［Abstract］　Mycoplasma pneumoniae(MP) is a major pathogen responsible for community-acquired pneumonia(CAP) in children and adolescents. In recent years, the incidence of MP infection has been on the rise, and the detection rate of macrolide-resistant Mycoplasma pneumoniae(MRMP) has been continuously increasing, making the clinical diagnosis and treatment of MP infection more challenging. The clinical manifestations of MP infection are diverse. Some pediatric patients with MP infection may progress to severe pneumonia or be accompanied by extrapulmonary system involvement. At present, the diagnostic methods for MP infection mainly include polymerase chain reaction(PCR), serological testing, multiplex PCR and metagenomic next-generation sequencing(mNGS), all of which facilitate early detection of MP infection and confirmation of its etiology. Macrolides remain the first-line treatment of MP infection. However, for the patients with drug-resistant gene mutations indicated by nucleic acid testing and poor response to macrolide treatment, alternative drugs such as tetracyclines or fluoroquinolones can be initiated according to the patients′ conditions. Some pediatric patients with refractory MP pneumonia respond well to the treatments of glucocorticoids and immunoglobulins. This paper, in combination with the latest evidence-based guidelines and expert consensuses, systematically summarizes the epidemiological features, pathogenesis, clinical manifestations, diagnostic techniques, drug-resistant mechanisms and treatment strategies of MP infection, providing a reference basis for clinical diagnosis, treatment and research of MP infection.]]> 2025/8/29 20:37:53 Mycoplasma pneumoniae Pneumonia in Children]]> SHANG Ziru, DING Guodong 5true ［Abstract］　Objective　To analyze the clinical efficacy and safety of extracorporeal membrane oxygenation(ECMO) in salvage treatment for children with fulminant Mycoplasma pneumoniae pneumonia(FMPP). Methods　A retrospective analysis was conducted on the clinical data of 14 pediatric patients with FMPP who were admitted to Department of Critical Care Medicine of Shanghai Children′s Hospital and were treated with ECMO from January 2017 to December 2019. The pediatric patients′ clinical data including general data, clinical and imaging features, initial parameters of mechanical ventilation and ECMO, complications and prognosis were summarized. Results　The salvage treatment with ECMO was performed on the 14 FMPP pediatric patients, with a median age of 45 months. Among them, 8 pediatric patients received veno-arterial ECMO(VA-ECMO) support, and 6 pediatric patients received veno-venous ECMO(VV-ECMO) support. Before ECMO, the median duration of fever was 12 days, and the median duration of mechanical ventilation was 65 hours. The median pre-ECMO oxygenation index(P/F) was 62 mmHg, and the median oxygenation index(OI) was 28. Before ECMO, the D-dimer levels in peripheral blood of all the pediatric patients were elevated, with a median value of 3.9 mg/L. The median running time of ECMO was 141 hours, and 11 pediatric patients underwent continuous renal replacement therapy. Five pediatric patients presented with ECMO-related complications, including 1 case of cerebral infarction, 1 case of heavy bleeding at the gums due to tooth decay, 1 case of membrane oxygenator and pipeline embolization and 2 cases of hemothorax. Among the 14 pediatric patients, 9 pediatric patients had mixed infections. Among them, 2 pediatric patients died of multiple organ failure due to complicating human adenovirus infection and secondary Acinetobacter baumannii infection, respectively. Conclusion　ECMO is an effective means in salvage treatment of cardiopulmonary failure in children with FMPP. However, the adoption of ECMO can lead to a high incidence of complications such as bleeding and coagulation in the children, and the complicating infections may result in a poor prognosis for the FMPP children.]]> 2025/8/29 0:00:00 Mycoplasma pneumoniae Pneumonia in Children]]> ZHOU Yiping, ZHANG Yucai, SHAN Yijun, CHEN Rongxin, SUN Ting, ZHU Guangyao, DOU Jiaying, CUI Yun 4true ［Abstract］　Objective　To analyze the clinical characteristics of severe and critical Mycoplasma pneumoniae pneumonia in children of different ages, and to provide theoretical basis for early clinical identification and standardized treatment of the disease. Methods　The clinical data of 83 pediatric patients with severe and critical Mycoplasma pneumoniae pneumonia who were admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from October 2023 to June 2024 were retrospectively analyzed. These pediatric patients were divided into infants and young children group(<3 years, 23 patients), preschool children group(3-6 years, 17 patients) and school-age children group(>6 years, 43 patients) according to their different ages, and their clinical data were analyzed. Results　All the pediatric patients had cough, and most of them presented with cough as the initial manifestation, and 79 pediatric patients(95.18%) were accompanied by fever. In the 83 pediatric patients, 22 pediatric patients(26.51%) experienced wheezing during the course of the disease. Wheezing was more common in the infants and young children group. Among the 29 pediatric patients(34.94%) who experienced dyspnea, the majority were from the school-age children group. The neutrophil to lymphocyte ratio and C-reactive protein in the blood of the pediatric patients were significantly higher than the normal values, while their procalcitonin and interleukin-6 did not increase significantly. The chest imaging manifestations of the pediatric patients were mostly characterized by diffuse consolidation shadows, followed by