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Sui DX, Ma HC, Wang CC, Shao HY, Xu SH, Fang NN. Diagnostic significance of HRCT imaging features in adult mycoplasma pneumonia: a retrospective study. Sci Rep 2024; 14:153. [PMID: 38168479 PMCID: PMC10761950 DOI: 10.1038/s41598-023-50702-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Mycoplasma pneumoniae pneumonia (MPP) often overlaps with the clinical manifestations and chest imaging manifestations of other types of community-acquired pneumonia (CAP). We retrospectively analyzed the clinical and imaging data of a group of patients with CAP, summarized their clinical and imaging characteristics, and discussed the diagnostic significance of their certain HRCT findings. The HRCT findings of CAP researched in our study included tree-in-bud sign (TIB), ground-glass opacity (GGO), tree fog sign (TIB + GGO), bronchial wall thickening, air-bronchogram, pleural effusion and cavity. The HRCT findings of all cases were analyzed. Among the 200 cases of MPP, 174 cases showed the TIB, 193 showed the GGO, 175 showed the tree fog sign, 181 lacked air-bronchogram. In case taking the tree fog sign and lack of air-bronchogram simultaneously as an index to distinguish MPP from OCAP, the sensitivity was 87.5%, the specificity was 97.5%, the accuracy was 92.5%. This study showed that that specific HRCT findings could be used to distinguish MPP from OCAP. The combined HRCT findings including the tree fog sign and lacked air-bronchogram simultaneously would contribute to a more accurate diagnosis of MPP.
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Affiliation(s)
- Dong-Xin Sui
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Han-Chen Ma
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Chao-Chao Wang
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Hong-Yan Shao
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Shao-Hua Xu
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Ning-Ning Fang
- Department of Anesthesiology, Qilu Hospital of Shandong University, No. 107, Wenhua Xi Road, Jinan, 250012, Shandong, China.
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Huang X, Gu H, Wu R, Chen L, Lv T, Jiang X, Li H, Guo B, Liu J, Li D, Zhao D, Liu F. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes. Respir Med 2024; 221:107480. [PMID: 38043865 DOI: 10.1016/j.rmed.2023.107480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The imaging findings of Mycoplasma pneumoniae pneumonia (MPP) vary; however, few studies have focused on the relationship of imaging classification with clinical manifestations and outcomes. OBJECTIVE To prospectively investigate whether chest imaging classification in Mycoplasma pneumoniae pneumonia (MPP) is associated with its clinical features and outcomes. METHODS A total of 1,401 hospitalized children with MPP were enrolled from January 2019 to December 2021. Imaging findings were categorized as bronchopneumonia and consolidation/atelectasis according to X-ray, and bronchopneumonia, consolidation/atelectasis, bronchiolitis, and mosaic pattern according to computed tomography (CT). Clinical characteristics and outcomes of patients with different imaging classifications were prospectively analyzed based on electronic medical records. RESULTS Bronchopneumonia was the most common finding (59.6%), while consolidation/atelectasis was the most severe group. Clinical manifestations and laboratory indicators for the consolidation/atelectasis group included serious abnormalities. Further, outcomes of the patients were worse, including having longer total durations of fever and hospitalization, greater hospitalization expenses, and a higher likelihood of developing refractory MPP, necrotizing pneumonia, and bronchiolitis obliterans (BO) in this group. The incidence of bronchiolitis, a disease characterized by a high prevalence of fever, moist rales, and an atopic constitution, tended to increase after the coronavirus disease pandemic and predisposed patients to BO. A mosaic pattern occurred in allergic and young individuals, with wheezing as the main manifestation, with patients having relatively mild symptoms and good outcomes. CONCLUSION Different imaging classifications have different clinical features and clinical outcomes; thus, formulating an imaging-based classification system is of great clinical value.
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Affiliation(s)
- Xia Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Haiyan Gu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ruxi Wu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Lei Chen
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Tian Lv
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xinyi Jiang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Huili Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Bin Guo
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jie Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Dan Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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Luo XQ, Luo J, Wang CJ, Luo ZX, Tian DY, Xie XH. Clinical features of severe Mycoplasma pneumoniae pneumonia with pulmonary complications in childhood: A retrospective study. Pediatr Pulmonol 2023; 58:2815-2822. [PMID: 37431970 DOI: 10.1002/ppul.26593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/20/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Incidence of severe M. pneumoniae pneumonia (SMPP) reported in China has been increasing over the last decade. We aimed to evaluate the clinical features of pediatric SMPP with pulmonary complications, according to laboratory tests and chest radiographic resolution patterns. MATERIAL AND METHODS We retrospectively reviewed 93 SMPP patients between January 2016 and February 2019, and grouped them by pneumonia pattern: pulmonary complications (63 patients) and extensive lung lesions without pulmonary complications (30 patients). RESULTS SMPP patients with pleural effusion (medium or large) and necrotizing pneumonia showed longer duration of fever, high serum value of lactate dehydrogenase (LDH), d-dimer, and LDH to albumin ratio (LAR). LAR and d-dimer were associated with moderate or massive pleural effusion, and d-dimer was associated with lung necrosis. The average time of radiographic resolution in the pulmonary complication group was 12 weeks, while those with elevated d-dimer were significantly more likely to have longer time for radiographic clearance. CONCLUSION We conclude that M. pneumoniae pneumonia in patients with pleural effusion (medium or large) or lung necrosis was more severe than those without pulmonary complications. LAR and d-dimer might be used as parameters to identify children susceptible to pleural effusion (medium or large) or lung necrosis, and longer time for radiographic clearance among pediatric patients of SMPP.
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Affiliation(s)
- Xue Qin Luo
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Luo
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Chong Jie Wang
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zheng Xiu Luo
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dai Yin Tian
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiao Hong Xie
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Zhang H, Sun C, Yu Z. Effect of azithromycin sequential therapy combined with budesonide nebulization on chest CT changes in children with mycoplasma pneumonia. Minerva Gastroenterol (Torino) 2023; 69:447-449. [PMID: 37013384 DOI: 10.23736/s2724-5985.23.03373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Affiliation(s)
- Huajun Zhang
- Department of Pediatrics, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Congling Sun
- Department of Pediatrics, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Zhongcui Yu
- Department of Pediatrics, Yantai Hospital of Traditional Chinese Medicine, Yantai, China -
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Hu S, Zhu Y, Dong D, Wang B, Zhou Z, Wang C, Tian J, Peng Y. Chest Radiographs Using a Context-Fusion Convolution Neural Network (CNN): Can It Distinguish the Etiology of Community-Acquired Pneumonia (CAP) in Children? J Digit Imaging 2022; 35:1079-1090. [PMID: 35585465 PMCID: PMC9116701 DOI: 10.1007/s10278-021-00543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
Clinical symptoms and inflammatory markers cannot reliably distinguish the etiology of CAP, and chest radiographs have abundant information related with CAP. Hence, we developed a context-fusion convolution neural network (CNN) to explore the application of chest radiographs to distinguish the etiology of CAP in children. This retrospective study included 1769 cases of pediatric pneumonia (viral pneumonia, n = 487; bacterial pneumonia, n = 496; and mycoplasma pneumonia, n = 786). The chest radiographs of the first examination, C-reactive protein (CRP), and white blood cell (WBC) were collected for analysis. All patients were stochastically divided into training, validation, and test cohorts in a 7:1:2 ratio. Automatic lung segmentation and hand-crafted pneumonia lesion segmentation were performed, from which three image-based models including a full-lung model, a local-lesion model, and a context-fusion model were built; two clinical characteristics were used to build a clinical model, while a logistic regression model combined the best CNN model and two clinical characteristics. Our experiments showed that the context-fusion model which integrated the features of the full-lung and local-lesion had better performance than the full-lung model and local-lesion model. The context-fusion model had area under curves of 0.86, 0.88, and 0.93 in identifying viral, bacterial, and mycoplasma pneumonia on the test cohort respectively. The addition of clinical characteristics to the context-fusion model obtained slight improvement. Mycoplasma pneumonia was more easily identified compared with the other two types. Using chest radiographs, we developed a context-fusion CNN model with good performance for noninvasively diagnosing the etiology of community-acquired pneumonia in children, which would help improve early diagnosis and treatment.
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Affiliation(s)
- Shasha Hu
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Yongbei Zhu
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China
| | - Di Dong
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Bei Wang
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Zuofu Zhou
- Department of Radiology, Fujian Provincial Maternity and Children's Hospital, Fujian Medical University, Fuzhou, 350000, China
| | - Chi Wang
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, State Key Laboratory of Management and Control for Complex Systems, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, 100191, China.
| | - Yun Peng
- Department of Radiology, National Center for Children' Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
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Wang X, Lin X. Analysis of Clinical Related Factors of Severe Mycoplasma pneumoniae Pneumonia in Children Based on Imaging Diagnosis. Comput Math Methods Med 2022; 2022:4852131. [PMID: 35265171 PMCID: PMC8898849 DOI: 10.1155/2022/4852131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/20/2021] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
Abstract
Severe pneumonia is a common acute respiratory disease in children, and it has a rapid onset and violent onset, which often affects the whole body. Moreover, typical clinical manifestations and signs often cannot be taken seriously or covered up in clinical work. Due to the short time for treatment, it is easy to cause improper diagnosis and treatment, aggravate the disease and further deteriorate, and even threaten the life of the child. In order to achieve early intervention and treatment of severe Mycoplasma pneumoniae pneumonia in children, reduce or shorten the course of the disease, and improve the cure rate, this paper combines the imaging diagnosis to study the analysis of clinical related factors of severe Mycoplasma pneumoniae pneumonia in children. In addition, this paper analyzes the experimental data with hospital case samples, conducts statistical research on the analysis of clinical related factors of severe Mycoplasma pneumoniae pneumonia in children, and proposes effective coping strategies.
