儿童危重症肺炎支原体肺炎的临床特征
Clinical Features of Fulminant Mycoplasma pneumoniae Pneumonia in Children
摘要: 肺炎支原体肺炎是儿童常见的社区获得性肺炎类型之一，一般症状较轻且具有自限性。然而，少数病例会出现严重威胁生命的并发症，需要生命支持，这类病例被定义为危重症肺炎支原体肺炎。自2023年起，肺炎支原体在国内外广泛流行，危重症患儿占比呈上升趋势。当前，针对该类危重症患儿的研究较少，且多以病案报道为主，各病例临床表现多样，导致患儿临床特征尚不明确，难以切实有力地支持临床治疗。本综述聚焦于归纳危重症肺炎支原体肺炎患儿的临床特征，以期为临床医生实现早期识别与及时有效治疗提供思路。
Abstract: Mycoplasma pneumoniae pneumonia is one of the common types of community-acquired pneumonia in children, typically presents with mild symptoms and exhibits self-limiting properties. However, in a few cases, severe life-threatening complications occur, which require life support. Such cases are defined as fulminant Mycoplasma pneumoniae pneumonia. Since 2023, Mycoplasma pneumoniae has been widely prevalent at home and abroad, and the proportion of fulminant children has shown an upward trend. At present, there are limited studies on fulminant Mycoplasma pneumoniae pneumonia, and most of them are case reports. The clinical manifestations of each case vary, resulting in unclear clinical characteristics of the children, which makes it difficult to provide strong support for clinical treatment. This paper focuses on summarizing the clinical characteristics of children with fulminant Mycoplasma pneumoniae pneumonia, aiming to provide ideas for clinicians to achieve early identification and timely and effective treatment.
文章引用：任怡昕, 代继宏. 儿童危重症肺炎支原体肺炎的临床特征[J]. 临床医学进展, 2025, 15(2): 1428-1435. https://doi.org/10.12677/acm.2025.152492

参考文献

[1] 中华人民共和国卫生健康委办公厅. 国家卫生健康委办公厅关于印发儿童肺炎支原体肺炎诊疗指南(2023年版)的通知[EB/OL]. 2023-02-06.
https://www.gov.cn/zhengce/zhengceku/2023-02/16/content_5741770.htm, 2024-12-13.
[2] Xie, X., Zhou, R., Ding, S., Ma, B., Zhang, X. and Zhang, Y. (2024) Emerging Trends and Concerns in Mycoplasma pneumoniae Pneumonia among Chinese Pediatric Population. Pediatric Research, 95, 1388-1390. [Google Scholar] [CrossRef] [PubMed]
[3] Bolluyt, D.C., Euser, S.M., Souverein, D., van Rossum, A.M., Kalpoe, J., van Westreenen, M., et al. (2024) Increased Incidence of Mycoplasma pneumoniae Infections and Hospital Admissions in the Netherlands, November to December 2023. Eurosurveillance, 29, Article ID: 2300724. [Google Scholar] [CrossRef] [PubMed]
[4] Nordholm, A.C., Søborg, B., Jokelainen, P., Lauenborg Møller, K., Flink Sørensen, L., Grove Krause, T., et al. (2024) Mycoplasma pneumoniae Epidemic in Denmark, October to December, 2023. Eurosurveillance, 29, Article ID: 2300707. [Google Scholar] [CrossRef] [PubMed]
[5] Edens, C., Clopper, B.R., DeVies, J., Benitez, A., McKeever, E.R., Johns, D., et al. (2024) Notes from the Field: Reemergence of Mycoplasma pneumoniae Infections in Children and Adolescents after the COVID-19 Pandemic, United States, 2018-2024. MMWR. Morbidity and Mortality Weekly Report, 73, 149-151. [Google Scholar] [CrossRef] [PubMed]
[6] Chan, E.D. and Welsh, C.H. (1995) Fulminant Mycoplasma pneumoniae Pneumonia. Western Journal of Medicine, 162, 133-142.
