Child ; Humans ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma

Most of Mycoplasma pneumoniae pneumonia (MPP) will be controlled after being treated with macrolide antibiotics. But in recent years refractory Mycoplasma pneumoniae pneumonia (RMPP), including severe mycoplasma pneumoniae pneumonia, are increased. RMPP often causes many severe complications and sequelae such as necrotizing pneumonia, bronchiolitis obliterans, bronchitis obliterans, atelectasis and bronchiectasis. Two main mechanisms of MPP are proposed: damages to airway directly by mycoplasma pneumonia (MP), and inflammatory reaction caused by mycoplasma pneumoniae (MP). RMPP is also associated with many other factors such as MP genotype and load, macrolide-resistant MP, airway mucus hypersecretion, hypercoagulability, combined infection with bacteria or viruses, and community acquired respiratory distress syndrome toxin (CARDS Tx). The exploration of mechanisms of RMPP helps us acquire effective treatment and prevent sequelae.

Humans ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma

Cough ; Exanthema ; Fever ; Humans ; Respiratory Sounds

Cough ; Dyspnea ; Fever ; Humans ; Recurrence

Objective To explore the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) with different imaging changes in children.Methods Hospitalized patients with MPP during September 2012 to August 2013 in Beijing New Century Children's Hospital were retrospectively reviewed.The data including clinical features,laboratory tests,treatment and prognosis were collected.The patients were divided into 3 groups according to the radiological findings,including interstitial infiltration (group 1),intralobular infiltration (group 2) and segmental or larger infiltration (group 3).The clinical data were compared among the 3 groups.Results The percentages of patients in the 3 groups were 18.8％ (36/191 cases) in group 1,39.8％ (76/19 cases) in group 2 and 41.4％ (79/191 cases) in group 3,respectively.In 144 cases of MPP patients older than 3 years old,48.6％ (70/144 cases) were segmental or larger infiltration.The incidence of higher fever,hypoxemia and elevated C-reaction protein and lactate dehydrogenase in group 3 [50.6％ (40/79 cases),87.3％ (69/79 cases),78.5％ (62/79 cases),29.1％ (23/79 cases)] were higher than those in group 1 [5.6％ (2/36 cases),61.1％ (22/36 cases),19.4％ (7/36 cases),0] and group 2 [10.5％ (8/76 cases),67.1％ (51/76 cases),14.5％ (11/76 cases),3.9％ (3/76 cases)],and the differences were significant(all P ＜ 0.01).Patients in group 3 had higher risk of cardiac and/or liver impairment,refractory MPP,and treated by glucocorticoids and bronchoalveolar lavage [41.8 ％ (33/79 cases),29.1％ (23/79 cases),94.9 ％ (75/79 cases),50.6％ (40/79 cases)].The hospital stay was (9.48 ±3.26) d in group 1,(9.24 ±2.97) d in group 2,and (12.09 ±3.01) d in group 3,respectively,and the difference was significant among 3 groups (F =19.348,P =0.005),the hospital stay in group 3 was longer than that in the other 2 groups (t =4.210,5.931,all P =0.000),while there was no difference between group 1 and group 2 (P ＞ 0.05).Patients in group 1 with wheeze were more co-mmon,and were treated by Azithromycin earlier than that in group 3 [(5.08 ± 3.43) d vs.(4.16 ± 2.20) d],the difference was significant(t =2.498,P =0.014),while the incidence of hypoxemia was common than that in group 2 (x2 =3.176,P =0.012).Conclusions MPP patients with segmental or larger infiltration are older than patients in the other groups,and present with severe complications,higher inflammatory factors,longer hospital stay,and higher risk for refractory MPP.Glucocorticoids and bronchoalveolar lavage are usually used in these patients.Patients with interstitial infiltration are prone to manifest with wheeze and hypoxemia,and its diagnosis and treatment by Azithromycin are usually delayed.Therefore,pediatrician should pay more attention to MPP patients with different imaging changes,in order to diagnose and treat the patients timely.

Objective The aim of our study was to study the CT findings of cryptococcosis in immunocompetent children.Methods CT scan and clinical data of 21 immunocompetent children with proven pulmonary cryptococcosis were retrospectively collected and analyzed.Results The CT scans demonstrated 1 mm subpleural nodule in the lingula of left lung in 1 patient and multiple nodules in 20 patients.Of 20 patients with multiple nodules,peripheral or subpleural distribution was found in 12 patients,and diffuse distribution in 8 patients.Of 20 patients with multiple nodules,Nodules of ＜ 10 mm was found in 18 patients,＜3 mm in 14 patients,and ＞ 10 mm in 2 patients.Round nodular with smooth margin was detected in 15 of 20 patients with multiple nodules.Lymphadenopathy was found in 17 patients including 3 patients with mild contrast enhancement and 2 patients with circular enhancement.Extrapulmonary lesions distributing in liver,spleen,kidney,and the nervous system were found in 14 patients.In follow-up,1 patient died and 20 patients fully recovered.ConclusionsPulmonary multiple nodules with lymphadenopathy is the characteristic CT findings in immunocompetent children with pulmonary crytococcosis which is prone to involve multiple extra-pulmonary organs.

