| Objective:The purpose of this study is to survey the clinical epidemiological characteristics of Mycoplasma pneumoniae pneumonia(MPP)and to analyze the risk factors of plastic bronchitis caused by Mycoplasma(MP)infection in soochow.Therefore,It will help us to improve the strategy for prevention and treatment of MPP.Methods:(1)The clinical data of 5142 children,who diagnosed with pneumonia and admitted in the respiratory department of children's hospital of soochow university from January 2011 to December 2018,were collected and retrospectively analyzed.These children were confirmed as MMP by serum MP-IgM and/or RT-Q-PCR of nasopharyngeal deep aspiration sample and alveolar lavage fluid.(2)Comparison was performed between the data of 121 cases of patients with MPP combined with PB and those of 218 MPP patients.All PB were confirmed by bronchoscopy.The risk factors of PB followed by MP infection were concluded.Results:1.The epidemiology of Mycoplasma pneumoniae pneumonia(1)Detection rate of MPP:5142(30.8%)cases were positive among the total 16,713 hospitalized children with pneumonia from 2011 to 2018.The detection rate was 20.6%,32.8%,45.0%,28.6%,30.9%,43.0%,24.6%and 21.8%in each year,from 2011 to 2018,with two epidemics in 2013 and 2016.(2)Seasonal distribution:The detection rates of spring,summer,autumn and winter were 24.9%,37.6%,35.6%and 24.7%respectively,Higher incidence were detected in summer and autumn than that of winter and spring(P<0.001).(3)Gender distribution:Higher incidence were detected in female than that of male(35.7%versus 27.8%,P<0.001).(4)Age distribution:The detection rate were 14.3%in infant group(?1 year),36.1%in young children group(1?3 year old),49.2%in preschool age group(3?6 year old),and 62.3%in school age group(>6 year old),respectively.The detection rates of MPP increased significantly with age(P<0.001).2.Epidemiology of Refractory plasma pneumoniae pneumonia(RMPP)(1)842 RMPP cases were diagnosed in 5142 children with MPP(16.4%).The detection rates were 11.4%,14.4%,13.0%,15.7%,17.6%,18.7%,20.1%and 23.7%in each year from 2011 to 2018,respectively.The incidence was gradually increased.(2)The average age of children with RMPP was 5.2±2.9,which was significantly higher than that of MPP(3.1±2.7)(P<0.001).(3)The detection rates of spring,summer,autumn and winter were 15.4%,17.5%,15.0%and 17.5%,respectively,with high incidence in summer and winter.(4)No significant incidence of RMPP was detected between male and female(15.6%versus 17.3%,P>0.05).3.Clinical features of MPP:(1)Cough was the most common symptom in patients of all age groups.Patients in school age group and the preschool group had higher incidence of fever than those in infants and young children group(82.9%and 80.5%versus 69.6%and 39.1%)(P<0.001),Asthma-like symptom were more common in Infants and young children than that of preschool and school-age children(44.0%,37.6%,19.6%,10.0%)(P<0.001),10.2%of school age patients were negative in pulmonary physical examination,and higher incidence of wheezing were found in infants and young children than those preschool and school-age patients(44.1%and 34.5%versus 20.7%and 9.1%)(P<0.001).(2)Bronchopneumonia and bronchiolitis were higher in infant than those of preschool and school-age.Lobular pneumonia was most common in school-age patients.The incidence of interstitial pneumonia was similar in each group.(3)The incidence of atelectasis,lung consolidation and pleural effusion was significantly higher in the school-age group than that in other age groups(all P<0.005).The incidence of cardiovascular system and liver involvement in the infant group was significantly higher than that in other age groups(all P<0.001),and there was no statistical difference in the incidence of neurological,joint,kidney and skin involvement in each age group(all P>0.05).(4)The abnormal rates of CRP,LDH and DD gradually increased with age(P<0.001).The abnormal rates of ALT and CKMB were the highest in the infant group(P<0.001).(5)Multiple pathogen infection rates in MPP was(47.2%),and the detection rate of bacterial infection was 27.0%.Streptococcus pneumoniae was the most common bacterial(15.2%),followed by haemophilus influenza(5.4%),Moraxella catarrhalis(2.3%),and Staphylococcus aureus(2.2%).The detection rate of virus infection was 28.2%,and the highest was rhinovirus(8.4%),followed by respiratory syncytial virus(6.6%),human boca virus(6.1%)and parainfluenosis virus(3.7%).Multiple pathogen infection tended to happen in the younger.The mixed infection rate of RMPP(36.0%)was lower than that of non-RMPP(50.9%),and there was no significant difference in pathogen composition between the two groups.4.Clinical characteristics and risk factors of plastic bronchitis(1)MP accounted for 74.5%of infection-related PB.The ratio of Male/Female is 0.98:1 in BP group versus 1.1:1 in non-BP group.The mean age of PB group was 5.65±2.77 years old,while that of non-PB group was 6.02±2.27 years old,with no statistically significant difference(P>0.05).(2)clinical manifestations:there was no statistical difference in the incidence of fever,cough and wheezing between the PB group and the non-PB group(P>0.05),and the duration of hospital stay,heat course and the incidence of hyperthermia,dyspnea,shortness of breath,cyanosis,and reduced respiratory sounds in the PB group were significant higher than that in the non-PB group(P<0.05).(3)Laboratory examination:the incidence of pleural effusion,?2 pulmonary lobe accumulation,atelectasis/consolidation,and mucosal necrosis under tracheal microscopy in the PB group were all significant higher than those in the non-PB group(P<0.05).The percentage of neutrophils and CD3+CD8+T cells in peripheral blood were significant higher in BP group than those in no-PB group(P<0.05).The ratio of CD4+/CD8+of PB group was lower than that in non-PB group(P<0.05).The levels of CRP,DD,LDH,ALT,and IgA in PB group were all significant higher than that in non-PB group,(P<0.05).(4)Treatment:More incidence of multi-time tracheal endoscopic irrigation,utilization of methylprednisolone and gamma globulin were found in the PB group than those in no-PB group(P<0.05).(5)Risk factor analysis:Multivariate Logistic regression analysis was performed.It is showed that pleural effusion(OR=8.445,95%CI:4.233?16.848),fever duration(OR=9.694,95%CI:4.528?20.752),CRP(OR=2.67,95%CI:1.241?5.774),and LDH(OR=2.430,95%CI:1.230?4.799)were independent risk factors for PB caused by MP infection(P<0.05).The critical values of fever duration,CRP and LDH were 11 days,40mg/L and 550U/L,respectively.Conclusions:1.The detection rate of MPP in Suchow was 30.8%from 2011 to 2018,and there were two epidemics in 2013 and 2016.The detection rate of RMPP in MPP is 16.4%,which increased year by year.High incidence of MPP were found in summer and autumn,in patients of early school age and school age,and in female.2.The main clinical manifestations were cough,High incidence of fever,lobar pneumonia,pleural effusion,atelectasis and lung consolidation were occurred in the elder children.High incidence of multi-infection,wheezing,bronchiolitis,and involvement of cardiovascular system and liver were found in infants.3.MP infection is an important cause of infection-related PB.It is often manifested as persistent high fever,dyspnea,decreased breath sounds on lung auscultation.More than 2 pulmonary lobe involvement,pleural effusion,atelectasis were common on imaging.Pleural effusion,long fever duration(?11 days),high level of CRP(?40mg/L)and LDH(?550 U/L)were independent risk factors for PB caused by MP infection.Remove the plastic material by bronchoscope suction or forceps is an effective treatment. |
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