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Background The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP). Method A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group ( n  = 306) and a RMPP group ( n  = 124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP. Results (1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P  < 0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P  < 0. 05). D-D had the highest predictive power for RMPP ( P  < 0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P  < 0.01). Conclusion Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.

Early assessment of refractory Mycoplasma pneumoniae pneumonia (RMPP) with plastic bronchitis (PB) allows timely removal of casts using fiberoptic bronchoscopic manipulation, which relieves airway obstruction and limit sequelae development. This study aimed to analyze clinical data for risk factors and develop a nomogram for early predictive evaluation of RMPP with PB. The clinical data of 1-14 year-old patients with RMPP were retrospectively analyzed. Patients were classified into a PB or non-PB group. The general characteristics, clinical symptoms, laboratory test results, imaging findings, and microscopic changes of the two groups were compared. A statistical analysis of the risk factors for developing PB was performed, and a nomogram model of risk factors was constructed. Of 120 patients with RMPP included, 68 and 52 were in the non-PB and PB groups, respectively. Using multivariate logistic regression analysis, fever before bronchoscopy, extrapulmonary complications, pleural effusion, cough duration, and lactate dehydrogenase (LDH) levels were identified as risk factors. A nomogram was constructed based on the results of the multivariate analysis. The area under the receiver operating characteristic curve value of the nomogram was 0.944 (95% confidence interval: 0.779-0.962). The Hosmer-Lemeshow test displayed good calibration of the nomogram (p = 0.376, R2 = 0.723). Conclusion : The nomogram model constructed in this study based on five risk factors (persistent fever before bronchoscopy, extrapulmonary complications, pleural effusion, cough duration, and LDH levels) prior to bronchoscopy can be used for the early identification of RMPP-induced PB. What is Known: • Refractory Mycoplasma pneumoniae pneumonia (RMPP) in children has been increasingly reported and recognized, which often leads to serious complications. • Plastic bronchitis (PB) is considered to be one of the causes of RMPP, and bronchoscopic treatment should be improved as soon as possible to remove plastic sputum thrombus in bronchus. What is New: • This study determined the risk factors for RMPP-induced PB. • The nomogram model constructed in this study prior to bronchoscopy can be used for the early identification of RMPP-induced PB, which facilitate the early bronchoscopic removal of casts, thereby promoting recovery and reducing cases with poor RMPP prognosis.

We summarize the chest CT manifestations and prognoses of children with Mycoplasma pneumoniae pneumonia combined with necrotizing pneumonia. We retrospectively analyzed the chest CT manifestations and prognoses of 155 cases of necrotizing pneumonia in children due to Mycoplasma pneumoniae infection and compared the differences in clinical features and laboratory indices between the group with unilateral monolobar necrosis of the lungs (Group A) and the group with unilateral multilobar and bilateral necrosis (Group B). The chest CT findings of the children in both groups revealed that the area of lung necrosis was confined to the unilateral monolobe in 124 children. The necrotic condition of the lungs included only hypodense shadows in 80 children (51.61%) and cystic cavities in the necrotic areas in 75 children (48.39%). Bronchoscopic manifestations: Endobronchitis was present in 135 children, ulcerative necrosis of the bronchi in 47, and occlusive bronchitis in four. A total of 101 children were followed up. A small percentage of patients have residual manifestations such as lobar atelectasis and bronchial wall changes. The number of days of fever and cases of respiratory distress were significantly greater in group B than in group A. Chest CT reveals pulmonary necrosis in children due to Mycoplasma pneumoniae infection: the area of pulmonary necrosis is mostly unilateral and unilobar, the lower lungs are predominant, and areas of reduced enhancement can be seen on enhanced CT. CT manifestations after clinical treatment may be approximately normal or leave a striped shadow, lung atelectasis, or pleural thickening.

Background We report the first documented case of macrolide-resistant Mycoplasma pneumoniae (MRMP) infection simultaneously complicated by both plastic bronchitis (PB) and Kawasaki disease (KD), expanding our understanding of severe MRMP-associated immune dysregulation. Case presentation A 7-year-old male presented with persistent high fever (39.8 °C), paroxysmal cough, and mucocutaneous manifestations. Diagnosis was established through multiple modalities: chest CT revealed bilateral consolidation with segmental airway narrowing; bronchoscopy demonstrated characteristic bronchial casts with focal mucosal necrosis; echocardiography showed right coronary artery dilation (Z-score + 2.334); and targeted next-generation sequencing (tNGS) identified MRMP with the A2063G mutation, alongside Streptococcus pneumoniae and Staphylococcus aureus co-infections. Treatment included oral doxycycline after macrolide failure, high-dose IVIG (2 g/kg), methylprednisolone (3 mg/kg/day), and therapeutic bronchoscopy. Complete resolution of coronary dilation and respiratory symptoms was achieved by the one-month follow-up. Conclusions This unprecedented case demonstrates how MRMP infection can trigger simultaneous, severe immune-mediated complications through shared inflammatory pathways. In regions with high MRMP prevalence (> 90%), clinicians should maintain vigilance for atypical manifestations in refractory pneumonia. Early bronchoscopy and tNGS for comprehensive pathogen identification are essential, while combined therapy with appropriate alternative antibiotics, corticosteroids, and IVIG can effectively manage these complex cases. Clinical trial number Not applicable.