[7] Izumikawa, K., Izumikawa, K., Takazono, T., Kosai, K., Morinaga, Y., Nakamura, S., et al. (2014) Clinical Features, Risk Factors and Treatment of Fulminant Mycoplasma pneumoniae Pneumonia: A Review of the Japanese Literature. Journal of Infection and Chemotherapy, 20, 181-185. [Google Scholar] [CrossRef] [PubMed]
[8] Izumikawa, K. (2016) Clinical Features of Severe or Fatal Mycoplasma pneumoniae Pneumonia. Frontiers in Microbiology, 7, Article 800. [Google Scholar] [CrossRef] [PubMed]
[9] Rollins, S., Colby, T. and Clayton, F. (1986) Open Lung Biopsy in Mycoplasma pneumoniae Pneumonia. Archives of Pathology & Laboratory Medicine, 110, 34-41.
[10] Maisel, J.C. (1967) Fatal Mycoplasma pneumoniae Infection with Isolation of Organisms from Lung. JAMA: The Journal of the American Medical Association, 202, 287-290. [Google Scholar] [CrossRef] [PubMed]
[11] Kannan, T.R., Hardy, R.D., Coalson, J.J., Cavuoti, D.C., Siegel, J.D., Cagle, M., et al. (2011) Fatal Outcomes in Family Transmission of Mycoplasma pneumoniae. Clinical Infectious Diseases, 54, 225-231. [Google Scholar] [CrossRef] [PubMed]
[12] Koletsky, R.J. and Weinstein, A.J. (1980) Fulminant Mycoplasma pneumoniae Infection. Report of a Fatal Case, and a Review of the Literature. American Review of Respiratory Disease, 122, 491-496.
[13] Miyashita, N., Obase, Y., Ouchi, K., Kawasaki, K., Kawai, Y., Kobashi, Y., et al. (2007) Clinical Features of Severe Mycoplasma pneumoniae Pneumonia in Adults Admitted to an Intensive Care Unit. Journal of Medical Microbiology, 56, 1625-1629. [Google Scholar] [CrossRef] [PubMed]
[14] Chen, X., Liu, F., Zheng, B., Kang, X., Wang, X., Mou, W., et al. (2022) Exhausted and Apoptotic BALF T Cells in Proinflammatory Airway Milieu at Acute Phase of Severe Mycoplasma pneumoniae Pneumonia in Children. Frontiers in Immunology, 12, Article 760488. [Google Scholar] [CrossRef] [PubMed]
[15] Gao, M., Wang, K., Yang, M., Meng, F., Lu, R., Zhuang, H., et al. (2018) Transcriptome Analysis of Bronchoalveolar Lavage Fluid from Children with Mycoplasma pneumoniae Pneumonia Reveals Natural Killer and T Cell-Proliferation Responses. Frontiers in Immunology, 9, Article 1403. [Google Scholar] [CrossRef] [PubMed]
[16] Narita, M. (2016) Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Frontiers in Microbiology, 7, Article 23. [Google Scholar] [CrossRef] [PubMed]
[17] Hon, K.L., Leung, A.S.Y., Cheung, K.L., Fu, A.C., Chu, W.C.W., Ip, M., et al. (2014) Typical or Atypical Pneumonia and Severe Acute Respiratory Symptoms in PICU. The Clinical Respiratory Journal, 9, 366-371. [Google Scholar] [CrossRef] [PubMed]
[18] Lee, K., Lee, C., Yang, T., Yen, T., Chang, L., Chen, J., et al. (2021) Severe Mycoplasma pneumoniae Pneumonia Requiring Intensive Care in Children, 2010-2019. Journal of the Formosan Medical Association, 120, 281-291. [Google Scholar] [CrossRef] [PubMed]
