Clinical Features of Severe or Fatal Mycoplasma pneumoniae Pneumonia.
Clinical Features of Severe or Fatal Mycoplasma pneumoniae Pneumonia.
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DOI：
10.3389/fmicb.2016.00800
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发表时间：
2016
影响因子：
5.2
通讯作者：
Izumikawa K
中科院分区：
文献类型：
--
作者：
Izumikawa K
肺炎支原体是引起儿童和年轻人社区获得性肺炎的最常见原因之一。尽管肺炎支原体感染率很高，但暴发性肺炎肺炎(MPP)的发生率相对较低。这篇文献综述通过检查流行病学、临床表现、发病机制和治疗方面的最新数据，突出了暴发性MPP的临床特征。暴发性MPP占所有MPP病例的0.5%-2%，主要影响没有潜在疾病的年轻人。主要临床表现包括咳嗽、发烧和呼吸困难，以及放射学检查中弥漫性异常表现。炎症标志物如白细胞和C反应蛋白水平升高，乳酸脱氢酶、IL-18、天冬氨酸转氨酶和丙氨酸转氨酶水平升高。暴发性MPP的确切发病机制尚不清楚，但理论包括对肺炎支原体的迟发性超敏反应和延迟的抗生素给药对疾病进展的贡献。治疗选择包括将适当的抗支原体药物与皮质类固醇配对，这将降低超敏反应，并且该治疗组的死亡率相当低。需要进一步的研究来确定重症和暴发型MPP的确切发病机制。
Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia in children and young adults. The incidence of fulminant M. pneumoniae pneumonia (MPP) is relatively rare despite the high prevalence of M. pneumoniae infection. This literature review highlights the clinical features of fulminant MPP by examining the most recent data in epidemiology, clinical presentation, pathogenesis, and treatment. Fulminant MPP accounts for 0.5–2% of all MPP cases and primarily affects young adults with no underlying disease. Key clinical findings include a cough, fever, and dyspnea along with diffuse abnormal findings in radiological examinations. Levels of inflammatory markers such as white blood cells and C-reactive protein are elevated, as well as levels of lactate dehydrogenase, IL-18, aspartate transaminase, and alanine transaminase. The exact pathogenesis of fulminant MPP remains unclear, but theories include a delayed hypersensitivity reaction to M. pneumoniae and the contribution of delayed antibiotic administration to disease progression. Treatment options involve pairing the appropriate anti-mycoplasma agent with a corticosteroid that will downregulate the hypersensitivity response, and mortality rates are quite low in this treatment group. Further research is necessary to determine the exact pathogenesis of severe and fulminant types of MPP.