Clinical and laboratory variants of the course of mycoplasma infection in children at the present stage

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Introduction. Studies over the past decade indicate an increasing role of "atypical" pathogens in the development of respiratory tract diseases in children, one of them is Mycoplasma pneumoniae (M. pneumoniae) [1]. Infection caused by this pathogen can occur in people of any age, but most often in children of preschool and school age [1].

Mycoplasmas, being prokaryotes, do not have a rigid cell wall, which also determines their resistance to beta-lactam antibiotics. Their special feature is the ability to attach to human cells using tip organelles and parasitize the cell membrane. With this localization, they become inaccessible to the body's defense factors [2]. The issue of studying the prevalence, diagnosis and treatment of respiratory mycoplasmosis remains relevant. Diagnosis of mycoplasma infection is difficult due to the lack of a specific clinical picture of the diseases[1].

 Globally, respiratory mycoplasmosis accounts for 10-16% of all cases of acute respiratory diseases. An example of confirmation of the significance of this pathology in Russia is the situation in 2018: 77 foci of community-acquired pneumonia were recorded, the causative agent of which was M. pneumoniae in 79.2% of cases. Among preschool-aged children(children from 3 to 6 years) and school-aged children(children older than 7 years), mycoplasma infection is registered in 44.4 and 61.6% of cases, respectively[3, 4].

The purpose of the work. To study the features of the respiratory mycoplasmosis clinic. Evaluate and compare the severity of mycoplasma infection (without pneumonia, bronchitis), bronchitis, and pneumonia caused by M. pneumoniae. To evaluate the results of laboratory tests, to identify deviations from the norm, by analyzing 44 medical records of patients of preschool and school age.

Materials and methods of research. A study was conducted that included the analysis of 44 medical records of patients. The sample consisted of children aged 2 to 17 years and 4 months who were treated at the CSTO Day Hospital No. 2 from September to December 2024. Anamnesis data, general clinical examination(general blood test, biochemical blood test), results of polymerase chain reaction(PCR) and serological diagnostics for Mycoplasma pneumonia detection, as well as thermometry, lung auscultation, and pharmacotherapy were analyzed. Physical development assessment was carried out using the WHO Anthro and Anthro plus\programs.

Research results. In the course of the study, 44 medical records of patients were analyzed, including 17 boys and 27 girls. The median age is 9 (6.3; 11.2) years. Analysis of the physical development of patients showed that 7(15.9%) of the examined children were tall, 8(18%) of the examined children were protein-energy deficient, and 10(23%) of the children were obese.

 The study group included 13 children (29.5%) with a diagnosis of mycoplasma infection of the upper respiratory tract, 12 patients (27.2%) with bronchitis caused by M. pneumonia, 19 patients (43.2%) with pneumonia of mycoplasma etiology. Pneumonia was focal in 12(63%) patients, segmental in 1(5%) patient, and polysegmental in 6(32%) patients. Among 4(9%) patients, the infection was complicated by otitis media, including 3 patients with bronchitis and 1 with mycoplasma infection of the upper respiratory tract. Tonsillitis was observed in 1 (2.27%) child. Sinusitis occurred in 1 (2.27%) patient. Bronchial obstructive syndrome was observed in 5 (11.4%) patients, including 2 children with focal pneumonia and 3 with acute bronchitis.

Mixed etiology infection (Mycoplasma pneumoniae and Chlamydophila pneumoniae) was observed in 3 subjects (6.8%), including 1 boy with a diagnosis of acute bronchitis and 2 girls with pneumonia. Hemophilic bacillus was sown in sputum from 3 children (6.8%), including 1 boy with polysegmental pneumonia, and 2 girls with polysegmental and lobar pneumonia. When combined with hemophilic bacillus, pneumonia more often had a polysegmental lesion(r=0.42, p<0.05). Class G antibodies to cytomegalovirus were detected in 7 (15.9%) patients, 9(20.5%) patients – to Epstein-Barr virus, and 5 (11.4%) - to herpes virus type 6.