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Affiliation(s)
- Xiaoshuai Wang
- Department of Pediatrics, Huai'an Maternal and Child Health Hospital, Huai'an, Jiangsu, China 223001
| | - Xiaofei Lin
- Department of Pediatrics, Huai'an Maternal and Child Health Hospital, Huai'an, Jiangsu, China 223001
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Liu J, Wang Y, He G, Wang X, Sun M. Quantitative CT comparison between COVID-19 and mycoplasma pneumonia suspected as COVID-19: a longitudinal study. BMC Med Imaging 2022; 22:21. [PMID: 35125096 PMCID: PMC8818096 DOI: 10.1186/s12880-022-00750-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/01/2022] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare imaging features between COVID-19 and mycoplasma pneumonia (MP). MATERIALS AND METHODS The data of patients with mild COVID-19 and MP who underwent chest computed tomography (CT) examination from February 1, 2020 to April 17, 2020 were retrospectively analyzed. The Pneumonia-CT-LKM-PP model based on a deep learning algorithm was used to automatically quantify the number, volume, and involved lobes of pulmonary lesions, and longitudinal changes in quantitative parameters were assessed in three CT follow-ups. RESULTS A total of 10 patients with mild COVID-19 and 13 patients with MP were included in this study. There was no difference in lymphocyte counts at baseline between the two groups (1.43 ± 0.45 vs. 1.44 ± 0.50, p = 0.279). C-reactive protein levels were significantly higher in MP group than in COVID-19 group (p < 0.05). The number, volume, and involved lobes of pulmonary lesions reached a peak in 7-14 days in the COVID-19 group, but there was no peak or declining trend over time in the MP group (p < 0.05). CONCLUSION Based on the longitudinal changes of quantitative CT, pulmonary lesions peaked at 7-14 days in patients with COVID-19, and this may be useful to distinguish COVID-19 from MP and evaluate curative effects and prognosis.
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Affiliation(s)
- Junzhong Liu
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China.
- Department of Medical Imaging, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, 7 Yuanxiao Street, Weifang City, 261041, Shandong Province, People's Republic of China.
| | - Yuzhen Wang
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Guanghui He
- Department of Interventional Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Xinhua Wang
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
| | - Minfeng Sun
- Department of Radiology, Weifang No. 2 People's Hospital, The Second Affiliated Hospital of Weifang Medical University, Weifang City, Shandong Province, China
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Bi Y, Jiang C, Qi H, Zhou H, Sun L. Computed Tomography Image Texture under Feature Extraction Algorithm in the Diagnosis of Effect of Specific Nursing Intervention on Mycoplasma Pneumonia in Children. J Healthc Eng 2021; 2021:6059060. [PMID: 34697567 PMCID: PMC8541873 DOI: 10.1155/2021/6059060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
To evaluate the effect of specific nursing intervention in children with mycoplasma pneumonia (MP), a feature extraction algorithm based on gray level co-occurrence matrix (GLCM) was proposed and combined with computed tomography (CT) image texture features. Then, 98 children with MP were rolled into the observation group with 49 cases (specific nursing) and the control group with 49 cases (routine nursing). CT images based on feature extraction algorithm of optimized GLCM were used to examine the children before and after nursing intervention, and the recovery of the two groups of children was discussed. The results showed that the proportion of lung texture increase, rope shadow, ground glass shadow, atelectasis, and pleural effusion in the observation group (24.11%, 3.86%, 8.53%, 15.03%, and 3.74%) was significantly lower than that in the control group (28.53%, 10.23%, 13.34%, 21.15%, and 8.13%) after nursing (P < 0.05). There were no significant differences in the proportion of small patchy shadows, large patchy consolidation shadows, and bronchiectasis between the observation group and the control group (P > 0.05). In the course of nursing intervention, in the observation group, the disappearance time of cough, normal temperature, disappearance time of lung rales, and absorption time of lung shadow (2.15 ± 0.86 days, 4.81 ± 1.14 days, 3.64 ± 0.55 days, and 5.96 ± 0.62 days) were significantly shorter than those in the control group (2.87 ± 0.95 days, 3.95 ± 1.06 days, 4.51 ± 1.02 days, and 8.14 ± 1.35 days) (P < 0.05). After nursing intervention, the proportion of satisfaction and total satisfaction in the experimental group (67.08% and 28.66%) was significantly higher than that in the control group (40.21% and 47.39%), while the proportion of dissatisfaction (4.26%) was significantly lower than that in the control group (12.4%) (P < 0.05). To sum up, specific nursing intervention was more beneficial to improve the progress of characterization recovery and the overall recovery effect of children with MP relative to conventional nursing. CT image based on feature extraction algorithm of optimized GLCM was of good adoption value in the diagnosis and treatment of MP in children.
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Affiliation(s)
- Yuyan Bi
- Department of Pediatric Ward, Jinan City People's Hospital, Jinan 271199, Shandong Province, China
| | - Cuifeng Jiang
- Department of Pediatric Surgery, Jinan City People's Hospital, Jinan 271199, Shandong Province, China
| | - Hua Qi
- Department of Pediatric Ward, Jinan City People's Hospital, Jinan 271199, Shandong Province, China
| | - Haiwei Zhou
- Department of Pediatric Ward, Jinan City People's Hospital, Jinan 271199, Shandong Province, China
| | - Lixia Sun
- Department of Nursing, Jinan City People's Hospital, Jinan 271199, Shandong Province, China
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Gülbay M, Özbay BO, Mendi BAR, Baştuğ A, Bodur H. A CT radiomics analysis of COVID-19-related ground-glass opacities and consolidation: Is it valuable in a differential diagnosis with other atypical pneumonias? PLoS One 2021; 16:e0246582. [PMID: 33690730 PMCID: PMC7946299 DOI: 10.1371/journal.pone.0246582] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/21/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the discrimination of parenchymal lesions between COVID-19 and other atypical pneumonia (AP) by using only radiomics features. METHODS In this retrospective study, 301 pneumonic lesions (150 ground-glass opacity [GGO], 52 crazy paving [CP], 99 consolidation) obtained from nonenhanced thorax CT scans of 74 AP (46 male and 28 female; 48.25±13.67 years) and 60 COVID-19 (39 male and 21 female; 48.01±20.38 years) patients were segmented manually by two independent radiologists, and Location, Size, Shape, and First- and Second-order radiomics features were calculated. RESULTS Multiple parameters showed significant differences between AP and COVID-19-related GGOs and consolidations, although only the Range parameter was significantly different for CPs. Models developed by using the Bayesian information criterion (BIC) for the whole group of GGO and consolidation lesions predicted COVID-19 consolidation and AP GGO lesions with low accuracy (46.1% and 60.8%, respectively). Thus, instead of subjective classification, lesions were reclassified according to their skewness into positive skewness group (PSG, 78 AP and 71 COVID-19 lesions) and negative skewness group (NSG, 56 AP and 44 COVID-19 lesions), and group-specific models were created. The best AUC, accuracy, sensitivity, and specificity were respectively 0.774, 75.8%, 74.6%, and 76.9% among the PSG models and 0.907, 83%, 79.5%, and 85.7% for the NSG models. The best PSG model was also better at predicting NSG lesions smaller than 3 mL. Using an algorithm, 80% of COVID-19 and 81.1% of AP patients were correctly predicted. CONCLUSION During periods of increasing AP, radiomics parameters may provide valuable data for the differential diagnosis of COVID-19.
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Affiliation(s)
- Mutlu Gülbay
- Department of Radiology, Ankara Numune Education and Research Hospital, Ankara City Hospital, Universiteler Mahallesi, Ankara, Çankaya, Turkey
| | - Bahadır Orkun Özbay
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara City Hospital, Universiteler Mahallesi, Ankara, Çankaya, Turkey
| | - Bökebatur Ahmet Raşit Mendi
- Department of Radiology, Ankara Numune Education and Research Hospital, Ankara City Hospital, Universiteler Mahallesi, Ankara, Çankaya, Turkey
| | - Aliye Baştuğ
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara City Hospital, Universiteler Mahallesi, Ankara, Çankaya, Turkey
| | - Hürrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara City Hospital, Universiteler Mahallesi, Ankara, Çankaya, Turkey
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Wang J, Mao J, Chen G, Huang Y, Zhou J, Gao C, Jin D, Zhang C, Wen J, Sun J. Evaluation on blood coagulation and C-reactive protein level among children with mycoplasma pneumoniae pneumonia by different chest imaging findings. Medicine (Baltimore) 2021; 100:e23926. [PMID: 33545964 PMCID: PMC7837868 DOI: 10.1097/md.0000000000023926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/28/2020] [Indexed: 12/13/2022] Open
Abstract
Mycoplasma pneumoniae infection may induce a systemic hypercoagulable abnormality, like organ embolism and infarction. Indexes of blood coagulation and C-reactive protein (CRP) have been reported different between healthy people and mycoplasma pneumoniae pneumonia (MPP) patients, but this difference in MPP patients with different chest imaging findings has rarely been reported.We performed a retrospective study of 101 children with MPP and 119 controls, combined with radiological examination and blood tests, to compare the blood coagulation and CRP level among MPP children with different chest imaging findings.For the MPP children with different chest imaging findings, there were significant differences in CRP, fibrinogen (FIB) and D-dimer (D-D) levels among subgroups (P = .004, P = .008 and P < .001 respectively). The CRP level in group of interstitial pneumonia was significantly higher than that in groups of bronchopneumonia and hilar shadow thickening (P = .003 and P = .001 respectively). And the FIB and D-D values in group of lung consolidation were significantly higher than that in the other 3 groups (all P < .05). When compared with controls, the white blood cell, CRP, FIB, and D-D levels in MPP children were significantly higher, and the activated partial thromboplastin time and thrombin time levels were significantly lower (all P < .05).Our results showed that CRP level changed most significantly in group of interstitial pneumonia, whereas FIB, D-D levels changed most significantly in the lung consolidation group.
