OBJECTIVETo study the association between wheezing and Mycoplasma pneumoniae (MP) infection in infants and young children.

METHODSA total of 228 hospitalized infants and young children who were diagnosed with lower respiratory tract infection were enrolled and classified into initial wheezing group (n=65), recurrent wheezing group (n=83), and non-wheezing group (n=80). Fasting serum was collected on the day or the second day of admission. ELISA was used to measure MP-IgM, chemiluminescence was used to measure serum total immunoglobulin E (TIgE), and EUROLine was used to measure the common serum allergen specific immunoglobulin E (sIgE). The data on the manifestations of atopic constitution and the family history of allergic diseases were collected.

RESULTSThe initial wheezing group and the recurrent wheezing group showed significantly higher positive MP infection rate and serum TIgE level than the non-wheezing group (P<0.05). The recurrent wheezing group showed a significantly higher positive rate of sIgE than the initial wheezing group and the non-wheezing group (P<0.05), and in these patients, the manifestations of atopic constitution and the family history of allergic diseases were closed associated with the pathogenesis of wheezing.

CONCLUSIONSMP infection is closely associated with wheezing in infants and young children. MP is one of the most common pathogens for wheezing in infants and young children, and the allergen sIgE, atopic constitution, and a family history of allergic diseases are important risk factors for recurrent wheezing.

Child, Preschool ; Female ; Humans ; Immunoglobulin E ; blood ; Infant ; Male ; Pneumonia, Mycoplasma ; complications ; Recurrence ; Respiratory Sounds ; etiology

We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depression of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normalization of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection.
Acute Disease ; Blood Coagulation Factors/metabolism ; Child, Preschool ; Hepatitis A/blood/diagnosis/*etiology ; Humans ; Male ; Mycoplasma pneumoniae/pathogenicity ; Partial Thromboplastin Time ; Pneumonia, Mycoplasma/blood/*complications

OBJECTIVETo explore the essential points for diagnosis of pulmonary embolism in children with mycoplasma pneumonia.

METHODRetrospective analysis of the clinical and laboratory data of a pediatric case who developed pulmonary embolism after mycoplasma pneumonia was performed for the key points for diagnosis.

RESULTA-six-year old boy was admitted with chief complaint of fever and cough for half a month, combined with chest pain and mild labored breath. Vital signs were stable. Breathing movement of the left side weakened and there was left lower lobe percussion dullness. Breath sound was found weakened in the left lung, and a few fine crackles were audible. The results of laboratory tests were as follows: mycoplasma antibody (IgM) 1:128, cold agglutinin test 1:1024, blood D dimer 14.81 mg/L; anticardiolipin antibody was positive; plasma protein C activity was 60% (normal range 70% - 130%). Pulmonary artery computed tomographic angiography revealed a mass opaque shadow in left lower lobe, the branch of left lower bronchial artery was partially obstructed. Echocardiography showed tricuspid valve mild regurgitation, estimated pulmonary pressure was 5.1 kPa. Single-photon emission computed tomography indicated that radioactivity distribution was apparently sparse in the dorsal segment, anterior basal segment, outer basal segment and inferior lingular segment of the left lung. The preliminary diagnosis on admission was mycoplasma pneumonia with pleural effusion, pulmonary embolism. Intravenous erythromycin combined with meropenem were administered. Anticoagulation therapy was initiated with low molecular weight heparin and then oral warfarin tablets. Pleural effusion disappeared soon, D dimer descended to 0.38 mg/L, and pulmonary artery pressure declined. After 3-month follow-up, anti-cardiolipin antibody was negative, plasma protein C activity recovered, and lung lesions were absorbed.

CONCLUSIONWhen mycoplasma pneumonia is accompanied by chest pain or dyspnea and there are bloody pleural effusion, pulmonary hypertension, positive antiphospholipid antibody and elevated D dimer, pulmonary embolism should be considered. Diagnosis could be clarified by the result of pulmonary artery computed tomographic angiography.

Antibodies, Antiphospholipid ; blood ; Child ; Fibrin Fibrinogen Degradation Products ; metabolism ; Humans ; Male ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; complications ; diagnosis ; Pulmonary Embolism ; complications ; diagnosis ; Retrospective Studies

BACKGROUNDMycoplasma pneumoniae (M. pneumoniae) is a frequent cause of respiratory tract infections. However, there is deficient knowledge about the clinical manifestations of M. pneumoniae infection. We described the clinical and laboratory findings of M. pneumoniae pneumonia in hospitalized children who were all diagnosed by a ≥ fourfold increase in antibody titer.

METHODSM. pneumoniae antibodies were routinely detected in children admitted with acute respiratory infection during a one-year period. The medical history was re-collected from children whose M. pneumoniae antibody titer increased ≥ fourfold at the bedside by a single person, and their frozen paired serum samples were measured again for the M. pneumoniae antibody titer.

