• Clinical and Experimental Pediatrics
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• 제45권3호
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• pp.401-405
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• 2002

저자들은 호흡곤란, 흉통 및 경부종창을 주소로 내원한 6세 남아에서 M. pneumoniae 폐렴에 동반된 양측성 특발성 긴장성 폐기흉 1례를 경험하였기에 문헌 고찰과 함께 국내 첫 증례로 보고하는 바이다.

• 농촌의학ㆍ지역보건
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• 제18권2호
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• pp.161-171
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• 1993

Mycoplasma pneumoniae(M. pneumoniae) is a primary pathogene of the respiratory tract in children. Most studies of such pneumonia involve a group of admitted patients in hospital, usually with major medical illness. We retrospectively studied the epidemiologic and clinical feature of 105 patients with serologically proven M. pneumoigic pneumonia treated at Gwang-Yang Hospital during a epidemic period of Jun. 1993 to Dec. 1993. All cases of pneumonia developed in this period were also reviewed and compared with serologically proven group. The results were as follows. 1. There were 63 males and 42 females, and the male /female ratio was 1.5 : 1. 2. More than half(57%) of cases belonged to 5-9 years of age group, and mean age was 6.5 years old. 3. Mean age was steadily decreased as prevalence of mycoplasmal pneumonia had been subsided. 4. The date of index case was June 26th, and that of median case was 3 months after the index case. 5. A major determinant of the outbreak seemed to be the population density rather than the population size. 6. Recurrence and serious complication were not observed in this period. 7. All cases of pneumonia developed in this period might be attributed to M. pnemoniae. These epidemiologic and clinical characteristics would contribute to the prevention and diagnosis of mycoplasmal pneumonia.

• Clinical and Experimental Pediatrics
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• 제60권5호
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• pp.151-157
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• 2017

Purpose: Macrolide resistance rate of Mycoplasma pneumoniae has rapidly increased in children. Studies on the clinical features between macrolide susceptible-M. pneumoniae (MSMP) and macrolide resistant-M. pneumoniae (MRMP) are lacking. The aim of this study was to identify the macrolide resistance rate of M. pneumoniae in Korean children with M. pneumoniae penupmonia in 2015 and compare manifestations between MSMP and MRMP. Methods: Among 122 children (0-18 years old) diagnosed with M. pneumoniae pneumonia, 95 children with the results of macrolide sensitivity test were included in this study. Clinical manifestations were acquired using retrospective medical records. Results: The macrolide resistant rate of M. pneumoniae was 87.2% (82 of 94 patients) in children with M. pneumoniae pneumonia. One patient showed a mixed type of wild type and A2063G mutation in 23S rRNA of M. pneumoniae. There were no significant differences in clinical, laboratory, and radiologic findings between the MSMP and MRMP groups at the first visit to our hospital. The time interval between initiation of macrolide and defervescence was significantly longer in the MRMP group ($4.9{\pm}3.3$ vs. $2.8{\pm}3.1days$, P=0.039). Conclusion: The macrolide resistant rate of M. pneumoniae is very high in children with M. pneumoniae pneumonia in Korea. The clinical manifestations of MRMP are similar to MSMP except for the defervescence period after administration of macrolide. Continuous monitoring of the occurrence and antimicrobial susceptibility of MRMP is required to control its spread and establish strategies for treating second-line antibiotic resistant M. pneumoniae infection.

• Clinical and Experimental Pediatrics
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• 제60권6호
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• pp.167-174
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• 2017

Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006-2007, 2011, and 2015-2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%-90%. Macrolide-resistant Mycoplasma pneumoniae (MRMP) harbors a point mutation in domain V of 23S rRNA with substitutions mainly detected at positions 2063 and 2064 of the sequence. The excessive use of macrolides may contribute to these mutations. MRMP can lead to clinically refractory pneumonia, showing no clinical or radiological response to macrolides, and can progress to severe and complicated pneumonia. Refractory MPP is characterized by an excessive immune response against the pathogen as well as direct injury caused by an increasing bacterial load. A change of antibiotics is recommended to reduce the bacterial load. Tetracyclines or quinolones can be alternatives for treating MRMP. Otherwise, corticosteroid or intravenous immunoglobulin can be added to the treatment regimen as immunomodulators to downregulate an excessive host immune reaction and alleviate immune-mediated pulmonary injury. However, the exact starting time point, dose, or duration of immunomodulators has not been established. This review focuses on the mechanism of resistance acquisition and treatment options for MRMP pneumonia.