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Affiliation(s)
| | | | | | | | | | | | | | - Chenying Zhang
- Department of Respiratory, the First People's Hospital of Lianyungang, Lianyungang, China
| | - Juan Wen
- Nanjing Maternity and Child Health Care Institute, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
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Wang J, Xia C, Sharma A, Gaba GS, Shabaz M. Chest CT Findings and Differential Diagnosis of Mycoplasma pneumoniae Pneumonia and Mycoplasma pneumoniae Combined with Streptococcal Pneumonia in Children. J Healthc Eng 2021; 2021:8085530. [PMID: 34221302 PMCID: PMC8219438 DOI: 10.1155/2021/8085530] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND In this day and age, 17% of children less than 5 years of age died of pneumonia; it is the common cause of children death. It is one of the main children respiratory infectious diseases, i.e., mycoplasma pneumonia (MP). The imaging examination can be adopted to quickly observe the morphology and scope of the pulmonary lesions and know the effect of disease treatment and subsequent changes in the disease in order to provide a basis for treatment. Therefore, the most commonly applied technology for detecting pneumonia in children is imaging technology, including chest X-ray and CT. OBJECTIVES The main objective of the work is to investigate the chest computed tomography (CT) findings of children patients with Mycoplasma pneumoniae pneumonia (MPP) and MP combined with streptococcal pneumonia (SP). The mixed infection of MP and SP is very common clinically, and the diagnosis of this type of mixed pneumonia is a critical research topic faced by pediatric respiratory physicians. The comparison is done on the incidence of bronchial and pulmonary interstitial lesions, the degree of lymph node enlargement, the volume and depth of pleural effusion, and the location and morphology of the pulmonary lesions in the chest CT images of children patients from the two groups. METHODS There were comparisons on the incidence of bronchial and pulmonary interstitial lesions, the degree of lymph node enlargement, the volume and depth of pleural effusion, and the location and morphology of the pulmonary lesions in the chest CT images of children patients from the two groups. All the experiments are done in the MATLAB. RESULTS The results showed that the proportions of reticular shadow, ground glass shadow, bronchial inflation phase, tube wall thickening, and vascular bundle thickening on the CT images of children patients from the MPP group were dramatically higher than those of the MP + SP group (P < 0.05). The maximum transverse diameter of enlarged lymph node in children patients from the MPP group was obviously larger than the diameter of the MP + SP group (P < 0.05). The number of children patients with pleural effusion was 22 in the MP + SP group, which was greatly higher than the MPP group (P < 0.05). CONCLUSION In conclusion, the chest CT images of children patients from the MPP group were mainly pulmonary interstitial changes. Furthermore, the alveolar inflammation could be observed on the CT images shown when children patients were combined with SP infection. The more obvious manifestations were that the flaky shadows appeared in the lungs, the pleural effusion became thicker, and the transverse diameters of enlarged lymph nodes were bigger.
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Affiliation(s)
- Jing Wang
- 1Department of Infectious Diseases, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Chen Xia
- 1Department of Infectious Diseases, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu 210008, China
| | - Ashutosh Sharma
- 2Institute of Computer Technology and Information Security, Southern Federal University, Rostov-on-Don, Russia
| | - Gurjot Singh Gaba
- 3School of Electronics and Electrical Engineering, Lovely Professional University, Phagwara 144411, India
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Wang S, Zha Y, Li W, Wu Q, Li X, Niu M, Wang M, Qiu X, Li H, Yu H, Gong W, Bai Y, Li L, Zhu Y, Wang L, Tian J. A fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis. Eur Respir J 2020; 56:2000775. [PMID: 32444412 PMCID: PMC7243395 DOI: 10.1183/13993003.00775-2020] [Citation(s) in RCA: 267] [Impact Index Per Article: 66.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has spread globally, and medical resources become insufficient in many regions. Fast diagnosis of COVID-19 and finding high-risk patients with worse prognosis for early prevention and medical resource optimisation is important. Here, we proposed a fully automatic deep learning system for COVID-19 diagnostic and prognostic analysis by routinely used computed tomography.We retrospectively collected 5372 patients with computed tomography images from seven cities or provinces. Firstly, 4106 patients with computed tomography images were used to pre-train the deep learning system, making it learn lung features. Following this, 1266 patients (924 with COVID-19 (471 had follow-up for >5 days) and 342 with other pneumonia) from six cities or provinces were enrolled to train and externally validate the performance of the deep learning system.In the four external validation sets, the deep learning system achieved good performance in identifying COVID-19 from other pneumonia (AUC 0.87 and 0.88, respectively) and viral pneumonia (AUC 0.86). Moreover, the deep learning system succeeded to stratify patients into high- and low-risk groups whose hospital-stay time had significant difference (p=0.013 and p=0.014, respectively). Without human assistance, the deep learning system automatically focused on abnormal areas that showed consistent characteristics with reported radiological findings.Deep learning provides a convenient tool for fast screening of COVID-19 and identifying potential high-risk patients, which may be helpful for medical resource optimisation and early prevention before patients show severe symptoms.
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Affiliation(s)
- Shuo Wang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- Contributed equally
| | - Yunfei Zha
- Dept of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
- Contributed equally
| | - Weimin Li
- Dept of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- Contributed equally
| | - Qingxia Wu
- College of Medicine and Biomedical Information Engineering, Northeastern University, Shenyang, China
- Contributed equally
| | - Xiaohu Li
- Dept of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
- Contributed equally
| | - Meng Niu
- Dept of Interventional Radiology, the First Hospital of China Medical University, Shenyang, China
- Contributed equally
| | - Meiyun Wang
- Dept of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University, Zhengzhou, China
- Contributed equally
| | - Xiaoming Qiu
- Dept of Radiology, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
- Contributed equally
| | - Hongjun Li
- Dept of Radiology, Beijing Youan Hospital of Capital Medical University, Beijing, China
- Contributed equally
| | - He Yu
- Dept of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Gong
- Dept of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Bai
- Dept of Medical Imaging, Henan Provincial People's Hospital and the People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Li
- Dept of Radiology, Beijing Youan Hospital of Capital Medical University, Beijing, China
| | - Yongbei Zhu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Liusu Wang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Jie Tian
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, China
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Qiu JL, Huang L, Shao MY, Chai YN, Zhang HJ, Li XF, Sun XX, Zhao QY, Duan F, Zhai WS. Efficacy and safety of azithromycin combined with glucocorticoid on refractory Mycoplasma pneumoniae pneumonia in children: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20121. [PMID: 32481378 DOI: 10.1097/md.0000000000020121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the efficacy and safety of azithromycin (AZI) combined with glucocorticoid (GC) in the treatment of children with refractory Mycoplasma pneumoniae. METHODS Computer search for PubMed, EMbase, Cochrane Library, China Biomedical Literature Database (CBMdisc), China Knowledge Network (CNKI), Wanfang, VIP (VIP), and a randomized controlled trial (RCT) of AZI combined with GC in the treatment of children with refractory Mycoplasma pneumoniae pneumonia test (RCT), the search time limit is built until March 20, 2019. Two researchers independently performed literature screening, data extraction, and literature risk bias, and meta-analysis was performed using RevMan 5.3 software. RESULTS A total of 12 RCTs were included, including 1130 patients. Meta-analysis showed that AZI combined with GC therapy significantly improved the total effective rate of the disease compared with the conventional treatment group (odds ratio [OR] = 6.37; 95% confidence interval [CI] 4.03, 10.07; P < .00001; I = 0%), effectively shortened the antipyretic time (SMD = -2.29; 95% CI -2.70, -1.88; P < .0001); promoted lung inflammation absorption (SMD = -1.89; 95% CI -2.38, -1.40; P < .0001), reduced cough time (SMD = -2.39; 95% CI -2.80, -1.99; P < .0001); shortened hospital stay (SMD = -2.19; 95% CI -3.21, -1.17; P < .0001); improved imaging findings (OR = 5.38; 95% CI 1.09, 26.51, P = .04); reduced inflammation index (SMD = -3.15; 95% CI -4.93, -1.36; P = .004); improved immune function (SMD = 1.29; 95% CI -0.02, 2.60; P < .0001); had no significant adverse reactions (OR = 1.18; 95% CI 0.71, 1.98; P = .53). CONCLUSIONS According to the current limited research evidence, the addition of GCs to the conventional treatment of refractory Mycoplasma pneumoniae in children can improve the clinical efficacy to a certain extent, and the safety is better. However, due to the quality and quantity of the included literature, the conclusions of this study need to be confirmed by more high-quality studies.
