| BackgroundMycoplasma pneumoniae(MP)is one of the most common causes of community acquired pneumonia(CAP)in children.MP infection can occur throughout the year.The most prevalent season of MP infection is winter in north China,but summer and autumn in south China,with an epidemic peak every 3 to 7 years.MP infection patients are the main infection source,who can spread MP through respiratory droplets.People of all ages are generally susceptible to MP,and children are the most susceptible population with the peak age of onset is preschool and school-age children.Mycoplasma pneumoniae pneumonia(MPP)is characterized by slow onset,severe symptoms but mild signs,long course,no typical clinical manifestations,easy to misdiagnose and delay treatment.Thus,it is very important to understand its epidemiological characteristics,clinical characteristics,diagnosis and treatment methods.ObjectivesThere is no report on large-sample epidemiological investigation and clinical characteristics of pediatric patients with CAP in Guangzhou.To bridge this gap,our study collected epidemiological data and clinical characteristics of 1202 pediatric patients with MPP hospitalized in our hospital from 2018 to 2021,to guide the prevention and treatment of MP infection and to provide clinical evidence for public health policy.MethodsThe epidemiological data and clinical characteristics of 1202 children with MPP who were hospitalized in pediatric department of our hospital from January 1,2018 to December 31,2021 were retrospectively analyzed.The differences of their distribution in different years,two years before and after the outbreak of COVID-19,months,seasons and gender were analyzed.The patients were grouped according to different age groups and mild and severe cases.The differences in clinical features,laboratory examination and imaging examination were compared.Results1.Among the 1202 children with MPP,there were 287 cases hospitalized in2018,724 cases hospitalized in 2019,134 cases hospitalized in 2020,and 57 cases hospitalized in 2021.The number of people diagnosed with MPP decreased significantly in the two years after COVID-19 prevention and control(2020-2021)compared to the two years before COVID-19 prevention and control(2018-2019).There were 658 cases(54.7%)of males and 543 cases(45.2%)of females,with a male to female ratio of 1.21:1.Among cases < 6 years old,the proportion of males was higher than that of females(P < 0.05).There were 263 cases(21.9%)in the infant group(0-1 years old),368 cases(30.6%)in the toddler group(1～3 years old),321cases(26.7%)in the preschool group(3-6 years old),and 250 cases(20.8%)in the school-age group(6-14 years old).MP infections in 2018,2019 and 2020 had two small peaks throughout the year,including August and November in 2018,July and October in 2019,and September and November in 2020.The peak of MP infection occurred in January 2021.The number of cases peaked in summer,followed by autumn.2.470 cases(39.1%)had mixed infection,187 cases(15.56%)had simple viral infection,144 cases(11.98%)had simple bacterial infection,9 cases(0.75%)had simple fungal infection,and 92 cases(7.65%)had two pathogens.38 cases(3.16%)were infected with three or more types of pathogens.There were 655 cases of coinfection,including 328 cases(50.08%)of viruses,297 cases(45.34%)of bacteria,22cases(3.36%)of fungi,and 4 cases(0.61%)of other atypical pathogens(3 cases of Chlamydia trachomatis and 1 case of Q Gerrickettsia).Among the cases with covirus infection,adenovirus infection was the most common(28.96%),followed by respiratory syncytial virus(22.87%).Among the co-bacterial infections,Streptococcus pneumoniae was the most common(27.95%),followed by Haemophilus influenzae(21.21%),and the other species accounted for less than 10%.Concomitant fungi and atypical pathogens were rare.3.A total of 914 cases(76.04%)had fever,including 31 cases(2.58%)with lowgrade fever(≤38℃),254 cases(21.13%)with moderate fever(38.1～39℃),618 cases(51.41%)with high fever(39.1～41℃),and 11 cases(0.92%)with ultra-high fever(>41℃).1184 cases(98.50%)had cough,including 74 cases(6.16%)had dry cough,1012 cases(84.19%)coughed with sputum,98 cases(8.15%)with dry cough at the beginning and sputum in the later stage.281(23.38%)cases had wheezing,and 1012(84.19%)cases had rales on auscultation of the lungs,including 166(13.81%)cases with unilateral rales and 846(70.38%)with bilateral rales.There were 224 cases(18.64%)having severe pneumonia.4.The average C-reactive protein(CRP)level was gradually increased with the age increasing(P < 0.05).Lactic dehydrogenase(LDH)levels were lowest in the preschool group,and roughly the same as those in the infant group(P<0.05).Fibrinogen levels increase with age(P<0.05).The proportion of unilateral pneumonia gradually increased with the age increasing.The proportion of bilateral pneumonia was higher in the infant group and the toddler group,accounting for >75%,and the lowest in the preschool group(P<0.05).The proportion of pulmonary consolidation was highest in the school-age group(22.30%),and the proportion in the young child group(10.50%))was the lowest(P<0.05).5.The proportion of mixed infection in SMPP group(56.7%)was higher than that in GMPP group(35.1%)(P < 0.05).The average fever duration,panting ratio,LDH,D-D and IFN-γ levels in SMPP group were higher than those in GMPP group(P< 0.05).LDH,interferon-γ,fever duration,wheezing,lung consolidation,pulmonary atelectasis,co-infection(they included simple co-viral infection,simple co-bacterial infection,simple co-fungal infection,infected with two pathogens,infected with three or more pathogens)(OR > 1,P < 0.05)were independent risk factors for SMPP.Using LDH and fever duration as predictors,the ROC curve was plotted,and the best cut-off value was obtained according to the Jordon index,and the accuracy of predicting SMPP at LDH ≥412.5U/L was 57.5%,the sensitivity was 73.2%,and the specificity was 54.1%.The accuracy of predicting SMPP at fever duration ≥7.5 days was58.3%,the sensitivity,56.8%,and specificity was 72.5%.Conclusions1.The onset age of MP infection is significantly earlier,and it has become an important pathogen of CAP in infants and children.Summer and autumn are the key periods for the prevention and control of MP infection in pediatric ward.Wearing masks,hand hygiene and reducing crowd gathering can help reduce the burden of MP infection.2.MP infection is easily co-infected with other pathogens.Virus and bacterial infection were common,among which adenovirus and respiratory syncytial virus were common.The most common bacteria were Streptococcus pneumoniae and Haemophilus influenzae.For infantile MPP patients,relevant viral and bacteriological examinations should be performed as soon as possible.For children with clear coinfection,antiviral and antibacterial therapy should be performed as soon as possible and reasonably.3.Fever in MPP children is more common in medium and high fever.Clinical attention should be paid to the possibility of wheezing caused by MP infection in infants.The MPP of infants and young children is mostly manifested as bilateral lung rales,while the rales of elderly infants are mainly unilateral.In the case of unilateral lung consolidation and atrentasis,physical examination is often more unpleasant and wet rales.4.The degree of elevated LDH level is related to the severity of the disease.The increase in Fib in older children with MPP should alert them to the risk of thrombosis and the possibility of developing SMPP.5.The possibility of SMPP should be vigilant when the heat course of MPP children is greater than 7.5d,LDH≥412.5U/L,wheeze occurs,pulmonary imaging suggests atriotasis,lung consolidation,or etiological examination suggests concurrent infection. |
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