Detection of Mycoplasma Pneumoniae Using Targeted Next-Generation Sequencing: A Comparative Analysis of Clinical Characteristics in Pure Infections and Co-Infections

Detection of Mycoplasma Pneumoniae Using Targeted Next-Generation Sequencing: A Comparative Analysis of Clinical Characteristics in Pure Infections and Co-Infections | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Detection of Mycoplasma Pneumoniae Using Targeted Next-Generation Sequencing: A Comparative Analysis of Clinical Characteristics in Pure Infections and Co-Infections Zhuman Du, Xiaoju Chen, Pei Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4502877/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia, exhibiting a periodic epidemic pattern. However, there is currently no research comparing the characteristics of co-infections in patients with Mycoplasma pneumoniae. This study aims to explore the epidemiological characteristics of co-infections associated with Mycoplasma pneumoniae and to assess the specific traits of laboratory findings utilizing targeted Next-Generation Sequencing (tNGS) technology. A total of 104 patients diagnosed with Mycoplasma pneumonia were included. Based on the results of targeted NGS testing, patients were divided into a group with pure Mycoplasma pneumoniae infection (46 cases) and a group with Mycoplasma pneumoniae co-infected with other bacterial infections (58 cases). Data regarding demographic characteristics, laboratory tests, and targeted NGS results from bronchial lavage fluid during hospitalization were collected. Patients with pure Mycoplasma pneumoniae infection exhibited significant differences in lymphocyte count, neutrophil-to-lymphocyte ratio, alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels compared to those with Mycoplasma pneumoniae complicated by other infections (P < 0.05 for all). The rate of pure Mycoplasma pneumoniae infection was higher in females than in males (P < 0.05). Older patients were more prone to pure Mycoplasma pneumoniae infection, whereas younger patients were more likely to have Mycoplasma pneumoniae complicated by bacterial infections (P < 0.05 for both). Furthermore, Streptococcus pneumoniae was the most common pathogen associated with co-infections, particularly prevalent among children (P < 0.05). There are differences in age, gender, and laboratory test results between patients with pure Mycoplasma pneumoniae infections and those with Mycoplasma pneumoniae coinfections, with varying infection characteristics displayed among patients of different age groups. Health sciences/Diseases/Respiratory tract diseases Health sciences/Medical research Mycoplasma pneumonia Co-infection Targeted Next-Generation Sequencing Bronchial Lavage Fluid Figures Figure 1 INTRODUCTION Mycoplasma is a small, free-living, wall-less, and self-replicating prokaryotic organism [ 1 ] . Over 200 species of Mycoplasma have been identified in humans, animals, plants, and arthropods, with major pathogenic species including Mycoplasma pneumoniae, Mycoplasma genitalium, Mycoplasma fermentans, Mycoplasma hominis, Mycoplasma penetrans, Mycoplasma pirum, and Mycoplasma urealyticum, which can cause respiratory and genitourinary diseases [ 2 ] . Among these pathogenic Mycoplasma species, Mycoplasma pneumoniae is the most significant and extensively studied species. It is one of the leading pathogens causing respiratory diseases and pneumonia in humans, particularly in children and adolescents [ 3 ] . Mycoplasma pneumoniae cannot be routinely cultured from respiratory specimens, and specific antibodies may not be detectable until 7–10 days after the onset of symptoms [ 4 ] . Therefore, investigating the true role of Mycoplasma pneumoniae in respiratory tract infections remains challenging [ 5 ] . In recent years, the emergence of targeted next-generation sequencing (tNGS) technology has greatly aided the rapid and accurate diagnosis of Mycoplasma pneumoniae pneumonia [ 6 , 7 ] . Adult Mycoplasma pneumoniae pneumonia and its co-infection with other pathogens have become hot research topics, and their clinical features are gradually being explored. This study aims to investigate the characteristics of Mycoplasma pneumoniae pneumonia co-infection and laboratory examination using targeted NGS technology. MATERIALS AND METHODS Patients and samples Patients admitted to the Affiliated Hospital of Chengdu University from June 1, 2022, to April 1, 2024, diagnosed with mycoplasma pneumonia by clinical and tNGS of bronchoalveolar lavage fluid were included in the study. A total of 104 patients were analyzed, and they were divided into two groups based on the results of tNGS: 46 cases of pure mycoplasma pneumonia infection and 58 cases of mycoplasma pneumonia with concurrent bacterial infections. All data were collected anonymously, and all patients or guardians had signed the informed consent form for hospital admission treatment. A retrospective review of the electronic medical records of the included mycoplasma pneumonia patients was conducted. Demographic characteristics were collected, including age and gender. The duration of hospitalization and clinical indicators measured at admission, such as complete blood count, C-reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and D-dimer, were recorded. Additionally, the results of tNGS testing of bronchoalveolar lavage fluid during hospitalization were documented. TNGS detection The tNGS sequencing was provided by Guangzhou Huayin Medical Laboratory Center Co. Ltd and Shanghai Cinopath Medical Testing Co. Ltd. The sequencing targets highly conserved regions of 99 respiratory pathogens using super-multiplex PCR combined with next-generation sequencing technology for gene sequencing to read the detection results of pathogens. These 99 regions include common respiratory pathogens such as viruses, bacteria, mycoplasmas, mycobacteria, and fungi. Data quality is achieved by removing low-quality and short (< 50 bp) reads. Ethics This is a single-center, retrospective, observational study conducted at a tertiary hospital in Chengdu, China. The study was approved by the “Ethics Committee of Clinical Medicine College & Affiliated Hospital of Chengdu University” (PJ2024-048-01). This study was conducted strictly in accordance with guidelines and regulations. All participants and/or their legal guardians provided informed consent. It complies with the Declaration of Helsinki. Statistics Data analysis was conducted using SPSS 27.0. Quantitative data that were normally distributed were described using the mean ± standard deviation, while data that were not normally distributed were described using the median (interquartile range). Categorical data were described using frequency (%). For normally distributed data, t-tests were used, while non-parametric tests were employed for skewed distributed data. Chi-square tests were used for categorical variables. A P value below 0.05 was considered significant (P < 0.05). RESULTS Table 1. Baseline Characteristics of Patients with Pure Mycoplasma Pneumoniae Infection and Patients with Mycoplasma