RESULTSOf the 635 children whose sera were detected for the M. pneumoniae antibody, paired sera were obtained from 82 and 29.3% (24/82) showed a ≥ fourfold increase in antibody titer. There were 24 cases, nine boys and 15 girls, aged from two to 14 years, whose second serum samples were taken on day 9 at the earliest after symptom onset; the shortest interval was three days. All children presented with a high fever (≥ 38.5°C) and coughing. Twenty-one had no nasal obstruction or a runny nose, and five had mild headaches which all were associated with the high fever. The disease was comparatively severe if the peak temperature was > 39.5°C. All were diagnosed as having pneumonia through chest X-rays. Four had bilateral or multilobar involvement and their peak temperatures were all ≤ 39.5°C. None of the children had difficulty in breathing and all showed no signs of wheezing.

CONCLUSIONSThe second serum sample could be taken on day 9 at the earliest after symptom onset meant that paired sera could be used for the clinical diagnosis of M. pneumoniae pneumonia in children at the acute stage. M. pneumoniae is a lower respiratory tract pathogen. Extrapulmonary complications were rare and minor in our study. High peak temperature (> 39.5°C) is correlated with the severity of M. pneumoniae pneumonia in children.

Acute Disease ; Adolescent ; Antibodies, Bacterial ; blood ; Child ; Child, Hospitalized ; Child, Preschool ; Female ; Humans ; Male ; Mycoplasma pneumoniae ; immunology ; Pneumonia, Mycoplasma ; complications ; diagnosis ; drug therapy ; Radiography, Thoracic

Acquired hemophilia is a rare disorder caused by autoantibodies to factor VIII (FVIII) (also referred to as factor VIII inhibitors or anti-FVIII) and may be associated with pregnancy, underlying malignancy, or autoimmune disorders. A 33-month-old girl who presented with hematochezia and ecchymotic skin lesions was diagnosed with Mycoplasma pneumoniae pneumonia by serology and polymerase chain reaction. Hematologic studies showed a prolonged activated partial thromboplastin time (aPTT), partially corrected mixing test for aPTT, reduced levels of FVIII, and the presence of antibodies against FVIII. She was treated conservatively with prednisone and intravenous immunoglobulin (IVIG) without FVIII transfusion and recovered without sequelae. This report provides the first description of acquired hemophilia due to anti-FVIII in association with M. pneumoniae in Korea. We discuss this case in the context of the current literature on acquired hemophilia in children.
Autoantibodies/blood ; Child, Preschool ; Factor VIII/immunology ; Female ; Hemophilia A/*etiology ; Humans ; Partial Thromboplastin Time ; Pneumonia, Mycoplasma/*complications/immunology ; Time Factors

A case of inflammatory pseudotumor of the lung occurring in a six-year-old boy is reported with clinicopathologic findings, including its ultrastructure. The patient had had frequent upper respiratory tract infections, and one and half year before the discovery of the lung mass, he suffered from pneumonia of the right lung, which was serologically proven to be a mycoplasma pneumoniae infection. Exploratory thoracotomy revealed a large mediastinal mass that was removed together with the right middle and lower lobes of the lung. The mass arose from the lung with an endobronchial element. Microscopically, the mass was composed of a variety of inflammatory and mesenchymal cells, including plasma cells, histiocytes, lymphocytes, and fibroblast-like spindle cells. Ultrastructurally, the spindle-shaped mesenchymal cells were either fibroblasts or myofibroblasts. At the time of diagnosis of the inflammatory pseudotumor of the lung, the serum titer of antimycoplasma antibody rose again, and the lung parenchyma adjacent to the mass showed interstitial pneumonia with features of bronchiolitis obliterans. The present case suggests that the inflammatory pseudotumor of the lung could be a postinflammatory lesion associated with mycoplasma pneumoniae infection.
Antibodies, Bacterial/blood ; Bronchiolitis Obliterans/complications ; Child ; Diagnosis, Differential ; Fibroma/etiology/*pathology/surgery ; Humans ; Lung Neoplasms/etiology/*pathology/surgery ; Male ; Mycoplasma pneumoniae/immunology/*pathogenicity ; Pneumonia, Mycoplasma/complications/microbiology/*pathology ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinical characteristics and treatment defects in slow-to-recover children with Mycoplasma pneumoniae pneumonia (MPP) associated with airway mucous plug formation, and to provide a basis for prognostic judgment and therapeutic guidance.

METHODSA retrospective analysis was performed on the clinical data of 67 children with MPP who were admitted between May 2012 and May 2014 and showed airway mucous plug formation in fiberoptic bronchoscope examinations. Based on the results of re-examinations using imaging methods, all patients were classified into a slow-to-recover group (n=30) and a control group (n=37). Comparisons of clinical outcomes, laboratory indices, imaging findings, and treatment methods were performed between the two groups. The receiver operating characteristic (ROC) curves were drawn to analyze the indices with significant differences.

RESULTSThe percentage of neutrophils, levels of C-reactive protein (CRP), lactic dehydrogenase (LDH), fibrinogen (FIB), and IgM in peripheral blood, and incidence of pleural effusion were significantly higher in the slow-to-recover group than in the control group (P<0.05). The fever duration and treatment time of azithromycin and fiberoptic bronchoscope for the first time were significantly longer in the slow-to-recover group than in the control group (P<0.05). The results of ROC curve analysis showed that the optimal cut-off points of fever duration, percentage of neutrophils, levels of CRP and FIB, and treatment time of fiberoptic bronchoscope for the first time were 11.5 days, 70.7%, 57 mg/L, 4.7 g/L, and 13.5 days, respectively, with sensitivity and specificity higher than 0.643 and 0.727.

