Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Pediatrics. 2011 Jun;127(6):e1605-9. doi: 10.1542/peds.2010-2624. Epub 2011 May 2.
Mycoplasma pneumoniae is a highly specialized parasitic bacterium that is a significant cause of community-acquired pneumonia in children. Although most such respiratory infections are mild, a minor percentage of patients require hospitalization and, occasionally, intensive treatment for respiratory failure. A variety of extrapulmonary sequelae of M pneumoniae infections have been described, including Stevens-Johnson syndrome. Macrolide resistance in M pneumoniae has developed rapidly in Asia, particularly in China, over the past decade and is now appearing in the United States. Emerging resistance to macrolides creates a therapeutic conundrum, particularly for pediatricians caring for young children in whom absolute or relative contraindications exist for the use of tetracyclines or fluoroquinolones, the 2 other main classes of drugs shown to be efficacious for M pneumoniae. We describe here the case of a child with a prolonged febrile illness associated with Stevens-Johnson-like mucocutaneous involvement who was found to have a respiratory infection with macrolide-resistant M pneumoniae.
肺炎支原体是一种高度特化的寄生细菌，是儿童社区获得性肺炎的重要病因。虽然大多数此类呼吸道感染较为轻微，但仍有少数患者需要住院治疗，有时还需要针对呼吸衰竭进行强化治疗。肺炎支原体感染可引起多种肺外并发症，包括史蒂文斯-约翰逊综合征。在过去十年中，肺炎支原体对大环内酯类药物的耐药性在亚洲，尤其是在中国迅速发展，目前已出现在美国。大环内酯类药物耐药性的出现给治疗带来了难题，尤其是对于儿科医生来说，他们在照顾年幼的儿童时，由于绝对或相对禁忌使用四环素类或氟喹诺酮类药物，而这两种药物是治疗肺炎支原体的另外两种主要有效药物。我们在此描述了一例发热时间延长的儿童病例，该患儿存在史蒂文斯-约翰逊样黏膜皮肤受累，且患有肺炎支原体引起的、对大环内酯类药物耐药的呼吸道感染。
