Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children
Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fe...
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doaj-96646722517f46488dd1b99149b100522021-08-22T04:28:39ZengElsevierJournal of Microbiology, Immunology and Infection1684-11822021-08-01544557565Rational stepwise approach for Mycoplasma pneumoniae pneumonia in childrenTi-An Tsai0Chang-Ku Tsai1Kuang-Che Kuo2Hong-Ren Yu3Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, TaiwanDepartment of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, TaiwanCorresponding author. Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, #123, Ta-Pei Road, Niao-Sung District, Kaohsiung, Taiwan. Fax: +886 7 733 8009.; Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, TaiwanMycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fever and clinical deterioration may occur, leading to severe disease. Two major complicated conditions that may be clinically encountered are macrolide-resistant MPP and refractory MPP. Regarding the epidemics in Taiwan, before 2017, the mean rate of macrolide resistance was below 30%. Notably, since 2018, the prevalence of macrolide-resistant MPP in Taiwan has increased rapidly. Macrolide-resistant MPP shows persistent fever and/or no radiological regression to macrolide antibiotics and may even progress to severe and complicated pneumonia. Tetracyclines (doxycycline or minocycline) or fluoroquinolones are alternative treatments for macrolide-resistant MPP. Refractory MPP is characterized by an excessive immune response against the pathogen. In this context, corticosteroids have been suggested as an immunomodulator for downregulating the overactive host immune reaction. Overuse of macrolides may contribute to macrolide resistance, and thereafter, an increase in macrolide-resistant MPP. Delayed effective antimicrobial treatment is associated with prolonged and/or more severe disease. Thus, the appropriate prescription of antibiotics, as well as the rapid and accurate diagnosis of MPP, is important. The exact starting point, dose, and duration of the immunomodulator are yet to be established. We discuss these important issues in this review.http://www.sciencedirect.com/science/article/pii/S1684118220302474M. pneumoniae pneumoniaMacrolide-resistanceRefractory mycoplasma pneumoniae pneumoniaCorticosteroid |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ti-An Tsai Chang-Ku Tsai Kuang-Che Kuo Hong-Ren Yu |
spellingShingle |
Ti-An Tsai Chang-Ku Tsai Kuang-Che Kuo Hong-Ren Yu Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children Journal of Microbiology, Immunology and Infection M. pneumoniae pneumonia Macrolide-resistance Refractory mycoplasma pneumoniae pneumonia Corticosteroid |
author_facet |
Ti-An Tsai Chang-Ku Tsai Kuang-Che Kuo Hong-Ren Yu |
author_sort |
Ti-An Tsai |
title |
Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children |
title_short |
Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children |
title_full |
Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children |
title_fullStr |
Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children |
title_full_unstemmed |
Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children |
title_sort |
rational stepwise approach for mycoplasma pneumoniae pneumonia in children |
publisher |
Elsevier |
series |
Journal of Microbiology, Immunology and Infection |
issn |
1684-1182 |
publishDate |
2021-08-01 |
description |
Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fever and clinical deterioration may occur, leading to severe disease. Two major complicated conditions that may be clinically encountered are macrolide-resistant MPP and refractory MPP. Regarding the epidemics in Taiwan, before 2017, the mean rate of macrolide resistance was below 30%. Notably, since 2018, the prevalence of macrolide-resistant MPP in Taiwan has increased rapidly. Macrolide-resistant MPP shows persistent fever and/or no radiological regression to macrolide antibiotics and may even progress to severe and complicated pneumonia. Tetracyclines (doxycycline or minocycline) or fluoroquinolones are alternative treatments for macrolide-resistant MPP. Refractory MPP is characterized by an excessive immune response against the pathogen. In this context, corticosteroids have been suggested as an immunomodulator for downregulating the overactive host immune reaction. Overuse of macrolides may contribute to macrolide resistance, and thereafter, an increase in macrolide-resistant MPP. Delayed effective antimicrobial treatment is associated with prolonged and/or more severe disease. Thus, the appropriate prescription of antibiotics, as well as the rapid and accurate diagnosis of MPP, is important. The exact starting point, dose, and duration of the immunomodulator are yet to be established. We discuss these important issues in this review. |
topic |
M. pneumoniae pneumonia Macrolide-resistance Refractory mycoplasma pneumoniae pneumonia Corticosteroid |
url |
http://www.sciencedirect.com/science/article/pii/S1684118220302474 |
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