Comparative analysis of clinical characteristics of drug-resistant Mycoplasma pneumoniae pneumonia and viral pneumonia in children under 6 years of age

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Methods In this study, 213 children with community-acquired pneumonia (CAP) admitted to the pediatrics department of Gansu Provincial Maternal and Child Health Hospital from March 2023 to August 2024 were selected and divided into the MRMPP group and the viral pneumonia group according to the results of Targeted next-generation sequencing (tNGS), and the general data, clinical characteristics, laboratory examinations, chest CT and fiberoptic bronchoscopic manifestations of the two groups were compared and analyzed. Results There were 145 cases (68.1%) in the MRMPP group and 68 cases (31.9%) in the viral pneumonia group. The incidence of severe illness was 59.3% and 29.4% in the MRMPP and viral pneumonia groups, respectively. The MRMPP group showed a higher proportion of fever, longer total duration of fever, more likely to hear moist rales and diminished breath sounds, and more likely to have wheezing and sputum sounds in the viral pneumonia group. The MRMPP group was dominated by increased levels of N%, CRP, D-D, and ESR, and the viral pneumonia group was dominated by increased levels of WBC, L%, Alb, ALT, and AST, and chest CT was more likely to show lobar pneumonia and lung consolidation, and the rates of fiberoptic bronchoscopy, bronchial inflammatory stenosis, and plasmacytoid bronchitis were higher. Conclusions Despite the differences in clinical features and laboratory tests between MRMPP and viral pneumonia in children under 6 years of age, it is difficult to differentiate them in clinical practice, and the use of tNGS may help to clarify the etiology of the infection when it is difficult to do so. Macrolide resistance Mycoplasma pneumoniae pneumonia viral pneumonia clinical features 1 Introduction Mycoplasma pneumoniae pneumonia (MPP) is one of the main causes of community-acquired pneumonia (CAP) in hospitalized children and is more common in preschool and school-age children, with a decreasing trend in the prevalence of infection with increasing age. [ 1 ] In recent years, the prevalence of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) has increased significantly, and the age tends to be lowered. [ 2 – 5 ] It leads to a significant increase in the proportion of severe pneumonia; however, the clinical symptoms of MRMPP lack specificity and are insufficient to differentiate it from pneumonia caused by other pathogens. Respiratory viruses, including respiratory syncytial virus, adenovirus, influenza virus, rhinovirus, and metapneumovirus, are also common causes of respiratory tract infections in children. [ 6 , 7 ] Clinical symptoms are similar to those of MRMPP, with fever, cough, malaise, and wet lung rales, and interstitial lung lesions predominating on chest imaging, which are often indistinguishable, especially in infants and young children. Currently, there are few studies on the differentiation of clinical features of MRMPP and viral pneumonia in children under 6 years of age. Therefore, in this study, we compared the clinical characteristics and laboratory findings of MRMPP and viral pneumonia in children under 6 years of age based on the targeted next-generation sequencing (tNGS) of respiratory pathogens in sputum or bronchoalveolar lavage fluid (BALF) from hospitalized children. 2 Materials and methods 2.1 Study population Two hundred and thirteen children diagnosed with CAP at the time of admission to the pediatric department of Gansu Maternal and Child Health Hospital from March 2023 to August 2024 were selected for a retrospective study and were divided into 145 cases in the MRMPP group and 68 cases in the viral pneumonia group according to the results of the tNGS test. The study participants were < 6 years old. Diagnosis follows Guidelines for the management of community-acquired pneumonia in children (2024 revision); [ 8 ] All children had clear MRMP or viral infection by tNGS testing. Children admitted in recovery from pneumonia (including more than 4 weeks of illness, more than 1 week of temperature stabilization, and resorption of imaging lung lesions), with bronchopulmonary dysplasia, immunodeficiency, bronchial asthma, or recurrent respiratory infections, with clear-cut infections with other pathogens, and with incomplete clinical history data were excluded. The Institutional Review Board of Gansu Maternal and Child Health Hospital reviewed the project and deemed it to be exempt from institutional oversight and granted a waiver for informed consent. 2.2 Sample collection Sputum, or BALF, was collected from all children on admission, and the collection process was carried out in strict accordance with the standard of aseptic operation. The natural sputum coughing method was used for children who could cough up sputum deep in the respiratory tract, and for children who were difficult to cough up sputum naturally, sterile sputum suction tubes were used to extract secretions deep in the trachea, and BALF was collected by the doctors of the Children's Bronchoscopy Center of Gansu Provincial Maternity and Child Health Hospital, who used fiberoptic bronchoscopes to take samples of bronchial alveolar lavage in accordance with the standard procedures. The specimens were kept in sterile sputum cups, and the amount of specimens should be > 4 ml, labeled, and stored at -20℃ for examination. 2.3 The tNGS detection methods The tNGS test is performed by Gansu Jinwei Institute of Medical Laboratory and Diagnostic Pathology. Using the tNGS kit, the combination of ultra-multiplex PCR and high-throughput sequencing technology is used to directly enrich for known pathogenic microorganisms and their virulence and/or drug resistance genes in clinical samples, and then perform high-throughput sequencing, which is then compared and analyzed with the database, and based on the sequence information of the comparison, the sample is judged to contain the species of pathogenic microorganisms, thus realizing the nucleic acids in the sample to be tested to be identified with high sensitivity and high resolution, and the detection of low concentrations of pathogenic microorganisms, especially the detection of their virulence and/or drug resistance genes. High-resolution identification of the nucleic acids in the samples to be tested, which is a significant advantage for the detection of pathogenic microorganisms in low concentrations, especially for the detection of their virulence and/or drug resistance genes. [ 9 ] The detection steps include: sample total nucleic acid extraction (including human nucleic acid, pathogenic bacteria, colonizing bacteria nucleic acid, etc.); enrichment of nucleic acids of target pathogens; obtaining sequence information of nucleic acids after target capture by high-throughput sequencing platform; and data analysis.Tests include 198 species covering Gram-positive bacteria, Gram-negative bacteria, DNA viruses, RNA viruses, fungi, special pathogens, and other respiratory tract infection pathogens, as well as 5 drug resistance genes. 2.4 Observation indicators Includes general information, clinical symptoms, pulmonary signs, laboratory indices, chest CT ,and fiberoptic bronchoscopic manifestations. 2.5 Statistical analysis All analyses were performed with commercially available statistical software (SPSS v25). Descriptive statistics was performed and reported by percentages for qualitative data and by means with standard deviations or medians with range for quantitative data. Continuous data were analyzed with the t-test, and categorical data were compared with the Chi-square test. All tests were two-tailed. Statistical significance was defined as p < 0.05 in the tests. 