AUTHOR=Liu Jinrong , He Ruxuan , Zhang Xiaoyan , Zhao Fei , Liu Liyong , Wang Heng , Zhao Shunying 

TITLE=Clinical features and “early” corticosteroid treatment outcome of pediatric mycoplasma pneumoniae pneumonia

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1135228

DOI=10.3389/fcimb.2023.1135228

ISSN=2235-2988

ABSTRACT=Background: Many children with mycoplasma pneumoniae (MP) pneumonia (MPP) developed sequelae such as bronchiolitis/bronchitis obliterans (BO). Early corticosteroid therapy might prevent disease progression. This study aimed to use “early” corticosteroids and observe the treatment outcome in patients with MPP.

Methods: Patients who had pulmonary infiltrations on chest imaging within 5 days of the disease course and were suspected of having MP infection on admission were enrolled. Among them, patients whose disease course was within 10 days on admission were ultimately enrolled. We analysed their data including the clinical features, the starting time and dose of corticosteroid therapy, and the treatment outcome. According to chest imaging, we divided patients into two groups (Group A: bronchiolitis-associated-lesions or ground-glass-opacities; Group B: pulmonary-segmental/lobar-consolidation). 

Results: 210 patients with confirmed MPP were ultimately enrolled. There were59 patients in Group A and 151 patients in Group B. Patients in Group A were more likely prone to have allergy histories, hypoxemia, and wheezing sound and wet rales on auscultation than those in Group B. Corticosteroid treatment was initiated between 5-10 days of disease onset in all patients and 6-7 days in most patients. Methylprednisolone was prescribed in all patients within 10 days of disease onset, and the highest prescribed dose was at least 2mg/kg/d. In Group A, methylprednisolone >2mg/kg/d was prescribed in 22 patients, and among them, 8 patients with diffuse bronchiolitis-associated lesions received high-dose methylprednisolone therapy. After 3 months, lung CT revealed slightly segmental ground-glass opacity in 3 patients. In Group B, methylprednisolone >2mg/kg/d was prescribed in 76 patients, and among them, 20 patients with pulmonary lobar consolidation received high-dose methylprednisolone therapy. After 3 months, chest imaging revealed incomplete absorption of pulmonary lesions in 7 patients. Among them, 5 patients with consolidation in more than one pulmonary lobe ultimately had slight BO.

Conclusions: In hospitalized patients with MPP, particularly severe MPP, the ideal starting time of corticosteroid treatment might be 5-10 days, preferably 6-7 days, after disease onset. The initial dosage of corticosteroid therapy should be decided according to the severity of the disease. MPP patients with diffuse bronchiolitis-associated-lesions/whole-lobar-consolidation on imaging might require high-dose corticosteroid therapy.