AiM  Vol.4 No.11 , September 2014
Status of Mycoplasma pneumoniae Pneumonia in Chinese Children: A Systematic Review
Abstract: Mycoplasma pneumoniae pneumonia (MPP) becomes one of the most important health problems in China recently. Date for MPP inChinais scarce. Although macrolides and/or cortical steroids had been reported to be effective treatment for MPP, the long-term outcome remained uncertain. A study on status of MPP in China was conducted via a systematic review of published studies which have the Chinese data and collected from published PubMed and core journals of China Knowledge Resource Integrated Database (CNKI). The analysis was based on epidemiology, clinical characteristics, treatment, drug resistance and prognosis. Twenty five articles concerned about MPP in Chinese children and adolescent were enrolled, including 11 studies on epidemiology/etiology, 11 studies on clinical characteristics, 7 studies on drug resistance, 5 studies on treatment from mainland China respectively. The overall incidence of MPP ranged from 7.1% to 54.4%. Fever and cough were most frequently identified in manifestations. Drug resistance to macrolides ranged from 18.9% to 90%. The outcome of treatment in patients who received combined treatment of macrolides, cephalosporin antibiotics and/or cortical steroid seems to be better than those who received macrolides only. Macrolide combined with cephalosporin or cortical steroid both may decrease the severity of MPP in the past decade. There was not enough evidence to suggest that cortical steroid can decrease the mortality of MPP in children. And a multi-center, randomized double blind research on the effect of cortical steroid was encouraged.
Cite this paper: Qin, Q. , Xu, B. , Liu, X. and Shen, K. (2014) Status of Mycoplasma pneumoniae Pneumonia in Chinese Children: A Systematic Review. Advances in Microbiology, 4, 704-711. doi: 10.4236/aim.2014.411076.

[1]   Himmelreich, R., Hilbert, H., Plagens, H., Pirkl, E., Li, B.C. and Herrmann, R. (1996) Complete Sequence Analysis of the Genome of the Bacterium Mycoplasma pneumoniae. Nucleic Acids Research, 24, 4420-4449.

[2]   Zhao, H., Li, S., Cao, L., Yuan, Y., Xue, G., Feng, Y., Yan, C., Wang, L., Fan, Z. and Sun, H. (2014) Surveillance of Mycoplasma pneumoniae Infection among Children in Beijing from 2007 to 2012. Chinese Medical Journal, 127, 1244-1248.

[3]   Ngeow, Y.F., Suwanjutha, S., Chantarojanasriri, T., Wang, F., Saniel, M., Alejandria, M., et al. (2005) An Asian Study on the Prevalence of Atypical Respiratory Pathogens in Community-Acquired Pneumonia. International Journal of Infectious Diseases, 9, 144-153.

[4]   Nour, M., Trabelsi, A., Maatouk, N. and Hammami, M. (2005) Amplification of P1 and 16S rRNA Genes by Nested PCR for Detection of Mycoplasma pneumoniae in Paediatric Patients. Pathologie Biologie, 53, 9-14.

[5]   Rudan, I., El Arifeen, S., Bhutta, Z.A., Black, R.E., Brooks, A., et al. (2011) Setting Research Priorities to Reduce Global Mortality from Childhood Pneumonia by 2015. PLoS Medicine, 8, Article ID: e1001099.

[6]   World Health Organization -Western Pacific Region Library.

[7]   World Health Organization -Regional Office for Southe-East Asia Library.

[8]   Ma, Z., Zheng, Y., Deng, J., Ma, X. and Liu, H. (2010) Characterization of Macrolide Resistance in Mycoplasma pneumoniae Isolated from Children in Shanghai, China. Diagnostic Microbiology and Infectious Disease, 67, 355-358.

[9]   Liu, G., Talkington, D.F., Fields, B.S., Levine, O.S., Yang, Y. and Tondella, M.L. (2005) Chlamydia Pneumoniae and Mycoplasma pneumoniae in Young Children from China with Community-Acquired Pneumonia. Diagnostic Microbiology and Infectious Disease, 52, 7-14.

