Analysis of the risk factors and clinical features of Mycoplasma pneumoniae pneumonia with embolism in children: a retrospective study

Abstract

Background Mycoplasmapneumoniae pneumonia (MPP) is a prevalent disease in community-acquired pneumonia among children. However, in addition to respiratory manifestations, it may also develop extra-pulmonary complications. Embolism is one of the uncommon extra-respiratory manifestations prone to severe sequelae and even death. This study aims to analyze the clinical features of MPP with embolism in children, and explore the associated risk factors of embolism in MPP patients. Methods A retrospective case–control analysis was performed on 48 children with MPP admitted to our hospital wards between January 2010 and December 2021. Embolism group comprised children with embolism by CTA or MRA results, whereas the non-embolism group comprised children with clinical suspicion of embolism but negative diagnostic imaging support. The clinical features, laboratory findings and imaging were analyzed to explore the risk factors for embolism in children with MPP. Results A total of 48 children with MPP were enrolled in the study (16 cases and 32 controls). In the embolism group, 10 patients (62.5%) had pulmonary embolism, 3 patients (18.75%) presented ventricle embolism, 2 patients (12.5%) presented cerebral and carotid artery embolism, one patient (6.25%) had a cerebral embolism, limb, and spleen, respectively. The univariate analysis revealed the maximum body temperature (Tmax), CRP, D-dimer (closest to CTA/MRA), the percentage of neutrophils (N%), pulmonary consolidation (⩾ 2/3 lobe), pleural effusion and atelectasis have significant differences between the embolism group and non-embolism group (P < 0.05). Multivariate logistic regression analysis showed that D-dimer (closest to CTA/MRA) > 3.55 mg/L [OR = 1.255 (95% CI: 1.025—1.537), P < 0.05], pulmonary consolidation (⩾ 2/3 lobe) [OR = 8.050 (95% CI: 1.341—48.327), P < 0.05], and pleural effusion [OR = 25.321 (95% CI: 2.738—234.205), P < 0.01] were independent risk factors for embolism in children with MPP. Conclusion In conclusion, MPP with embolism patients have more D-dimer values and severe radiologic manifestations.

Pulmonary Thrombotic Complication of Mycoplasma pneumoniae Pneumonia in Chinese Children: Clinical Feature and Risk Factor Analysis

“…Liu et al 4 reported that D-dimer >11.1 mg/L was useful for the early diagnosis of thrombus formation in pediatric MPP patients. Han et al’s 5 study found that D-dimer (closest to CTA/MRA) >3.55 mg/L was an independent risk factor for thrombotic complications in MPP children. Our study showed that D-dimer was a significant predictor of PT in SMPP patients, with an optimal cutoff value of 3.98 µg/mL, which was in agreement with the results of Han et al…”

“…1,2 Although traditionally regarded as a self-limiting disease, it has recently garnered increased attention due to its association with serious complications, particularly vascular thrombotic diseases. 3,4 Pulmonary thrombosis (PT) is the most frequent thrombotic complication of MPP in children, 4,5 and domestic literature reports that Mycoplasma pneumoniae (MP) infection is one of the main risk factors for PT in this population. 6 Without timely diagnosis and treatment, PT ranks as the third leading cause of MPP-related mortality.…”

Extensive and Progressive Cerebral Infarction Associated with Mycoplasma pneumoniae Infection. A Case Report and Literature Review

“…Therefore, it's of vital signi cance to nd risk factors which indicate severe extra-pulmonary complication like cerebral infarction based on clinical manifestations, biochemical examinations and chest radiography. A retrospective casecontrol analysis [17] performed on 48 children with MP pneumonia found that pulmonary consolidation (⩾2/3 lobe), and pleural effusion were independent risk factors for embolism in children with MPP. In our literature review, 19/35 (54%) patients were found to have consolidation and 12/35 (34%) patients have pleural uid.…”

“…Thus, a hypercoagulable state combined with impaired endothelial anticoagulant function would facilitate subsequent embolism and lead to cerebral artery occlusion. MP infection can promote the body to produce auto-antibodies such as anticardiolipin antibodies (ACA), β2-glycoprotein antibodies or lupus anticoagulant antibodies, and then form immune complexes, resulting in the injury of respiratory tract and other organs outside the lungs [17]. Therefore, vasculitis is another mechanism causing cerebral infarction.…”

Intracardiac and Cerebral Thrombosis Complicated With Mycoplasma Pneumonia

“…Severe mycoplasma pneumonia with pulmonary consolidation was the most strongly associated risk factor for thrombosis. Among those cases reported from the embolism group, most cases are extracted from pulmonary embolism, whereas ventricle or cerebral embolism occurs rarely [ 17 ].…”