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Initial presentation, etiology and risk factors for adverse outcomes in infection-associated plastic bronchitis in

Huan Cao1, Dongge Liang1, Han Huang1

  • 1Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China.

Frontiers in Pediatrics
|March 30, 2026
PubMed

Insights

Mycoplasma pneumoniae is the main cause of infection-associated plastic bronchitis in children. Elevated LDH and D-dimer levels may predict poor outcomes, even with treatment, highlighting the need for early biomarkers.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Radiology

Background:

  • Infection-associated plastic bronchitis (PB) is a serious condition in children.
  • Understanding its causes, imaging, and outcomes is crucial for effective management.

Purpose of the Study:

  • To analyze pathogen distribution, imaging findings, radiologic outcomes, and risk factors for poor prognosis in pediatric infection-associated PB.
  • To identify predictors of adverse outcomes in children with PB.

Main Methods:

  • Retrospective study of 86 hospitalized children diagnosed with infection-associated PB.
  • Classification of patients into favorable, poor, and indeterminate prognosis groups based on radiologic findings.
  • Comparison of clinical and laboratory data between favorable and poor prognosis groups to identify risk factors.

Main Results:

  • Mycoplasma pneumoniae (MP) caused 94.2% of cases, with 35.8% being co-infections.
  • 6 (7.4%) patients experienced adverse outcomes, including persistent atelectasis and bronchiectasis, with one requiring surgery.
  • Elevated lactate dehydrogenase (LDH) and D-dimer levels were significantly higher in the poor prognosis group (p<0.01).
  • The poor outcome group required more interventions like bronchoscopy, higher glucocorticoid doses, and increased use of low molecular weight heparin and IV immunoglobulin.

Conclusions:

  • Mycoplasma pneumoniae is the predominant pathogen in pediatric infection-associated PB.
  • While most children improve, some develop long-term complications like bronchiectasis and atelectasis.
  • Elevated LDH and D-dimer levels may serve as early predictive biomarkers for unfavorable outcomes in children with PB.
Abstract

Keywords:
etiologyimaging featuresmycoplasma pneumoniaeoutcomesplastic bronchitis

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