Hanhan Usama, Orlowski James, Fiallos Mariano
University Community Hospital, Tampa, FL 33613, USA.
Open Respir Med J. 2008;2:35-8. doi: 10.2174/1874306400802010035. Epub 2008 May 7.
BACKGROUND #ENTITYSTARTX00026;
Viral respiratory infections (VRI) have been commonly associated with exacerbation of wheezing in asthmatic children. Mycoplasma pneumoniae (MP) causes many respiratory syndromes that clinically mimic VRI. Due to the nature of the organism, cultures are of no practical value and the diagnosis is usually made by serology. Only a few studies have associated mycoplasma infections with acute exacerbations of wheezing in the asthmatic patient. This study was an attempt to assess the incidence of recent mycoplasma infections in patients with status asthmaticus and to review their laboratory, clinical and radiological findings.
Retrospective review of all patients admitted to PICU over 12 month period with status asthmaticus. Recent mycoplasma infection was determined utilizing the Immunocard Mycoplasma Enzyme Immunoassay (EIA) for detection of MP IgM antibodies (Meredian Diagnostics, Inc., Cincinnati, OH) RESULTS;: The records of 44 patients were reviewed. 9 were excluded because MP tests were never obtained during hospitalization. 15/35 (42%) were MP Positive. There were no statistically significant differences (P>0.05) in length of hospitalization (LOH), ICU days, duration of continuous albuterol aerosol hours (cont. Nebs hrs.), days on O2 (02 days) or WBC between the two groups, however patients who were mycoplasma positive were treated with a macrolide antibiotic in addition to their standard asthma therapy. Patients with evidence of recent MP infection were more likely to have one or more infiltrates on their CXR (13/15 vs 7/20; P= 0.002).
Our study suggests that recent MP infections play a significant role in exacerbations of asthma and occurrence of status asthmaticus in children. The presence of infiltrates on CXR in status asthmaticus warrants tests for MP.
背景
病毒性呼吸道感染(VRI)通常与哮喘儿童喘息加重有关。肺炎支原体(MP)可引发多种临床上类似于VRI的呼吸道综合征。由于该病原体的特性,培养方法并无实际价值,诊断通常通过血清学检测进行。仅有少数研究将支原体感染与哮喘患者喘息急性加重相关联。本研究旨在评估哮喘持续状态患者近期支原体感染的发生率,并回顾其实验室、临床及影像学检查结果。
对12个月期间入住儿科重症监护病房(PICU)的所有哮喘持续状态患者进行回顾性研究。采用免疫卡支原体酶免疫测定法(EIA)(美国俄亥俄州辛辛那提市Meredian诊断公司)检测MP IgM抗体,以确定近期支原体感染情况。结果:对44例患者的记录进行了回顾。9例被排除,因为住院期间从未进行过MP检测。15/35(42%)例MP检测呈阳性。两组在住院时间(LOH)、ICU住院天数、持续沙丁胺醇气雾剂使用小时数(持续雾化小时数)、吸氧天数(吸氧天数)或白细胞计数方面无统计学显著差异(P>0.05),然而支原体阳性患者除接受标准哮喘治疗外,还接受了大环内酯类抗生素治疗。近期有MP感染证据的患者更有可能在胸部X线片(CXR)上出现一处或多处浸润影(13/15 vs 7/20;P = 0.002)。
我们的研究表明,近期MP感染在儿童哮喘加重及哮喘持续状态的发生中起重要作用。哮喘持续状态患者胸部X线片上出现浸润影提示有必要进行MP检测。