for children with MPP, highlighting the need to understand their risk factors in order to improve disease prognosis. This study aims to assess the risk factors for complications in hospitalized children with MPP in China.

METHODS

A comprehensive review of Chinese and English databases was conducted up to April 2024 to retrieve studies focusing on complications in hospitalized children with MPP. Pooled effect sizes were calculated using random-effects or fixed-effects models. Statistical analyses were performed using R software and RevMan 5.3.

RESULTS

This meta-analysis encompassed a total of 17 studies. We analyzed multiple risk factors associated with complications, including prolonged fever (OR: 3.79, aOR: 1.64), pleural effusion (OR: 3.71, aOR: 6.70), extensive lung infiltration (OR: 5.52, aOR: 3.57), ≥ 2/3 consolidation in a single lung lobe (OR: 4.29, aOR: 4.52), right upper lung lesion (OR: 4.84, aOR: 3.57), extrapulmonary manifestations (OR: 3.20, aOR: 1.89), hypoxemia (OR: 7.58, aOR: 12.43), delayed administration of glucocorticoids (OR: 7.93, aOR: 6.67), and delayed administration of macrolides (OR: 2.75, aOR: 3.84).

CONCLUSION

Hospitalized children with SMPP and RMPP may have a higher risk of complications, and it is important to identify risk factors early and provide appropriate treatment to minimize complications. The current level of evidence is relatively low and may not accurately reflect the actual clinical situation in China. Further high-quality studies are needed to validate and clarify these findings.

TRIAL REGISTRATION

Our protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42024534397).

New-generation tetracyclines for severe macrolide-resistant Mycoplasma pneumoniae pneumonia in children: a retrospective analysis

BACKGROUND

Macrolide-resistant Mycoplasma pneumoniae (MRMP) strains are increasingly prevalent, leading to a rise in severe Mycoplasma pneumoniae pneumonia incidence annually, which poses a significant threat to children's health. This study aimed to compare the effectiveness and safety of oral minocycline and doxycycline for the treatment of severe MRMP pneumonia in children.

METHODS

This retrospective analysis included children treated for severe MRMP pneumonia at the Pediatric Department of Tongji Hospital, Shanghai, China, between September 2023 and January 2024 using minocycline and doxycycline. The patients were divided into four groups according to treatment: oral doxycycline alone (DOX group), oral minocycline alone (MIN group), oral doxycycline with intravenous glucocorticoids (DOXG group), and oral minocycline with intravenous glucocorticoids (MING group). Student's t-test, Mann-Whitney U test, and χ2 or Fisher's exact tests were used for group comparisons.

RESULTS

A total of 165 patients were included in this study: 84 received minocycline, and 81 received doxycycline. The DOX group had higher fever resolution rates within 24, 48, and 72 h compared to the MIN group (63.2% vs. 31.8%, 79.0% vs. 63.6%, and 100% vs. 90.9%, respectively; all p < 0.05). The DOXG group showed higher fever resolution rates within 24 and 48 h than the MING group (92.3% vs. 83.4%, 100% vs. 92.7%, all p > 0.05). There were no statistically significant differences in time to imaging improvement, cough improvement, and disappearance of wet rales between groups, regardless of glucocorticoid combination. The longer the duration of fever prior to tetracycline therapy, the greater the likelihood of hypoxemia (p = 0.039) and a greater than two-fold elevation in the D-dimer level (p = 0.004).Univariate binary logistic regression model analysis revealed that CRP and erythrocyte sedimentation rate at disease onset were associated with defervescence within 24 h after treatment with tetracyclines alone (p = 0.020, p = 0.027), with erythrocyte sedimentation rate also influencing defervescence within 48 h (p = 0.022).

CONCLUSION

Doxycycline treatment resulted in a higher rate of defervescence than minocycline. Prompt treatment reduced the probability of pleural effusion, hypoxemia, pulmonary atelectasis, and D-dimer levels > 2 times the reference value.

The epidemic characteristics of Mycoplasma pneumoniae infection among children in Anhui, China, 2015-2023

The number of pediatric respiratory tract infection cases in China has significantly increased this year, and Mycoplasma pneumoniae is one of the main pathogens. This study aimed to investigate the epidemiological characteristics of M. pneumoniae in children in the Anhui region and to provide evidence for the prevention and control strategies of M. pneumoniae in children in this region. A total of 66,488 pediatric patients with respiratory tract infection were enrolled from January 2015 to November 2023 in this study. The results of this study exhibited that M. pneumoniae infection in the Anhui region was characterized by a high positive rate during 2021-2023, especially this year is considered a year of pandemic for M. pneumoniae infection. Moreover, the positive rate of M. pneumoniae in female children is significantly higher than in male children, and the infection rate of M. pneumoniae in children increases significantly with age, particularly in school-aged children.