Purpose To explore the effectiveness of flexible bronchoscopy in pediatric Mycoplasma pneumoniae pneumonia (MPP). Methods This retrospective cohort study included children with MPP admitted between 2016 and 2019 in Shanghai. Tracheobronchial manifestations, etiologic findings, therapeutic effect, and health-economic indicators were assessed in bronchoscopy (plus bronchoalveolar lavage (BAL)) and non-bronchoscopy group. We used propensity-score matching and multivariable logistic regression to investigate the effect of bronchoscopy and BAL on disease recovery. Results In 900 children with MPP, 24/278 (8.6%) of those who underwent bronchoscopy had sputum plugs. Coinfection rate was four-fold enhanced by BAL (19.6% vs. 4.5%, p  < 0.01) in patients with severe MPP (SMPP) and nearly doubled (10.8% vs. 5.9%, p  = 0.03) in those without SMPP, compared with no BAL. Total of 224 (24.9%) patients had multilobar consolidation; after BAL, a significantly shorter lesion-resolution duration was observed on imaging (OR: 0.2, 95% CI: 0.0−0.7). However, longer fever duration (OR: 2.8, 95% CI: 1.7−4.8), hospital stay (OR: 3.1, 95% CI: 1.9−5.1), and higher costs were found in the bronchoscopy group than in the non-bronchoscopy group. Conclusions Through BAL, coinfection may explain one-fifth of causes for SMPP. Bronchoscopy with BAL may increase the detection rate of pathogen and resolve pulmonary lesions in patients with multilobar consolidation. Impact Flexible bronchoscopy with bronchoalveolar lavage is of great assistance in the timely detection of coinfection, sputum plug and inflammatory polyps in children with Mycoplasma pneumoniae pneumonia (MPP), and improves the recovery of lung damage in MPP patients with multilobar consolidation. This study provides new insights into the indications of flexible bronchoscopy for the diagnosis and treatment of pediatric patients with MPP.

Severe Mycoplasma pneumoniae pneumonia (SMPP) poses significant diagnostic challenges due to its clinical features overlapping with those of other common respiratory diseases. This study aims to develop and validate machine learning (ML) models for the early identification of SMPP and the risk prediction for liver and heart damage in SMPP using accessible laboratory indicators. Cohort 1 was divided into SMPP group and other respiratory diseases group. Cohort 2 was divided into myocardial damage, liver damage, and non-damage groups. The models built using five ML algorithms were compared to screen the best algorithm and model. Receiver Operating Characteristic (ROC) curves, accuracy, sensitivity, and other performance indicators were utilized to evaluate the performance of each model. Feature importance and Shapley Additive Explanation (SHAP) values were introduced to enhance the interpretability of models. Cohort 3 was used for external validation. In Cohort 1, the SMPP differential diagnostic model developed using the LightGBM algorithm achieved the highest performance with AUC ROC = 0.975. In Cohort 2, the LightGBM model demonstrated superior performance in distinguishing myocardial damage, liver damage, and non-damage in SMPP patients (accuracy = 0.814). Feature importance and SHAP values indicated that ALT and CK-MB emerged as pivotal contributors significantly influencing Model 2’s output magnitude. The diagnostic and predictive abilities of the ML models were validated in Cohort 3, demonstrating the models had some clinical generalizability. The Model 1 and Model 2 constructed by LightGBM algorithm showed excellent ability in differential diagnosis of SMPP and risk prediction of organ damage in children.

Background Previous research has demonstrated a notable increase in neutrophil counts among pediatric patients with plastic bronchitis (PB) associated with Mycoplasma pneumoniae pneumonia (MPP). However, the role of neutrophils in MPP-associated PB remains largely elusive. Methods This is a nested case-control study that enrolled patients diagnosed with MPP who underwent bronchoscopy in our department during the MPP pandemic from September 2023 to January 2024. We conducted an analysis of clinical characteristics, blood samples, bronchoalveolar lavage fluid (BALF), and cast specimens, correlating these factors with the development and outcomes of PB. Results Among the 557 patients with MPP included in the study, 21 (3.8%) developed PB. The peripheral neutrophil count was identified as an independent risk factor for PB (OR = 3.113 [95%CI 1.050–9.224], P  = 0.04) and exhibited strong predictive value for the condition (AUC = 0.885 [95%CI 0.796–0.975], P  < 0.001). Notably, there was a marked presence of neutrophil infiltration and neutrophil extracellular traps (NETs) formation in the blood, BALF, and cast samples from patients with PB. Furthermore, the levels of neutrophils and NETs correlated significantly with clinical outcomes. Conclusion A high level of neutrophils poses a risk for PB and demonstrates strong predictive value for its diagnosis. Neutrophils and NETs are closely linked to the clinical outcomes of PB in patients with MPP.