3 Results 3.1 Comparative analysis of general information In the MRMPP group, 83 (57.2%) were male and 62 (42.8%) were female. In the viral pneumonia group, 35 (51.5%) were male and 33 (48.5%) were female. The difference between the two groups was statistically significant when comparing the age of onset of disease in months and the length of hospitalization ( P < 0.05). 142 (97.9%) children in the MRMPP group and 62 (91.2%) children in the viral pneumonia group had been treated with antibiotics prior to hospitalization, and the difference was not statistically significant ( P > 0.05). 86 (59.3%) children in the MRMPP group and 20 (29.4%) children in the viral pneumonia group developed severe pneumonia; the difference was statistically significant ( P < 0.001) (Table 1 ). Table 1 General characterization of the two groups of children General information MRMPP(n = 145) Viral pneumonia(n = 68) χ 2 / t /Z P Gender Male 83(57.2) 35(51.5) 0.624 0.430 Female 62(42.8) 33(48.5) Age (months) 64(48.0,70.0) 37(12.5,53.8) –6.129 <0.001 Length of hospitalization(days) 6.72 ± 2.04 6.07 ± 1.98 2.169 0.031 Antibiotics prior to admission 142(97.9) 62(91.2) 3.683 0.055 severe pneumonia 86(59.3) 20(29.4) 16.553 <0.001 3.2 Comparative analysis of clinical symptoms and pulmonary signs Children in the MRMPP group were more likely to have febrile symptoms and longer total duration of fever than those in the viral pneumonia group, and the difference was statistically significant ( P 0.05). Moist rales were more likely to be audible in the lungs, and respiratory sounds were diminished in the MRMPP group, while wheezing was more likely to be present in the viral pneumonia group, and sputum sounds were more likely to be audible in the lungs, and the difference was statistically significant ( P < 0.05) (Table 2 ). Table 2 Analysis of clinical symptoms and pulmonary signs in two groups of children Clinical presentations MRMPP (n = 145) Viral pneumonia(n = 68) χ 2 /Z P Symptoms Raised body temperature 116(86.2) 50(73.5) 5.076 0.024 Duration of fever(days) 6(3,8) 3(0,6) –4.288 <0.001 Cough(days) 16(12.0,19.5) 17(10.0,20.0) –0.667 0.498 Breather 22(15.2) 19(27.9) 4.856 0.028 Dyspnea 6(4.1) 2(2.9) 0.002 0.967 Hypoxemia 16(11.0) 7(10.3) 0.026 0.871 Signs Moist rales 116(80.0) 34(50.0) 20.002 <0.001 Sputum sounds 25(17.2) 27(39.7) 12.660 <0.001 Wheezing sounds 18(12.4) 15(22.1) 3.289 0.070 Diminished breath sounds 16(11.0) 0(0) 8.113 0.004 3.3 Comparative analysis of laboratory tests The MRMPP group was dominated by increased levels of N%, CRP, D-D, ESR, etc., and the viral pneumonia group was dominated by increased levels of WBC, L%, Alb, ALT, AST, etc., and the differences were statistically significant ( P 0.05) (Table 3 ). Table 3 Analysis of laboratory findings in two groups of children Parameter MRMPP(n = 145) Viral pneumonia(n = 68) χ 2 /Z P WBC(×10 9 /L) 7.77(6.14,9.78) 8.83(7.24,11.54) –2.417 0.016 L% 32.80(24.35,43.30) 44.10(30.70,63.70) –4.288 <0.001 N% 57.30(46.75,67.45) 44.00(26.15,58.35) –4.590 <0.001 CRP(mg/L) 7.36(2.96,18.48) 4.01(1.00,16.38) –2.258 0.024 PCT(ng/ml) 0.21(0.17,0.26) 0.23(0.18,0.30) –1.874 0.061 Alb(g/L) 42.70(40.95,44.40) 45.10(42.25,47.70) –4.195 <0.001 LDH(U/L) 339.00(286.00,411.50) 313.00(273.25,424.75) –0.873 0.383 D-D(mg/L) 0.43(0.33,0.74) 0.37(0.25,0.62) –2.049 0.040 ESR(mm/h) 25.00(17.00,36.50) 14.50(8.25,24.75) –4.070 <0.001 ALT(U/L) 13.30(9.75,16.95) 15.40(12.00,26.73) –3.393 0.001 AST(U/L) 33.30(28.45,40.10) 40.70(33.35,49.48) –3.929 <0.001 CK(U/L) 86.00(66.00,121.00) 94.50(72.00,121.50) –0.887 0.375 CKMB(U/L) 31.80(22.55,52.00) 33.75(26.03,46.48) –1.284 0.199 3.4 Comparative analysis of chest CT 145 (100.0%) children in the MRMPP group and 63 (92.6%) children in the viral pneumonia group developed lobar pneumonia, and 67 (46.2%) children in the MRMPP group and 15 (22.1%) children in the viral pneumonia group developed lung consolidation, and the difference was statistically significant ( P 0.05) (Table 4 ). Table 4 Characterization of chest CT in two groups of children Chest CT MRMPP(n = 145) Viral pneumonia(n = 68) χ 2 P Lobar pneumonia 145(100.0) 63(92.6) 7.946 0.005 Lung consolidation 67(46.2) 15(22.1) 11.401 0.001 Pleural effusion 13(9.0) 1(1.5) 3.102 0.078 Pulmonary atelectasis 2(1.4) 2(2.9) 0.058 0.809 3.5 Comparative analysis of fiberoptic bronchoscopy Fiberoptic bronchoscopy with bronchoalveolar lavage was perfected in 56 (38.6%) children in the MRMPP group and 9 (13.2%) children in the viral pneumonia group, and the difference was statistically significant (χ2 = 14.069, P < 0.001).White mucus plug-like, jelly-like, flocculent, streak-like, and tofu scum-like secretion was seen in fiberoptic bronchoscopy of the children in the MRMPP group; of these, 3 cases (2.1%) had 2 bronchoscopies during the course of the disease, 1 (0.7%) had 3 bronchoscopies, 1 (0.7%) had persistent spasm of the airway after bronchoscopy, and they were extubated and ventilator-assisted respiration was given; 13 (9.0%) had inflammatory stenosis of the bronchus visible on bronchoscopy, and 9 (13.2%) had manifestations of plasmablastic bronchitis. The children in the viral pneumonia group had white mucus-like secretion under fiberoptic bronchoscopy, and no cases of multiple fiberoptic bronchoscopy, bronchial inflammatory stenosis, or plasmacytoid bronchitis were found, and the difference was statistically significant ( P < 0.05). 3.6 Pathogenetic characterization All of the children with MPP in this study were infected with MRMP, had a 100% drug resistance rate, and were genotyped with a point mutation A2063G in region V of the 23SrRNA structural domain. Among the children in the viral pneumonia group, there were 27 cases (39.7%) of respiratory syncytial virus pneumonia, 11 cases (16.2%) of parapneumovirus pneumonia, 9 cases (13.2%) of parainfluenza virus pneumonia, 6 cases (8.8%) of adenovirus pneumonia, 5 cases (7.4%) each of influenza virus pneumonia and rhinovirus pneumonia, 2 cases (2.9%) of coronavirus pneumonia, and 1 case (1.4%) each of enterovirus, novel coronavirus, and boca virus in 1 case each (1.5%). 4 Discussion MP and viruses are common pathogens that cause atypical pneumonia in children, and these two respiratory pathogen infections have different treatments, prognoses, and protective measures, which are crucial to identify by early clinical features. In this study, the MRMPP group had a significant difference in the age of onset in months greater than the children in the viral pneumonia group. There was no statistically significant difference in the number of days of hospitalization and pre-hospital antibiotic use between the two groups. Similar to the results of previous studies, children with MRMPP had a higher incidence of fever, severe pneumonia, and a longer total duration of fever. [ 10 ] It may be related to the fact that children under 6 years of age have an underdeveloped respiratory system, relatively narrow bronchial lumen, immature immune system function, and weak resistance to infection. Previous studies have noted that laboratory test results, including levels of WBC, L%, N%, CRP, PCT, LDH, ESR, ALT, and AST, are helpful in differentiating viral pneumonia from MPP. [ 11 – 15 ] In this study, we found that among the inflammatory indexes, although WBC and L% were lower in the MRMPP group than in the children in the viral pneumonia group, N% and CRP were higher than in the children in the viral pneumonia group, and there was no significant difference in the levels of PCT between the two groups of children.Elevated levels of Alb, ALT, and AST were seen in both children with MRMPP and viral pneumonia and were more pronounced in children with viral pneumonia compared to those in the MRMPP group, which may be This may be related to the direct toxic