Objective To explore the association between the polymorphisms of TSC1,TSC2,PTEN genes and autism in Chinese Han population.Methods 274 autism patients and 386 heahh controls were recruited,and SnaPshot technique was used to genotype the 13 tagSNPs of TSC1,TSC2 and PTEN genes.The allele,genotype and haplotype frequencies of the SNPs were compared using SHEsis and SNPStats softwares.Results Mter Bonferroni correction,the allele distribution of rs2809244 (TSC1) (x2 =9.537,P=0.002,adjusted P=0.016),rs1050700 (TSC1) (x2 =9.313,P=0.002,adjusted P=0.016),rs2072314(TSC2) (P＜0.01,adjusted P＜0.01) and rs8063461 (TSC2) (P＜0.01,adjusted P＜0.01)showed significant difference between two groups (P＜0.05).The genotype frequencies of rs2072314(TSC2)and rs8063461(TSC2) showed significant difference between two groups(P＜0.05).Moreover,the frequency of haplotype A-G (OR =14.548,95％ CI =5.450-38.830) in the haplotype block rs2809244-rs3761840 showed significant difference between two groups(P＜0.05),A-G significantly increases the risk of autism.The frequencies of haplotype A-A (OR=0.608,95％ CI =0.409-0.903,P=0.013),G-A (OR=7.812,95％ CI =5.338-11.459,P＜0.01)and G-G (OR=0.356,95％ CI =0.274-0.463,P＜0.01) in the haplotype block rs2074969-rs8063461 were identified,which were significant difference between two groups(P＜0.05),and AA and G-G significantly reduced but G-A increased the risk of autism.Conclusion The polymorphisms of TSC1 and TSC2 genes might associate with autism in Chinese Han population.

Objective To explore the clinical significance of adenosine deaminase ( ADA) in pleural ef-fusion for diagnosis of tuberculosis pleuritis in children. Methods The level of ADA in pleural effusion was ret-rospectively analyzed in 28 cases with purulent pleuritis,thirty-four cases with mycoplasma pneumoniae pleuri-tis,forty-five cases with tuberculosis pleuritis from July 2011 to January 2014 in Beijing Children′s Hospital Af-filiated to Capital Medical University. Results The level of ADA in three groups was expressed by median (range interquartile). ADA in the purulent pleuritis group [126. 35 (76. 80,178. 13)U/L]was higher than the group of mycoplasma pneumoniae pleuritis [ 55. 55 ( 42. 80, 79. 03 ) U/L ] and tuberculosis pleuritis [ 26. 50 (22. 05,50. 95)U/L]. The difference was statistically significant (P< 0. 01). The cut-off value of pleural effu-sion ADA for diagnosis of tuberculosis pleuritis is not available by application of ROC curve. Conclusion Higher ADA value is not only the characteristic of tuberculosis pleuritis,but also purulent pleuritis and mycoplas-ma pneumoniae pleuritis. ADA has no clinical value in diagnosis of tuberculosis pleuritis in children.

Objective To evaluate the diagnostic value of transbronchial lung biopsy (TBLB) in pediatric interstitial lung diseases.Methods Retrospective data evaluation the efficacy and application of 10 undiagnosed pediatric interstitial lung diseases patients by No-X-ray guided TBLB between December 2013 and December 2014 were investigated.Results Specimens from all cases were successfully obtained,6 patients were confirmed by pathological diagnoses,and4 patients were confirmed by pathology and clinical manifestations.Among 10 patients,3 of them had allergic alveolitis,2 cases had bronchiolitis obliterans organizing pneumonia (BOOP),1 had pulmonary vasculitis,2 cases had nonspecific interstitial pneumonia,and the other 2 had bronchiolitis obliterans.The complications include 2 pneumothorax,1 case was cured with thoracic cavity closed drainage,and the other case case did not receive special treatment and alleviated himself.No bleeding and other complications occurred.Conclusion The results suggest that TBLB is a safe and effective minimally invasive modality for the diagnosis of pediatric diffuse lung disease.