INTRODUCTION
Mycoplasma pneumoniaepneumonia (MPP) is one of the most common types of community-acquired pneumonia (CAP) in children.1 Macrolide antibiotics are effective treatments for most patients, but in some cases MPP may progress to severe MPP (SMPP). SMPP patients exhibit poor responses to single macrolide antibiotics and progression of disease that is accompanied by persistent high fever, aggravation of pulmonary lesions, and additional complications, such as necrotizing pneumonia, atelectasis, bronchiectasis, obliterative bronchiolitis (OB), and other disorders. SMPP complications can lead to repeated infections and decreased quality of life for afflicted children.2,3
The pathogenesis of SMPP likely involves many processes, such as excessive immune inflammatory reactions, mixed infections, and so on. Therefore, the abovementioned factors should be considered during SMPP treatment to reduce the development of pulmonary sequelae. Notably, using bronchoscopy we have found that MPP is associated with specific manifestations such as airway mucus blockage and mucosal necrosis as main findings that cannot be completely eliminated by conservative treatments such as antibiotics and glucocorticoids. Indeed, airway blockage is of particular concern in that it can occur within a short period of time and progress to permanent atelectasis. Therefore, avoidance of OB should be an early treatment priority for practitioners caring for pediatric MPP patients in China, especially in the northern region.4 Consequently, a better understanding of the effects of early abnormal dynamic inflamed airway changes on later incidence of airway occlusions and their implications for MMP treatment have not yet been reported. Such information may be acquired via bronchoscopy, which can facilitate SMPP diagnosis during acute-phase MMP by providing bronchial lavage fluid for pathogen detection and information pertaining to microscopic disease manifestations. Also, bronchoscopy can reveal complete membranous obstructions within subsegmental bronchi of OB cases.
In this retrospective study, we analyzed bronchoscopic findings of pediatric SMPP patients admitted to Beijing Children’s Hospital affiliated with Capital Medical University from October 2017 to January 2019 to reveal correlations between bronchoscopically determined disease manifestations and SMPP prognosis.