• Pediatric Infection and Vaccine
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• 제16권1호
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• pp.92-96
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• 2009

Mycoplasma pneumoniae는 소아 및 청소년에게 발병하는 폐렴의 주요한 원인균으로, 중추신경계, 피부나 점막, 소화기계 등의 합병증을 자주 동반하는 것으로 알려져 있다. 하지만 M. pneumoniae와 관련된 심장의 합병증은 비교적 흔하지 않은 것으로 알려져 있고 특히 소아에서는 드문 것 로 알려져 있다. 이에 저자들은 M. pneumoniae 폐렴으로 입원하여 치료 중에 속발한 심근염으로 사망한 47개월 여아에 관한 증례를 보고하는 바이다.

• Allergy, Asthma & Respiratory Disease
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• 제6권6호
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• pp.295-302
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• 2018

Purpose: It is thought that Mycoplasma pneumoniae infection is more prevalent and causes more severe pneumonia in school-age children and young adults than in preschool children; however, recent studies suggest that the infection may be underdiagnosed and more severe in preschool children. This study investigated the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) and the risk factors of refractory MPP (RMPP) by age. Methods: We retrospectively reviewed the medical records of 353 children admitted due to MPP from January 2015 to December 2016. Demographics, clinical information, laboratory data and radiological findings were collected from all patients in this study. The patients were divided into 2 groups by the age of 6 years. Also, both preschool (< 6 years old) and school-age (${\geq}6$ years old) children were divided into RMPP and non-RMPP patients. Results: Total febrile days, febrile days before admission and the duration of macrolide antibiotic therapy were significantly longer in school-age children than in preschool children. School-age children had significantly greater risk of lobar consolidation (P=0.036), pleural effusion (P=0.001) and extrapulmonary complications (P=0.019). Necrotizing pneumonia and bronchiolitis obliterans tended to occur more frequently in preschool children than in school-age children. In both preschool and school-age children, lactate dehydrogenase (LDH) levels were significantly higher in RMPP patients than in non-RMPP patients. In preschool children, LDH > 722 IU/L (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.44-6.50) and ferritin > 177 ng/mL (OR, 5.38; 95% CI, 1.61-19.49) were significant risk factors for RMPP, while LDH > 645 IU/L (OR, 4.12; 95% CI, 1.64-10.97) and ferritin > 166 ng/mL (OR, 5.51; 95% CI, 1.59-22.32) were so in school-age children. Conclusion: Clinical features of MPP were significantly different between preschool and school-age children. LDH and ferritin may be significant factors of RMPP in preschool and school-age children.

• Tuberculosis and Respiratory Diseases
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• 제63권6호
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• pp.515-520
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• 2007

M. pneumoniae는 지역사회폐렴의 중요한 원인균으로 대개 경증의 임상상을 보이지만 급성호흡곤란증후군을 일으킬 정도로 중증의 폐렴을 보이는 경우가 드물게 보고 되고 있다. 저자들은 일반적인 임상적인 경과와 달리 심한 폐침윤과 호흡곤란을 호소한 M. pneumoniae 폐렴 2예를 보고한다. 이들은 M. pneumoniae 폐렴의 전형적인 임상양상을 보이지 않았으나 중증지역사회폐렴의 양상을 보여 처음부터 새로운 퀴놀론이나 마크로라이드가 포함된 경험적 항생제 투여를 시작하였다. 또한 처음부터 M. pneumoniae IgG또는 IgM의 의미있는 상승과 추적검사에서 더욱 상승된 항체가를 보이고 혈청 검사에서 다른 감염증의 가능성을 배제하여 M. pneumoniae 폐렴으로 진단하였으며 합병증을 남기지 않고 치료가 되었다. 두 증례를 통하여 저자들은 M. pneumoniae 감염이 중증의 지역사회폐렴의 원인의 하나로 고려되어야 하며, 중증 폐렴소견을 보이는 경우에도 마크로라이드나 퀴놀론을 포함한 경험적 항생제 치료가 필요할 수 있음을 경험하여 보고한다.