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Affiliation(s)
- Jian-Li Qiu
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Li Huang
- Department of Rehabilitation Medicine, Foresea Life Insurance Guangzhou General Hospital, Guangzhou City, Guangdong Province
| | - Ming-Yi Shao
- Department of Scientific Research, First Affiliated Hospital of Henan University of Chinese Medicine
| | - Yu-Na Chai
- Department of pharmacy, The First Affiliated Hospital of Zhengzhou University
| | - Hui-Juan Zhang
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Xiang-Feng Li
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Xiao-Xu Sun
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Qian-Yi Zhao
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
| | - Fei Duan
- Department of Personnel, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province, People's Republic of China
| | - Wen-Sheng Zhai
- Department of Pediatrics, First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou City, Henan Province
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Huang L, Huang X, Jiang W, Zhang R, Yan Y, Huang L. Independent predictors for longer radiographic resolution in patients with refractory Mycoplasma pneumoniae pneumonia: a prospective cohort study. BMJ Open 2018; 8:e023719. [PMID: 30567824 PMCID: PMC6303577 DOI: 10.1136/bmjopen-2018-023719] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine prospectively the radiographic clearance of refractory Mycoplasma pneumoniae pneumonia (RMPP) in immunocompetent children, and to identify independent predictors of time to complete radiographic resolution in patients with RMPP. DESIGN A prospective cohort study. SETTING Children's Hospital of Soochow University, China. PARTICIPANTS A total of 187 patients with RMPP treated with bronchoscopy were prospectively enrolled in the study between January 2012 and December 2015. METHODS Serial chest radiographs were obtained after discharge every 4 weeks up to a maximum of 24 weeks after diagnosis or until large infiltration on chest radiographs had resolved. Multivariate logistic regression was performed to identify independent predictors of time to complete radiographic resolution. RESULTS Of the 187 patients with RMPP, bronchial mucus plug formation was detected in 73 (39.0%). C reactive protein (CRP) ≥50 mg/L, lactate dehydrogenase (LDH) ≥480 U/L, total fever duration ≥10 days and presence of mucus plugs were associated with longer time to radiographic clearance (all p<0.01). Compared with children without mucus plugs, those with mucus plugs were significantly more likely to have longer time to radiographic clearance (adjusted OR: 11.5; 95% CI 2.5 to 45.7; p<0.01). CONCLUSION Clinicians might use duration of fever, CRP, LDH and presence of mucus plugs as parameters to identify children at a longer time to radiographic clearance in patients with RMPP.
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Affiliation(s)
- Lizhen Huang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xia Huang
- Department of Respiratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Wujiang Jiang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Rong Zhang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yongdong Yan
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Li Huang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
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Bruno Pedersen AS, Østergaard L, Jespersen S. [Servere atypical pneumonia with macrolide-resistant Mycoplasma pneumoniae]. Ugeskr Laeger 2018; 180:V02180101. [PMID: 30037385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This is a case report of a 47-year-old woman, who was admitted to hospital, due to severe cough and fever. A chest X-ray showed bilateral infiltrates, and sputum was found positive for Mycoplasma pneumoniae. She received treatment with intravenous clarithromycin but did not recover. After ten days macrolide-resistant M. pneumoniae was found in a throat swab. Moxifloxacin was administered, and she recovered quickly afterwards. Macrolide-resistant M. pneumoniae is an increasing problem and should be suspected, when there is no clinical effect on macrolides. Quinolones or tetracyclines may be used, when macrolide-resistant M. pneumoniae is detected.
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Søndergaard MJ, Friis MB, Hansen DS, Jørgensen IM. Clinical manifestations in infants and children with Mycoplasma pneumoniae infection. PLoS One 2018; 13:e0195288. [PMID: 29698412 PMCID: PMC5919654 DOI: 10.1371/journal.pone.0195288] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/14/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in older children. Pulmonary and extra-pulmonary symptoms associated with M. pneumoniae infection are reported. M. pneumoniae is mainly epidemic in Denmark with the recurrence every 4-7th year. AIMS Retrospectively, to describe the epidemiology and clinical features, in infants and children, during the M. pneumoniae epidemic in 2010 and 2011. METHODS All children under the age of 16 that were tested for M. pneumoniae during the period 01.02.2010-31.01.2012 were included. Medical charts, as well as radiological findings, were reviewed for all children with M. pneumoniae. A post-hoc analysis of viral co-infections was done on part of the cohort. RESULTS 134 of 746 children were tested positive for M. pneumoniae by PCR or serology. Positive tests were found in 65% of children seven years and older, in 30% of 2-6-year-olds and 4% of infants (less than two years of age). Viral co-infection was found in 27% of the tested samples. The clinical presentation was a cough, asthma-like symptoms and low-grade fever. Extra-pulmonary symptoms were common and presented as nausea/vomiting by 33% of the children and skin manifestations by 25%. 84% of the children had a chest x-ray taken, and there were positive radiological findings in 94% of these. CONCLUSION M. pneumoniae also affected infants and young children and symptoms were similar to infections with respiratory viruses, but severe LRTI were also seen. During an up-coming epidemic, assessment of extra-pulmonary manifestations can be helpful when diagnosing M. pneumoniae infections.
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Seo H, Cha SI, Shin KM, Lim JK, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Relationship Between Clinical Features and Computed Tomographic Findings in Hospitalized Adult Patients With Community-Acquired Pneumonia. Am J Med Sci 2018; 356:30-38. [PMID: 30049328 PMCID: PMC7093861 DOI: 10.1016/j.amjms.2018.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/05/2023]
Abstract
Background Data on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images. Methods Patients with CAP who underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data. Results A total of 40 patients (2.4%) were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups. Conclusions The bronchiolitis group was characterized by a higher frequency of M. pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.
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Affiliation(s)
- Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
| | - Kyung-Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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MESH Headings
- Algorithms
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/microbiology
- Anemia, Hemolytic, Autoimmune/pathology
- Anemia, Hemolytic, Autoimmune/therapy
- Anti-Bacterial Agents/therapeutic use
- Blood Transfusion
- Fever/microbiology
- Humans
- Male
- Middle Aged
- Mycoplasma pneumoniae/isolation & purification
- Pneumonia, Mycoplasma/complications
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/diagnostic imaging
- Pneumonia, Mycoplasma/drug therapy
- Tomography, X-Ray Computed
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Saraya T, Watanabe T, Tsukahara Y, Ohkuma K, Ishii H, Kimura H, Yan K, Goto H, Takizawa H. The Correlation between Chest X-ray Scores and the Clinical Findings in Children and Adults with Mycoplasma pneumoniae Pneumonia. Intern Med 2017; 56:2845-2849. [PMID: 28943541 PMCID: PMC5709625 DOI: 10.2169/internalmedicine.8500-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective To compare the radiological and laboratory data of children and adults with Mycoplasma pneumoniae pneumonia (MPP) and to evaluate the correlation between the total affected lung area and the clinical findings. Methods We retrospectively examined the data from MPP patients who visited our hospital during the period from April 2006 to July 2014. All data were retrieved at the time of the diagnosis of MPP and were analyzed to investigate the correlation between the clinical findings and the total affected lung area using a chest X-ray scoring system. Results We identified 71 children and 54 adults with MPP. The incidence of consolidation, which was the most common chest X-ray finding in both groups, was similar (children: n = 62, 87.3%; adults: n = 45, 83.3%). In contrast, air bronchogram, bronchial thickening, and atelectasis were observed significantly more frequently among children than among adults. In both groups, a chest X-ray scoring system revealed a zonal predominance of the affected area (middle-to-lower lung fields). The body temperature and serum data such as the C-reactive protein level, white blood cell count, and lactate dehydrogenase level were significantly higher in the child group than in the adult group. The total score did not significantly correlate with the above-mentioned inflammatory markers or the presence of hypoxemia in either group. Conclusion This study showed the first evidence of a correlation between the extent of lung abnormalities on chest X-ray (calculated as a total score) and the clinical findings, including the presence of hypoxemia, in children and adults with MPP.
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Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Takayasu Watanabe
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Yayoi Tsukahara
- Department of Radiology, Kyorin University School of Medicine, Japan
| | - Kosuke Ohkuma
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Hirokazu Kimura
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Japan
| | - Kunimasa Yan
- Department of Pediatrics, Kyorin University School of Medicine, Japan
| | - Hajime Goto
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
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Affiliation(s)
- Timothy Shao Ern Tan
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Omar Abdulla
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
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Bohr AL, Aagaard TG, Birgens H, Søborg C. [Severe haemolysis caused by Mycoplasma pneumoniae]. Ugeskr Laeger 2015; 177:V03150207. [PMID: 26509456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mycoplasma pneumoniae is naturally resistant to betalactamase antibiotics but is sensitive to macrolides. Occasionally, infections with M. pneumoniae can lead to severe anaemia due to its ability to cause haemolysis when cold agglutination occurs. Increasing bacterial resistance to macrolid antibiotics is a growing concern worldwide. We present two cases where infection with M. pneumoniae caused severe haemolysis, one of which was macrolide-resistant.