bronchiolitis manifestations. The chest imaging patterns varied among different age groups of the pediatric patients. Some of the pediatric patients had extrapulmonary complications. In the 83 pediatric patients, 21 pediatric patients(25.30%) were accompanied by mixed infections of other viruses. The course of the disease in the pediatric patients with mixed infections was longer than that in the pediatric patients with single Mycoplasma pneumoniae infection. With effective control of pathogens, the progression of the disease could be halted in the most pediatric patients within a short period of time after the administration of conventional doses of glucocorticoids. After effective treatments, all the pediatric patients improved and were discharged from the hospital. The follow-up results showed that only a few pediatric patients had sequelae. Conclusion　Severe Mycoplasma pneumoniae pneumonia and critical Mycoplasma pneumoniae pneumonia have the same clinical characteristics in pediatric patients of different ages, but also have unique clinical manifestations in pediatric patients of various age groups. Early identification of the disease and taking targeted intervention measures can lead to a better prognosis for the pediatric patients.]]> 2025/8/29 0:00:00 Mycoplasma pneumoniae Pneumonia in Children]]> REN Xue, WANG Lijie 3true ［Abstract］　Objective　To analyze the clinical features and prognosis of 11 cases of Mycoplasma pneumoniae pneumonia(MPP) complicated with pulmonary embolism in children. Methods　A retrospective analysis was conducted on the clinical data and follow-up results of 11 pediatric patients with MPP complicated with pulmonary embolism who were admitted to Inner Mongolia Autonomous Region People′s Hospital from May 2023 to May 2024. Results　Among the 11 pediatric patients, there were 5 males and 6 females, with a median age of 8 years(ranging from 5 to 14 years). Fever and cough were found to exist in all the pediatric patients, accompanied by chest pain in 5 patients, difficulty breathing in 3 patients, decreased breath sounds in 6 patients, wheezing in 3 patients, pleural effusion in 5 patients and mediastinal emphysema in 1 patient. Pulmonary computed tomography angiography(CTA) showed partial branch embolism in the pulmonary artery. The levels of D-dimer in all the pediatric patients were increased to varying degrees［(1.22-17.07)μg/mL］. The 11 pediatric patients were treated with macrolide antibiotics, doxycycline and low-molecular-weight heparin calcium. Seven pediatric patients′ conditions were controlled, while 4 pediatric patients had residual bronchiolitis obliterans. Conclusion　MPP complicated with pulmonary embolism in children mostly presents with cough, fever, chest pain, and difficulty breathing, accompanied by elevated levels of D-dimer at different levels. Active anti-infection, anticoagulant and thrombolytic treatments should be given to the children, and most of them have a good prognosis.]]> 2025/8/29 0:00:00 Mycoplasma pneumoniae Pneumonia in Children]]> FAN Yuhong, LI Junli, SU Xuewen 2true ［Abstract］　Objective　To study the clinical value of serum ficolin-3, CD4⁺/CD8⁺ T lymphocyte ratio combined with neutrophil-to-lymphocyte ratio(NLR) in prognosis assessment of pediatric patients with Mycoplasma pneumoniae pneumonia(MPP) complicated with Epstein-Barr virus(EBV) infection. Methods　The clinical data of 146 pediatric patients with MPP complicated with EBV infection who were admitted to Northwest University First Hospital from January 2021 to May 2023 were retrospectively analyzed. The levels of ficolin-3, CD4⁺/CD8⁺ T lymphocyte ratio and NLR in the serum of the pediatric patients were detected after admission(before treatment). The pediatric patients were followed up for 12 months after hospital discharge. According to the prognosis, the pediatric patients were divided into good prognosis group(100 cases) and bad prognosis group(46 cases). Multivariate logistic regression was used to analyze the factors affecting the prognosis of the pediatric patients with MPP complicated with EBV infection. The efficacy of ficolin-3, CD4⁺/CD8⁺ T lymphocyte ratio and NLR in predicting the prognosis of the pediatric patients with MPP complicated with EBV infection by using receiver operating characteristic(ROC) curve. Results　Compared with the good prognosis group, the bad prognosis group had long fever duration, high proportion of pulmonary shadows ≥two-thirds of the lung lobes and high proportion of severe cases, and high C-reactive protein and ficolin-3 levels and NLR, and low CD4⁺/CD8⁺ T lymphocyte ratio, with statistically significant differences between the two groups(P<0.05). The results of multivariate logistic regression analysis showed that higher ficolin-3 levels and NLR, lower CD4⁺/CD8⁺ T lymphocyte ratio, severe MPP and pulmonary shadows ≥two-thirds of the lung lobes were independent risk factors for poor prognosis of the pediatric patients with MPP complicated with EBV infection(P<0.05). The results of ROC curve analysis showed that ficolin-3, CD4⁺/CD8⁺ T lymphocyte ratio and NLR could predict poor prognosis of the pediatric patients with MPP complicated with EBV infection. The combined prediction efficacy of the three indicators［AUC(95%CI)=0.874(0.837-0.911)］ was better than that of the single indicator(P<0.05). Conclusion　The combined detection of serum level of ficolin-3, CD4⁺/CD8⁺ T lymphocyte ratio and NLR is helpful to predict the prognosis of the pediatric patients with MPP complicated with EBV infection.]]> 2025/8/29 20:37:53 Mycoplasma pneumoniae Pneumonia in Children]]> 1, LI Xiu′e¹, ZHENG Xiaowei¹, ZHANG Yan², REN Li¹]]> SUN Hui¹, LI Xiu′e¹, ZHENG Xiaowei¹, ZHANG Yan², REN Li¹ 1true