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.