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Gayretli Aydın ZG, Yalçınkaya R, Aydın Teke T, Bayhan Gİ, Öz FN, Metin Timur Ö, Ekşioğlu AS, Tanır G. [Coexistence of Pulmonary Hydatid Cyst and Mycoplasma pneumoniae Pnömonia in a Child]. Turkiye Parazitol Derg 2015; 39:159-163. [PMID: 26081892 DOI: 10.5152/tpd.2015.3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hydatid cyst is a zoonotic disease and endemic in Turkey. The disease can involve any organ. The most common involved organ is lung in childhood. Hydatid cyst of lung may be asymptomatic or may be sometimes ruptured or infected. Secondary bacterial infections associated with the hydatid cyst are well known. A previously not reported pediatric case of hydatid cyst with Mycoplasma pneumoniae pneumonia is described in this report. It is emphasized that M. pneumoniae should be kept in mind as a cause of infected hydatid cyst which is unresponsive to beta-laktam antibiotics.
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Affiliation(s)
- Zeynep Gökçe Gayretli Aydın
- Dr. Sami Ulus Kadın Doğum, Çocuk Sağlığı ve Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk Enfeksiyon Bilim Dalı, Ankara, Türkiye.
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Ma YJ, Wang SM, Cho YH, Shen CF, Liu CC, Chi H, Huang YC, Huang LM, Huang YC, Lin HC, Ho YH, Mu JJ. Clinical and epidemiological characteristics in children with community-acquired mycoplasma pneumonia in Taiwan: A nationwide surveillance. J Microbiol Immunol Infect 2014; 48:632-8. [PMID: 25311405 DOI: 10.1016/j.jmii.2014.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/18/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is the leading cause of hospitalization of children. Mycoplasma pneumoniae is one of the most common pathogens. The disease severity is diverse, and the diagnosis remains a challenge to clinical pediatricians. The aims of this study are to provide a nationwide surveillance of the epidemiology and clinical manifestations of community-acquired mycoplasma pneumonia (CAMP) in children in Taiwan. METHODS The medical records of children enrolled by the Taiwan Pediatric Infectious Disease Alliance (TPIDA) project during 2010-2011 were reviewed. Hospitalized children with segmental or lobar pneumonia were included. The demographic, clinical, laboratory and radiographic data were analyzed. Nasopharyngeal swabs, pleural effusion, and serum were collected for multiplex viral and bacterial polymerase chain reaction (PCR), mycoplasma immunoglobulin M (IgM), or paired immunoglobulin G (IgG) titer. RESULTS There were overall 127 children with CAMP. Among them, 16 (12.6%) children had PCR and IgM positivity, 74 (58.3%) children had a positive serologic study, 34 (27.8%) children had positive PCR detection, and three (2.4%) children had paired IgG above a four-fold increase. Enrolled patients were divided into two groups before and after the age of 5 years. Children younger than 5 years or younger had a significantly longer hospitalization, higher intensive care unit (ICU) admission rates, and more complications. They were more frequent to receive oxygen supplementation and even surgical intervention. The white blood cell counts and C-reactive protein levels were higher in children 5 years old or younger. CONCLUSION Mycoplasma pneumoniae is an important etiology of CAP in children 5 years or younger. They had a longer length of hospitalization, higher inflammatory responses, and more complications, compared to children older than 5 years.
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Affiliation(s)
- Yun-Ju Ma
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Shih-Min Wang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan
| | - Yu-Hao Cho
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan
| | - Ching-Chuan Liu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan City, Taiwan; Taiwan Pediatric Infectious Disease Alliance, Taiwan.
| | - Hsin Chi
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Yi-Chuan Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Division of Infectious Diseases, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Li-Min Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, National Taiwan University and Hospital, Taipei City, Taiwan
| | - Yhu-Chering Huang
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiao-Chuan Lin
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; School of Medicine, China Medical University, Taichung City, Taiwan; Department of Pediatrics, China Medical University Hospital, Taichung City, Taiwan
| | - Yu-Huai Ho
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Division of Infectious Disease, Department of Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jung-Jung Mu
- Taiwan Pediatric Infectious Disease Alliance, Taiwan; Centers for Disease Control, Taiwan
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Li SR, Mu JH, Chang L, Yan YC, Yuan XY, Chen HZ. [Chest CT features and outcome of necrotizing pneumonia caused by Mycoplasma pneumoniae in children (report of 30 cases)]. Zhonghua Er Ke Za Zhi 2013; 51:211-215. [PMID: 23751584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To summarize the chest CT features and outcome of necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae in children and to review the changes of common inflammatory parameters in NP patients to help clinicians understand the proper timing of CT scan. METHOD The imaging data from 30 cases of Mycoplasma pneumoniae pneumonia in NP group and 24 cases with non-necrotizing Mycoplasma penumoniae pneumonia (control group) were analyzed retrospectively. The changes of common inflammatory parameters in NP group and control group were compared. RESULT (1) The chest CT findings of NP (30 cases): 28 cases showed unilateral pneumonia, and 20 cases showed single lobar consolidation, 10 cases had multiple lobes involvement; pulmonary cavities were seen in 27 cases. There were decreased enhancement areas in the consolidation (22 cases). (2) The dynamic changes of CT signs during follow-up: The CT scan performed during the 1 - 2 months after onset of disease (23 cases) showed that pulmonary consolidation in 2 cases (9%) were absorbed, 18 cases (78%)had cavities in lung, 16 cases (70%) had pleural thickening, 2 cases (9%) atelectasis and 1 case (4%) bronchopleural fistula;the CT scan performed during the 2 - 3 months after onset of disease (11 cases) showed pulmonary consolidation in 7 cases (64%) were absorbed, 10 cases (91%) pleural thickness, 7 cases (64%) with cavities in lung, 5 cases (45%) atelectasis, 2 cases (18%) pulmonary lobe cysts and 1 case bronchopleural fistula. The CT scan performed at 3.5 years of disease course (10 cases) showed that there were no pulmonary consolidation in any of the cases, 4 cases had atelectasis, 4 cases had pulmonary cysts, and 1 case had band-like scars. (3) There were significant differences between NP group and control group in the maximum peripheral blood WBC, proportion of neutrophil and C-reactive protein(CRP, mg/L) (P < 0.01, 0.01, 0.001, respectively), and there was significant difference between the 2 groups in the duration of fever, abnormal WBC(d) and CRP(d) (P < 0.001). CONCLUSION The chest CT features of NP caused by Mycoplasma pneumoniae in children were single lobular consolidation in most cases, NP had decreased parenchymal enhancement and cavity in the consolidation, and recovery was slow, the outcome included recovery, atelectasis or lobar cystic degeneration. The clinicians should pay more attention to the common inflammatory parameters when they suspect the Mycoplasma pneumoniae pneumonia is progressing into necrosis and make correct decision for chest CT examination.
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Affiliation(s)
- Su-rong Li
- Department of Radiology and Division of Respiratory Diseases, Capital Institute of Pediatrics, Beijing 100020, China
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Xia Y, Wu CK, Tang YY, Cao J. [Differences in the clinical features of Mycoplasma pneumoniae pneumonia among children of different ages]. Zhongguo Dang Dai Er Ke Za Zhi 2013; 15:179-182. [PMID: 23498757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To investigate the clinical features of Mycoplasma pneumoniae pneumonia (MPP) among children of different ages. METHODS Retrospective analysis was performed on the clinical data of 112 children who were hospitalized due to MMP between January 2010 and December 2011. The children were divided into 3 groups according to their ages: infants (<3 years; n=20), preschool-aged children (≥3 years; n=41), and school-aged children (6-15.2 years; n=51). The three groups were compared in terms of their clinical symptoms, pulmonary signs, chest X-ray findings and laboratory test results. RESULTS The infant group presented mainly with expectoration and wheezing, accompanied by low fever. They showed gastrointestinal symptoms as the most common extra-pulmonary manifestation and had evident pulmonary signs. The majority of the school-aged children group presented with high fever and a severe dry cough, and wheezing was seen in several of them. They showed rash as the most common extra-pulmonary manifestation and had slight pulmonary signs. The symptoms of the preschool-aged children group were in between. In the infant and preschool-aged children groups, most showed bronchopneumonia on chest X-ray, while in the school-aged children group, chest X-rays mostly showed segmental parenchymatous infiltration. The infant group had a higher lymphocyte count than the school-aged children group, while the school-aged children group had a higher serum C-reactive protein level than the infant group. CONCLUSIONS The clinical features of MPP are different among children of different ages, especially between infants and school-aged children.
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Affiliation(s)
- Yu Xia
- Department of Pediatrics, People's Hospital of Lishui County, Nanjing, China.
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Bongrand Y, Blais MC, Alexander K. Atypical pneumonia associated with a Mycoplasma isolate in a kitten. Can Vet J 2012; 53:1109-1113. [PMID: 23543932 PMCID: PMC3447318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
An atypical case of Mycoplasma pneumonia with an unusual radiographic and computed tomographic pattern was diagnosed in a Siamese kitten. The cat showed no response to broad-spectrum antibiotic therapy including enrofloxacin. The administration of doxycycline led to a dramatic clinical and radiographic improvement.
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Affiliation(s)
- Yannick Bongrand
- Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec J2S 2M2, Canada.
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Trčko K, Marko PB, Miljković J. Leukocytoclastic vasculitis induced by Mycoplasma pneumoniae infection. Acta Dermatovenerol Croat 2012; 20:119-122. [PMID: 22726289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kaltenis P, Uzomeckiene V, Rygertiene KJ, Bernatoniene G. [Acute glomerulonephritis associated with Mycoplasma pneumonia]. Medicina (Kaunas) 2010; 46:360-363. [PMID: 20679753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A rare case of acute glomerulonephritis associated with Mycoplasma pneumoniae pneumonia is described. Although various types of renal damage associated with Mycoplasma infection have been reported in medical literature, kidney disease resembled classical postinfectious glomerulonephritis in this case. Possibly, the only difference was that the first signs of kidney disease almost coincided with symptoms of respiratory tract infection, instead of appearing at least a week later. The clinical course and outcome of the kidney disease were favorable.