effect of the virus, which produces cytokines that cause systemic and localized liver damage, or it may be related to the complication of pneumonia with liver ischemia and hypoxia. [ 16 ] D-D is a soluble fibrin degradation product, and studies have reported that elevated D-D is associated with the development of thrombophilia. In agreement with previous studies, [ 17 ] in the present study, elevated levels of D-D were prevalent in children with pneumonia and were more pronounced in the MRMPP group, but no cases of thrombosis or embolism were found. LDH can be a reliable indicator of pneumonia severity recognition, timing of glucocorticoid administration, and prognosis prediction. [ 18 , 19 ] The present study found no statistically significant difference in LDH levels between the two groups, which may be related to the small sample size included in the present study and also to the age distribution. It has been found that MP can produce an adhesion protein that adsorbs to the respiratory ciliary epithelium, leading to nutrient depletion of respiratory epithelial cells, release of toxins, and ultimately stagnation of the cilia and cell death, thus destroying the respiratory defense function, damaging the respiratory epithelium, and causing edema of the bronchial mucosa and thickening of the tube walls. [ 20 ] Children with MRMPP were more likely to have wet rales and decreased breath sounds in the lungs and were more likely to have lobar pneumonia and solid changes in the lungs on chest CT. Fiberoptic bronchoscopy showed a large amount of mucous secretions and was more likely to be associated with bronchial inflammatory stenosis and plasmacytoid bronchitis, suggesting that MRMP can not only aggravate inflammatory exudation from the lungs of the children by destroying the mucous membrane of the bronchial tubes and the movement of the cilia but also make it difficult to discharge the secretions. In contrast, children with viral pneumonia were more likely to have wheezing, sputum sounds were more likely to be heard in the lungs, and white mucus-like secretions were more often seen on fiberoptic bronchoscopy, suggesting that mucus plugging and mucosal necrosis occurred less frequently than in MRMPP. In this study, MRMPP was more likely to develop severe pneumonia than viral pneumonia, so timely and multiple bronchoscopic alveolar lavage therapy is also important to clear airway secretions and prevent complications such as luminal obstruction, pulmonary atelectasis, and occlusive bronchitis. Infancy is the golden stage of children's growth and development, and the clinic faces a great challenge for drug selection; macrolides are the first-line antimicrobial drugs for MPP, and due to the overuse of antibiotics, the rate of MP resistance has risen significantly, and the study reported that the rate of MP resistance in children in Nanjing, China, was 92.4% from 2014 to 2016. [ 21 ] MP drug resistance rate of children in Wuhan area to reach 84.5% by 2023. [ 22 ] The genotypes of the resistant strains were all point mutations in the 23SrRNA structural domain V region A2063G. The MP resistance rate in this study was 100.0%, and the genotypes were consistent with the above literature reports. Studies have shown that MRMP may have an impact on the rational use of antimicrobial therapy in the early clinical phase and is strongly associated with disease severity and prognosis. [ 23 ] Fluoroquinolones and tetracyclines have been found to be effective for MRMP, but given the potential adverse effects, fluoroquinolones are explicitly contraindicated in children because of musculoskeletal damage, and tetracyclines, which can cause permanent discoloration of the teeth, can only be used in children over 8 years of age. [ 24 ] Most of the children in both groups in this study had been treated with cephalosporins or macrolides before admission, and a few patients were treated with β-lactams, fluoroquinolones, or tetracycline antibiotics. Therefore, early identification of pathogenic bacteria based on clinical features is necessary to provide better guidance for rational drug use and precise treatment. Among the MP detection methods, microbial culture is difficult to be used for clinical diagnosis because it requires special conditions and grows slowly with a low positive rate, and the MP-IgM antibody test usually appears about 1 week after infection, which can be used as a diagnostic indicator for early infection, but it exists in the organism for a long time, and it may be a previous infection. [ 25 ] The main advantage of this study is the use of tNGS testing, which clarifies the causative pathogen in all cases, is time-consuming, has a high pathogen detection rate, and provides a reliable basis for retrospective analysis of the clinical characteristics of the children and laboratory tests.Previous studies have reported that the main viral infections in lower respiratory tract infections in children are respiratory syncytial virus, influenza virus, metapneumovirus, rhinovirus, parainfluenza virus, and adenovirus. [ 26 , 27 ] Differences with the results of previous studies: the main pathogens of viral pneumonia in our study were respiratory syncytial virus, parapneumovirus, parainfluenza virus, and adenovirus, which may be related to the short period of time of our surveillance and the different areas of surveillance. 5 Conclusions MRMPP and viral pneumonia are prevalent in children under 6 years of age, and the clinical features lack specificity. Although the present study found that there are differences in clinical manifestations and laboratory tests between children with MRMPP and viral pneumonia, it is difficult to differentiate them in clinical practice, and the use of tNGS may help to clarify the etiology of the infections when it is difficult to differentiate them. Declarations Ethics approval and consent to participate The study was reviewed by the Institutional Review Board of Gansu Maternal and Child Health Hospital which determined the project to be a quality improvement/program evaluation project that did not require approval, ethical oversight, or informed consent from participants. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests All authors have participated in the concept and design; analysis and interpretation of data; drafting or revising of the manuscript, and that they have approved the manuscript as submitted. None of the article contents are under consideration for publication in any other journal. There are no prior submissions with any overlapping information. None of the authors has any potential conflicts of interest, real or perceived, relative to this manuscript. The authors have no financial disclosures to make. Funding No funding was received for this work. Author Contribution Yue Yang was involved in the conception, methodology, formal analysis, investigation, and drafting of the manuscript. Yuxiang Zhang, Xuan Liang, and Jing Qi all participated in this research investigation. Rongfang Zhang contributed to the critical revision of important intellectual content of the article. All authors revised the manuscript, approved its publication, and agreed to be accountable for all aspects of the work to ensure that any questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Acknowledgements We would like to thank all the pediatricians who participated in this survey. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for‐profit sectors. Data availability statement The data that support the findings of this study are available from the corresponding author, Rongfang Zhang, upon reasonable request. References KIM K, JUNG S, KIM M, et al. Global Trends in the Proportion of Macrolide-Resistant Mycoplasma pneumoniae Infections: A Systematic Review and Meta-analysis [J]. JAMA Netw Open. 2022;5(7):e2220949. CHEN Y, JIA X, GAO Y, et al. Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023 [J]. Front Microbiol. 2024;15:1449511. LI Y, WU M, LIANG Y, et al. Mycoplasma pneumoniae infection outbreak in Guangzhou, China after COVID-19 pandemic [J]. Virol J. 2024;21(1):183. XU M, LI Y, SHI Y, et al. 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Mycoplasma pneumoniae in pediatric patients: Do macrolide-resistance and/or delayed treatment matter? [J]. J Microbiol Immunol Infect. 2019;52(2):329–35. AHN J G, CHO H K, LI D, et al. Efficacy of tetracyclines and fluoroquinolones for the treatment of macrolide-refractory Mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis [J]. BMC Infect Dis. 2021;21(1):1003. GAO L, SUN Y. Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review [J]. Ann Med. 2024;56(1):2386636. YAN Y, SUN J, JI K, et al. High incidence of the virus among respiratory pathogens in children with lower respiratory tract infection in northwestern China [J]. J Med Virol. 2023;95(1):e28367. WANG S, WANG X F, LI N, et al. [Distribution of non-bacterial pathogens in 1 788 children with community-acquired pneumonia] [J]. Zhongguo Dang Dai Er Ke Za Zhi. 2023;25(6):633–8. Additional Declarations No competing interests reported. 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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-5432454","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":383722990,"identity":"dd3be98b-1bc7-4975-a978-08de5c1cd12d","order_by":0,"name":"月 杨","email":"","orcid":"","institution":"Gansu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"月","middleName":"","lastName":"杨","suffix":""},{"id":383722991,"identity":"7c71af92-4774-4ce0-b42a-8eb409dcd018","order_by":1,"name":"Yuxiang Zhang","email":"","orcid":"","institution":"Gansu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yuxiang","middleName":"","lastName":"Zhang","suffix":""},{"id":383722992,"identity":"d8cf81f6-2691-40af-b7fa-d3aec692aee9","order_by":2,"name":"Xuan Liang","email":"","orcid":"","institution":"Gansu Maternal and Child Health Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Liang","suffix":""},{"id":383722993,"identity":"3e1bf07a-3d2a-4b69-9350-6aa5c2ae34c5","order_by":3,"name":"Jing Qi","email":"","orcid":"","institution":"Gansu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Qi","suffix":""},{"id":383722994,"identity":"2fc3cf1a-2dbb-402b-a0fa-53c14d0e095d","order_by":4,"name":"Rongfang Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACPjBpA8TsjY0PPhCjhQ1MpgExz+FmwxmkaZFIb5PmIEoL+/Fn0hUJdnnykQ8bpBkY7OR0Gwhp4UlIkzyTkFxseDuxwbiAIdnY7ABBhyUck2z8wZy4cXZiQ/IMhgOJ2whq4X/YJtmQUJ+4cebBhsM8RGmRSGYDajmcOF+CsbGZSC3PmC0bEo4nbuBJbGacYUCEX/j50x/ebEioTpzffvz5jw8VdnIEtQABiwSINACrNCCsHASYwclEvoE41aNgFIyCUTACAQB9YUJaiT6PvQAAAABJRU5ErkJggg==","orcid":"","institution":"Gansu Maternal and Child Health Hospital","correspondingAuthor":true,"prefix":"","firstName":"Rongfang","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-11-11 13:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5432454/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5432454/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70438313,"identity":"5ccd4990-fc13-4b19-9b7d-598b66696a55","added_by":"auto","created_at":"2024-12-03 07:26:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":601602,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5432454/v1/4d526530-6d81-42b4-8f4c-7866e1525740.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative analysis of clinical characteristics of drug-resistant Mycoplasma pneumoniae pneumonia and viral pneumonia in children under 6 years of age","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eMycoplasma pneumoniae pneumonia (MPP) is one of the main causes of community-acquired pneumonia (CAP) in hospitalized children and is more common in preschool and school-age children, with a decreasing trend in the prevalence of infection with increasing age.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e In recent years, the prevalence of macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) has increased significantly, and the age tends to be lowered.\u003csup\u003e[\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e It leads to a significant increase in the proportion of severe pneumonia; however, the clinical symptoms of MRMPP lack specificity and are insufficient to differentiate it from pneumonia caused by other pathogens. Respiratory viruses, including respiratory syncytial virus, adenovirus, influenza virus, rhinovirus, and metapneumovirus, are also common causes of respiratory tract infections in children.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Clinical symptoms are similar to those of MRMPP, with fever, cough, malaise, and wet lung rales, and interstitial lung lesions predominating on chest imaging, which are often indistinguishable, especially in infants and young children. Currently, there are few studies on the differentiation of clinical features of MRMPP and viral pneumonia in children under 6 years of age. Therefore, in this study, we compared the clinical characteristics and laboratory findings of MRMPP and viral pneumonia in children under 6 years of age based on the targeted next-generation sequencing (tNGS) of respiratory pathogens in sputum or bronchoalveolar lavage fluid (BALF) from hospitalized children.\u003c/p\u003e"},{"header":"2 Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study population\u003c/h2\u003e \u003cp\u003eTwo hundred and thirteen children diagnosed with CAP at the time of admission to the pediatric department of Gansu Maternal and Child Health Hospital from March 2023 to August 2024 were selected for a retrospective study and were divided into 145 cases in the MRMPP group and 68 cases in the viral pneumonia group according to the results of the tNGS test. The study participants were \u0026lt;\u0026thinsp;6 years old. Diagnosis follows Guidelines for the management of community-acquired pneumonia in children (2024 revision);\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e All children had clear MRMP or viral infection by tNGS testing. Children admitted in recovery from pneumonia (including more than 4 weeks of illness, more than 1 week of temperature stabilization, and resorption of imaging lung lesions), with bronchopulmonary dysplasia, immunodeficiency, bronchial asthma, or recurrent respiratory infections, with clear-cut infections with other pathogens, and with incomplete clinical history data were excluded. The Institutional Review Board of Gansu Maternal and Child Health Hospital reviewed the project and deemed it to be exempt from institutional oversight and granted a waiver for informed consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Sample collection\u003c/h2\u003e \u003cp\u003eSputum, or BALF, was collected from all children on admission, and the collection process was carried out in strict accordance with the standard of aseptic operation. The natural sputum coughing method was used for children who could cough up sputum deep in the respiratory tract, and for children who were difficult to cough up sputum naturally, sterile sputum suction tubes were used to extract secretions deep in the trachea, and BALF was collected by the doctors of the Children's Bronchoscopy Center of Gansu Provincial Maternity and Child Health Hospital, who used fiberoptic bronchoscopes to take samples of bronchial alveolar lavage in accordance with the standard procedures. The specimens were kept in sterile sputum cups, and the amount of specimens should be \u0026gt;\u0026thinsp;4 ml, labeled, and stored at -20℃ for examination.