Pneumoniae Co-infection. Baseline Characteristics Total (N = 104 ) Pure Mycoplasma Pneumoniae Infection group (n=46) Mycoplasma Pneumoniae Co-infection group (n=58) p-Value Age, y, mean ±SD 25.16±19.66 31.48±18.35 20.16±19.37 0.003 Male 45(43.3%) 13(12.5%) 32(30.8%) 0.006 Female 59(56.7%) 33(31.7%) 26(25.0%) Days of hospitalization, mean ±SD 8.93±3.30 8.63 ±3.49 9.17 ±3.16 0.409 Abbreviations. SD: standard deviation; By comparing and analyzing the laboratory examination results of patients with pure Mycoplasma pneumoniae infection and those with Mycoplasma pneumoniae co-infection (Table 2), we identified significant differences between the two groups in certain key hematological and inflammatory markers. There were significant differences in lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels between the pure Mycoplasma pneumoniae infection group and the Mycoplasma pneumoniae co-infection group. However, the differences in white blood cell count, neutrophil count, C-reactive protein (CRP), procalcitonin, aspartate aminotransferase (AST), and D-dimer between the two groups were not statistically significant. Table 2. Laboratory Examinations of Patients with Pure Mycoplasma Pneumoniae Infection and Patients with Mycoplasma Pneumoniae Co-infection Laboratory Test (Reference Range) Total (N = 104 ) Pure Mycoplasma Pneumoniae Infection group (n=46) Mycoplasma Pneumoniae Co-infection group (n=58) p-Value White blood cell (3.5-9.5) x 109/L, mean ±SD 7.42±2.24 7.26±2.07 7.53±2.37 0.573 Lymphocytes (1.1-3.2) x 109/L, mean ±SD 1.79±0.97 1.51±0.86 2.01±1.00 0.014 Neutrophils (1.8-6.3) x 109/L ,mean ±SD 4.92±1.91 5.09±1.68 4.79±2.08 0.451 Hypersensitive C-reactive (0-10.0) mg/L, median (IQR) 21.32(5.35-51.13) 31.30(11.75-65.27) 12.35 (4.87-45.81) 0.050 Neutrophil-to-Lymphocyte Ratio（NLR）, median (IQR) 3.00 (1.94-4.66) 3.88 (2.60-5.23) 2.31 (1.56-3.88) 0.048 Procalcitonin (<0.5) ng/mL, median (IQR) 0.08 (0.05-0.13) 0.08 (0.05-0.16) 0.06 (0.05-0.11) 0.293 Aspartate aminotransferase (13.0-35.0) IU/L, mean ±SD 30.82±20.23 30.79±17.96 30.85±22.04 0.989 Alanine aminotransferase (7.0-40.0) IU/L, mean ±SD 26.72±25.73 32.78±31.38 21.88±19.08 0.007 Lactate dehydrogenase (120.0-250.0) IU/L, mean ±SD 237.13±90.32 216.17±53.50 253.89±108.99 0.027 D-dimer (＜0.5) ug/mL, median (IQR) 0.43 (0.33-0.52) 0.39 (0.33-0.49) 0.47 (0.33-0.55) 0.309 Abbreviations. SD: standard deviation; IQR: interquartile range. This study conducted a comparative analysis of the distribution of pathogens among pneumonia patients of different age groups (age >15 years and age ≤15 years) (Figure 1). The results showed that Streptococcus pneumoniae was the most common pathogen in both groups, especially in children aged ≤15 years, with a total of 33 cases. Additionally, Haemophilus influenzae was also relatively common among patients in both age groups, with 16 and 17 cases respectively. Notably, Staphylococcus aureus had a higher detection rate among patients, with a total of 6 cases. Other pathogens, such as Enterococcus faecalis, Mycoplasma hominis, Ureaplasma urealyticum, Enterococcus faecium, Klebsiella pneumoniae, Burkholderia cepacia, Klebsiella pneumoniae, Burkholderia gladioli, Mycoplasma ureaplasma, and Serratia marcescens, were detected at a lower rate in both groups, with no more than 2 cases each. This study used targeted next-generation sequencing (tNGS) technology to statistically analyze the distribution of co-infecting pathogens in patients with Mycoplasma pneumoniae infection who were younger than 15 years old (age ≤ 15 years) and those who were 15 years old or older (age > 15 years). The results (Table 3 and Table 4) showed a statistically significant association between age and type of infection (P 15 years. In contrast, there were 34 cases in the Mycoplasma pneumoniae co-infection group among patients aged ≤ 15 years and 24 cases in those aged > 15 years, indicating that age is an important factor affecting the type of Mycoplasma pneumoniae infection. Specifically, older patients (age > 15 years) were more likely to develop pure Mycoplasma pneumoniae infection, while younger patients (age ≤ 15 years) more commonly exhibited co-infection with Mycoplasma pneumoniae. Secondly, as the most common pathogen in Mycoplasma pneumoniae infection patients, both in terms of pure infection and co-infection, Streptococcus pneumoniae was more frequently co-infection in patients with Mycoplasma pneumoniae infection aged ≤ 15 years, whereas in the group of Mycoplasma pneumoniae patients aged > 15 years, the incidence of co-infection with other pathogens was higher. Table 3. Relationship between Age and Mycoplasma Pneumoniae Co-infection age ≤15 years old age ＞15 years old Pure Mycoplasma Pneumoniae Infection group 10(9.62%) 36(34.62%) Mycoplasma Pneumoniae Co-infection group 34(32.69%) 24(23.08%) χ 2 - Value 14.30 p-Value ＜0.001 Table 4. Relationship between Age and Co-infection with Streptococcus pneumoniae in Mycoplasma Pneumonia age ≤15 years old age ＞15 years old Mycoplasma pneumoniae co-infection with other bacterial infections 11(10.58%) 45(43.27%) Mycoplasma pneumoniae co-infection with Streptococcus pneumoniae 33(31.73%) 15(14.42%) χ 2 - Value 25.54 p-Value ＜0.001 DISCUSSION Mycoplasma pneumoniae pneumonia is a global cause of community-acquired pneumonia, presenting with periodic epidemic patterns, with a cycle of approximately 4 to 7 years. This is due to the gradual decline in population immunity and the emergence of new subspecies of Mycoplasma pneumoniae [8] . In late 2023, an outbreak of respiratory diseases in children occurred in China, during which Mycoplasma pneumoniae became the predominant respiratory infection type among children [9] . However, we also observed an increasing trend in the infection rate of Mycoplasma pneumoniae pneumonia in adults. Therefore, our study included participants from the population during the outbreak of Mycoplasma pneumoniae pneumonia in China in 2023, including both children and adults with Mycoplasma pneumoniae pneumonia, with an age range of 1-74 years. Laboratory diagnosis of Mycoplasma pneumoniae pneumonia is particularly important because this disease cannot be diagnosed based solely on clinical symptoms and signs. The most widely used detection method currently is the enzyme immunoassay, which is used to detect Mycoplasma pneumoniae IgM, IgG, and IgA antibodies [1] . However, in recent years, targeted next-generation sequencing (tNGS) technology based on multiplex PCR has emerged, which can detect Mycoplasma pneumoniae infection earlier than serology. This method employs real-time quantitative PCR targeting the P1 gene in respiratory specimens to detect Mycoplasma pneumoniae, showing a sensitivity of 60% and specificity of 96.7% compared to serology [4] . Its sensitivity is always superior to traditional methods and it is increasingly considered as the “new gold standard” [5] . In this study, all patients were diagnosed with Mycoplasma pneumoniae pneumonia using tNGS detection technology, and the specimens were obtained from lower respiratory tract samples (bronchoalveolar