儿童肺炎支原体诱导的皮疹和黏膜炎临床特征分析

doi:10.3969/j.issn.1006-7795.2023.01.019

摘要/Abstract

摘要： 目的比较肺炎支原体(Mycoplasma pneumoniae,MP)和药物诱导的儿童Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)的临床特征、治疗管理和预后之间的差异。方法对河北省儿童医院2010－2021年收治的94例SJS和206例多形性红斑患儿进行筛选,对MP检测阳性的患儿(MP病例组,26例)与MP阴性且有明确药物因素的患儿(药物对照组,31例)进行比较分析。结果与药物对照组相比,MP病例组患儿以年长儿多见,大于72月龄儿童的占比明显高于药物对照组,且均存在黏膜受累,以眼周黏膜(n=25,96.2%)最常见。其治疗主要为大环内酯类抗生素(100%)、皮质类固醇(84.6%)、免疫球蛋白(26.9%),中毒性表皮坏死松解症严重程度评分(severity-of-illness score for toxic epidermal necrolysis,SCORTEN)在2分及以上,均使用皮质类固醇,应用静脉注射用免疫球蛋白比例随SCORTEN评分增高而升高,MP病例组患儿平均住院日短于药物对照组,未见死亡病例。结论 MP相关SJS常见于学龄期儿童,眼部黏膜、口唇黏膜常受累,住院时间短,病死率低,预后更好。

关键词: 肺炎支原体, Stevens-Johnson综合征, 中毒性表皮坏死松解症严重程度评分

Abstract: Objective To compare the clinical characteristics, treatment management and prognosis of Mycoplasma pneumoniae (MP) and drug-induced Stevens-Johnson syndrome (SJS) in children. Methods The clinical data of 94 children with SJS and 206 cases with erythema multiforme admitted to our hospital from 2010 to 2021 were retrospectively analyzed, and the control group consisting of MP positive children(n=26) and MP negative children(control group,n=31)with definite drug factors was compared and analyzed. Results In this study, MP positive SJS was more common in older children, and its incidence in children over 72 months was significantly higher than control group. Mucosal involvement was found in all patients, especially periocular mucosa (n=25, 96.2%). The main treatments were macrolide antibiotics (100%), corticosteroid (Cs) (84.6%) and intravenous immunoglobulin (IVIG) (26.9%). All patients with a severity-of-illness score for toxic epidermal necrolysis(SCORTEN) of 2 or above were treated with Cs. The proportion of IVIG was increased with the increase of SCORTEN. Conclusion MP-induced SJS is common in school-age children, with lower hospital stay,lower mortality, and better prognosis. The mucous membranes of the eye and mouth are often involved.

Key words: mycoplasma pneumonia, Stevens-Johnson syndrome, severity-of-illness score for toxic epidermal necrolysis(SCORTEN)

中图分类号:

R725.9

贾艳红, 郭芳, 武晓圆, 李文辉. 儿童肺炎支原体诱导的皮疹和黏膜炎临床特征分析[J]. 首都医科大学学报, 2023, 44(1): 131-136.

Jia Yanhong, Guo Fang, Wu Xiaoyuan, Li Wenhui. Clinical characteristics of rash and mucositis induced by Mycoplasma Pneumoniae in children[J]. Journal of Capital Medical University, 2023, 44(1): 131-136.