[10]   He, X.Y., Wang, X.B., Zhang, R., Yuan, Z.J., Tan, J.J., Peng, B., Huang, Y., Liu, E.M., Fu, Z., Bao, L.M. and Zou, L. (2013) Investigation of Mycoplasma pneumoniae Infection in Pediatric Population from 12,025 Cases with Respiratory Infection. Diagnostic Microbiology and Infectious Disease, 75, 22-27.

[11]   Cao, B., Zhao, C.J., Yin, Y.D., Zhao, F., Song, S.F., Bai, L., Zhang, J.Z., Liu, Y.M., Zhang, Y.Y., Wang, H. and Wang, C. (2010) High Prevalence of Macrolide Resistance in Mycoplasma pneumoniae Isolates from Adult and Adolescent Patients with Respiratory Tract Infection in China. Clinical Infectious Diseases, 51, 189-194.

[12]   Ou, Z.-Y., Zhou, R., Wang, F.-H., Lu, J.-P., Xia, J.-Q., Xia, H.-M., Zhang, J.-T., Gong, S.-T., Deng, L., Wu, Z.-H. and Zeng, Q.-Y. (2008) Retrospective Analysis of Mycoplasma pneumoniae Infection in Pediatric Fatal Pneumonia in Guangzhou, South China. Clinical Pediatrics, 47, 791-796.

[13]   Yang, A.M., Song, J.H., Huang, R., Jin, S.J. and Yang, P. (2013) Mycoplasma pneumoniae Infection and Drug Resistance in Children: An Analysis of 1026 Cases. Chinese Journal of Contemporary Pediatrics, 15, 522-525.

[14]   Xin, D., Mi, Z., Han, X., Qin, L., Li, J., Wei, T., Chen, X., Ma, S., Hou, A., Li, G. and Shi, D. (2009) Molecular Mechanisms of Macrolide Resistance in Clinical Isolates of Mycoplasma pneumoniae from China. Antimicrobial Agents and Chemotherapy, 53, 2158-2159.

[15]   Jiang, Y., Liu, X.J., Qin, X.G., Dong, Y.Q., Dong, X.P. and Xin, D.L. (2013) Drug Resistance of MP and Its Mechanism: A Study of Children in Beijing Distinct in 2011. Chinese Journal of General Practitioners, 16, 3778-3782.

[16]   Lu, A., Wang, L., Zhang, X. and Zhang, M. (2011) Combined Treatment for Child Refractory Mycoplasma pneumoniae Pneumonia with Ciprofloxacin and Glucocorticoid. Pediatric Pulmonology, 46, 1093-1097.

[17]   Zhang, Q., Guo, Z., Bai, Z. and MacDonald, N.E. (2013) A 4 Year Prospective Study to Determine Risk Factors for Severe Community Acquired Pneumonia in Children in Southern China. Pediatric Pulmonology, 48, 390-397.

[18]   Zhao, H., Li, S., Cao, L., Yuan, Y., Xue, G., Feng, Y., Yan, C., Wang, L., Fan, Z. and Sun, H. (2014) Surveillance of Mycoplasma pneumoniae Infection among Children in Beijing from 2007 to 2012. Chinese Medical Journal (English Edition), 127, 1244-1248.

[19]   Cui, S.-N., GU, L. and He, F. (2012) Clinical Observation on Efficacy of Azithromycin Combined with Ceftriaxone Sodium in the Treatment of Refractory Mycoplasma pneumoniae Pneumonia in Children. World Clinical Drugs, 33, 743-747.

[20]   Wu, X.-X., Shen, J. and Zheng, Y.-P. (2013) Observation on Efficacy and Safety of Azithromycin in the Treatment of Mycoplasma pneumonia in Children. Chinese Journal of Nonocomiology, 23, 5798-5800.

[21]   Wu, X.-J. (2014) Clinical Observation of 68 Cases of Azithromycin Injection Treatment of Mycoplasma pneumonia in Children. Chinese Journal of Modern Drug Application, 8, 160-161.

[22]   Zhang, T., Wang, B., Wang, H.Q., Tang, Y.P., Liu, M.L., Peng, S.M., et al. (2014) Correlation between Drug Resistance and Clinical Treatment of Mycoplasma pneumoniae. Chinese Journal of Obstetrics Gynecology and Pediatrics (Electronic Edition), 10, 29-40.

[23]   Sun, X.-Q. (2013) Analysis of Mycoplasma pneumonia in Children and Clinical Features of 216 Cases with Pulmonary Complications. A Guide to Chinese Medicine, 11, 437-438.

