Clinical Diagnosis and Treatment of 31 Children with Mycoplasma pneumoniae Necrotizing Pneumonia

Zhaoxia Wang,1 Yuxin Zhao,2 Hongfang Liu3 1Department of Pediatrics, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong, People’s Republic of China; 2Department of Ophthalmology, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong, People’s Republic of China; 3Department of Standardized Training Management for Resident Physicians, Weihai Central Hospital Affiliated to Qingdao University, Weihai, Shandong, People’s Republic of ChinaCorrespondence: Zhaoxia Wang, Department of Pediatrics, Weihai Central Hospital Affiliated to Qingdao University, No. 3, West of Mishan East Road, Wendeng District, Weihai, Shandong, 264400, People’s Republic of China, Email [email protected]: This study aimed to summarize the clinical characteristics and outcomes of necrotizing pneumonia caused by Mycobacterium pneumoniae in children.Methods: The clinical features, accessory examinations, treatments, and prognoses of 31 children with M. pneumoniae necrotizing pneumonia admitted to our hospital between January 2020 and June 2023 were retrospectively analyzed.Results: There were 31 patients, including 14 males and 17 females, with an average age of (6.77 ± 0.98) years. The length of hospitalization was 23.38 ± 5.56 days, with an average length of fever (22.10 ± 5.64) days. At the beginning of the disease, all patients had high fever and cough. Respiratory sounds were reduced in 29 cases, rales were audible in 13 cases, and wheezing sounds were audible in 4 cases. Pulmonary imaging revealed multiple alveolar or cavity formations in the lung consolidation areas and pleural effusion in 29 cases. The peak value of WBC in peripheral blood was (17.84 ± 3.72) × 109/L, and the proportion of neutrophils was (80.83 ± 4.19) %. C-reactive protein peak was (131.68 ± 36.47) mg/L, and D-dimer peak value was (6.79 ± 2.22) mg/L; The course of pulmonary necrosis was (11.61 ± 3.48) days. Bronchoscopy and lavage were performed on 30 patients. Two patients underwent closed thoracic drainage, and one patient underwent pulmonary lobectomy. After comprehensive treatment with macrolide antibiotics and glucocorticoids, the patient’s prognosis improved.Conclusion: Mycoplasma pneumoniae necrotizing pneumonia is more common in preschool and school-aged children with a long heat course and hospital stay. When WBC, neutrophil ratio, D-dimer, and C-reactive protein levels increase significantly, combined with pleural effusion, CT examination of the lungs should be performed to identify M. pneumoniae necrotizing pneumonia at an early stage. Despite a long disease course, most patients have a good prognosis after active treatment.Keywords: Mycoplasma pneumoniae, necrotizing pneumonia, children