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Antigen-Capture Enzyme-Linked Immunosorbent Assay for Specific Detection of Mycoplasma pneumoniae
Published on: February 24, 2023
[Clinical characteristics and predictive factors of refractory Mycoplasma pneumoniae pneumonia]
Jin-rong Liu1, Yun Peng, Hai-ming Yang
1Respiratory and Infectious Diseases Center, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China.
Insights
Predictive factors for refractory Mycoplasma pneumoniae pneumonia (RMPP) in children include prolonged fever, elevated CRP, and extensive lung consolidation. Early identification of these markers aids in timely treatment of RMPP.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Radiology
Background:
- Mycoplasma pneumoniae pneumonia (MPP) is common in children.
- Refractory MPP (RMPP) presents a clinical challenge due to persistent symptoms and potential complications.
- Early recognition of RMPP is crucial for effective management.
Purpose of the Study:
- To identify clinical characteristics and predictive factors of RMPP in children.
- To develop criteria for earlier diagnosis and treatment of RMPP.
Main Methods:
- Retrospective analysis of 213 children with MPP (72 RMPP, 141 mild MPP).
- Inclusion of febrile duration, inflammatory markers (WBC, CRP), and radiological findings.
- Multivariate logistic regression to identify independent risk factors for RMPP.
- Prospective validation of predictive criteria in 100 additional patients.
Main Results:
- RMPP patients exhibited longer febrile duration (>10 days) and higher CRP levels (>40 mg/L).
- Radiological findings in RMPP included large lobar consolidation (>2/3 lobe) with high density (CT value 40-50 HU), often with pleural effusion.
- Independent predictors for RMPP were prolonged fever, elevated CRP, and extensive consolidation (ORs ranging from 1.586 to 4.344).
- Diagnostic criteria achieved high sensitivity (0.96) and specificity (0.94) for RMPP.
Conclusions:
- Prolonged fever (>10 days), elevated CRP (>40 mg/L), and extensive, dense lobar consolidation are key predictors of RMPP.
- These factors can aid in the early identification and management of RMPP in pediatric patients.
- The established criteria demonstrate high accuracy in diagnosing RMPP.
Objective:
To investigate clinical characteristics and predictive factors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children so as to recognize and treat the disease earlier.
Method:
The data including febrile time, inflammatory markers (WBC, neutrophil, CRP) and radiological features of 213 children hospitalized with Mycoplasma pneumoniae pneumonia (MPP) (72 with refractory MPP and 141 with mild MPP were retrospectively analyzed). The primary diagnostic criteria of refractory MPP: the patient's condition still deteriorates after treatment with macrolides for more than 5 days. The independent variables which had significant difference in univariate analysis was analyzed by multivariate logistic regression analysis. The predictive criteria of RMPP were further applied in 100 other patients prospectively. Kappa test was used to evaluate the accuracy rate.
Result:
Refractory MPP patients: febrile time was more than 10 days, white blood cell (WBC) count was (3.8 - 18.5)×10(9)/L in peripheral blood routine test, CRP was 38 mg/L - > 160 mg/L, large lobar consolidation with high density (> 2/3 pulmonary lobe, CT value 40 - 50 HU, without air bronchogram). Mild MPP patients: febrile time was less than 10 days, CRP was often less than 40 mg/L. Independent risk factors for RMPP were febrile time, CRP, large consolidation area with high density in lungs with or without pleural effusion (OR = 1.586, P = 0.017; OR = 4.344, P = 0.001; OR = 2.660, P = 0.012), CT value 40 - 50 HU which were demonstrated by logistic regression analysis. The specificity, sensitivity and Youden index for this diagnostic test were respectively 0.96, 0.94 and 0.90 at a CRP cut off of 40 mg/L. The sensitivity, specificity, and Kappa value for the above criteria to diagnose RMPP were respectively 0.96, 0.94 and 0.9.
Conclusion:
The predictive factors for RMPP are febrile time (> 10 days), CRP (> 40 mg/L), large lobar consolidation with high density (> 2/3 pulmonary lobe, CT value > 40 HU with or without pleural effusion) for the purpose of treating earlier.
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