lavage fluid), which provides more reliable evidence compared to previous studies that mainly used sputum and blood samples. Previous studies have shown that leukocytosis and elevated C-reactive protein are common in patients with Mycoplasma pneumoniae pneumonia [10, 11] . Liver function abnormalities indicated by elevated alanine aminotransferase and aspartate aminotransferase are common in patients with fulminant Mycoplasma pneumoniae pneumonia. It has been found that patients with acute respiratory failure associated with Mycoplasma pneumoniae pneumonia have significantly increased white blood cell count, C-reactive protein, lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase levels [10-12] . Wang et al. demonstrated that serum lactate dehydrogenase (LDH) has good diagnostic accuracy for refractory Mycoplasma pneumoniae pneumonia and can be used as a diagnostic marker for refractory Mycoplasma pneumoniae pneumonia [13] . However, there is currently no research comparing the characteristics of co-infection in patients with Mycoplasma pneumoniae pneumonia. Therefore, based on the advantages of tNGS technology, we divided the patients into a group with pure Mycoplasma pneumoniae infection and a group with Mycoplasma pneumoniae co-infection, and analyzed the clinical characteristics between the two groups. We found that lymphocyte count, neutrophil-lymphocyte ratio, alanine aminotransferase, and lactate dehydrogenase levels showed statistically significant differences between the two groups. This provides reference for clinically distinguishing whether patients have concurrent bacterial infections and can be helpful in treatment selection. Although most studies have focused on children with Mycoplasma pneumoniae infection, the incidence of Mycoplasma pneumoniae infection in adults with community-acquired pneumonia has increased in recent years [14-16] . In this study, we used tNGS technology to analyze bronchoalveolar lavage fluid samples to explore the differences in co-infection and pathogen spectrum between pediatric and adult patients. Consistent with the study by Kyi et al., we found that the most common co-detection with Mycoplasma pneumoniae infection was Streptococcus pneumoniae and Hemophilus influenzae [6] . Moreover, we further analyzed the differences between adults and children and found that pure Mycoplasma pneumoniae infection was more common in older patients (age >15 years), while Mycoplasma pneumoniae co-infection was more common in younger patients (age ≤15 years). Furthermore, in the analysis of the pathogen spectrum in Mycoplasma pneumoniae co-infection, it was found that co-infection with Streptococcus pneumoniae was more common in children with Mycoplasma pneumoniae infection, while co-infection with other pathogens was more prevalent in adults with Mycoplasma pneumoniae infection. This interesting finding provides valuable insights into the potential pathogens or colonizing microbiota that may exist in different age groups of patients. CONCLUSION Patients with pure Mycoplasma pneumoniae infection and patients with Mycoplasma pneumoniae co-infection exhibit differences in age, gender, and laboratory examinations, and demonstrate distinct infection characteristics among different age groups. Declarations Author contributions: Zhuman Du carried out the studies and participated in collecting the data; Zhuman Du and Pei Chen drafted the manuscript; Zhuman Du, Pei Chen and Xiaoju Chen performed the statistical analysis and participated in its design; all authors read and approved the final manuscript. Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose. Data availability: The data that support the results of the study are available from the corresponding author upon reasonable request. References Kumar S. Mycoplasma pneumoniae: A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections. Indian J Med Res. 2018. 147(1): 23–31. He J, Liu M, Ye Z, et al. Insights into the pathogenesis of Mycoplasma pneumoniae (Review). Mol Med Rep. 2016. 14(5): 4030–4036. Bajantri B, Venkatram S, Diaz-Fuentes G. Mycoplasma pneumoniae: A Potentially Severe Infection. J Clin Med Res. 2018. 10(7): 535–544. Pitcher D, Chalker VJ, Sheppard C, George RC, Harrison TG. Real-time detection of Mycoplasma pneumoniae in respiratory samples with an internal processing control. J Med Microbiol. 2006. 55(Pt 2): 149–155. Loens K, Ieven M. Mycoplasma pneumoniae: Current Knowledge on Nucleic Acid Amplification Techniques and Serological Diagnostics. Front Microbiol. 2016. 7: 448. Kyi D, Xiao Y, Wang X, et al. Predominance of A2063G mutant strains in the Mycoplasma pneumoniae epidemic in children-a clinical and epidemiological study in 2023 in Wuhan, China. Int J Infect Dis. 2024: 107074. Xing FF, Chiu KH, Deng CW, et al. Post-COVID-19 Pandemic Rebound of Macrolide-Resistant Mycoplasma pneumoniae Infection: A Descriptive Study. Antibiotics (Basel). 2024. 13(3): 262. Gadsby NJ, Reynolds AJ, McMenamin J, et al. Increased reports of Mycoplasma pneumoniae from laboratories in Scotland in 2010 and 2011 - impact of the epidemic in infants. Euro Surveill. 2012. 17(10): 20110 [pii]. Xu Y, Yang C, Sun P, et al. Epidemic Features and Megagenomic Analysis of Childhood Mycoplasma Pneumoniae post COVID-19 Pandemic: A 6-year Study in Southern China. Emerg Microbes Infect. 2024: 2353298. Izumikawa K, Izumikawa K, Takazono T, et al. Clinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: a review of the Japanese literature. J Infect Chemother. 2014. 20(3): 181–5. Li F, Kong S, Xie K, Zhang Y, Yan P, Zhao W. High ratio of C-reactive protein/procalcitonin predicts Mycoplasma pneumoniae infection among adults hospitalized with community acquired pneumonia. Scand J Clin Lab Invest. 2021. 81(1): 65–71. Izumikawa K. Clinical Features of Severe or Fatal Mycoplasma pneumoniae Pneumonia. Front Microbiol. 2016. 7: 800. Wang S, Jiang Z, Li X, Sun C, Zhang Y, Xiao Z. Diagnostic value of serum LDH in children with refractory Mycoplasma pneumoniae pneumoniae: A systematic review and meta-analysis. Front Pediatr. 2023. 11: 1094118. Ren Y, Wang Y, Liang R, et al. Development and validation of a nomogram for predicting Mycoplasma pneumoniae pneumonia in adults. Sci Rep. 2022. 12(1): 21859. Hakamifard A, Saffaei A. Macrolide-resistant Mycoplasma pneumoniae in adults with community acquired pneumonia: challenges and risks. East Mediterr Health J. 2020. 26(2): 141–142. Metsälä R, Ala-Korpi S, Rannikko J, Helminen M, Renko M. Mycoplasma pneumoniae may cause dyspnoea and hospitalisations in young healthy adults. Eur J Clin Microbiol Infect Dis. 2021. 40(7): 1427–1431. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4502877","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":313318521,"identity":"28a004e3-733d-4bbd-a1f2-e7ccbb305008","order_by":0,"name":"Zhuman Du","email":"","orcid":"","institution":"Clinical Medicine College＆ Affiliated Hospital of Chengdu University","correspondingAuthor":false,"prefix":"","firstName":"Zhuman","middleName":"","lastName":"Du","suffix":""},{"id":313318522,"identity":"5731c00c-42b7-48e3-bc8d-f06d233c44b3","order_by":1,"name":"Xiaoju Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYHCCxMc/Kmzk2NjbDxCtJdmY4UyaMR/PmQSitbBJM7YdTpwn4WBAnHr+GQnPpAvbmNPbJBgSGH5UbCOsReLMgWTrGefYctukGw8w9py5TViLAXtD4g2eMp7cNpkDCcyMbcRoYWZIkOBhk0hnk0gwIFILe0OSNE+bQQLxWkB+MZxxJsGwDRjIB4nyC/+MnMQHHyr+y8u3tx988KOCCC0MDDwJcOYBYtQDATuxCkfBKBgFo2DEAgCifDvjklplzAAAAABJRU5ErkJggg==","orcid":"","institution":"Clinical Medicine College＆ Affiliated Hospital of Chengdu University","correspondingAuthor":true,"prefix":"","firstName":"Xiaoju","middleName":"","lastName":"Chen","suffix":""},{"id":313318523,"identity":"da7acae9-294d-4200-bf5d-addcac858e1f","order_by":2,"name":"Pei Chen","email":"","orcid":"","institution":"Clinical Medicine College＆ Affiliated Hospital of Chengdu University","correspondingAuthor":false,"prefix":"","firstName":"Pei","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-05-30 12:00:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4502877/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4502877/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58385709,"identity":"6851ab1f-4bd6-4ba9-9766-8cb067e81fe7","added_by":"auto","created_at":"2024-06-14 18:41:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20334,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNumber of cases of different bacteria detected by tNGS in bronchoalveolar lavage fluid from adults and children.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4502877/v1/9c5a221bd7639903826d53dd.png"},{"id":58387412,"identity":"4b2f6283-0c39-4899-a82a-1d64a5f4531a","added_by":"auto","created_at":"2024-06-14 18:49:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":534531,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4502877/v1/b5068dc7-970a-427f-9284-e70ee2e12e1b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Detection of Mycoplasma Pneumoniae Using Targeted Next-Generation Sequencing: A Comparative Analysis of Clinical Characteristics in Pure Infections and Co-Infections","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMycoplasma is a small, free-living, wall-less, and self-replicating prokaryotic organism\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Over 200 species of Mycoplasma have been identified in humans, animals, plants, and arthropods, with major pathogenic species including Mycoplasma pneumoniae, Mycoplasma genitalium, Mycoplasma fermentans, Mycoplasma hominis, Mycoplasma penetrans, Mycoplasma pirum, and Mycoplasma urealyticum, which can cause respiratory and genitourinary diseases\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Among these pathogenic Mycoplasma species, Mycoplasma pneumoniae is the most significant and extensively studied species. It is one of the leading pathogens causing respiratory diseases and pneumonia in humans, particularly in children and adolescents\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Mycoplasma pneumoniae cannot be routinely cultured from respiratory specimens, and specific antibodies may not be detectable until 7\u0026ndash;10 days after the onset of symptoms\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Therefore, investigating the true role of Mycoplasma pneumoniae in respiratory tract infections remains challenging\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. In recent years, the emergence of targeted next-generation sequencing (tNGS) technology has greatly aided the rapid and accurate diagnosis of Mycoplasma pneumoniae pneumonia\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Adult Mycoplasma pneumoniae pneumonia and its co-infection with other pathogens have become hot research topics, and their clinical features are gradually being explored. This study aims to investigate the characteristics of Mycoplasma pneumoniae pneumonia co-infection and laboratory examination using targeted NGS technology.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and samples\u003c/h2\u003e \u003cp\u003ePatients admitted to the Affiliated Hospital of Chengdu University from June 1, 2022, to April 1, 2024, diagnosed with mycoplasma pneumonia by clinical and tNGS of bronchoalveolar lavage fluid were included in the study. A total of 104 patients were analyzed, and they were divided into two groups based on the results of tNGS: 46 cases of pure mycoplasma pneumonia infection and 58 cases of mycoplasma pneumonia with concurrent bacterial infections. All data were collected anonymously, and all patients or guardians had signed the informed consent form for hospital admission treatment. A retrospective review of the electronic medical records of the included mycoplasma pneumonia patients was conducted. Demographic characteristics were collected, including age and gender. The duration of hospitalization and clinical indicators measured at admission, such as complete blood count, C-reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, and D-dimer, were recorded. Additionally, the results of tNGS testing of bronchoalveolar lavage fluid during hospitalization were documented.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eTNGS detection\u003c/h2\u003e \u003cp\u003eThe tNGS sequencing was provided by Guangzhou Huayin Medical Laboratory Center Co. Ltd and Shanghai Cinopath Medical Testing Co. Ltd. The sequencing targets highly conserved regions of 99 respiratory pathogens using super-multiplex PCR combined with next-generation sequencing technology for gene sequencing to read the detection results of pathogens. These 99 regions include common respiratory pathogens such as viruses, bacteria, mycoplasmas, mycobacteria, and fungi. Data quality is achieved by removing low-quality and short (\u0026lt;\u0026thinsp;50 bp) reads.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEthics\u003c/h2\u003e \u003cp\u003eThis is a single-center, retrospective, observational study conducted at a tertiary hospital in Chengdu, China. The study was approved by the \u0026ldquo;Ethics Committee of Clinical Medicine College \u0026amp; Affiliated Hospital of Chengdu University\u0026rdquo; (PJ2024-048-01). This study was conducted strictly in accordance with guidelines and regulations. All participants and/or their legal guardians provided informed consent. It complies with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistics\u003c/h2\u003e \u003cp\u003eData analysis was conducted using SPSS 27.0. Quantitative data that were normally distributed were described using the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while data that were not normally distributed were described using the median (interquartile range). Categorical data were described using frequency (%). For normally distributed data, t-tests were used, while non-parametric tests were employed for skewed distributed data. Chi-square tests were used for categorical variables. A P value below 0.05 was considered significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Characteristics of Patients with Pure Mycoplasma Pneumoniae Infection and Patients with Mycoplasma Pneumoniae Co-infection.