IMPORTANCE

The number of pediatric respiratory tract infection cases in China has significantly increased this year, and Mycoplasma pneumoniae is one of the main pathogens. This study aimed to investigate the epidemiological characteristics of M. pneumoniae in children in the Anhui region and provide evidence for the prevention and control strategies of M. pneumoniae in children in this region.

An exceptionally large wave of M. pneumoniae infections among children in Tianjin post COVID-19 pandemic

Background

The coronavirus disease 2019 (COVID-19) pandemic has caused a persistent lowering of Mycoplasma pneumoniae (M. pneumoniae), which is commonly found in children with respiratory tract infections (RTIs). However, in 2023, we observed an unusually high number of M. pneumoniae infections among children from Tianjin, the second largest city in northern China. This study sought to analyze the epidemiological characteristics of children with RTIs caused by M. pneumoniae in northern China post COVID-19, in order to provide a theoretical basis for clinical diagnosis and treatment.

Methods

Between January 2019 and December 2023, a total of 78,886 children with respiratory infections from General Hospital of Tianjin Medical University were included in this study. A rapid immunochromatographic assay kit was used to test for M. pneumoniae specific immunoglobulin M (IgM) in these patients. The relevant clinical data of M. pneumoniae-positive cases were also collected, and analyzed by SPSS software.

Results

Out of the 78,886 samples collected, a total of 11,268 tested positive for M. pneumoniae specific-IgM antibody. The average positive rate was 14.3% in the past 5 years. In the year 2023 alone, there were 5,870 M. Pneumoniae positive cases, surpassing the combined count from the previous 4 years. The incidence of M. pneumoniae had significantly surged since September 2023, peaking at 1,717 cases in November 2023, with a notable surge during the fourth quarter. The prevalence of M. pneumoniae infection was primarily observed among children aged 4-6 years and 7-9 years both before and during the COVID-19 pandemic; however, a noticeable increase was observed among children aged 10-14 years after the pandemic ended. Boys exhibited a lower positive rate (13.19%) compared to girls (15.56%). In addition, the proportion of pneumonia cases in 2023 was significantly higher than that in previous years (P<0.001).

Conclusions

Our study revealed that following a prolonged global lowering of M. pneumoniae since the COVID-19 pandemic, a significant outbreak had emerged in northern China since September 2023. The proportion of M. pneumoniae positive children in the older age group increased in 2023 compared to that observed in 2019. Additionally, there was an increase in the proportion of pneumonia among M. pneumoniae positive cases in 2023 compared to the pre-COVID-19 pandemic period.

Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023

We collected respiratory specimens from 128 pediatric patients diagnosed with pneumonia in Beijing in late 2023. Mycoplasma pneumoniae was detected in 77.3% (99/128) patients, with 36.4% (4/11), 82.9% (34/41), 80.3% (61/76) in children aged less than 3 years, 3-6 years, over 7 years, respectively. Mycoplasma pneumoniae (M. pneumoniae) was characterized using P1 gene typing, MLVA typing and sequencing of domain V of the 23S rRNA gene. P1 gene type 1 (P1-1; 76.1%, 54/71) and MLVA type 4-5-7-2 (73.7%, 73/99) were predominant. MLVA identified a new genotype: 3-4-6-2. Macrolide resistance-associated mutations were detected in 100% of samples, with A2063G accounting for 99% and A2064G for 1%. The positive rate of M. pneumoniae was higher compared to previous reports, especially in children less than 3 years, suggesting a M. pneumoniae epidemic showing a younger age trend occurred in late 2023 in Beijing, China. Higher proportions of macrolide-resistant M. pneumoniae, P1-1 and 4-5-7-2 genotype M. pneumoniae indicated increased macrolide resistance rate and genotyping shift phenomenon, which might be attributable to this epidemic. Additionally, complete clinical information from 73 M. pneumoniae pneumonia inpatients were analyzed. The incidence of severe M. pneumoniae pneumonia was 56.2% (41/73). Mycoplasma pneumoniae pneumonia patients exhibited longer duration of fever, with a median value of 10.0 days (IQR, 8.0-13.0), and higher incidence of complications (74.0%, 54/73). However, in this cohort, we found that the severity of M. pneumoniae pneumonia, co-infection, or complications were not associated with M. pneumoniae P1 gene or MLVA types. Clinicians should be aware that patients infected with macrolide-resistant M. pneumoniae exhibited more severe clinical presentations.

