儿童肺炎支原体肺炎混合超鞭毛虫感染18例

Mycoplasma pneumoniae pneumonia coinfected with hypermasfigote in 18 children

目的探讨肺炎支原体肺炎患儿并支气管肺泡灌洗液（BALF）中检出超鞭毛虫的临床特征。方法回顾性分析18例肺炎支原体肺炎混合超鞭毛虫感染患儿（男7例，女11例；年龄5个月-13岁；病程2～60d；居住农村平房13例，城镇楼房5例）的临床症状、实验室检查、影像学资料、支气管镜下表现、治疗及转归，分析肺炎支原体肺炎混合超鞭毛虫感染的临床特点及治疗方法。结果临床症状：咳嗽18例，发热14例，喘息4例。血常规：白细胞增高13例，嗜酸性粒细胞增高5例；C反应蛋白增高11例；红细胞沉降率增快8例；18例患儿中，11例行免疫功能检查，IgG增高3例，IgM增高2例，IgA增高5例；CD4／CD8比值降低11例。BALF中嗜酸性粒细胞增高1例。BALF中检出超鞭毛虫18例。胸部影像学：局部斑片状高密度影为主。支气管镜下表现：黏膜充血、白色分泌物附着及纵行皱褶，管腔内条絮状分泌物漂浮，痰栓壅塞。经大环内酯类联合甲硝唑静脉滴注，其中5例予甲硝唑肺内灌洗，治疗效果良好。结论超鞭毛虫已成为聊城地区的新型下呼吸道病原体，儿童肺炎支原体肺炎可混合超鞭毛虫感染，对肺炎支原体肺炎迁延不愈者，应警惕混合超鞭毛虫感染，并加用甲硝唑治疗，效果良好。

Objective To explore the clinical manifestations of hypermastigote detected from bronchoalveolar lavage fluid in children with mycoplasma pneumoniae pneumonia （MPP）. Methods The clinical data from 18 cases （7 male cases,11 female cases;the age raged from 5 months to 13 years;13 case lived in rural cottage,5 cases lived in town building;the course ranged from 2 to 60 days） of MPP coinfected with hypermastigote were retrospectively analyzed, including the symptomatic and physical examination data, laboratory test, chest imaging features, bronchoscopic manifestation imaging, treatment and prognosis. The clinical characteristics and treatment of MPP coinfected with hypermastigote were analyzed. Results Clinical symptoms showed that 18 cases had cough,14 cases had fever and 4 cases had asthma;laboratory blood routine test detected that 13 cases had increased leukocytes ,5 cases with increased eosinophils ; 11 cases with increased C reactive protein and 8 cases with increased erythrocyte sedimentation rate. Eleven of 18 cases received immunological examination ,which showed that 3 cases had increased IgG,2 cases with increased IgM ,5 cases with increased IgA, and 11 cases with decreased ratio of CD4 and CD8 ; bronchoalveolar lavage fluid test showed that 1 case had increased eosinophils and hypermastigote were detected in 18 cases. High density spotty shadow were seen in chest imaging. Mucosal congestion, attached with white sputamentum, longitudinal folds, floc floating and sputum boh obstructing within the lumen were seen under the bronchoscopy. The macrolides antibiotics combined with metronidazole （5 cases received metronidazole lung lavage ） were effective. Conclusions Hypermastigote is a new type pathogen isolated from the lower respiratory tract in Liaocheng. For patients with MPP who have unsatisfactory response, hypermastigote should be taken into account and combined with metronidazole in therapy for better effect.