参考文献

[1] Waites K B, Talkington D F. Mycoplasma pneumoniae and its role as a human pathogen[J]. Clin Microbiol Rev, 2004, 17(4): 697-728.
[2] Narita M. Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae infection on the basis of possible pathogenesis[J]. Front Microbiol, 2016, 7: 23.
[3] Canavan T N, Mathes E F, Frieden I, et al. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review[J]. J Am Acad Dermatol, 2015, 72(2): 239-245.
[4] 国家卫生计生委合理用药专家委员会儿童用药专业组. 中国儿童肺炎支原体感染实验室诊断规范和临床实践专家共识(2019年)[J]. 中华儿科杂志, 2020, 58(5): 366-373.
[5] 中华医学会皮肤性病学分会药物不良反应研究中心. Stevens-Johnson综合征/中毒性表皮坏死松解症诊疗专家共识[J]. 中华皮肤科杂志, 2021, 54(5): 376-381.
[6] Bastuji-Garin S, Fouchard N, Bertocchi M, et al. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis[J]. J Invest Dermatol, 2000, 115(2): 149-153.
[7] Sauteur P M M, Goetschel P, Lautenschlager S. Mycoplasma pneumoniae and mucositis—part of the Stevens-Johnson syndrome spectrum[J]. J Dtsch Dermatol Ges, 2012, 10(10): 740-746.
[8] Schalock P C, Dinulos J G H. Mycoplasma pneumoniae-induced cutaneous disease[J]. Int J Dermatol, 2009, 48(7): 673-681.
[9] Zhang L, Lai M M, Ai T, et al. Analysis of Mycoplasma pneumoniae infection among children with respiratory tract infections in hospital in Chengdu from 2014 to 2020[J]. Transl Pediatr, 2021, 10(4): 990-997.
[10] Kutty P K, Jain S, Taylor T H, et al. Mycoplasma pneumoniae among children hospitalized with community-acquired pneumonia[J]. Clin Infect Dis, 2019, 68(1): 5-12.
[11] 张继燕, 陈艳萍. 重症渗出性多形红斑并发闭塞性细支气管炎5例临床分析及文献复习[J]. 中国中西医结合儿科学, 2020, 12(5): 413-417.
[12] Matar M, Kessler R, Olland A, et al. End-stage respiratory failure secondary to bronchiolitis obliterans syndrome induced by toxic epidermal necrosis, also known as lyell syndrome: a case report[J]. Transplant Proc, 2021, 53(4): 1371-1374.
[13] Sugino K, Hebisawa A, Uekusa T, et al. Bronchiolitis obliterans associated with Stevens-Johnson syndrome: histopathological bronchial reconstruction of the whole lung and immunohistochemical study[J]. Diagn Pathol, 2013, 8: 134.
[14] Thangaraju S, Bagri N, Gupta V, et al. Mycoplasma-induced rash and mucositis or Steven-Johnson syndrome[J]. Indian J Pediatr, 2021, 88(8): 802-804.
[15] Chen N, Li M. Case report and literature review: clinical characteristics of 10 children with Mycoplasma pneumoniae-induced rash and mucositis[J]. Front Pediatr, 2022, 10: 823376.
[16] Olson D, Watkins L K F, Demirjian A, et al. Outbreak of Mycoplasma pneumoniae-associated Stevens-Johnson syndrome[J]. Pediatrics, 2015, 136(2): e386-e394.
[17] Liew Y C C, Choo K J L, Oh C C, et al. Mycoplasma-induced Stevens-Johnson syndrome/toxic epidermal necrolysis: case-control analysis of a cohort managed in a specialized center[J]. J Am Acad Dermatol, 2022, 86(4): 811-817.
[18] Aoyama Y, Sawada F, Makino E, et al. Multiple drug sensitization syndrome: a distinct phenotype associated with unrecognized Mycoplasma pneumonia infection[J]. JAAD Case Rep, 2017, 3(4): 301-305.
[19] White K D, Chung W H, Hung S I, et al. Evolving models of the immunopathogenesis of T cell-mediated drug allergy: the role of host, pathogens, and drug response[J]. J Allergy Clin Immunol, 2015, 136(2): 219-234.
[20] Vujic I, Shroff A, Grzelka M, et al. Mycoplasma pneumoniae-associated mucositis—case report and systematic review of literature[J]. J Eur Acad Dermatol Venereol, 2015, 29(3): 595-598.
[21] Simecka J W, Ross S E, Cassell G H, et al. Interactions of mycoplasmas with B cells: antibody production and nonspecific effects[J]. Clin Infect Dis, 1993, 17(Suppl 1): S176-S182.
[22] Luo Z X, Luo J, Liu E M, et al. Effects of prednisolone on refractory Mycoplasma pneumoniae pneumonia in children[J]. Pediatr Pulmonol, 2014, 49(4): 377-380.
[23] Ye L P, Zhang C, Zhu Q X. The effect of intravenous immunoglobulin combined with corticosteroid on the progression of Stevens-Johnson syndrome and toxic epidermal necrolysis: a meta-analysis[J]. PLoS One, 2016, 11(11): e0167120.
[24] Beheshti R, Cusack B. Atypical Stevens-Johnson syndrome associated with Mycoplasma pneumoniae[J]. Cureus, 2022, 14(2): e21825.
[25] Rajan T V. The Gell-Coombs classification of hypersensitivity reactions: a re-interpretation[J]. Trends Immunol, 2003, 24(7): 376-379.
[26] Lin C C, Chen C B, Wang C W, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: risk factors, causality assessment and potential prevention strategies[J]. Expert Rev Clin Immunol, 2020, 16(4): 373-387.
[27] Abe R. Immunological response in Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. J Dermatol, 2015, 42(1): 42-48.
[28] Tristani-Firouzi P, Petersen M J, Saffle J R, et al. Treatment of toxic epidermal necrolysis with intravenous immunoglobulin in children[J]. J Am Acad Dermatol, 2002, 47(4): 548-552.
[29] Prins C, Kerdel F A, Padilla R S, et al. Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases[J]. Arch Dermatol, 2003, 139(1): 26-32.
[30] Zhu Q Y, Ma L, Luo X Q, et al. Toxic epidermal necrolysis: performance of SCORTEN and the score-based comparison of the efficacy of corticosteroid therapy and intravenous immunoglobulin combined therapy in China[J]. J Burn Care Res, 2012, 33(6): e295-e308.
[31] Tsai T Y, Huang I H, Chao Y C, et al. Treating toxic epidermal necrolysis with systemic immunomodulating therapies: a systematic review and network meta-analysis[J]. J Am Acad Dermatol, 2021, 84(2): 390-397.