Background We analyzed the clinical characteristics of children with plastic bronchitis (PB) caused by Mycoplasma pneumoniae (MP) and explored its risk factors. Methods We prospectively analyzed clinical data of children with MP pneumonia (MPP) treated with fiberoptic bronchoscopy (FB). Patients were classified into a PB and non-PB group. General information, clinical manifestations, laboratory tests, results of computed tomography scan, and FB findings were compared between groups. We conducted statistical analysis of risk factors for developing PB. Results Of 1169 children who had MPP and were treated with FB, 133 and 1036 were in the PB and non-PB groups, respectively. There were no significant differences in sex, age, and incident season between groups ( P  > 0.05). The number of children in the PB group decreased during the COVID-19 pandemic. Compared with children in the non-PB group, those in the PB group had longer duration of hospitalization, increased levels of neutrophil (N), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, lactate dehydrogenase (LDH), alanine transaminase (ALT) and aspartate transaminase (AST); lower levels of lymphocyte (L) and platelet (PLT); and higher incidence of lack of appetite, decreased breath sounds, single lobar infiltrate, pleural effusion, pericardial effusion, mucosal erosion and/or necrosis, and bronchial embolization. L levels and pleural effusion were identified as risk factors in multivariate logistic regression. Conclusions Children with PB caused by MPP had a strong and local inflammatory response. L levels and pleural effusion were independent risk factors of PB with MPP in children. Our findings will help clinicians identify potential PB in pediatric patients for early and effective intervention.

Mycoplasma pneumoniae (MP) bronchiolitis can potentially lead to severe respiratory symptoms and long-term complications. This study aimed to determine the risk factors for the development of hypoxemia in MP bronchiolitis and report its prognosis. From January 2017 to December 2024, a total of 178 children with MP bronchiolitis, including 53 cases in the hypoxemia group and 125 cases in the control group, were selected. The clinical data, laboratory indicators, and imaging findings of the two groups were compared. Binary logistic regression analysis was used to identify the risk factors for the development of hypoxemia, and the receiver operating characteristic curve was employed to validate the predictive effect of the risk factors on hypoxemia. The hypoxemia group exhibited a higher incidence of a history of allergic diseases and wheezing sounds, accompanied by substantial elevations in C-reactive protein levels and greater areas of CT involvement (P < 0.05). The presence of a history of allergic diseases, wheezing sounds, and the number of infected lung lobes were independent risk factors for the development of hypoxemia. The group with hypoxemia demonstrated a delayed improvement in symptoms, signs and lung function during follow-up (P < 0.05). Seven cases of bronchiolitis obliterans were diagnosed in the hypoxemia group while none in the control group. MP bronchiolitis patients with a history of allergic diseases, wheezing sounds, and involvement of at least three lung lobes are prone to developing hypoxemia. And those who experience hypoxemia recover more slowly during short-term follow-up and have a higher incidence of bronchiolitis obliterans.

Mycoplasma pneumoniae is the leading cause of community-acquired pneumonia in children. With increasing macrolide resistance, the use of second-line antibiotics such as tetracyclines and quinolones is also increasing. Clinical data were collected from 13 institutions between September 2023 and February 2024. MPP was defined as the detection of M. pneumoniae via polymerase chain reaction or serological tests and radiologic evidence of pneumonic infiltration. Among the 389 children with MPP included in the analysis, 89.1% were macrolide resistant (MR). The treatment groups were as follows: spontaneous resolution (SR, 21.9%), macrolide alone (ML, 18.0%), macrolide with other treatments (ML-O, 38.0%), and second-line antibiotics and/or steroids (2nd-A/S, 22.1%). The median fever duration was 5 days for the SR group, 7 days for both the ML and 2nd-A/S groups, and 8 days for the ML-O group. The ML-O group had significantly greater hospitalization rates (93.9% vs. 81.4–84.7%, P  = 0.023) and longer hospital stays (5.0 days vs. 3.0–4.0 days, P  < 0.001). The median times to defervescence from the initiation of macrolide and second-line treatments were 2–3 days and 0–2 days, respectively. In conclusion, despite high MR rates, macrolide monotherapy remains effective in many patients, even those with macrolide-resistant M. pneumoniae .