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 The tNGS detection methods\u003c/h2\u003e \u003cp\u003eThe tNGS test is performed by Gansu Jinwei Institute of Medical Laboratory and Diagnostic Pathology. Using the tNGS kit, the combination of ultra-multiplex PCR and high-throughput sequencing technology is used to directly enrich for known pathogenic microorganisms and their virulence and/or drug resistance genes in clinical samples, and then perform high-throughput sequencing, which is then compared and analyzed with the database, and based on the sequence information of the comparison, the sample is judged to contain the species of pathogenic microorganisms, thus realizing the nucleic acids in the sample to be tested to be identified with high sensitivity and high resolution, and the detection of low concentrations of pathogenic microorganisms, especially the detection of their virulence and/or drug resistance genes. High-resolution identification of the nucleic acids in the samples to be tested, which is a significant advantage for the detection of pathogenic microorganisms in low concentrations, especially for the detection of their virulence and/or drug resistance genes.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e The detection steps include: sample total nucleic acid extraction (including human nucleic acid, pathogenic bacteria, colonizing bacteria nucleic acid, etc.); enrichment of nucleic acids of target pathogens; obtaining sequence information of nucleic acids after target capture by high-throughput sequencing platform; and data analysis.Tests include 198 species covering Gram-positive bacteria, Gram-negative bacteria, DNA viruses, RNA viruses, fungi, special pathogens, and other respiratory tract infection pathogens, as well as 5 drug resistance genes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Observation indicators\u003c/h2\u003e \u003cp\u003eIncludes general information, clinical symptoms, pulmonary signs, laboratory indices, chest CT ,and fiberoptic bronchoscopic manifestations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eAll analyses were performed with commercially available statistical software (SPSS v25). Descriptive statistics was performed and reported by percentages for qualitative data and by means with standard deviations or medians with range for quantitative data. Continuous data were analyzed with the t-test, and categorical data were compared with the Chi-square test. All tests were two-tailed. Statistical significance was defined as \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the tests.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Comparative analysis of general information\u003c/h2\u003e \u003cp\u003eIn the MRMPP group, 83 (57.2%) were male and 62 (42.8%) were female. In the viral pneumonia group, 35 (51.5%) were male and 33 (48.5%) were female. The difference between the two groups was statistically significant when comparing the age of onset of disease in months and the length of hospitalization (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). 142 (97.9%) children in the MRMPP group and 62 (91.2%) children in the viral pneumonia group had been treated with antibiotics prior to hospitalization, and the difference was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). 86 (59.3%) children in the MRMPP group and 20 (29.4%) children in the viral pneumonia group developed severe pneumonia; the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characterization of the two groups of children\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRMPP(n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eViral pneumonia(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e/\u003cem\u003et\u003c/em\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83(57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35(51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62(42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64(48.0,70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37(12.5,53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–6.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of hospitalization(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.07\u0026thinsp;\u0026plusmn;\u0026thinsp;1.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotics prior to admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142(97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62(91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esevere pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86(59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Comparative analysis of clinical symptoms and pulmonary signs\u003c/h2\u003e \u003cp\u003eChildren in the MRMPP group were more likely to have febrile symptoms and longer total duration of fever than those in the viral pneumonia group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference between the two groups in terms of cough duration, dyspnea, hypoxemia, and wheezing sounds in the lungs (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Moist rales were more likely to be audible in the lungs, and respiratory sounds were diminished in the MRMPP group, while wheezing was more likely to be present in the viral pneumonia group, and sputum sounds were more likely to be audible in the lungs, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of clinical symptoms and pulmonary signs in two groups of children\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical presentations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMRMPP\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eViral pneumonia(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRaised body temperature\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116(86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50(73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration of fever(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(3,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(0,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e–4.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCough(days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(12.0,19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(10.0,20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e–0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBreather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(15.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDyspnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.967\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypoxemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(10.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSigns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMoist rales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116(80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSputum sounds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWheezing sounds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(12.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiminished breath sounds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(11.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Comparative analysis of laboratory tests\u003c/h2\u003e \u003cp\u003eThe MRMPP group was dominated by increased levels of N%, CRP, D-D, ESR, etc., and the viral pneumonia group was dominated by increased levels of WBC, L%, Alb, ALT, AST, etc., and the differences were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference in PCT, LDH, CK, and CKMB between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnalysis of laboratory findings in two groups of children\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRMPP(n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eViral pneumonia(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e/Z\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC(\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.77(6.14,9.