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.157534246575343%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.863013698630137%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N =\u003c/strong\u003e\u003cstrong\u003e104\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.602739726027398%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePure Mycoplasma Pneumoniae Infection group (n=46)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.82191780821918%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMycoplasma Pneumoniae Co-infection group (n=58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.554794520547945%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.157534246575343%\" valign=\"top\"\u003e\n \u003cp\u003eAge, y, mean \u0026plusmn;SD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.404109589041095%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e25.16\u0026plusmn;19.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.061643835616437%\" valign=\"top\"\u003e\n \u003cp\u003e31.48\u0026plusmn;18.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.82191780821918%\" valign=\"top\"\u003e\n \u003cp\u003e20.16\u0026plusmn;19.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.554794520547945%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.157534246575343%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.404109589041095%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e45(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.061643835616437%\" valign=\"top\"\u003e\n \u003cp\u003e13(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.82191780821918%\" valign=\"top\"\u003e\n \u003cp\u003e32(30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.554794520547945%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.006 \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.228456913827655%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.050100200400802%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e59(56.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.649298597194388%\" valign=\"top\"\u003e\n \u003cp\u003e33(31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.07214428857716%\" valign=\"top\"\u003e\n \u003cp\u003e26(25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.157534246575343%\" valign=\"top\"\u003e\n \u003cp\u003eDays of hospitalization, mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.404109589041095%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e8.93\u0026plusmn;3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.061643835616437%\" valign=\"top\"\u003e\n \u003cp\u003e8.63 \u0026plusmn;3.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.82191780821918%\" valign=\"top\"\u003e\n \u003cp\u003e9.17 \u0026plusmn;3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.554794520547945%\" valign=\"top\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations. SD: standard deviation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBy comparing and analyzing the laboratory examination results of patients with pure Mycoplasma pneumoniae infection and those with Mycoplasma pneumoniae co-infection (Table 2), we identified significant differences between the two groups in certain key hematological and inflammatory markers. There were significant differences in lymphocyte count, neutrophil-to-lymphocyte ratio (NLR), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels between the pure Mycoplasma pneumoniae infection group and the Mycoplasma pneumoniae co-infection group. However, the differences in white blood cell count, neutrophil count, C-reactive protein (CRP), procalcitonin, aspartate aminotransferase (AST), and D-dimer between the two groups were not statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Laboratory Examinations of Patients with Pure Mycoplasma Pneumoniae Infection and Patients with Mycoplasma Pneumoniae Co-infection\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\" style=\"margin-right: calc(26%); width: 74%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.60876897133221%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory Test (Reference Range)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.33389544688027%\" colspan=\"3\" valign=\"top\" style=\"width: 8.3477%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N =\u003c/strong\u003e\u003cstrong\u003e104\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.537942664418214%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePure Mycoplasma Pneumoniae Infection group (n=46)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.66779089376054%\" valign=\"top\" style=\"width: 16.5971%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMycoplasma Pneumoniae Co-infection group\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=58)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.33389544688027%\" valign=\"top\" style=\"width: 8.2494%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.922428330522767%\" colspan=\"2\" valign=\"top\" style=\"width: 12.6688%;\"\u003e\n \u003cp\u003eWhite blood cell (3.5-9.5) x 109/L, mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.05564924114671%\" colspan=\"3\" valign=\"top\" style=\"width: 11.2939%;\"\u003e\n \u003cp\u003e7.42\u0026plusmn;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.537942664418214%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e7.26\u0026plusmn;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.463743676222595%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e7.53\u0026plusmn;2.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.020236087689714%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eLymphocytes (1.1-3.2) x 109/L, mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" colspan=\"3\" valign=\"top\" style=\"width: 6.4817%;\"\u003e\n \u003cp\u003e1.79\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.905723905723907%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003e1.51\u0026plusmn;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e2.01\u0026plusmn;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eNeutrophils\u0026nbsp;(1.8-6.3)\u0026nbsp;x 109/L\u0026nbsp;,mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e4.92\u0026plusmn;1.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e5.09\u0026plusmn;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e4.79\u0026plusmn;2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eHypersensitive\u0026nbsp;C-reactive (0-10.0)\u0026nbsp;mg/L,\u0026nbsp;median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e21.32(5.35-51.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e31.30(11.75-65.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e12.35 (4.87-45.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eNeutrophil-to-Lymphocyte Ratio（NLR）,\u0026nbsp;median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e3.00 (1.94-4.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e3.88 (2.60-5.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e2.31 (1.56-3.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eProcalcitonin (\u0026lt;0.5) ng/mL, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e0.08 (0.05-0.