[19] Ling, Y., Zhang, T., Guo, W., Zhu, Z., Tian, J., Cai, C., et al. (2020) Identify Clinical Factors Related to Mycoplasma pneumoniae Pneumonia with Hypoxia in Children. BMC Infectious Diseases, 20, Article No. 534. [Google Scholar] [CrossRef] [PubMed]
[20] Wang, Y., Zhou, Y., Bai, G., Li, S., Xu, D., Chen, L., et al. (2024) Expert Consensus on the Diagnosis and Treatment of Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Children. World Journal of Pediatrics, 20, 901-914. [Google Scholar] [CrossRef] [PubMed]
[21] Chen, Y., Hsu, W. and Chang, T. (2020) Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia. Emerging Infectious Diseases, 26, 1382-1391. [Google Scholar] [CrossRef] [PubMed]
[22] Zhang, T., Han, C., Guo, W., Ning, J., Cai, C. and Xu, Y. (2021) Case Report: Clinical Analysis of Fulminant Mycoplasma pneumoniae Pneumonia in Children. Frontiers in Pediatrics, 9, Article 741663. [Google Scholar] [CrossRef] [PubMed]
[23] Ding, L., Zhao, Y., Li, X., Wang, R., Li, Y., Tang, X., et al. (2020) Early Diagnosis and Appropriate Respiratory Support for Mycoplasma pneumoniae Pneumonia Associated Acute Respiratory Distress Syndrome in Young and Adult Patients: A Case Series from Two Centers. BMC Infectious Diseases, 20, Article No. 367. [Google Scholar] [CrossRef] [PubMed]
[24] Zhang, X. and Yu, Y. (2023) Severe Pediatric Mycoplasma Pneumonia as the Cause of Diffuse Alveolar Hemorrhage Requiring Veno-Venous Extracorporeal Membrane Oxygenation: A Case Report. Frontiers in Pediatrics, 10, Article 925655. [Google Scholar] [CrossRef] [PubMed]
[25] Van Bever, H.P., Van Doorn, J.W.D. and Demey, H.E. (1992) Adult Respiratory Distress Syndrome Associated with Mycoplasma pneumoniae Infection. European Journal of Pediatrics, 151, 227-228. [Google Scholar] [CrossRef] [PubMed]
[26] Liu, J., He, R., Wu, R., Wang, B., Xu, H., Zhang, Y., et al. (2020) Mycoplasma pneumoniae Pneumonia Associated Thrombosis at Beijing Children’s Hospital. BMC Infectious Diseases, 20, Article No. 51. [Google Scholar] [CrossRef] [PubMed]
[27] Park, S.J., Pai, K.S., Kim, A.R., Lee, J.H., Shin, J.I. and Lee, S.Y. (2012) Fulminant and Fatal Multiple Organ Failure in a 12-Year-Old Boy Withmycoplasma Pneumoniaeinfection. Allergy, Asthma and Immunology Research, 4, 55-57. [Google Scholar] [CrossRef] [PubMed]
[28] Moynihan, K.M., Barlow, A., Nourse, C., Heney, C., Schlebusch, S. and Schlapbach, L.J. (2018) Severe Mycoplasma pneumoniae Infection in Children Admitted to Pediatric Intensive Care. Pediatric Infectious Disease Journal, 37, e336-e338. [Google Scholar] [CrossRef] [PubMed]
[29] Leonardi, S., Pavone, P., Rotolo, N. and La Rosa, M. (2005) Stroke in Two Children with Mycoplasma pneumoniae Infection a Causal or Casual Relationship? The Pediatric Infectious Disease Journal, 24, 843-845. [Google Scholar] [CrossRef] [PubMed]
[30] Stettner, M., Albrecht, P., Derksen, A., Hartmann, C., Turowski, B., Neuen-Jacob, E., et al. (2012) Clinical Improvement Precedes Lesion Size Regression in a Severe Case of Acute Disseminated Encephalomyelitis. BMJ Case Reports, 2012, bcr-2012-006844. [Google Scholar] [CrossRef] [PubMed]