Comparison of the clinical characteristics in parents and their children in a series of family clustered Mycoplasma pneumoniae infections

BACKGROUND

Mycoplasma pneumoniae infections have increased in China recently, causing some evidence of familial clustering. The purpose of this study was to compare the clinical features of parents and children in cases of familial clustering of Mycoplasma pneumoniae infection.

METHODS

A retrospective analysis was performed on the cases of familial clustering of Mycoplasma pneumoniae infection, and the clinical characteristics of parents and children were compared.

RESULTS

We identified 63 families, of these, 57 (65.5%) adults and 65 (94.2%) children required hospitalization. Fifty-seven adults (mean age 35.1 ± 4.6 years, 80.7% female) and 55 children (mean age 6.3 ± 3.9 years, 54.5% female) were included in the analysis. The incidence of mycoplasma infection in adults had increased gradually over the past year, while the rate in children had spiked sharply since June 2023. The clinical symptoms were similar in the two groups, mainly fever and cough. The peak temperature of children was higher than that of adults (39.1 ± 0.7℃ vs 38.6 ± 0.7℃, p = 0.004). Elevated lactate dehydrogenase was more common in children than in adults (77.8% vs 11.3%, p < 0.001). Bronchial pneumonia and bilateral involvement were more common in children, while adults usually had unilateral involvement. Three (60%) adults and 21 (52.5%) children were macrolide-resistant Mycoplasma pneumoniae infected. Children were more likely to be co-infected (65.5% vs 22.8%, p < .001). Macrolides were used in most children and quinolones were used in most adults. Ten (18.2%) children were diagnosed with severe Mycoplasma pneumoniae pneumonia, whereas all adults had mild disease. Children had a significantly longer fever duration than adults ((5.6 ± 2.2) days vs (4.1 ± 2.2) days, p = 0.002). No patient required mechanical ventilation or died.

CONCLUSIONS

Mycoplasma pneumoniae infection shows a familial clustering epidemic trend at the turn of summer and autumn, with different clinical characteristics between parents and children.

Association between Mycoplasma pneumoniae infection, high‑density lipoprotein metabolism and cardiovascular health (Review)

The association between Mycoplasma pneumoniae (M. pneumoniae) infection, high-density lipoprotein metabolism and cardiovascular disease is an emerging research area. The present review summarizes the basic characteristics of M. pneumoniae infection and its association with high-density lipoprotein and cardiovascular health. M. pneumoniae primarily invades the respiratory tract and damages the cardiovascular system through various mechanisms including adhesion, invasion, secretion of metabolites, production of autoantibodies and stimulation of cytokine production. Additionally, the present review highlights the potential role of high-density lipoprotein for the development of prevention and intervention of M. pneumoniae infection and cardiovascular disease, and provides suggestions for future research directions and clinical practice. It is urgent to explore the specific mechanisms underlying the association between M. pneumoniae infection, high-density lipoprotein metabolism, and cardiovascular disease and analyze the roles of the immune system and inflammatory response.

Construction and Validation of a Nomogram Model to Predict the Severity of Mycoplasma pneumoniae Pneumonia in Children

Background

This study aimed to develop a nomogram model for early prediction of the severe Mycoplasma pneumoniae pneumonia (MPP) in children.

Methods

A retrospective analysis was conducted on children with MPP, classifying them into severe and general MPP groups. The risk factors for severe MPP were identified using Logistic Stepwise Regression Analysis, followed by Multivariate Regression Analysis to construct the nomogram model. The model's discrimination was evaluated using a receiver operating characteristic curve, its calibration with a calibration curve, and the results were visualized using the Hosmer-Lemeshow goodness-of-fit test.

Results

Univariate analysis revealed that age, duration of fever, length of hospital-stay, decreased sounds of breathing, respiratory rate, hypokalemia, and incidence of co-infection were significantly different between severe and general MPP. Significant differences (p < 0.05) were also observed in C-reactive protein, procalcitonin, peripheral blood lymphocyte count, neutrophil-to-lymphocyte ratio, ferritin, lactate dehydrogenase, alanine aminotransferase, interleukin-6, immunoglobulin A, and CD4+ T cells between the two groups. Logistic Stepwise Regression Analysis showed that age, decreased sounds of breathing, respiratory rate, duration of fever (OR = 1.131; 95% CI: 1.060-1.207), length of hospital-stay (OR = 1.415; 95% CI: 1.287-1.555), incidence of co-infection (OR = 1.480; 95% CI: 1.001-2.189), ferritin level (OR = 1.003; 95% CI: 1.001-1.006), and LDH level (OR = 1.003; 95% CI: 1.001-1.005) were identified as risk factors for the development of severe MPP (p < 0.05 in all). The above factors were applied in constructing a nomogram model that was subsequently tested with 0.862 of the area under the ROC curve.