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e0.08 (0.05-0.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e0.06 (0.05-0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eAspartate aminotransferase (13.0-35.0) IU/L, mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e30.82\u0026plusmn;20.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e30.79\u0026plusmn;17.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e30.85\u0026plusmn;22.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eAlanine aminotransferase (7.0-40.0)\u0026nbsp;IU/L, mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e26.72\u0026plusmn;25.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e32.78\u0026plusmn;31.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e21.88\u0026plusmn;19.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eLactate dehydrogenase (120.0-250.0)\u0026nbsp;IU/L, mean \u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e237.13\u0026plusmn;90.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e216.17\u0026plusmn;53.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e253.89\u0026plusmn;108.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.569023569023567%\" colspan=\"2\" valign=\"top\" style=\"width: 13.8473%;\"\u003e\n \u003cp\u003eD-dimer (＜0.5) ug/mL, median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"3\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e0.43 (0.33-0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.50841750841751%\" colspan=\"2\" valign=\"top\" style=\"width: 10.2136%;\"\u003e\n \u003cp\u003e0.39 (0.33-0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.420875420875422%\" valign=\"top\" style=\"width: 14.7312%;\"\u003e\n \u003cp\u003e0.47 (0.33-0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.993265993265993%\" valign=\"top\" style=\"width: 9.1333%;\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations. SD: standard deviation; IQR: interquartile range.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study conducted a comparative analysis of the distribution of pathogens among pneumonia patients of different age groups (age \u0026gt;15 years and age \u0026le;15 years) (Figure 1). The results showed that Streptococcus pneumoniae was the most common pathogen in both groups, especially in children aged \u0026le;15 years, with a total of 33 cases. Additionally, Haemophilus influenzae was also relatively common among patients in both age groups, with 16 and 17 cases respectively. Notably, Staphylococcus aureus had a higher detection rate among patients, with a total of 6 cases. Other pathogens, such as Enterococcus faecalis, Mycoplasma hominis, Ureaplasma urealyticum, Enterococcus faecium, Klebsiella pneumoniae, Burkholderia cepacia, Klebsiella pneumoniae, Burkholderia gladioli, Mycoplasma ureaplasma, and Serratia marcescens, were detected at a lower rate in both groups, with no more than 2 cases each.\u003c/p\u003e\n\u003cp\u003eThis study used targeted next-generation sequencing (tNGS) technology to statistically analyze the distribution of co-infecting pathogens in patients with Mycoplasma pneumoniae infection who were younger than 15 years old (age \u0026le; 15 years) and those who were 15 years old or older (age \u0026gt; 15 years). The results (Table 3 and Table 4) showed a statistically significant association between age and type of infection (P\u0026lt;0.001). Among patients aged \u0026le; 15 years, there were 10 cases of pure Mycoplasma pneumoniae infection, while there were 36 cases in patients aged \u0026gt; 15 years. In contrast, there were 34 cases in the Mycoplasma pneumoniae co-infection group among patients aged \u0026le; 15 years and 24 cases in those aged \u0026gt; 15 years, indicating that age is an important factor affecting the type of Mycoplasma pneumoniae infection. Specifically, older patients (age \u0026gt; 15 years) were more likely to develop pure Mycoplasma pneumoniae infection, while younger patients (age \u0026le; 15 years) more commonly exhibited co-infection with Mycoplasma pneumoniae. Secondly, as the most common pathogen in Mycoplasma pneumoniae infection patients, both in terms of pure infection and co-infection, Streptococcus pneumoniae was more frequently co-infection in patients with Mycoplasma pneumoniae infection aged \u0026le; 15 years, whereas in the group of Mycoplasma pneumoniae patients aged \u0026gt; 15 years, the incidence of co-infection with other pathogens was higher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Relationship between Age and Mycoplasma Pneumoniae Co-infection\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.08641975308642%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.39858906525573%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eage\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026le;15 years old\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.514991181657848%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eage\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e＞15 years old\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.08641975308642%\" valign=\"top\"\u003e\n \u003cp\u003ePure Mycoplasma Pneumoniae Infection group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.39858906525573%\" valign=\"top\"\u003e\n \u003cp\u003e10(9.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.514991181657848%\" valign=\"top\"\u003e\n \u003cp\u003e36(34.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.08641975308642%\" valign=\"top\"\u003e\n \u003cp\u003eMycoplasma Pneumoniae Co-infection group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.39858906525573%\" valign=\"top\"\u003e\n \u003cp\u003e34(32.69%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.514991181657848%\" valign=\"top\"\u003e\n \u003cp\u003e24(23.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.18021201413428%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.81978798586572%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e14.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.18021201413428%\" valign=\"top\"\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.81978798586572%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Relationship between Age and Co-infection with Streptococcus pneumoniae in Mycoplasma Pneumonia\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.08641975308642%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.39858906525573%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eage\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026le;15 years old\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.514991181657848%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eage\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e＞15 years old\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.08641975308642%\" valign=\"top\"\u003e\n \u003cp\u003eMycoplasma pneumoniae co-infection with other bacterial infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.39858906525573%\" valign=\"top\"\u003e\n \u003cp\u003e11(10.