Mycoplasma pneumoniae and Adenovirus Coinfection Cause Pediatric Severe Community-Acquired Pneumonia

Abstract

Consolidation is one complication of pediatric severe community-acquired pneumonia (SCAP) that can respond poorly to conservative medical treatment. We investigated the pathogens that cause pediatric SCAP including cases with persistent consolidation that need bronchoscopy intervention. Alveolar lavage fluid (ALF) samples collected from cases admitted to Children's Hospital of Fudan University with SCAP during January 2019 to March in 2019 were retrospectively tested by the RespiFinder 2SMART multiplex PCR (multi-PCR) assay targeting 22 respiratory pathogens. A total of 90 cases and 91 samples were enrolled; 80.0% (72/90) of the cases had pulmonary consolidation and/or atelectasis. All samples were positive with targeted pathogens tested by multi-PCR, and 92.3% (84/91) of the samples were co-detected with pathogens. Mycoplasma pneumoniae (MP) and adenovirus (ADV) as the two dominant pathogens, with the positive rates of 96.7% (88/91) and 79.1% (72/91), respectively. Most of the samples were positive with MP and ADV simultaneously. As a control, 78.0% (71/91) of the samples were positive by conventional tests (CT), in which MP had the detection rate of 63.9% (55/86) by a traditional real-time PCR assay, while ADV were positive in 13.1% (12/91) of the samples by a direct immunofluorescence assay (DFA). In cases with persistent pulmonary consolidation, the positive rates of pathogens by multi-PCR and CT were 100% (72/72) and 81.9% (59/72), respectively. There were no significant differences of MP or ADV positive rates between cases with and without pulmonary consolidation. MP and ADV most prevalent in pediatric SCAP cases required fiberscope intervention, and presented with coinfections dominantly. IMPORTANCE Pathogens that cause pediatric severe community-acquired pneumonia (SCAP) requiring bronchoscopy intervention are understudied. Through this study, we explore the etiology of SCAP form alveolar lavage fluid (ALF) samples by the RespiFinder 2SMART multi-PCR assay. It is observed that high mixed detection rates of Mycoplasma pneumoniae and adenovirus in ALF samples collected from hospitalized SCAP children experienced bronchoscopy intervention. Eighty percent of the cases had pulmonary consolidation and/or atelectasis. The presence of possible coinfection of these two pathogens might contribute to poor clinical anti-infection response. The results of this study might be helpful for the selection of clinical strategies for the empirical treatment of such pediatric SCAP cases.

Keywords: alveolar lavage fluid; children; consolidation; multiple polymerase chain reaction; pathogen; severe community-acquired pneumonia.

FIG 1

Mixed pathogens detection by CT and multi-PCR. (A) The positive rate of pathogens by CT was 78.0% (71/91). Bacteria were found in 63.7% (58/91) of the samples, including MP detected from 63.9% (55/86) of the samples. The targeted viruses were positive in 27.5% (25/91) of the samples. The co-positive rate of pathogens of bacteria and viruses was 13.2% (12/91). Twenty samples were negative tested by CT. (B) All (91/91, 100.0%) samples were positive tested by multi-PCR. The positive rate of MP and targeted viruses were 96.7% (88/91) and 87.9% (85/91), respectively. The co-positive rate of bacteria and viruses was 90.1% (82/91).

FIG 2

Pathogen detection of the 90 cases by RespiFinder 2SMART multi-PCR. The results of 2009 influenza A (H1N1) pandemic positive in RespiFinder 2SMART multi-PCR were counted as FLUA. One 2-year-old patient had two specimens, his first ALF sample was positive with MP and ADV, he had the second fiberscope intervention 3 days later and the ALF sample was reported as MP, ADV, and HCoV-C229E positive. “*”, pathogens positive rate of 91 samples by multi-PCR compared with that of CT, P < 0.05.

FIG 3

Pathogens detected in 90 cases by CT and multi-PCR in three groups.