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.83(7.24,11.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–2.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32.80(24.35,43.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.10(30.70,63.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–4.288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57.30(46.75,67.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44.00(26.15,58.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–4.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCRP(mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.36(2.96,18.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.01(1.00,16.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–2.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePCT(ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.21(0.17,0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.23(0.18,0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–1.874\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlb(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42.70(40.95,44.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.10(42.25,47.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–4.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e339.00(286.00,411.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e313.00(273.25,424.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD-D(mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.43(0.33,0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.37(0.25,0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–2.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESR(mm/h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25.00(17.00,36.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.50(8.25,24.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–4.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.30(9.75,16.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.40(12.00,26.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–3.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.30(28.45,40.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.70(33.35,49.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–3.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86.00(66.00,121.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94.50(72.00,121.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–0.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKMB(U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31.80(22.55,52.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.75(26.03,46.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e–1.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Comparative analysis of chest CT\u003c/h2\u003e \u003cp\u003e145 (100.0%) children in the MRMPP group and 63 (92.6%) children in the viral pneumonia group developed lobar pneumonia, and 67 (46.2%) children in the MRMPP group and 15 (22.1%) children in the viral pneumonia group developed lung consolidation, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistically significant difference between the two groups of children who developed pleural effusion and pulmonary atelectasis (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacterization of chest CT in two groups of children\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChest CT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMRMPP(n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eViral pneumonia(n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eχ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLobar pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e145(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63(92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung consolidation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePleural effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13(9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary atelectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.809\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Comparative analysis of fiberoptic bronchoscopy\u003c/h2\u003e \u003cp\u003eFiberoptic bronchoscopy with bronchoalveolar lavage was perfected in 56 (38.6%) children in the MRMPP group and 9 (13.2%) children in the viral pneumonia group, and the difference was statistically significant (χ2\u0026thinsp;=\u0026thinsp;14.069,\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).White mucus plug-like, jelly-like, flocculent, streak-like, and tofu scum-like secretion was seen in fiberoptic bronchoscopy of the children in the MRMPP group; of these, 3 cases (2.1%) had 2 bronchoscopies during the course of the disease, 1 (0.7%) had 3 bronchoscopies, 1 (0.7%) had persistent spasm of the airway after bronchoscopy, and they were extubated and ventilator-assisted respiration was given; 13 (9.0%) had inflammatory stenosis of the bronchus visible on bronchoscopy, and 9 (13.2%) had manifestations of plasmablastic bronchitis. The children in the viral pneumonia group had white mucus-like secretion under fiberoptic bronchoscopy, and no cases of multiple fiberoptic bronchoscopy, bronchial inflammatory stenosis, or plasmacytoid bronchitis were found, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Pathogenetic characterization\u003c/h2\u003e \u003cp\u003eAll of the children with MPP in this study were infected with MRMP, had a 100% drug resistance rate, and were genotyped with a point mutation A2063G in region V of the 23SrRNA structural domain. Among the children in the viral pneumonia group, there were 27 cases (39.7%) of respiratory syncytial virus pneumonia, 11 cases (16.2%) of parapneumovirus pneumonia, 9 cases (13.2%) of parainfluenza virus pneumonia, 6 cases (8.8%) of adenovirus pneumonia, 5 cases (7.4%) each of influenza virus pneumonia and rhinovirus pneumonia, 2 cases (2.9%) of coronavirus pneumonia, and 1 case (1.4%) each of enterovirus, novel coronavirus, and boca virus in 1 case each (1.5%).\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eMP and viruses are common pathogens that cause atypical pneumonia in children, and these two respiratory pathogen infections have different treatments, prognoses, and protective measures, which are crucial to identify by early clinical features. In this study, the MRMPP group had a significant difference in the age of onset in months greater than the children in the viral pneumonia group. There was no statistically significant difference in the number of days of hospitalization and pre-hospital antibiotic use between the two groups. Similar to the results of previous studies, children with MRMPP had a higher incidence of fever, severe pneumonia, and a longer total duration of fever.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e It may be related to the fact that children under 6 years of age have an underdeveloped respiratory system, relatively narrow bronchial lumen, immature immune system function, and weak resistance to infection.\u003c/p\u003e \u003cp\u003ePrevious studies have noted that laboratory test results, including levels of WBC, L%, N%, CRP, PCT, LDH, ESR, ALT, and AST, are helpful in differentiating viral pneumonia from MPP.\u003csup\u003e[\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e In this study, we found that among the inflammatory indexes, although WBC and L% were lower in the MRMPP group than in the children in the viral pneumonia group, N% and CRP were higher than in the children in the viral pneumonia group, and there was no significant difference in the levels of PCT between the two groups of children.Elevated levels of Alb, ALT, and AST were seen in both children with MRMPP and viral pneumonia and were more pronounced in children with viral pneumonia compared to those in the MRMPP group, which may be This may be related to the direct toxic effect of the virus, which produces cytokines that cause systemic and localized liver damage, or it may be related to the complication of pneumonia with liver ischemia and hypoxia.