The disease was accompanied by fever in 38 (86.4%) patients, in 6 (13.6%) patients the disease proceeded without fever. Subfebrile fever accompanied patients with mycoplasma infection of the upper respiratory tract for an average of 4 (1.0; 9) days, with bronchitis-2 (1.0; 5.25) days, with pneumonia-2 (1.5; 7.5) days. Pyretic fever was observed only in patients with pneumonia for 4 (0.0; 6.5) days. Mycoplasma pneumonia was more often accompanied by febrile fever (r=0.31, p<0.05). Pyretic fever was observed in 2 patients with pneumonia caused by Mycoplasma pneumoniae, mainly in older children, among other groups there was no diagnosis. This type of fever was more often observed in children with a combination of mycoplasma infection with Haemophilus influenzae (r=0.37, p<0.05) and Chlamydophila pneumoniae (r=0.37, p<0.05). In older children, the disease was more frequent and prolonged with pyretic fever (r=0.33, p<0.05).

            Among patients with mycoplasma infection of the upper respiratory tract, rhinitis was observed in 2 patients (15%), with bronchitis-in 8 patients(66.6%), with pneumonia-in 5 patients (26.3%).

Pharyngitis was observed in 44 (100%) children of all groups. The average duration was 8 (6; 9) days in children with mycoplasma infection of the upper respiratory tract, 6.5(4; 9.5) days in patients with bronchitis, and 9 (8; 10) days in subjects with pneumonia.

Cough was observed in 6 patients(46.15%) with mycoplasma infection, for a duration of 7 (5.5; 7.5) days. In children with bronchitis and pneumonia, cough was observed in 100% of cases, by duration 7 (4,7; 10,3), 9 (8; 10) days, respectively. Children with pneumonia had a longer cough (r=0.48, p<0.05).

In children with mycoplasma infection of the upper respiratory tract, there were no complaints of decreased appetite, weakness was observed in 4 (30.7%) patients in the first days of the disease; 5 (41.6%) patients with bronchitis complained of decreased appetite and weakness; 11 patients(57.8%) with pneumonia complained of decreased appetite and weakness. appetite, 13 (68.4%) for general weakness.

Physical changes in the form of hard breathing persisted in children with bronchitis for an average of 6.5 (4.8; 10.3) days, with pneumonia-9 (8.0; 9.0) days. The data indicate a longer course of the disease and changes in the auscultation picture in children with pneumonia caused by M. Pneumoniae. Subjects with bronchitis had dry wheezing in 4(33.33%) patients, wet wheezing in 8 (66.7%) patients, lasting 7 (5.0; 8.8) days. Dry wheezing was observed in 6(31.5%) patients with pneumonia, while wet wheezing was observed in 16(84.2%) patients. In terms of duration, wet wheezing was heard for an average of 8 (7.0; 9.0) days.

In the course of a general blood test, leukocytosis was observed in 13 children(29.5%), leukopenia – in 3(6.8%). Leukopenia was more common in young children (r=0.3, p<0.05). Leukocytosis was observed in 4 (30.7%) patients with mycoplasma infection of the upper respiratory tract. Among the subjects with bronchitis, leukocytosis was observed in 5 patients (41.6%). In patients with pneumonia, 4 (21%) had leukocytosis, and 3(15.7%) had leukopenia.

An increase in the level of neutrophils among all subjects was observed in 12 children(27.3%), neutropenia – in 13(29.5%). Among patients with mycoplasma infection of the upper respiratory tract, neutrophilosis was observed in 4 patients (30.7%), and a decrease in the level of neutrophils – in 5 patients (38.5%). Among the subjects with bronchitis, an increase in neutrophil levels was observed in 5(41.6%) patients, neutropenia-in 4 (33.33%) children. In patients with pneumonia, neutrophilosis occurs in 3 patients(15.7%), and a decrease in the level of neutrophils – in 4(21%).

Lymphocytosis among all patients is observed in 10 (22.7%) cases, a decrease in the level of lymphocytes – in 11 (25%) patients. In subjects with mycoplasma infection of the upper respiratory tract, an increase in the level of lymphocytes was observed in 3 (23%) cases, lymphocytopenia – in 2 (15.4%) patients. In children with bronchitis, lymphocytosis is observed in 5 patients(41.6%), a decrease in the level of lymphocytes - in 3(25%). Among those hospitalized with pneumonia, an increase in the level of lymphocytes was observed in 2(10.5%) people, lymphocytopenia – in 6(31.5%). Among children with pneumonia, there is a tendency to lower the level of lymphocytes.

