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High-Risk CCL14 lineage drives severe Mycoplasma pneumoniae pneumonia in children: a study in central China

Chunbo Hao1, Zijie Li1, Yanjuan Yu1

  • 1Henan International Joint Laboratory of Children's Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China.

Clinical and Experimental Pediatrics
|April 16, 2026
PubMed
Abstract

Insights

A hypervirulent Mycoplasma pneumoniae (MP) strain, CCL14, drove severe pediatric pneumonia post-COVID in China. This macrolide-resistant strain necessitates integrated surveillance for better disease management.

Area of Science:

  • Infectious Diseases
  • Molecular Epidemiology
  • Pediatric Pneumology

Background:

  • Post-pandemic Mycoplasma pneumoniae (MP) infections surged, especially in China.
  • Understanding MP strain genetics and severity links is crucial but lacking for central China.
  • Genotypic characterization of prevalent MP strains and their clinical impact requires further investigation.

Purpose of the Study:

  • To assess the association between predominant MP strains and disease severity.
  • To analyze epidemiological features of MP pneumonia (MPP) in Henan, China (2020-2024).
  • To correlate MP genotypes with clinical outcomes in pediatric patients.

Main Methods:

  • Integrated clinical data from 3,060 pediatric patients.
  • Epidemiological analysis of MPP in Henan region.
  • Multilocus sequence typing (MLST) and MLVA on bronchoalveolar lavage fluid (BALF) from 137 patients.
  • Phylogenetic analysis to identify strain lineages.

Main Results:

  • Two major MP genotypes co-circulated: ST3 (57.7%, 31.6% severe) and ST14 (26.3%, 72.2% severe).
  • The ST14/3-5-6-2 lineage (CCL14) was significantly linked to increased disease severity (P<0.001).
  • CCL14-infected patients showed hyperinflammation (elevated D-dimer, C4, platelets); ~75% of strains were macrolide-resistant.

Conclusions:

  • The CCL14 lineage drives severe, macrolide-resistant pediatric MPP in Henan, China.
  • Molecular surveillance integrated with clinical monitoring is vital for reducing disease burden.
  • Identifying hypervirulent MP strains is key to managing outbreaks.
Keywords:
Disease severityMultilocus sequence typingMycoplasma pneumoniaePneumonia

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