CONCLUSIONSThe fever duration, percentage of neutrophils, level of CRP, level of FIB, and treatment time of fiberoptic bronchoscope for the first time can predict a recovery time longer than two months in children with MPP associated with mucous plug formation.

Airway Obstruction ; etiology ; Bronchoscopy ; C-Reactive Protein ; analysis ; Child ; Child, Preschool ; Female ; Fibrinogen ; analysis ; Humans ; Male ; Neutrophils ; Pneumonia, Mycoplasma ; blood ; complications ; ROC Curve ; Retrospective Studies

OBJECTIVETo study the relationship between the changes of inflammation-associated factors, C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), white blood cell (WBC) and neutrophils, and the severity in children with Mycoplasma pneomoniae pneumonia (MPP).

METHODSNinety-two children with acute MPP consisting of 52 cases with concomitant systemic inflammation response syndrome (SIRS) and 40 cases without SIRS were enrolled in this study. The 52 cases with concomitant SIRS were classified into two groups based on the severity of SIRS: mild SIRS (n=25) and severe SIRS (n=27). CRP, PCT, ESR and WBC count and the percentage of neutrophils (NE%) were detected on admission and one week after anti-inflammation treatment.

RESULTSAll of patients showed increased serum CRP contents at admission. The serum CRP contents were the highest in the severe SIRS group, followed by the mild SIRS and non-SIRS groups on admission (P < 0.05 or 0.01). The serum CRP contents were reduced in all of patients after 1-week treatment. The severe SIRS group still demonstrated higher serum CRP contents than the non-SIRS and the mild SIRS groups (P < 0.01). The severe SIRS group had increased serum PCT contents on admission, which were significantly higher than those of the mild SIRS and non-SIRS groups (P < 0.01). After 1-week treatment, the serum PCT contents were reduced in the severe SIRS group but remained higher than in the mild SIRS and non-SIRS groups (P < 0.01). ESR increased significantly in the severe SIRS group than in the mild SIRS and non-SIRS groups on admission (P < 0.01). One-week treatment did not significantly decrease ESR in all three groups. The WBC count and NE% in the mild and severe SIRS groups were significantly higher than in the non-SIRS group and the severe SIRS group had higher WBC count and NE% than the mild SIRS group on admission (P < 0.05). The WBC count and NE% decreased after 1-week treatment in the mild and severe SIRS groups (P < 0.05). One inflammation-associated factor (only CRP) increase was predominant in the non-SIRS group (65%), 2 factors increase in the mild SIRS group (56%), and three or more factors increase in the severe SIRS group (70.4%).

CONCLUSIONSThe detection of inflammation-associated factors, CRP, PCT, ESR, WBC and neutrophils, are valuable to the evaluation of severity in MPP.

Adolescent ; Blood Sedimentation ; C-Reactive Protein ; analysis ; Calcitonin ; blood ; Calcitonin Gene-Related Peptide ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Leukocyte Count ; Male ; Pneumonia, Mycoplasma ; blood ; complications ; drug therapy ; Protein Precursors ; blood ; Systemic Inflammatory Response Syndrome ; blood ; drug therapy

Reported herein is an adult case of Fisher syndrome (FS) that occurred as a complication during the course of community-acquired pneumonia caused by Mycoplasma pneumoniae. A 38-yr-old man who had been treated with antibiotics for serologically proven M. pneumoniae pneumonia presented with a sudden onset of diplopia, ataxic gait, and areflexia. A thorough evaluation including brain imaging, cerebrospinal fluid examination, a nerve conduction study, and detection of serum anti-ganglioside GQ1b antibody titers led to the diagnosis of FS. Antibiotic treatment of the underlying M. pneumoniae pneumonia was maintained without additional immunomodulatory agents. A complete and spontaneous resolution of neurologic abnormalities was observed within 1 month, accompanied by resolution of lung lesions.
Adult ; Anti-Bacterial Agents/therapeutic use ; Antibodies/blood ; Diplopia/etiology ; Erythrocyte Count ; Gangliosides/immunology ; Humans ; Lung/radiography ; Male ; Miller Fisher Syndrome/*diagnosis/etiology ; Pneumonia, Mycoplasma/complications/*diagnosis/drug therapy ; Tomography, X-Ray Computed

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Anti-Inflammatory Agents ; therapeutic use ; Azithromycin ; administration & dosage ; therapeutic use ; Biomarkers ; blood ; Child ; Eyelids ; pathology ; Humans ; Immunoglobulin M ; blood ; Lip ; pathology ; Male ; Methylprednisolone ; administration & dosage ; therapeutic use ; Mucositis ; diagnosis ; drug therapy ; microbiology ; Mycoplasma pneumoniae ; drug effects ; isolation & purification ; Pneumonia, Mycoplasma ; complications ; diagnosis ; drug therapy