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Affiliation(s)
- Petras Kaltenis
- Children's Hospital, Vilnius University, Santariskiu 4, 08406 Vilnius, Lithuania.
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29
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Belianin II, Shmelev EI. [Ozone therapy for protracted pneumonias]. Probl Tuberk Bolezn Legk 2009:28-33. [PMID: 19455984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
After 3 weeks or more of treatment, 36 patients who were found to have X-ray signs of pneumonia (pulmonary infiltrative changes, fever, productive cough, weakness) were randomized into two matched groups (a study group and a control one). 77.7 and 55% of control and study group patients changed and continued antibacterial therapy. The study group patients were additionally given intravenous infusions of 400 ml of ozonized sodium chloride solution (pO3) containing 1.6 microg/ml of O3 twice weakly for 21 days. Blood ozonization considerably accelerated the resolution time of X-ray infiltrative changes so that they were undetectable in all study group patients by week 4 while they were only in 61.1% of the control groups. Blood ozonization used in combination with antibiotics permitted caused a sputum negative reaction against Chlamydia and Mycoplasma 2-3 weeks earlier. Infusions of pO3 just after the first ozonization made it possible to eliminate a clinical sign of chronic infection, such as weakness, to accelerate productive cough relief on day 10, and to reduce the number of fever patients. Ozone therapy for protracted pneumonias substantially enhances the efficiency of antibiotic treatment.
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MESH Headings
- Adolescent
- Adult
- Aged
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Bacteria/isolation & purification
- Chlamydia/isolation & purification
- Female
- Follow-Up Studies
- Humans
- Infusions, Intravenous
- Male
- Middle Aged
- Mycoplasma/isolation & purification
- Ozone/administration & dosage
- Ozone/therapeutic use
- Pneumonia/diagnosis
- Pneumonia/diagnostic imaging
- Pneumonia/drug therapy
- Pneumonia/microbiology
- Pneumonia/therapy
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/diagnostic imaging
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/therapy
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/diagnostic imaging
- Pneumonia, Mycoplasma/drug therapy
- Pneumonia, Mycoplasma/microbiology
- Pneumonia, Mycoplasma/therapy
- Radiography, Thoracic
- Sputum/microbiology
- Time Factors
- Treatment Outcome
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Lacroix LE, Galetto A, Haenggeli CA, Gervaix A. Delayed recognition of Guillain-Barré syndrome in a child: a misleading respiratory distress. J Emerg Med 2008; 38:e59-61. [PMID: 18922663 DOI: 10.1016/j.jemermed.2008.02.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 01/17/2008] [Accepted: 02/20/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in childhood. Respiratory symptoms can mask neurologic signs, leading to a delay in diagnosis. OBJECTIVES We report this case to highlight the diagnostic difficulty in children suffering from GBS who have respiratory involvement as the main clinical findings on presentation. CASE REPORT This case report describes a 9-year-old girl presenting with respiratory distress, weakness, limb pain, and hypertension. The severe respiratory involvement due to a Mycoplasma pneumoniae lung infection led to a delay in diagnosing GBS in this child. CONCLUSION Unexplained weakness, together with respiratory involvement and associated dysautonomia, should support the possibility of GBS.
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Affiliation(s)
- Laurence E Lacroix
- Division of Pediatric Emergency, University Children's Hospital, Geneva, Switzerland
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Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia. Pediatr Radiol 2007; 37:1286-8. [PMID: 17899058 DOI: 10.1007/s00247-007-0611-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 07/18/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022]
Abstract
We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed.
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Affiliation(s)
- José L Vázquez
- Department of Radiology, Complejo Hospitalario Universitario de Vigo, Pizarro 22, Vigo, 36204, Spain.
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Swischuk LE. Respiratory symptoms, pneumonia, what is the organism? Pediatr Emerg Care 2007; 23:676-7. [PMID: 17876265 DOI: 10.1097/pec.0b013e31814e0914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Leonard E Swischuk
- Department of Radiology, The University of Texas Medical Branch, Galveston, TX, USA
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Marguet C. [Bronchopulmonary infections in the enfant and the child]. Rev Prat 2007; 57:1237-44. [PMID: 17691270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
MESH Headings
- Acute Disease
- Age Factors
- Anti-Bacterial Agents/administration & dosage
- Anti-Bacterial Agents/therapeutic use
- Bronchiolitis, Viral/complications
- Bronchiolitis, Viral/diagnosis
- Bronchiolitis, Viral/diagnostic imaging
- Bronchiolitis, Viral/drug therapy
- Bronchiolitis, Viral/epidemiology
- Bronchiolitis, Viral/therapy
- Bronchitis/diagnosis
- Bronchitis/diagnostic imaging
- Bronchitis/drug therapy
- Child
- Child, Preschool
- Community-Acquired Infections/diagnosis
- Hospitalization
- Humans
- Infant
- Oxygen Inhalation Therapy
- Pneumonia/diagnosis
- Pneumonia/diagnostic imaging
- Pneumonia/drug therapy
- Pneumonia/therapy
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/diagnostic imaging
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/therapy
- Pneumonia, Mycoplasma/diagnosis
- Pneumonia, Mycoplasma/diagnostic imaging
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/drug therapy
- Pneumonia, Viral/therapy
- Prognosis
- Radiography, Thoracic
- Respiratory Insufficiency/diagnosis
- Respiratory Insufficiency/etiology
- Risk Factors
- Time Factors
- Tobacco Smoke Pollution/adverse effects
- Tomography, X-Ray Computed
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Affiliation(s)
- Christophe Marguet
- Unité de pneumologie et allergologie pédiatrique, centre de ressource et de compétence mixte pour la mucoviscidose, département de pédiatrie, centre hospitalier universitaire de Rouen, hôpital Charles-Nicolle, 76031 Rouen.
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Abstract
BACKGROUND The purpose of the present paper was to evaluate the clinical and chest radiographic features of pediatric patients with serologically proven Mycoplasma pneumoniae pneumonia (mycoplasma pneumonia). METHODS The clinical records and chest radiographs of 39 consecutive patients (19 male, 20 female; age 3-13 years) with serologically positive IgG and IgM mycoplasma pneumonia were reviewed. RESULTS More than 90% of patients presented with fever and cough and 48% of patients had leukocyte count >10,000/mm(3). A C-reactive protein (CRP) level >0.375 mg/dL was noted in 28 patients (72%). Chest radiographs displayed four different patterns: (i) peribronchial and perivascular interstitial infiltrates (n= 19, 49%); (ii) airspace consolidations (n= 15, 38%); (iii) reticulonodular opacification (n= 3, 8%); and (iv) nodular or mass-like opacification (n= 2, 5%). Bilateral peribronchial perivascular interstitial infiltrations in central and middle lung zones were frequently seen (n= 19, 49%). Other radiological features were bilateral lesions in 51% of patients, pleural effusion in 23%, and hilar lymphadenopathy in 13%. Means of duration for treatment response and hospitalization were 2.5 and 5 days, respectively. CONCLUSION There are various radiological features of mycoplasma pneumonia in children. Bilateral peribronchial and perivascular interstitial infiltrates were most frequently seen in the present patients.
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Affiliation(s)
- Shu-Chiang Hsieh
- Department of Radiology, Taipei Medical University--Municipal Wan Fang Hospital, Taipei, Taiwan
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Tanaka H, Takahashi H, Hayashi N. [Imaging diagnosis of Mycoplasma pneumoniae pneumonia]. Nihon Rinsho 2007; 65 Suppl 2 Pt. 1:240-6. [PMID: 17455624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Hiroshi Tanaka
- Third Department of Internal Medicine, Sapporo Medical University School of Medicine
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Abstract
OBJECTIVE AND BACKGROUND This study was designed to clarify chest computerized tomography (CT) findings of Mycoplasma pneumoniae pneumonia facilitating differential diagnosis from CAP (community acquired pneumonia) caused by other organisms. METHODS We retrospectively reviewed the CT findings of 36 patients (median age 33 years, 15 males, 21 females) with serologically proven M. pneumoniae pneumonia and 52 patients (median age 61 years, 37 males, 15 females) suffering from CAP with no serological evidence of M. pneumoniae infection. The CT images were analyzed by experienced pulmonologists. RESULTS The most common finding in the M. pneumoniae pneumonia group was bronchial wall thickening, when we compared it with the CAP group (p<0.0001, Fisher's exact probability test). In the CAP group infected with other organisms, dense consolidations with air bronchograms were more frequent than any other findings (p=0.0279, chi-square test). CONCLUSIONS The diagnosis of M. pneumoniae pneumonia would appear to be reliable when we found bronchial wall thickening in the chest CT images.
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Affiliation(s)
- Takahito Nei
- The 4th Department of Internal Medicine, Nippon Medical School, Tokyo.
