Wu Xiongting, Chen Rong, Mo Di, Wang Yinyan, Xia Yuxiao, He Mengzhang
Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2024 Oct 31;16(10):6789-6798. doi: 10.21037/jtd-24-729. Epub 2024 Oct 14.
(MP) has recently become an important pathogen of respiratory infection in both children and adults. The objective of this study was to investigate the detection rate of MP and clinical features of viral coinfection in pneumonia (MPP) after the coronavirus disease 2019 (COVID-19) pandemic in southern Guangzhou.
We reviewed 3,094 patients with respiratory infection who visited the respiratory medicine and pediatrics department from October 2023 to January 2024. Patients underwent polymerase chain reaction (PCR) or immunoglobulin M (IgM) serology for MP, influenza virus (IFV), respiratory syncytial virus (RSV), adenovirus (ADV) and enterovirus (EV). We further compared the clinical, laboratory, and imaging findings of the MPP patients with and without viral coinfection. In order to identify the significant association with viral coinfection in MPP, multivariable logistic regression analysis was performed.
MP infection was identified in 746 (36.69%) children and 140 (13.20%) adults, and there were 308 (41.29%) children and 76 (54.29%) adults with MPP. Eighty-four (27.27%) children and 7 (5.0%) adults with MPP had viral coinfection. Viral coinfection including MPP-RSV (4.22%), MPP-ADV (4.22%), MPP-EV (7.14%) and MPP-IFV (11.68%) was identified in children. These patients had a higher frequency of fever, higher white blood cell, higher concentration of C-reactive protein and procalcitonin, and higher proportion of lactate dehydrogenase (LDH) at greater than 250 U/L. Imaging feature of consolidation and air bronchogram sign was observed in both MPP and viral coinfection. Multivariable analysis showed fever (adjusted odds ratio, 3.46; 95% confidence interval, 1.02-11.74; P=0.047) and elevated procalcitonin of greater than 5 ng/mL (adjusted odds ratio, 3.17; 95% confidence interval: 1.50-6.72; P=0.003) as the factors associated with the viral coinfection, suggesting that viral infections could aggravate the primary MP infection or predispose patients to secondary bacterial infection.
Viral coinfection in MPP was common after the COVID-19 pandemic in southern Guangzhou. Increase in procalcitonin should be considered as a possibility of viral coinfection in children with MPP. This finding suggests the need for viral test in children with elevated procalcitonin in MPP, which could help clinicians identify viral coinfection at an early stage and provide timely antiviral intervention.
肺炎支原体（MP）最近已成为儿童和成人呼吸道感染的重要病原体。本研究的目的是调查2019年冠状病毒病（COVID-19）大流行后广州南部肺炎支原体肺炎（MPP）中MP的检出率及病毒合并感染的临床特征。
我们回顾了2023年10月至2024年1月期间到呼吸内科和儿科就诊的3094例呼吸道感染患者。患者接受了针对MP、流感病毒（IFV）、呼吸道合胞病毒（RSV）、腺病毒（ADV）和肠道病毒（EV）的聚合酶链反应（PCR）或免疫球蛋白M（IgM）血清学检测。我们进一步比较了合并病毒感染和未合并病毒感染的MPP患者的临床、实验室和影像学表现。为了确定与MPP中病毒合并感染的显著关联，进行了多变量逻辑回归分析。
在746例（36.69%）儿童和140例（13.20%）成人中检测到MP感染，其中有308例（41.29%）儿童和76例（54.29%）成人患有MPP。84例（27.27%）患有MPP的儿童和7例（5.0%）患有MPP的成人存在病毒合并感染。在儿童中发现的病毒合并感染包括MPP-RSV（4.22%）、MPP-ADV（4.22%）、MPP-EV（7.14%）和MPP-IFV（11.68%）。这些患者发热频率更高、白细胞更高、C反应蛋白和降钙素原浓度更高，且乳酸脱氢酶（LDH）大于250 U/L的比例更高。MPP和病毒合并感染均观察到实变和空气支气管征的影像学特征。多变量分析显示发热（调整后的优势比，3.46；95%置信区间，1.02-11.74；P=0.047）和降钙素原升高大于5 ng/mL（调整后的优势比，3.17；95%置信区间：1.50-6.72；P=0.003）是与病毒合并感染相关的因素，提示病毒感染可能加重原发性MP感染或使患者易发生继发性细菌感染。
广州南部COVID-19大流行后，MPP中的病毒合并感染很常见。MPP患儿降钙素原升高时应考虑病毒合并感染的可能性。这一发现表明，对于MPP中降钙素原升高的儿童需要进行病毒检测，这有助于临床医生早期识别病毒合并感染并及时提供抗病毒干预。