• Journal of Microbiology and Biotechnology
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• 제28권10호
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• pp.1730-1735
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• 2018

Bacterial pneumonia is one of the most common causes of mortality in Korea. In 2016, the mortality rate from pneumonia was 16,476 deaths per 100,000, which was an 11% increase from the previous year. The aim of our study was to determine the distribution of the bacterial pathogens causing respiratory symptoms in different age groups over a 10-year period. Between January 2008 and September 2017, 1,861 specimens from 1,664 patients admitted to Dankook University Hospital with respiratory symptoms were examined. We used multiplex polymerase chain reaction (PCR) to detect six bacterial pneumonia pathogens: Bordetella pertussis, Chlamydophila pneumoniae, Haemophilus influenzae, Legionella pneumophila, Mycoplasma pneumoniae, and Streptococcus pneumoniae. We detected bacterial pneumonia pathogens in 1,281 (68.83%) specimens. Of the 1,709 pathogens detected, S. pneumoniae was the most common (48.57%; n = 830) followed by H. influenzae (40.08%; n = 685). Most infections were found among children younger than 10 years (92.69%; n = 1,584). Although S. pneumoniae was the most common pathogen detected in all age groups, M. pneumoniae infection increased in prevalence with age (p < 0.05). The rate of co-infection was also high among these patients (31.1%; n = 399), which peaked in 2015 (54.55%; n = 42/77). The prevalence of bacterial pneumonia in Cheonan, along with the proportion of co-infections among patients increased over the 10-year study period. The findings will aid the development of treatment and prevention guidelines.

• Clinical and Experimental Pediatrics
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• 제64권9호
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• pp.459-467
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• 2021

Mycoplasma pneumoniae (MP) is the most common cause of childhood bacterial pneumonia. Although macrolide is known to be effective as a first-line therapy, the proportion of macrolide resistance in MP pneumonia has strikingly increased during recent 2 decades in East Asia. This is challenging to physicians since they have to decide more often whether to use secondary treatment. Diagnostic methods to detect macrolide-resistance of MP are currently not available in Korean hospitals. Even in the diagnosis of MP infection, both serologic and molecular test have limitation: inability to differentiate current illness from carriage or asymptomatic infection. Combining these 2 diagnostic methods and excluding infection caused by other respiratory pathogens allow a more reliable diagnosis. This effort is even more demanding in recent years to keep children from unnecessary exposure to secondary antibiotics. Although several observational studies have reported that tetracycline and fluoroquinolone, which are considered in the treatment of refractory MP pneumonia, have efficacy of shortening the duration of fever and respiratory symptoms, those findings need to be proven by well-designed prospective studies. The use of tetracycline and fluoroquinolone in children is generally tolerable, as supported by many observational data. However, since concerns about side effects still remain, careful consideration about benefits and risks is needed to decide their use.

• Tuberculosis and Respiratory Diseases
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• 제63권6호
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• pp.511-514
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• 2007

Mycoplasma pneumoniae에 의한 폐렴의 임상양상은 다양하다고 알려져 있으며, 흉부 방사선 소견상 대부분 기관지 주위 폐렴이나 반점형 폐 침윤 양상을 보이고 폐허탈은 5% 정도로 매우 드물게 발생하는 것으로 되어 있다. 본 저자들은 미열, 두통, 건성 기침, 근육통 등 비정형적인 폐렴의 증상을 보이면서 대엽성 무기 폐로 발현한, 마이코플라즈마 폐렴을 경험하였기에 이를 보고하는 바이다.