Conclusion

Age, decreased sound of breathing, respiratory rate, duration of fever, length of hospital-stay, co-infection with other pathogen(s), ferritin level, and LDH level were the significant contributors for the establishment of a nomogram model to predict the severity of MPP in children.

Study on red blood cell distribution width in children with severe Mycoplasma pneumoniae pneumonia

Background: This study aimed to investigate the clinical value of the red blood cell distribution width (RDW) in severe Mycoplasma pneumoniae pneumonia (MPP). Methods: A total of 185 children with diagnosed severe MPP were included. The patients' case records and laboratory examination data were analyzed retrospectively. The children were grouped into quartiles based on RDW. Results: Univariate analysis revealed that RDW was significantly correlated with the Pediatric Risk of Mortality (PRISM) III score, Sepsis-Related Organ Failure Assessment score, incidence of invasive intubation and 30-day in-hospital mortality. After adjustment for the severity of illness, multivariate analysis revealed that the PRISM III score and RDW were factors independently associated with 30-day in-hospital mortality. Conclusion: This study revealed that RDW could be correlated with the long-term prognosis and severity of severe MPP.

Comparison of serodiagnosis methods for community-acquired Mycoplasma pneumoniae respiratory tract infections in children

This study aimed to evaluate the diagnostic value of chemiluminescence immunoassay (CLIA), passive particle agglutination (PPA), and indirect immunofluorescence assay (IFA) in detecting Mycoplasma pneumoniae infection in children. Serum samples from 165 children with acute community-acquired respiratory tract infections were examined using CLIA, PPA, and IFA, and consistency coefficient, specificity, and sensitivity were analyzed. Compared with the PPA (titer ≥ 1:160), the consistency coefficients of the immunoglobulin(Ig)M-CLIA, immunoglobulin(Ig)G-CLIA and IgM-IFA methods were 93.94%, 75.76%, and 83.64%, respectively. The positive likelihood ratio (PLR) and specificity of IgM-CLIA was 19.40 and 95.49%, respectively. The consistency coefficient of (IgM+IgG)-CLIA and PPA (titer ≥ 1:160) was 89.1%, and the sensitivity and negative predictive value of (IgM+IgG)-CLIA were 96.88% and 98.94%, respectively. CLIA MP-IgM has high concordance with PPA, and its specificity and sensitivity are higher than those of CLIA MP-IgG and IFA MP-IgM, suggesting its better diagnosis of early MP infection. The sensitivity and negative predictive value of CLIA MP (IgM+IgG) were higher than those of PPA or IFA, indicating that it should be considered as a priority in the diagnosis of MP infection.

Risk Prediction Model for Necrotizing Pneumonia in Children with Mycoplasma pneumoniae Pneumonia

Objective

To analyze the predictive factors for necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) and construct a prediction model.

Methods

The clinical data with MPP at the Children's Hospital of Kunming Medical University from January 2014 to November 2022 were retrospectively analyzed. Eighty-four children with MPP who developed NP were divided into the necrotizing group, and 168 children who did not develop NP were divided into the non-necrotizing group by propensity-score matching. LASSO regression was used to select the optimal factors, and multivariate logistic regression analysis was used to establish a clinical prediction model. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the nomogram. Clinical decision curve analysis was used to evaluate the clinical predictive value.

Results

LASSO regression analysis showed that bacterial co-infection, chest pain, LDH, CRP, duration of fever, and D-dimer were the influencing factors for NP in children with MPP (P < 0.05). The results of ROC analysis showed that the AUC of the prediction model established in this study for predicting necrotizing MPP was 0.870 (95% CI: 0.813-0.927, P < 0.001) in the training set and 0.843 (95% CI: 0.757-0.930, P < 0.001) in the validation set. The Bootstrap repeated sampling for 1000 times was used for internal validation, and the calibration curve showed that the model had good consistency. The Hosmer-Lemeshow test showed that the predicted probability of the model had a good fit with the actual probability in the training set and the validation set (P values of 0.366 and 0.667, respectively). The clinical decision curve showed that the model had good clinical application value.

Conclusion

The prediction model based on bacterial co-infection, chest pain, LDH, CRP, fever duration, and D-dimer has a good predictive value for necrotizing MPP.