title: Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children.
abstract: OBJECTIVE
  The purpose of this study was to explore the clinical and laboratory characteristics of children with refractory Mycoplasma pneumoniae pneumonia (RMPP).
  
  
  METHODS
  Seventy-six children with RMPP and 26 children with non-refractory M. pneumoniae pneumonia (NRMPP), confirmed by both serology and fluorescent quantitation PCR in bronchoalveolar lavage fluid (BALF), were evaluated retrospectively.
  
  
  RESULTS
  Compared to those with NRMPP, children with RMPP were older (66.6±39.0 vs. 48.4±35.4 months, p=0.038) and had a longer duration of fever (12.7±2.6 vs. 7.5±1.8 days) and hospital stay (12.1±3.2 vs. 7.4±2.9 days). Children with RMPP presented neutrophil infiltration both in serum and BALF, as well as severe pulmonary lesions with pleural effusion. Children with RMPP had a significantly higher M. pneumoniae DNA load in BALF compared to NRMPP patients, and the M. pneumoniae load in BALF was significantly correlated with neutrophils and inversely correlated with macrophages for both the NRMPP and RMPP groups. The serum concentrations of tumor necrosis factor alpha (median 114.5 pg/ml, range 49.1-897.9 pg/ml) and interferon gamma (median 376.9 pg/ml, range 221.4-1997.6 pg/ml) were significantly higher in children with RMPP compared to children with NRMPP.
  
  
  CONCLUSIONS
  This study indicates that a direct microbe effect and the subsequent induced excessive host immune response contribute in part to the progression of RMPP.
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China.
authors.forename: Meijuan
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China.
authors.forename: Yongdong
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China.
authors.forename: Canhong
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Molecular Clinical Laboratory, Soochow University Affiliated Children's Hospital, Suzhou, P.R. China.
authors.forename: Xuejun
authors.initials: X
authors.lastname: Shao
authors.affiliation: Department of Molecular Clinical Laboratory, Soochow University Affiliated Children's Hospital, Suzhou, P.R. China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Molecular Clinical Laboratory, Soochow University Affiliated Children's Hospital, Suzhou, P.R. China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Cell Biology and Immunology, UNT Health Science Center at Fort Worth, Texas, USA.
authors.forename: Xiangle
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China. Electronic address: szdxjiwei@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Ji
authors.affiliation: Department of Respiratory Disease, Soochow University Affiliated Children's Hospital, Jingde Road No. 303, Suzhou, Jiangsu Province, 215003, P.R. China. Electronic address: chen_zheng_rong@163.com.
authors.forename: Zhengrong
authors.initials: Z
authors.lastname: Chen
mesh_terms: D001992:Bronchoalveolar Lavage Fluid; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005334:Fever / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007371:Interferon-gamma / Q000097:blood; D007902:Length of Stay; D008168:Lung / Q000473:pathology; D008297:Male; D009177:Mycoplasma pneumoniae / Q000235:genetics / Q000302:isolation & purification; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis* / Q000276:immunology; D012189:Retrospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D004269:DNA, Bacterial; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma
keywords: Children; Clinical characteristics; Refractory Mycoplasma pneumoniae pneumonia