[24]   Zhang, Y.-M., Liu, X.-Y. and Jiang, Z.-F. (2010) One-Year Follow-Up Study for Mycoplasma pneumoniae Pneumonia with Pulmonary Atelectasis Complications. Chinese Journal of Practical Pediatrics, 25, 143-146.

[25]   Gao, H., Luo, Z.-X., Luo, J., Xu X.-J., Liu, E.-M. and Fu, Z. (2013) Clinical Risk Factor for Children with Mycoplasma pneumoniae Pneumonia Sequelae. Chongqing Medical University, 38, 165-167.

[26]   Tan, Z.-T. (2013) Study on the Clinical Manifestation and Pathogenesis of Mycoplasma pneumoniae Pneumonia in Children. Maternal and Child Health Care of China, 28, 5467-5468.

[27]   Ke, L.-Q., Wang, F.-M., Li, Y.-J. and Luo, Y.-C. (2013) Epidemiological Characteristics of Mycoplasma pneumoniae Pneumonia in Children. Chinese Journal of Contemporary Pediatrics, 15, 33-36.

[28]   Xu, Y.-C., Zhu, L.-J., Xu, D., Tao, X.-F., Li, S.-X., Tang, L.-F. and Chen, Z.-M. (2011) Epidemiological Characteristics and Meteorological Factors of Childhood Mycoplasma pneumoniae Pneumonia in Hangzhou. World Journal of Pediatrics, 7, 240-244.

[29]   Liu, X.-Yu., Wei, Z.-Q., Wang, D.-D. and Suo, J.-Y. (2013) Analysis of 46 Cases of Infant Pneumonia Mycoplasma pneumonia. People’s Military Surgeon, 56, 1328-1329.

[30]   Ren, L.-X., Dong, H.-Q., Ning, J., Guo, W. and Wan, L.-Y. (2013) Analysis and Pulmonary Function and Fiberoptic Bronchoscopy Clinical and Imaging Features of Mycoplasma pneumonia in Infants. Guangdong Medical Journal, 34, 2686-2688.

[31]   Shi, X., Yu, F. and Huang, Q.-L. (2014) Clinical Manifestation of Children with Mycoplasma pneumonia. Chinese Journal of Nosocomiology, 206-210.

[32]   Jiao, A.X., Rao, X.C., Jiang, Q.B., Ma, Y.Y., Pan, Y.N., Hu, Y.H. and Liu, X.C. (2010) Comparative Study of Persistent and Non Persistent Pneumonia Mycoplasma pneumonia in Children with Airway Mucosal Injury. Chinese Journal of Evidence-Based Pediatrics, 3, 111-115.

[33]   Lim, W.S., Macfarlane, J.T., Boswell, T.C., Harrison, T.G., Rose, D., et al. (2001) Study of Community Acquired Pneumonia Aetiology (SCAPA) in Adults Admitted to Hospital: Implications for Management Guidelines. Thorax, 56, 296-301.

[34]   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.

[35]   Loens, K., Beck, T., Ursi, D., Overdijk, M., Sillekens, P., Goossens, H., et al. (2008) Development of Real-Time Multiplex Nucleic Acid Sequence-Based Amplification for Detection of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella spp. in Respiratory Specimens. Journal of Clinical Microbiology, 46, 185-191.

[36]   Thurman, K.A., Warner, A.K., Cowart, K.C., Benitez, A.J. and Winchell, J.M. (2011) Detection of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. in Clinical Specimens Using a Single-Tube Multiplex Real-Time PCR Assay. Diagnostic Microbiology and Infectious Disease, 70, 1-9.

[37]   Waites, K.B., Balish, M.F. and Atkinson, T.P. (2008) New Insights into the Pathogenesis and Detection of Mycoplasma pneumoniae Infections. Future Microbiology, 3, 635-648.

[38]   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.

[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.

[40]   Shen, Y.L., Zhang, J., Hu, Y.H. and Shen, K.L. (2013) Combination Therapy With Immune-Modulators and Moxifloxacin on Fulminant Macrolide-Resistant Mycoplasma pneumoniae Infection: A Case Report. Pediatric Pulmonology, 48, 519-522.