title: Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast.
abstract: BACKGROUND
  The influence of Mycoplasma pneumoniae (MP) infection on bronchiolitis remains unclear. Additionally, reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive.
  
  
  METHODS
  Children with respiratory syncytial virus (RSV)-induced bronchiolitis were divided into two groups: RSV+MP group and RSV group. Each group was randomly divided into two subgroups: one received routine and placebo treatment, while the other received routine and montelukast treatment for 9 months. The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded. Blood parameters were determined.
  
  
  RESULTS
  Patients in the RSV+MP group exhibited an older average age, fever, more frequent flaky and patchy shadows in chest X-rays, more frequent extrapulmonary manifestations, and longer hospital stays compared with patients in the RSV group. Additionally, higher baseline blood eosinophil counts, eosinophil cationic protein (ECP), total immunoglobulin E (IgE), interleukin (IL)-4, IL-5, IL-4/interferon-γ ratios, leukotriene (LT) B4, and LTC4, and lower baseline lipoxin A4 (LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group. Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months. This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts, ECP and total IgE, as well as the montelukast-dependent recovery in T helper (Th) 1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis.
  
  
  CONCLUSIONS
  RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection. Add-on therapy with montelukast for 9 months was beneficial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.
authors.affiliation: Department of Pediatrics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China. kad-yc@163.com.
authors.forename: Sheng-Hua
authors.initials: SH
authors.lastname: Wu
authors.affiliation: Department of Pediatrics, Jiangsu Maternity and Children Healthcare Hospital, Nanjing, 210036, China.
authors.forename: Xiao-Qing
authors.initials: XQ
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Kong
authors.affiliation: Department of Pediatrics, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China.
authors.forename: Pei-Ling
authors.initials: PL
authors.lastname: Yin
authors.affiliation: Department of Pediatrics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Pediatrics, Central Hospital of Tengzhou, Tengzhou, 277500, China.
authors.forename: Pei-Yuan
authors.initials: PY
authors.lastname: Liao
authors.affiliation: Department of Pediatrics, Qidong People's Hospital, 753 Central Jianghai Road, Qidong, 226200, China.
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Wu
mesh_terms: D000085:Acetates / Q000627:therapeutic use*; D001988:Bronchiolitis / Q000188:drug therapy* / Q000821:virology*; D060085:Coinfection; D003521:Cyclopropanes; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D011019:Pneumonia, Mycoplasma / Q000150:complications*; D011446:Prospective Studies; D011804:Quinolines / Q000627:therapeutic use*; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000188:drug therapy*; D013440:Sulfides
chemical_list: D000085:Acetates; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; C093875:montelukast
keywords: Mycoplasma pneumoniae; bronchiolitis; leukotrienes; montelukast; respiratory syncytial virus
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