[31] Guo, Y., Yang, L., Shao, S., Zhang, N., Hua, Y., Zhou, K., et al. (2023) Coronary Artery Dilation in Children with Febrile Illnesses Other than Kawasaki Disease: A Case Report and Literature Review. Heliyon, 9, e21385. [Google Scholar] [CrossRef] [PubMed]
[32] Gu, L., Chen, X., Li, H., Qu, J., Miao, M., Zhou, F., et al. (2014) A Case of Lethal Hemolytic Anemia Associated with Severe Pneumonia Caused by Mycoplasma Pneumoniae. Chinese Medical Journal, 127, 3839. [Google Scholar] [CrossRef] 
[33] Kurugol, Z., Onen, S.S. and Koturoglu, G. (2012) Severe Hemolytic Anemia Associated with Mild Pneumonia Caused by Mycoplasma pneumonia. Case Reports in Medicine, 2012, Article ID: 649850. [Google Scholar] [CrossRef] [PubMed]
[34] Xu, F., Dai, C., Wu, X. and Chu, P. (2011) Overwhelming Postsplenectomy Infection Due to Mycoplasma pneumoniae in an Asplenic Cirrhotic Patient: Case Report. BMC Infectious Diseases, 11, Article No. 162. [Google Scholar] [CrossRef] [PubMed]
[35] Shen, Y.L., Zhang, J., Hu, Y.H. and Shen, K.L. (2012) Combination Therapy with Immune-Modulators and Moxifloxacin on Fulminant Macrolide-Resistant Mycoplasma pneumoniae Infection: A Case Report. Pediatric Pulmonology, 48, 519-522.
[36] Tagliabue, C., Salvatore, C.M., Techasaensiri, C., Mejias, A., Torres, J.P., Katz, K., et al. (2008) The Impact of Steroids Given with Macrolide Therapy on Experimental Mycoplasma pneumoniae Respiratory Infection. The Journal of Infectious Diseases, 198, 1180-1188. [Google Scholar] [CrossRef] [PubMed]
[37] Radisic, M., Torn, A., Gutierrez, P., Defranchi, H.A. and Pardo, P. (2000) Severe Acute Lung Injury Caused by Mycoplasma pneumoniae: Potential Role for Steroid Pulses in Treatment. Clinical Infectious Diseases, 31, 1507-1511. [Google Scholar] [CrossRef] [PubMed]
[38] Tsuruta, R., Kawamura, Y., Inoue, T., Kasaoka, S., Sadamitsu, D. and Maekawa, T. (2002) Corticosteroid Therapy for Hemolytic Anemia and Respiratory Failure Due to Mycoplasma pneumoniae Pneumonia. Internal Medicine, 41, 229-232. [Google Scholar] [CrossRef] [PubMed]
[39] Tamura, A., Matsubara, K., Tanaka, T., Nigami, H., Yura, K. and Fukaya, T. (2008) Methylprednisolone Pulse Therapy for Refractory Mycoplasma pneumoniae Pneumonia in Children. Journal of Infection, 57, 223-228. [Google Scholar] [CrossRef] [PubMed]
[40] Okumura, T., Kawada, J., Tanaka, M., Narita, K., Ishiguro, T., Hirayama, Y., et al. (2019) Comparison of High-Dose and Low-Dose Corticosteroid Therapy for Refractory Mycoplasma pneumoniae Pneumonia in Children. Journal of Infection and Chemotherapy, 25, 346-350. [Google Scholar] [CrossRef] [PubMed]
[41] Heith, C.S., Hume, J.R., Steiner, M.E. and Fischer, G.A. (2018) Fulminant Mycoplasma Infection Requiring ECMO in a Previously Healthy Child: Case Report and Review. Journal of Pediatric Intensive Care, 7, 106-109.

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