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e D-D is a soluble fibrin degradation product, and studies have reported that elevated D-D is associated with the development of thrombophilia. In agreement with previous studies,\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e in the present study, elevated levels of D-D were prevalent in children with pneumonia and were more pronounced in the MRMPP group, but no cases of thrombosis or embolism were found. LDH can be a reliable indicator of pneumonia severity recognition, timing of glucocorticoid administration, and prognosis prediction.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e The present study found no statistically significant difference in LDH levels between the two groups, which may be related to the small sample size included in the present study and also to the age distribution.\u003c/p\u003e \u003cp\u003eIt has been found that MP can produce an adhesion protein that adsorbs to the respiratory ciliary epithelium, leading to nutrient depletion of respiratory epithelial cells, release of toxins, and ultimately stagnation of the cilia and cell death, thus destroying the respiratory defense function, damaging the respiratory epithelium, and causing edema of the bronchial mucosa and thickening of the tube walls.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e Children with MRMPP were more likely to have wet rales and decreased breath sounds in the lungs and were more likely to have lobar pneumonia and solid changes in the lungs on chest CT. Fiberoptic bronchoscopy showed a large amount of mucous secretions and was more likely to be associated with bronchial inflammatory stenosis and plasmacytoid bronchitis, suggesting that MRMP can not only aggravate inflammatory exudation from the lungs of the children by destroying the mucous membrane of the bronchial tubes and the movement of the cilia but also make it difficult to discharge the secretions. In contrast, children with viral pneumonia were more likely to have wheezing, sputum sounds were more likely to be heard in the lungs, and white mucus-like secretions were more often seen on fiberoptic bronchoscopy, suggesting that mucus plugging and mucosal necrosis occurred less frequently than in MRMPP. In this study, MRMPP was more likely to develop severe pneumonia than viral pneumonia, so timely and multiple bronchoscopic alveolar lavage therapy is also important to clear airway secretions and prevent complications such as luminal obstruction, pulmonary atelectasis, and occlusive bronchitis.\u003c/p\u003e \u003cp\u003eInfancy is the golden stage of children's growth and development, and the clinic faces a great challenge for drug selection; macrolides are the first-line antimicrobial drugs for MPP, and due to the overuse of antibiotics, the rate of MP resistance has risen significantly, and the study reported that the rate of MP resistance in children in Nanjing, China, was 92.4% from 2014 to 2016.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e MP drug resistance rate of children in Wuhan area to reach 84.5% by 2023.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e The genotypes of the resistant strains were all point mutations in the 23SrRNA structural domain V region A2063G. The MP resistance rate in this study was 100.0%, and the genotypes were consistent with the above literature reports. Studies have shown that MRMP may have an impact on the rational use of antimicrobial therapy in the early clinical phase and is strongly associated with disease severity and prognosis.\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e Fluoroquinolones and tetracyclines have been found to be effective for MRMP, but given the potential adverse effects, fluoroquinolones are explicitly contraindicated in children because of musculoskeletal damage, and tetracyclines, which can cause permanent discoloration of the teeth, can only be used in children over 8 years of age.\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e Most of the children in both groups in this study had been treated with cephalosporins or macrolides before admission, and a few patients were treated with β-lactams, fluoroquinolones, or tetracycline antibiotics. Therefore, early identification of pathogenic bacteria based on clinical features is necessary to provide better guidance for rational drug use and precise treatment. Among the MP detection methods, microbial culture is difficult to be used for clinical diagnosis because it requires special conditions and grows slowly with a low positive rate, and the MP-IgM antibody test usually appears about 1 week after infection, which can be used as a diagnostic indicator for early infection, but it exists in the organism for a long time, and it may be a previous infection.\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e The main advantage of this study is the use of tNGS testing, which clarifies the causative pathogen in all cases, is time-consuming, has a high pathogen detection rate, and provides a reliable basis for retrospective analysis of the clinical characteristics of the children and laboratory tests.Previous studies have reported that the main viral infections in lower respiratory tract infections in children are respiratory syncytial virus, influenza virus, metapneumovirus, rhinovirus, parainfluenza virus, and adenovirus.\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e Differences with the results of previous studies: the main pathogens of viral pneumonia in our study were respiratory syncytial virus, parapneumovirus, parainfluenza virus, and adenovirus, which may be related to the short period of time of our surveillance and the different areas of surveillance.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eMRMPP and viral pneumonia are prevalent in children under 6 years of age, and the clinical features lack specificity. Although the present study found that there are differences in clinical manifestations and laboratory tests between children with MRMPP and viral pneumonia, it is difficult to differentiate them in clinical practice, and the use of tNGS may help to clarify the etiology of the infections when it is difficult to differentiate them.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The study was reviewed by the Institutional Review Board of Gansu Maternal and Child Health Hospital which determined the project to be a quality improvement/program evaluation project that did not require approval, ethical oversight, or informed consent from participants. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003e All authors have participated in the concept and design; analysis and interpretation of data; drafting or revising of the manuscript, and that they have approved the manuscript as submitted. None of the article contents are under consideration for publication in any other journal. There are no prior submissions with any overlapping information. None of the authors has any potential conflicts of interest, real or perceived, relative to this manuscript. The authors have no financial disclosures to make.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYue Yang was involved in the conception, methodology, formal analysis, investigation, and drafting of the manuscript. Yuxiang Zhang, Xuan Liang, and Jing Qi all participated in this research investigation. Rongfang Zhang contributed to the critical revision of important intellectual content of the article. All authors revised the manuscript, approved its publication, and agreed to be accountable for all aspects of the work to ensure that any questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe would like to thank all the pediatricians who participated in this survey. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for‐profit sectors.\u003c/p\u003e\u003ch2\u003eData availability statement\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are available from the corresponding author, Rongfang Zhang, upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKIM K, JUNG S, KIM M, et al. Global Trends in the Proportion of Macrolide-Resistant Mycoplasma pneumoniae Infections: A Systematic Review and Meta-analysis [J]. JAMA Netw Open. 2022;5(7):e2220949.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN Y, JIA X, GAO Y, et al. Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023 [J]. Front Microbiol. 2024;15:1449511.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI Y, WU M, LIANG Y, et al. 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Comparative analysis of the clinical and epidemiological characteristics of human influenza virus versus human respiratory syncytial virus versus human metapneumovirus infection in nine provinces of China during 2009\u0026ndash;2021 [J]. J Med Virol. 2022;94(12):5894\u0026ndash;903.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e[Guidelines for the management. of community-acquired pneumonia in children (2024 revision)] [J]. Zhonghua Er Ke Za Zhi. 2024;62(10):920\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIN A, SINGH A, ALLRED A, et al. Targeted Next-Generation Sequencing Assay for Direct Detection and Serotyping of Salmonella from Enrichment [J]. J Food Prot. 2024;87(4):100256.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXIE X Y, ZHOU R Y, DING SA, et al. Emerging trends and concerns in Mycoplasma pneumoniae pneumonia among Chinese pediatric population [J]. Pediatr Res. 2024;95(6):1388\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGUO H, LIANG J, LIN H, et al. Differentiate Clinical Characteristics Between Viral Pneumonia and Mycoplasma pneumoniae and Nomograms for Predicting Mycoplasma pneumoniae: A Retrospective Study in Primary Hospitals [J]. Pediatr Infect Dis J. 2023;42(12):1035\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGUO W L, WANG J, ZHU L Y, et al. Differentiation between mycoplasma and viral community-acquired pneumonia in children with lobe or multi foci infiltration: a retrospective case study [J]. BMJ Open. 2015;5(1):e006766.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKIM C H LEEE, LEE YJ, et al. Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea [J]. BMC Infect Dis. 2020;20(1):132.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFAN F, LV J, YANG Q, et al. Clinical characteristics and serum inflammatory markers of community-acquired mycoplasma pneumonia in children [J]. Clin Respir J. 2023;17(7):607\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWROTEK A, ROBAKIEWICZ J, PAWLIK K et al. The Etiology of Community-Acquired Pneumonia Correlates with Serum Inflammatory Markers in Children [J]. J Clin Med, 2022, 11(19).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNAEEM M, BANO N. MANZOOR S, Pathogenetic Mechanisms of Liver-Associated Injuries, Management, and Current Challenges in COVID-19 Patients [J]. Biomolecules, 2023, 13(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHENG Y, HUA L, ZHAO Q, et al. The Level of D-Dimer Is Positively Correlated With the Severity of Mycoplasma pneumoniae Pneumonia in Children [J]. 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Efficacy of tetracyclines and fluoroquinolones for the treatment of macrolide-refractory Mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis [J]. BMC Infect Dis. 2021;21(1):1003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGAO L, SUN Y. Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review [J]. Ann Med. 2024;56(1):2386636.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYAN Y, SUN J, JI K, et al. High incidence of the virus among respiratory pathogens in children with lower respiratory tract infection in northwestern China [J]. J Med Virol. 2023;95(1):e28367.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWANG S, WANG X F, LI N, et al. [Distribution of non-bacterial pathogens in 1 788 children with community-acquired pneumonia] [J]. Zhongguo Dang Dai Er Ke Za Zhi. 2023;25(6):633\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Macrolide resistance, Mycoplasma pneumoniae pneumonia, viral pneumonia, clinical features","lastPublishedDoi":"10.21203/rs.3.rs-5432454/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5432454/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eComparative analysis of differences in clinical features and laboratory findings between macrolide-resistant Mycoplasma pneumoniae pneumoniae (MRMPP) and viral pneumonia in children under 6 years of age.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e In this study, 213 children with community-acquired pneumonia (CAP) admitted to the pediatrics department of Gansu Provincial Maternal and Child Health Hospital from March 2023 to August 2024 were selected and divided into the MRMPP group and the viral pneumonia group according to the results of Targeted next-generation sequencing (tNGS), and the general data, clinical characteristics, laboratory examinations, chest CT and fiberoptic bronchoscopic manifestations of the two groups were compared and analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere were 145 cases (68.1%) in the MRMPP group and 68 cases (31.9%) in the viral pneumonia group. The incidence of severe illness was 59.3% and 29.4% in the MRMPP and viral pneumonia groups, respectively. The MRMPP group showed a higher proportion of fever, longer total duration of fever, more likely to hear moist rales and diminished breath sounds, and more likely to have wheezing and sputum sounds in the viral pneumonia group. The MRMPP group was dominated by increased levels of N%, CRP, D-D, and ESR, and the viral pneumonia group was dominated by increased levels of WBC, L%, Alb, ALT, and AST, and chest CT was more likely to show lobar pneumonia and lung consolidation, and the rates of fiberoptic bronchoscopy, bronchial inflammatory stenosis, and plasmacytoid bronchitis were higher.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDespite the differences in clinical features and laboratory tests between MRMPP and viral pneumonia in children under 6 years of age, it is difficult to differentiate them in clinical practice, and the use of tNGS may help to clarify the etiology of the infection when it is difficult to do so.\u003c/p\u003e","manuscriptTitle":"Comparative analysis of clinical characteristics of drug-resistant Mycoplasma pneumoniae pneumonia and viral pneumonia in children under 6 years of age","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-03 07:18:05","doi":"10.21203/rs.3.rs-5432454/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-01-01T06:03:03+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-11-25T07:59:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-20T14:56:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-20T14:56:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-11-11T13:34:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"faeaa8d4-c1f5-46bd-91dd-92cc83e4a68d","owner":[],"postedDate":"December 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-12-03T07:18:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-03 07:18:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5432454","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5432454","identity":"rs-5432454","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}