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.514991181657848%\" valign=\"top\"\u003e\n \u003cp\u003e45(43.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.08641975308642%\" valign=\"top\"\u003e\n \u003cp\u003eMycoplasma pneumoniae co-infection with Streptococcus pneumoniae\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.39858906525573%\" valign=\"top\"\u003e\n \u003cp\u003e33(31.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.514991181657848%\" valign=\"top\"\u003e\n \u003cp\u003e15(14.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.18021201413428%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e- Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.81978798586572%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e25.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"53.18021201413428%\" valign=\"top\"\u003e\n \u003cp\u003ep-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"46.81978798586572%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMycoplasma pneumoniae pneumonia is a global cause of community-acquired pneumonia, presenting with periodic epidemic patterns, with a cycle of approximately 4 to 7 years. This is due to the gradual decline in population immunity and the emergence of new subspecies of Mycoplasma pneumoniae\u003csup\u003e[8]\u003c/sup\u003e. In late 2023, an outbreak of respiratory diseases in children occurred in China, during which Mycoplasma pneumoniae became the predominant respiratory infection type among children\u003csup\u003e[9]\u003c/sup\u003e. However, we also observed an increasing trend in the infection rate of Mycoplasma pneumoniae pneumonia in adults. Therefore, our study included participants from the population during the outbreak of Mycoplasma pneumoniae pneumonia in China in 2023, including both children and adults with Mycoplasma pneumoniae pneumonia, with an age range of 1-74 years.\u003c/p\u003e\n\u003cp\u003eLaboratory diagnosis of Mycoplasma pneumoniae pneumonia is particularly important because this disease cannot be diagnosed based solely on clinical symptoms and signs. The most widely used detection method currently is the enzyme immunoassay, which is used to detect Mycoplasma pneumoniae IgM, IgG, and IgA antibodies\u003csup\u003e[1]\u003c/sup\u003e. However, in recent years, targeted next-generation sequencing (tNGS) technology based on multiplex PCR has emerged, which can detect Mycoplasma pneumoniae infection earlier than serology. This method employs real-time quantitative PCR targeting the P1 gene in respiratory specimens to detect Mycoplasma pneumoniae, showing a sensitivity of 60% and specificity of 96.7% compared to serology\u003csup\u003e[4]\u003c/sup\u003e. Its sensitivity is always superior to traditional methods and it is increasingly considered as the \u0026ldquo;new gold standard\u0026rdquo;\u0026nbsp;\u003csup\u003e[5]\u003c/sup\u003e. In this study, all patients were diagnosed with Mycoplasma pneumoniae pneumonia using tNGS detection technology, and the specimens were obtained from lower respiratory tract samples (bronchoalveolar lavage fluid), which provides more reliable evidence compared to previous studies that mainly used sputum and blood samples.\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that leukocytosis and elevated C-reactive protein are common in patients with Mycoplasma pneumoniae pneumonia\u003csup\u003e[10, 11]\u003c/sup\u003e. Liver function abnormalities indicated by elevated alanine aminotransferase and aspartate aminotransferase are common in patients with fulminant Mycoplasma pneumoniae pneumonia. It has been found that patients with acute respiratory failure associated with Mycoplasma pneumoniae pneumonia have significantly increased white blood cell count, C-reactive protein, lactate dehydrogenase, alanine aminotransferase, and aspartate aminotransferase levels\u003csup\u003e[10-12]\u003c/sup\u003e. Wang et al. demonstrated that serum lactate dehydrogenase (LDH) has good diagnostic accuracy for refractory Mycoplasma pneumoniae pneumonia and can be used as a diagnostic marker for refractory Mycoplasma pneumoniae pneumonia\u0026nbsp;\u003csup\u003e[13]\u003c/sup\u003e. However, there is currently no research comparing the characteristics of co-infection in patients with Mycoplasma pneumoniae pneumonia. Therefore, based on the advantages of tNGS technology, we divided the patients into a group with pure Mycoplasma pneumoniae infection and a group with Mycoplasma pneumoniae co-infection, and analyzed the clinical characteristics between the two groups. We found that lymphocyte count, neutrophil-lymphocyte ratio, alanine aminotransferase, and lactate dehydrogenase levels showed statistically significant differences between the two groups. This provides reference for clinically distinguishing whether patients have concurrent bacterial infections and can be helpful in treatment selection.\u003c/p\u003e\n\u003cp\u003eAlthough most studies have focused on children with Mycoplasma pneumoniae infection, the incidence of Mycoplasma pneumoniae infection in adults with community-acquired pneumonia has increased in recent years\u003csup\u003e[14-16]\u003c/sup\u003e. In this study, we used tNGS technology to analyze bronchoalveolar lavage fluid samples to explore the differences in co-infection and pathogen spectrum between pediatric and adult patients. Consistent with the study by Kyi et al., we found that the most common co-detection with Mycoplasma pneumoniae infection was Streptococcus pneumoniae and Hemophilus influenzae\u003csup\u003e[6]\u003c/sup\u003e. Moreover, we further analyzed the differences between adults and children and found that pure Mycoplasma pneumoniae infection was more common in older patients (age \u0026gt;15 years), while Mycoplasma pneumoniae co-infection was more common in younger patients (age \u0026le;15 years). Furthermore, in the analysis of the pathogen spectrum in Mycoplasma pneumoniae co-infection, it was found that co-infection with Streptococcus pneumoniae was more common in children with Mycoplasma pneumoniae infection, while co-infection with other pathogens was more prevalent in adults with Mycoplasma pneumoniae infection. This interesting finding provides valuable insights into the potential pathogens or colonizing microbiota that may exist in different age groups of patients.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePatients with pure Mycoplasma pneumoniae infection and patients with Mycoplasma pneumoniae co-infection exhibit differences in age, gender, and laboratory examinations, and demonstrate distinct infection characteristics among different age groups.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor contributions: Zhuman Du carried out the studies and participated in collecting the data; Zhuman Du and Pei Chen drafted the manuscript; Zhuman Du, Pei Chen and Xiaoju Chen performed the statistical analysis and participated in its design; all authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eConflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.