Effects of Methylprednisolone Pulse Therapy on RefractoryMycoplasma pneumoniaePneumonia in Children

Abstract

PurposeMycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. The clinical course is typically self-limited and benign; however, rare cases of severe pneumonia can develop despite appropriate antibiotic therapy. We studied the effects of methylprednisolone pulse therapy on severe refractory M. pneumoniae pneumonia in children.MethodsThe clinical effects of methylprednisolone therapy were evaluated retrospectively in 12 children with severe refractory M. pneumoniae pneumonia, which was diagnosed serologically. All patients developed respiratory distress, high fever, and initial lobar pneumonic consolidation based on radiological findings. All clinical symptoms deteriorated despite appropriate antibiotic therapy. Thus, children were treated with intravenous methylprednisolone pulse therapy in addition to antibiotics.ResultsThe average febrile period before admission was 4.9±1.7 days, and fever persisted in all children until steroid administration. Methylprednisolone pulse therapy (30 mg/kg) was given 5.4±2.5 days after admission. After methylprednisolone pulse therapy, clinical symptoms improved in all patients without adverse events. The fever subsided 0-2 h after initiation of corticosteroid therapy. The abnormal radiological findings resolved within 2.6±1.3 days, and the high C-reactive protein levels (6.7±5.9 mg/dL) on admission decreased to 1.3±1.7 mg/dL within 3.0±1.1 days after starting corticosteroid therapy.ConclusionsThree-day methylprednisolone pulse therapy could be applied to treatment of refractory M. pneumoniae pneumonia despite appropriate antibiotic therapy and appeared to be efficacious and well-tolerated.

Lactate Dehydrogenase as a Biomarker for Prediction of RefractoryMycoplasma pneumoniaePneumonia in Children

“…10,11 Clinically, corticosteroids have been used for refractory M. pneumoniae pneumonia and have a dramatic beneficial effect in both children and adults. 2,4,12 Clinicians must be cognizant of children with M. pneumoniae pneumonia at risk for developing refractory or serious illnesses and initiate steroid therapy in a timely fashion. Thus, it is desirable to predict refractory illness as soon as possible.…”

The clinical characteristics of corticosteroid-resistant refractory Mycoplasma Pneumoniae pneumonia in children

“…Although mycoplasmal pneumonia is usually self-limited and benign, some cases may proceed to clinical and radiological deterioration despite appropriate macrolide therapy, which were defined as refractory M. pneumoniae pneumonia (RMPP). The rapidity of response to treatment of RMPP with systemic corticosteroid is satisfying, and it significantly improves the clinical symptoms and outcomes89. Nonetheless, with the use of standard corticosteroid regimens (2 mg/kg/day), fever persists for more than 3 days after treatment in around 20% of children with RMPP10.…”

Histological findings in severe Mycoplasma pneumoniae pneumonia

“…Our histological finding that macrophages are enriched in infiltrating cells can explain the fact that IL-18 increases in patients with severe M. pneumoniae pneumonia. The use of corticosteroids combined with antibiotic therapy to decrease the inflammatory response -with dramatic beneficial effectshas also been demonstrated in several studies [2][3][4][5][6][7]14]. Our histological study indicated that corticosteroids might be effective against oedema of the alveolar, bronchial and bronchiolar walls, polypoid organizing tissue and cellular bronchiolitis with lymphocytic infiltration.…”

“…It is well known that some cases develop into severe pneumonia [2][3][4][5][6][7]. Several studies have demonstrated that an excessive host cellular response, especially with respect to IL-18, plays a critical role in the development of serious pulmonary manifestations [8][9][10][11][12][13].…”

“…Several studies have demonstrated that an excessive host cellular response, especially with respect to IL-18, plays a critical role in the development of serious pulmonary manifestations [8][9][10][11][12][13]. Thus, immunosuppressive therapy, such as with corticosteroids, down-regulates the cell-mediated immune responses and has been shown to have a profound beneficial effect [2][3][4][5][6][7][11][12][13][14]. On this point, little information is available concerning the histology of M. pneumoniae pneumonia in humans because pneumonia severity is usually mild, and the histological findings of severe M. pneumoniae pneumonia have mainly been investigated using autopsy specimens.…”