Sheng Chu-Qiao, Yang Chun-Feng, Ao Yu, Zhao Zhi-Yue, Li Yu-Mei
Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
Exp Ther Med. 2021 Mar;21(3):201. doi: 10.3892/etm.2021.9634. Epub 2021 Jan 11.
Mycoplasma is one of the most common pathogens causing community-acquired pneumonia in pediatric patients. In recent years, the number of refractory or severe cases with drug resistance has been gradually increasing and cases that developed embolism after () infection have been reported. The present study retrospectively analyzed the clinical features, diagnosis and treatment of pneumonia (MPP) combined with pulmonary embolism (PE) in a series of 7 cases encountered between January 1st, 2016 to August 1st, 2019 at the Department of Pediatric Intensive Care Unit of The First Hospital of Jilin University (Changchun, China). Combined with relevant Chinese and international studies published during the last two decades, a comprehensive analysis was performed. All of the pediatric patients of the present study had fever, cough and dyspnea respiratory symptoms at onset and the disease progressed rapidly. Thereafter, PE was confirmed by a series of examinations. Pulmonary CT indicated patchy inflammations and significantly elevated D-dimer levels, accompanied by positive anticardiolipin antibodies. Furthermore, a filling defect in the pulmonary artery branch was observed on CT pulmonary angiography (CTPA) examination. In 2 cases, the condition was improved with anti-infection and anticoagulation treatment with low-molecular-weight heparin and warfarin, respectively, and the pulmonary embolism disappeared after 3-4 months. A total of 5 cases, who were not responsive to the drug treatment, underwent surgical resection. During the operation, the local tissues were determined to be infarcted and the pathological diagnosis was consistent with pulmonary infarction. Among the 5 cases, 2 died of Acute Respiratory Distress Syndrome at 3-8 days after the operation. The remaining patients underwent 6-12 months of follow-up and respiratory rehabilitation and their quality of life is now good. In conclusion, compared with healthy individuals, pediatric patients with critical MPP have an elevated risk of embolism. It is necessary to be vigilant regarding whether MMP is combined with PE and perform timely CTPA examination. Early detection, early treatment and surgical intervention (if necessary) may significantly reduce the risk of mortality and disability.
支原体是引起儿童社区获得性肺炎最常见的病原体之一。近年来,难治性或耐药性重症病例数量逐渐增加,且有感染后发生栓塞的病例报道。本研究回顾性分析了2016年1月1日至2019年8月1日期间,吉林大学第一医院(中国长春)儿科重症监护病房收治的7例肺炎支原体肺炎(MPP)合并肺栓塞(PE)患儿的临床特征、诊断及治疗情况。结合过去二十年发表的相关国内和国际研究进行综合分析。本研究中所有儿科患者起病时均有发热、咳嗽和呼吸困难等呼吸道症状,且病情进展迅速。此后,通过一系列检查确诊为PE。肺部CT显示斑片状炎症,D - 二聚体水平显著升高,伴有抗心磷脂抗体阳性。此外,CT肺动脉造影(CTPA)检查显示肺动脉分支有充盈缺损。2例患者分别通过抗感染及低分子肝素和华法林抗凝治疗病情好转,3 - 4个月后肺栓塞消失。共有5例患者药物治疗无效,接受了手术切除。手术中确定局部组织梗死,病理诊断与肺梗死一致。5例患者中有2例在术后3 - 8天死于急性呼吸窘迫综合征。其余患者接受了6 - 12个月的随访及呼吸康复治疗,目前生活质量良好。总之,与健康个体相比,重症MPP患儿发生栓塞的风险升高。有必要警惕MMP是否合并PE,并及时进行CTPA检查。早期发现、早期治疗及必要时的手术干预可显著降低死亡和残疾风险。