\u003c/p\u003e\n\u003cp\u003eData availability: The data that support the results of the study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKumar S. Mycoplasma pneumoniae: A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections. Indian J Med Res. 2018. 147(1): 23\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe J, Liu M, Ye Z, et al. Insights into the pathogenesis of Mycoplasma pneumoniae (Review). Mol Med Rep. 2016. 14(5): 4030\u0026ndash;4036.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBajantri B, Venkatram S, Diaz-Fuentes G. Mycoplasma pneumoniae: A Potentially Severe Infection. J Clin Med Res. 2018. 10(7): 535\u0026ndash;544.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePitcher D, Chalker VJ, Sheppard C, George RC, Harrison TG. Real-time detection of Mycoplasma pneumoniae in respiratory samples with an internal processing control. J Med Microbiol. 2006. 55(Pt 2): 149\u0026ndash;155.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoens K, Ieven M. Mycoplasma pneumoniae: Current Knowledge on Nucleic Acid Amplification Techniques and Serological Diagnostics. Front Microbiol. 2016. 7: 448.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKyi D, Xiao Y, Wang X, et al. Predominance of A2063G mutant strains in the Mycoplasma pneumoniae epidemic in children-a clinical and epidemiological study in 2023 in Wuhan, China. Int J Infect Dis. 2024: 107074.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXing FF, Chiu KH, Deng CW, et al. Post-COVID-19 Pandemic Rebound of Macrolide-Resistant Mycoplasma pneumoniae Infection: A Descriptive Study. Antibiotics (Basel). 2024. 13(3): 262.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGadsby NJ, Reynolds AJ, McMenamin J, et al. Increased reports of Mycoplasma pneumoniae from laboratories in Scotland in 2010 and 2011 - impact of the epidemic in infants. Euro Surveill. 2012. 17(10): 20110 [pii].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Y, Yang C, Sun P, et al. Epidemic Features and Megagenomic Analysis of Childhood Mycoplasma Pneumoniae post COVID-19 Pandemic: A 6-year Study in Southern China. Emerg Microbes Infect. 2024: 2353298.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzumikawa K, Izumikawa K, Takazono T, et al. Clinical features, risk factors and treatment of fulminant Mycoplasma pneumoniae pneumonia: a review of the Japanese literature. J Infect Chemother. 2014. 20(3): 181\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi F, Kong S, Xie K, Zhang Y, Yan P, Zhao W. High ratio of C-reactive protein/procalcitonin predicts Mycoplasma pneumoniae infection among adults hospitalized with community acquired pneumonia. Scand J Clin Lab Invest. 2021. 81(1): 65\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIzumikawa K. Clinical Features of Severe or Fatal Mycoplasma pneumoniae Pneumonia. Front Microbiol. 2016. 7: 800.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang S, Jiang Z, Li X, Sun C, Zhang Y, Xiao Z. Diagnostic value of serum LDH in children with refractory Mycoplasma pneumoniae pneumoniae: A systematic review and meta-analysis. Front Pediatr. 2023. 11: 1094118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRen Y, Wang Y, Liang R, et al. Development and validation of a nomogram for predicting Mycoplasma pneumoniae pneumonia in adults. Sci Rep. 2022. 12(1): 21859.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakamifard A, Saffaei A. Macrolide-resistant Mycoplasma pneumoniae in adults with community acquired pneumonia: challenges and risks. East Mediterr Health J. 2020. 26(2): 141\u0026ndash;142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMets\u0026auml;l\u0026auml; R, Ala-Korpi S, Rannikko J, Helminen M, Renko M. Mycoplasma pneumoniae may cause dyspnoea and hospitalisations in young healthy adults. Eur J Clin Microbiol Infect Dis. 2021. 40(7): 1427\u0026ndash;1431.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mycoplasma pneumonia, Co-infection, Targeted Next-Generation Sequencing, Bronchial Lavage Fluid","lastPublishedDoi":"10.21203/rs.3.rs-4502877/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4502877/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMycoplasma pneumoniae is a common pathogen of community-acquired pneumonia, exhibiting a periodic epidemic pattern. However, there is currently no research comparing the characteristics of co-infections in patients with Mycoplasma pneumoniae. This study aims to explore the epidemiological characteristics of co-infections associated with Mycoplasma pneumoniae and to assess the specific traits of laboratory findings utilizing targeted Next-Generation Sequencing (tNGS) technology. A total of 104 patients diagnosed with Mycoplasma pneumonia were included. Based on the results of targeted NGS testing, patients were divided into a group with pure Mycoplasma pneumoniae infection (46 cases) and a group with Mycoplasma pneumoniae co-infected with other bacterial infections (58 cases). Data regarding demographic characteristics, laboratory tests, and targeted NGS results from bronchial lavage fluid during hospitalization were collected. Patients with pure Mycoplasma pneumoniae infection exhibited significant differences in lymphocyte count, neutrophil-to-lymphocyte ratio, alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) levels compared to those with Mycoplasma pneumoniae complicated by other infections (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all). The rate of pure Mycoplasma pneumoniae infection was higher in females than in males (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Older patients were more prone to pure Mycoplasma pneumoniae infection, whereas younger patients were more likely to have Mycoplasma pneumoniae complicated by bacterial infections (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for both). Furthermore, Streptococcus pneumoniae was the most common pathogen associated with co-infections, particularly prevalent among children (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There are differences in age, gender, and laboratory test results between patients with pure Mycoplasma pneumoniae infections and those with Mycoplasma pneumoniae coinfections, with varying infection characteristics displayed among patients of different age groups.\u003c/p\u003e","manuscriptTitle":"Detection of Mycoplasma Pneumoniae Using Targeted Next-Generation Sequencing: A Comparative Analysis of Clinical Characteristics in Pure Infections and Co-Infections","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-14 18:41:15","doi":"10.21203/rs.3.rs-4502877/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a7ffec47-bea6-4d33-9d48-c36245be64c2","owner":[],"postedDate":"June 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33126838,"name":"Health sciences/Diseases/Respiratory tract diseases"},{"id":33126839,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2024-06-14T18:41:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-14 18:41:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4502877","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4502877","identity":"rs-4502877","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}