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Gaillat J, Flahault A, deBarbeyrac B, Orfila J, Portier H, Ducroix JP, Bébéar C, Mayaud C. Community epidemiology of Chlamydia and Mycoplasma pneumoniae in LRTI in France over 29 months. Eur J Epidemiol 2006; 20:643-51. [PMID: 16119439 DOI: 10.1007/s10654-005-5868-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The role of Chlamydia pneumoniae (CP) and Mycoplasma pneumoniae (MP) in lower respiratory tract infections (LRTI) is still little known in community settings. METHODS In all, 3207 adult cases of LRTI (871 with pneumonia, and 2336 with acute bronchitis) were prospectively included in the ETIIC1 ETIIC : ETude de l'Incidence des Infections respiratoires basses d'origine Communautaire dues A Chlamydia pneumoniae et Mycoplasma pneumoniae (Incidence of CP and MP in LRTI in community settings) program by 303 general practitioners and 24 hospital physicians in France between September 1997 and February 2000. The polymerase chain reaction and immunoassays were used to detect CP or MP in 3198 pharyngeal specimens obtained by gargling. RESULTS Of these 3198 patients, 232 (7.3%), were PCR-positive for CP and/or MP. Immunoassays were far less sensitive than PCRs (Se = 2 and 13% for MP and CP). Among the 2336 patients with acute bronchitis, PCR was positive for CP in 95 (4.1%), and for MP, in 54 (2.3%). Among the 671 patients with radiologically confirmed pneumonia, PCR was positive for CP in 23 (3.4%), and for MP in 49 (7.3%). CP and MP displayed significant geographic heterogeneity. Independent clinical determinants of positive PCR for CP and/or MP were age below 45 years, previous antimicrobial therapy (especially betalactams). Clinical signs were not of practical use in distinguishing accurately between etiologic diagnoses. CONCLUSIONS CP or MP diagnosed by PCR were found in more than 7% of patients with LRTI in community settings with a significant geographical heterogeneity and significant temporal trends in the incidence.
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Nambu A, Saito A, Araki T, Ozawa K, Hiejima Y, Akao M, Ohki Z, Yamaguchi H. Chlamydia pneumoniae: comparison with findings of Mycoplasma pneumoniae and Streptococcus pneumoniae at thin-section CT. Radiology 2005; 238:330-8. [PMID: 16304082 DOI: 10.1148/radiol.2381040088] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To retrospectively compare thin-section computed tomographic (CT) findings of Chlamydia pneumoniae pneumonia with those of Streptococcus pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia. MATERIALS AND METHODS Institutional review board and patient informed consent were not required. Twenty-four patients with C pneumoniae pneumonia (17 men, seven women; age range, 19-89 years) underwent thin-section CT; 41 patients with S pneumoniae pneumonia (28 men, 13 women; age range, 19-91 years) and 30 patients with M pneumoniae pneumonia (20 men, 10 women; age range, 16-67 years) were also enrolled. Thin-section CT scans of each patient were retrospectively and independently assessed by two chest radiologists for consolidation, ground-glass opacity (GGO), bronchovascular bundle thickening, nodules, pleural effusion, lymphadenopathy, reticular or linear opacity, airway dilatation, pulmonary emphysema, and bilateral lung involvement. Consensus was reached for disagreements. The frequency of each finding was compared among the three types of pneumonia by using the chi2 test. RESULTS For C pneumoniae pneumonia, CT demonstrated consolidation in 20 patients, GGO in 13, bronchovascular bundle thickening in 17, nodules in 18, pleural effusion in six, lymphadenopathy in eight, reticular or linear opacity in 15, airway dilatation in nine, pulmonary emphysema in 11, and bilateral lung involvement in 12. Bronchovascular bundle thickening (P = .022) and airway dilatation (P = .034) were significantly more frequent in patients with C pneumoniae pneumonia than in those with S pneumoniae pneumonia. Reticular or linear opacity (P = .017), airway dilatation (P = .016), and associated pulmonary emphysema (P = .003) were significantly more frequent in patients with C pneumoniae pneumonia than in those with M pneumoniae pneumonia. CONCLUSION C pneumoniae pneumonia demonstrates a wide spectrum of thin-section CT findings that are similar to those of S pneumoniae pneumonia and M pneumoniae pneumonia; airway dilatation and bronchovascular thickening were significantly more frequent in patients with C pneumoniae pneumonia.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, Kofu Municipal Hospital, Kofu, Yamanashi prefecture, Japan.
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Lee I, Kim TS, Yoon HK. Mycoplasma pneumoniae pneumonia: CT features in 16 patients. Eur Radiol 2005; 16:719-25. [PMID: 16215734 DOI: 10.1007/s00330-005-0026-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 06/21/2005] [Accepted: 09/02/2005] [Indexed: 11/29/2022]
Abstract
The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F = 9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age < 18 years) and the adult (age > or = 18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern.
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Affiliation(s)
- Inho Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, South Korea
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Abstract
The objective of this study was to identify the clinical and pulmonary CT findings associated with Chlamydia pneumoniae pneumonia and to compare them with those of Mycoplasma pneumoniae pneumonia. The clinical features and CT scans of 40 patients with C. pneumoniae pneumonia and 42 patients with M. pneumoniae pneumonia were retrospectively reviewed. There were no significant differences between the two etiologic agents with regard to clinical signs. Chest CT findings in patients with C. pneumoniae pneumonia consisted mainly of ground-glass attenuation (n = 38) and acinar patterns (n = 28). Acinar patterns and pleural effusions (n = 12) were observed significantly more frequently than in patients with M. pneumoniae pneumonia (P < 0.0001, P < 0.039, respectively). CT findings of centrilobular nodules and bronchial wall thickening were significantly less common than in the M. pneumoniae pneumonia patients (P < 0.0001, P < 0.0001, respectively). The CT finding of acinar patterns, although nonspecific, can be considered suggestive of C. pneumoniae pneumonia.
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Affiliation(s)
- Fumito Okada
- Department of Diagnostic and Interventional Radiology, Oita University Faculty of Medicine, Oita, Japan.
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41
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Kluge S, Azizi M, Baumann HJ, Meyer A, Kirsten D. Klinik, Diagnostik und Therapie der Mykoplasmen-Pneumonie. Pneumologie 2004; 58:733-8. [PMID: 15476112 DOI: 10.1055/s-2004-818536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mycoplasma pneumoniae is a common respiratory pathogen in community acquired pneumonia. In severe cases extrapulmonary manifestations of the disease may be prominent. Proof of infection is found, though usually delayed, through serologic methods. A calculated therapy of community acquired pneumonia, especially in younger patients with interstitial infiltrates, should therefore include effective treatment for Mycoplasma pneumoniae. Macrolide antibiotics are the most commonly used antibiotics in the treatment of mycoplasma infection, alternatives include ketolides, quinolones and tetracyclines.
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Affiliation(s)
- S Kluge
- Zentrum für Innere Medizin, Medizinische Klinik I, Universitätsklinikum Hamburg-Eppendorf
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42
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Hammerschmidt S, Gessner C, Seyfarth HJ, Schauer J, Wirtz H. [Febrile respiratory infection and erythema in a 25-year-old man]. Dtsch Med Wochenschr 2003; 128:261-4. [PMID: 12571794 DOI: 10.1055/s-2003-37076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 26-year-old man fell acutely ill with fever (39 degrees C), rigor, dry cough, headache and pain in the neck and limbs. Ambulant treatment with amoxycillin, later cefuroximaxetil, worsened his general condition. At admission to hospital he had, over his trunk and limbs, cocarde-like, erythematous efflorescences up to 2 cm in diameter with central elevations and blisters. Additional acute bronchitis, pharyngitis, stomatitis, tonsillitis, conjunctivitis and urethritis indicated extensive mucosal involvement. INVESTIGATIONS Significant findings were: 9900/microl WBC, ESR 57 mm at one hour, C-reactive protein 160 mg/l, capillary pO2 6.4 kPa, pCO2 4.2 kPa. Mycoplasma serology (days 1, 8, 15) took a typical course. Chest radiogram showed an interstitial infiltrate on day 5. DIAGNOSIS Respiratory Mycoplasma infection with interstitial pneumonia and exudative erythema multiforme. TREATMENT AND COURSE Because infection with an atypical pathogen was suspected, antibiotic treatment was changed to erythromycin and, at the suggestion of the dermatologist and ophthalmologist, local treatment (erythromycin, dexamethasone and dexpanthenol) was begun. Mycoplasma serology was first positive on day 3. The fever had disappeared on day 6 and the rash had regressed. Blood gases and blood picture were normal by day 8. The patient was discharged on day 18, after marked improvement of the skin and mucosal changes. CONCLUSION The occurrence of a rare dermatological complication of a relatively common respiratory Mycoplasma infection can, when the erythema precedes positive Mycoplasma serology, aid in the differential diagnosis.
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Affiliation(s)
- S Hammerschmidt
- Medizinische Klinik I, Pneumologie, Kardiologie und Intensivmedizin, Universität Leipzig.
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43
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Korppi M, Remes S, Heiskanen-Kosma T. Serum procalcitonin concentrations in bacterial pneumonia in children: a negative result in primary healthcare settings. Pediatr Pulmonol 2003; 35:56-61. [PMID: 12461740 DOI: 10.1002/ppul.10201] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A microbe-specific diagnosis in community-acquired pneumonia (CAP) is difficult in children, and studies on nonspecific chest radiographic and host response markers have been inconsistent. Serum procalcitonin (PCT) is a newly recognized, promising marker for differentiating between bacterial and viral infections. Serum PCT was measured by a luminometric assay in 190 children with CAP diagnosed in the primary healthcare setting during a population-based study in a geographically defined population. The pneumococcal, mycoplasma, chlamydia, and viral etiology of infections was studied by an extensive serologic test panel. The median PCT concentrations were 0.47, 0.46, and 0.35 ng/mL in children aged <5 years, 5-9 years, and >/=10 years (P = 0.004). An elevated PCT >1.0 ng/mL was seen in 12.1% and >2.0 ng/mL in only 2.1% of the children. No association was seen between severity (inpatient vs. outpatient care) and etiology of CAP (evidence for pneumococcal, mycoplasma, or chlamydia, vs. viral infection). We conclude that serum PCT measurements have no role in the diagnosis of bacterial CAP in children in primary healthcare settings.