Acceleration of erythrocyte sedimentation rate was observed in 19 subjects(43.2%), including 6 (46.2%) with mycoplasma infection of the upper respiratory tract, 7 (58.3%) with bronchitis, 6 (31.5%) with a diagnosis of pneumonia caused by M.pneumoniae. C-reactive protein was elevated in 7 (15.9%) children.

Diagnosis was carried out using PCR studies and enzyme immunoassay, with the determination of IgM and IgG\levels. Sometimes a combination of\methods was used. PCR study was performed in 11 patients (25%), ELISA in 39 patients (88.6%), on average on 13.5 (5.5; 16.5) days of the disease.

Antibacterial therapy was used with drugs from the group of tetracyclines (Doxycycline), cephalosporins of the 3rd generation (Ceftriaxone), macrolides (Clarithromycin, Azithromycin). Among patients with mycoplasma infection of the upper respiratory tract, 7(53.8%) children received therapy with antibiotics from the macrolide group, lasting 10(8.5; 10.0) days, 4 (30.7%) children received an antibiotic from the tetracycline group, lasting an average of 7 (4.0; 9.0) days. Some patients continued antibiotic therapy at home. One child (7.6%) received combination therapy with macrolides and tetracyclines, 1 patient received only symptomatic treatment.

Treatment of patients with bronchitis in the hospital was carried out in 5 (41.6%) patients with antibiotics of the tetracycline group, lasting 8 (5.0; 9.0) days, in 4 (33.3%) children-with antibiotics from the macrolide group, lasting 5 (5.0; 6.0) days, 1(8.33%) the patient was treated with an antibacterial drug of the 3rd generation cephalosporin group, 7,5 (7,3; 7,7), 1 (8,33%) the patient received combined therapy with cephalosporins and macrolides.

10 (52.6%) patients with pneumonia received tetracycline therapy lasting 11 (9.5; 11.5) days, 7 (36.8%) patients received macrolides lasting 10 (8.0; 11.3) days, and 1 (5.2%) patient received a cephalosporin antibiotic third generation, lasting 10 days, 1 patient(5.2%) was prescribed 2 antibiotics from the group of macrolides and tetracyclines. Antibiotic therapy for mycoplasma pneumonia is the longest, in contrast to other clinical forms of the disease.

            Conclusion. Thus, it can be concluded that mycoplasma infections are a common disease affecting the respiratory tract, in most cases, in children of preschool and school age. The most severe pneumonia is caused by M. Pneumoniae in comparison with other forms, which is expressed by a longer retention of cough, physical changes, such as wet wheezing. The variety of clinical forms of the disease, an ambiguous picture of the general, biochemical blood analysis, and inflammatory markers can make it difficult to make a diagnosis in a short time, which can lead to the development of complications. It is necessary to apply specific diagnostic methods in a timely manner-serological methods, PCR - diagnostics of pharyngeal or sputum smears, testing for sensitivity to antibiotics, for making a diagnosis, prescribing effective pharmacotherapy and the onset of clinical recovery.

 

About the authors

Elizaveta Sergeevna Avdeeva

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: eavdeeva03@bk.ru
ORCID iD: 0009-0003-0175-9350
SPIN-code: 3238-6087

4th year student of the Faculty of Pediatrics

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Ekaterina Vladimirovna Solopova

Voronezh State Medical University named after N. N. Burdenko

Email: Ekarerinaa.16@mail.ru
ORCID iD: 0009-0005-9686-4894

4th year student of the Faculty of Pediatrics

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Anna Sergeevna Ivannikova

Voronezh State Medical University named after N. N. Burdenko

Email: ivannikofff@mail.ru
ORCID iD: 0000-0002-3664-6394

k. m. n., Associate Professor of the Department of Faculty and Palliative Pediatrics

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

Olga Vladimirovna Brykina

Voronezh State Medical University named after N. N. Burdenko

Email: infectionvrn03@mail.ru
ORCID iD: 0009-0002-8155-0110

Assistant of the Department of Faculty and Palliative Pediatrics

Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia

References

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