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Affiliation(s)
- Matti Korppi
- Department of Paediatrics, Kuopio University Hospital, Kuopio University, Kuopio, Finland.
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44
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Onodera A, Yazaki K, Ito T, Sato K. [Mycoplasma pneumoniae pneumonia with a tumorous shadow on chest radiography--a case report]. Nihon Kokyuki Gakkai Zasshi 2002; 40:837-9. [PMID: 12642918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
A 16-year-old woman was admitted with a 1-week history of increasing cough and fever. Chest radiography and computed tomography revealed a tumorous shadow in the right upper lung field. Serologic testing provided evidence of a Mycoplasma pneumoniae infection. The clinical findings did not improve after 3 days of minocycline treatment, or after another 3 days in which levofloxacin was administered in combination with minocycline. The patient gradually improved after treatment with erythromycin replaced the minocycline treatment. This was a rare case of Mycoplasma pneumoniae pneumonia with a tumorous shadow in the chest radiograph.
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Affiliation(s)
- Akihiko Onodera
- Division of Respiratory Medicine, Yuri Kumiai General Hospital, 38 Yago, Kawaguti, Honjo City, Akita 015-8511, Japan
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45
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Abstract
A 5 year old boy with serological and clinical evidence of Mycoplasma pneumoniae infection, which was complicated by popliteal artery thrombosis, is described. Intra-arterial urokinase, in conjunction with medical treatment, resulted in clinical recovery and angiographic resolution of the thrombus. The variety of extrapulmonary complications associated with the M pneumoniae infections continues to broaden. Thrombolytic therapies should be considered when similar clinical circumstances arise.
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Affiliation(s)
- C U Joo
- Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School, Chonju, Korea.
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46
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Abstract
This study was conducted to determine whether one could identify viral and bacterial pulmonary infections with confidence. It has been our impression for some time that one could differentiate viral from bacterial pulmonary infections on the basis of roentgenographic findings alone and to test this hypothesis, we conducted this study where the roentgenographic findings first were categorized as being due to viral or bacterial infection and then compared with clinical results. The overall accuracy was just over 90% and our method of analysis is presented.
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47
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Esposito S, Blasi F, Bellini F, Allegra L, Principi N. Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with pneumonia. Mowgli Study Group. Eur Respir J 2001; 17:241-5. [PMID: 11334126 DOI: 10.1183/09031936.01.17202410] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The most common clinical signs, host responses and radiographic patterns were studied in 203 Italian children hospitalized for community-acquired pneumonia in order to clarify the role of clinical and radiological characteristics in the diagnosis of Mycoplasma pneumoniae and/or Chlamydia pneumoniae infections. Antibody measurements in paired sera and polymerase chain reaction on nasopharyngeal aspirates were used to establish the diagnoses of acute M. pneumoniae and C. pneumoniae infection, and the aetiologic data were correlated with the clinical, laboratory and radiographic data obtained on admission. No significant association was observed between evidence of M. pneumoniae and/or C. pneumoniae infection and periods of episode during the year, mean age of the study subjects, individual symptoms, physical findings or laboratory test results. Furthermore, no significant correlation was observed in relation to the radiological findings and M. pneumoniae and/or C. pneumoniae infection. This study shows that neither clinical findings nor laboratory parameters distinguished Mycoplasma pneumoniae and/or Chlamydia pneumoniae infection in children with pneumonia. Radiological findings also have a limited capacity to differentiate aetiologic agents. The priorities for future research include the development of rapid, easily accessible and cost-effective diagnostic tests useful for each episode of pneumonia in children.
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Affiliation(s)
- S Esposito
- Paediatric Dept I, Istituto di Ricerca e di Cura a Carattere Scientifico, Maggiore Hospital, Milan, Italy
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48
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Abstract
Clinical symptoms in mycoplasma infection are nonspecific. Pulmonary involvement may be widespread or focal and segmental and is accompanied by signs including rales, rhonchi, and decreased breath sounds. Although manifestations of mycoplasma infection are usually confined to the respiratory tract, a wide variety of extrarespiratory manifestations can also occur, including more severe associated diseases such as myocarditis, acute disseminated encephalomyelitis, and cerebral arteriovenous occlusion. The radiographic findings in mycoplasma pneumonia are also nonspecific and in some cases closely resemble those seen in children with viral infections of the lower respiratory tract. Focal reticulonodular opacification confined to a single lobe is a radiographic pattern that seems to be more closely associated with mycoplasma infection than with other types of pediatric respiratory illnesses, and the diagnosis of mycoplasma pneumonia should be considered whenever focal or bilateral reticulonodular opacification is seen. Hazy or ground-glass consolidations frequently occur, but dense homogeneous consolidations like those seen with bacterial pneumonias are uncommon. Atelectasis or transient pseudoconsolidations due to confluent interstitial shadows are often seen. Radiographic findings alone are not sufficient for the definitive diagnosis of mycoplasma pneumonia, but in combination with clinical findings they can significantly improve the accuracy of diagnosis in this disease.
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Affiliation(s)
- S D John
- Department of Radiology, University of Texas-Houston Medical School, 6431 Fannin-MSB2.100, Houston, TX 77030, USA.
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49
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Itoh I, Ishida T, Hashimoto T, Arita M, Osawa M, Tachibana H, Nishiyama H, Takakura S, Bando K, Nishizawa Y, Amitani R, Onishi H, Taguchi Y. [Chest radiograph of atypical pneumonia: comparison among Chlamydia pneumoniae. Pneumonia, ornithosis, and Mycoplasma pneumoniae pneumonia]. Kansenshogaku Zasshi 2000; 74:954-60. [PMID: 11140079 DOI: 10.11150/kansenshogakuzasshi1970.74.954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
No report has been found comparing Chlamydia pneumoniae (C. pneumoniae) pneumonia radiographically with other atypical pneumonias, Chlamydia psittaci (C. psittaci) pneumonia and Mycoplasma pneumoniae (M. pneumoniae) pneumonia. We described the chest radiographs of three kinds of pneumonia cases: 46 cases of C. pneumoniae pneumonia, 39 cases of C. psittaci pneumonia, and 131 cases of M. pneumoniae pneumonia. Radiographic shadows were categorized into main shadows and sub-shadows. The main shadows are classified from the viewpoint of the characteristics; air space consolidation(AS), ground-glass opacity(GG), reticular shadow(RS), bronchopneumonia(BP), and small nodular shadows (SN). The size, the site, and the number of the main shadows were also analyzed. In comparison among the three pneumonias, BP was the most frequent in M. pneumoniae pneumonia (0.40/case). AS predominated in C. pneumoniae pneumonia (0.67/case), and GG in C. psittaci pneumonia (0.62/case). The number of main shadows was equal, about 1.4/case in three pneumonias. Large shadows were less frequent in M. pneumoniae pneumonia than C. pneumoniae pneumonia (p = 0.02) and C. psittaci pneumonia (p = 0.01). Main shadows were more frequent in the outer zone in M. pneumoniae pneumonia than C. psittaci pneumonia (p = 0.01), and in the middle zone in C. psittaci pneumonia than in M. pneumoniae pneumonia (p = 0.02). Cases with bilateral main shadows were less common in M. pneumoniae pneumonia (9%) than C. pneumoniae pneumonia(33%, p = 0.001) and C. psittaci pneumonia(30%, p = 0.005). Thickening of bronchovascular bundles as a sub-shadow was most frequently noted in M. pneumoniae pneumonia. Some differences among the three atypical pneumonias were seen in the chest radiograph. However, no specific findings of C. pneumoniae pneumonia were shown radiographically in this study.
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Affiliation(s)
- I Itoh
- Department of Internal Medicine, Kurashiki Central Hospital
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50
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Abstract
Two types of bronchiole, the terminal bronchiole and the respiratory bronchiole, have structural and functional differences. The former is characterized as a conducting airway and the latter is closely related to a gas-exchange function as it has numerous alveoli on the wall. Therefore, the diseases occurring at bronchiole demonstrate different pathological, radiological and clinical pictures depending on which bronchiole is mainly involved. The disease that mainly involves the conducting airway is appreciated as a small airway disease. Constrictive bronchiolitis is a well-recognized entity classified in this category. Whereas the disease mainly involves the respiratory bronchiole and distal alveolar space, it is recognized as an interstitial and parenchymal disease. BOOP or RB-ILD is classified in this category. These two types of bronchiolar diseases reveal the contrast clinical pictures, including incidence, causative disease, response to the treatment, prognosis, respiratory function test as well as the radiological findings. This pictorial essay will illustrate the radiological features of the varieties of bronchiolitis.
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Affiliation(s)
- M Takahashi
- Deparment of Radiology, Shiga University of Medical Science, Seta-Tsukinowa, Otsu, 520-2192, Shiga, Japan
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