Analysis of clinical characteristics of severe mycoplasma pneumoniae pneumonia complicated with virus infection in children

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Methods SMPP patients admitted to Affiliated Hospital of Jining Medical Universityfrom July 2021 to June 2022 requiring bronchoscopic alveolar lavage were retrospectively collected. Multiple reverse transcription polymerase chain reaction (mRT-PCR) was used to detect respiratory pathogens combined with serum mycoplasma antibody titer. The children were divided into Mycoplasma Pneumoniae (MP) infection group and MP mixed virus infection group according to whether they were infected with mixed virus or not. The differences of clinical manifestations, physical examination, laboratory examination, imaging data and bronchoscopy manifestations were analyzed. Results Among 784 children with SMPP, 425 were males (54.21%) and 359 were females (45.79%). The ratio of males to females was 1.18:1. Children over 5 years old were the high incidence group of SMPP. There were 638 cases of single MP infection (81.38%), 146 cases of co-infection (18.62%), and the top two cases of co-infection were adenovirus (ADV) in 74 cases (50.68%) and respiratory syncytial virus (RSV) in 67 cases (45.89%). Compared with the MP mixed virus infection group, there were statistically significant differences in age, season, hospital stay, fever time, lung consolidation and emphysema (P 0.05). Compared with MP mixed ADV group, there were significant differences in the level of lactate dehydrogenase and season (P < 0.05). Conclusion Adenovirus and respiratory syncytial virus are the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar. The age of MP patients with virus infection was younger, the hospitalization time was longer, the fever time was longer, and the patients with emphysema were more. The level of lactate dehydrogenase in children with RSV infection was higher than that in patients with ADV infection. Severe mycoplasma pneumoniae pneumonia Viral infection Clinical features Children 1. Introduction Severe mycoplasma pneumoniae pneumonia (SMPP) is characterized by rapid disease progression and complex clinical manifestations, which can easily lead to severe pulmonary diseases such as necrotizing pneumonia, attasis, bronchiolitis obliterans and extrapulmonary complications, posing a serious threat to the health of children [ 1 ]. Viruses, bacteria or some atypical pathogens are the main pathogens of SMPP mixed infection, with an incidence as high as 30%-60%[ 2 – 3 ]. A major challenge for pediatricians remains the ability to identify and manage severe infections early enough to improve prognosis and reduce mortality. In recent years, with the increasing maturity of fiberoptic bronchoscopy technology, the adoption of alveolar lavage fluid for etiological detection has a higher etiological detection rate than the original oral (or nasal) retention of induced sputum, which can more effectively guide clinical rational diagnosis and treatment[ 4 ]. Therefore, this study retrospectively analyzed the clinical data of SMPP children treated by fiberbronchoscopic alveolar lavage, aiming to explore the clinical characteristics and related risk factors of SMPP with viral infection, and provide theoretical basis for early diagnosis, targeted prevention and treatment of severe pneumonia in children. 2. Materials and methods 2.1 Study subjects and group Study subjects were hospitalized children diagnosed with severe mycoplasma pneumoniae pneumonia from July 2021 to June 2022. Diagnostic criteria: The patients were 1 week, chest imaging examination showed improvement); (2) previous malignant tumors, immune deficiency diseases, chronic underlying diseases; (3) Patients with a history of thrombosis; (4) Patients with contraindications of bronchoscopy and incomplete clinical data. General clinical data of the subjects were collected, including demographic data, clinical manifestations and results of auxiliary examinations (within 24 hours of admission). They were divided into single MP infection group and MP mixed infection group according to whether the virus was mixed. Informed consent was signed by close relatives of the child. This study was approved by the Hospital Medical Ethics Committee (2021C234). 2.2 Etiological diagnosis All the children with etiological diagnosis had bronchoscopy indications and no contraindications of bronchoscopy. About 3ml of BALF was collected from each patient and the samples were stored at -80s℃for 2 hours. SureX 13 multiple detection kit for respiratory pathogens from Ningbo Health Gene Technology Co., Ltd. was used to detect common viruses and atypical bacteria in 200µL BALF. mRT-PCR products were analyzed on an Applied Biosystems 3500Dx genetic analyzer with internal label LIZ500, and then GeneMapper 4.1 software was used (Thermo Fisher Scientific, Waltham, MA, USA) for analysis. Influenza A virus (FluA, FLUA) was detected in BALF. H1N1, H3N2), influenza B virus (FluB), Parainfluenza virus (PIV), adenovirus (ADV), respiratory syncytial virus (RSV), human rhinovirus (HRV), human metapneumovirus (hMPV), human Boca virus (HBoV), coronavirus (CoV), mycoplasma pneumoniae and Chlamydia pneumoniae at least 1 positive, Virus or atypical pathogen infection is considered to be present. Etiological diagnosis of MP infection: one of them can be confirmed: (1) MP-igm antibody positive; (2) Single MP antibody titer ≥ 1:160 (particle agglutination method); (3) Pulmonary alveolar lavage fluid (mRT-PCR) tested positive for MP-DNA [ 4 ]. 2.3 Statistical analysis SPSS 26.0 software was used for statistical analysis of data. Continuous variables conforming to normal distribution were represented by x ± s, and T-test was applied between the two groups. The counting data were expressed as percentage (%), and the comparison of the significant difference of rates was conducted by 2 test. Continuous variables that do not conform to the normal distribution are represented by the median (IQR) using the Mann-Whitney U test in non-parametric statistical methods. Bilateral P < 0.05 was used as the test level to determine the statistical significance. 3. Results 3.1 General data A total of 784 children with SMPP who were hospitalized in the pediatrics Department of the Affiliated Hospital of Jining Medical College from July 2021 to June 2022 for bronchoscopic alveolar lavage were included, including 425 males (54.21%) and 359 females (45.79%), with a male to female ratio of 1.18:1. The youngest was 7 months, the oldest was 163 months (13 years July), and the average age was 76.10 years (about 6.3 years). 40 cases (5.1%) were 5 years old, and the high incidence of SMPP was > 5 years old. There were 49 cases (6.25%) in spring, 146 cases (18.62%) in summer, 349 cases (44.52%) in autumn, 240 cases (30.61%) in winter, and most cases (75.13%) in autumn and winter. All 784 samples were diagnosed with SMPP, of which 638 (81.38%) were infected with single MP and 146 (18.62%) were infected with co-virus. The detection rate of virus infection from high to low was 74 cases (50.68%) of adenovirus, 67 cases (45.89%) of syncytial virus, 12 cases (8.21%) of rhinovirus, 9 cases (6.16%) of parainfluenza virus, 8 cases (5.48%) of influenza B virus, 5 cases (3.42%) of metapneumovirus and 1 case (0.68%) of Boca virus. There were significant differences in age, season and length of hospital stay between the single MP infection group and the MP mixed virus infection group (P < 0.05). The age of onset was younger and the length of hospital stay was longer in the MP mixed virus infection group. The incidence of single MP infection group was the highest in autumn, and the incidence of MP mixed virus infection group was the highest in summer. Compared with MP mixed ADV group and MP mixed RSV group, statistical analysis showed that there was a significant difference in the incidence season between the two groups (P < 0.05), that is, the incidence of MP mixed ADV group in spring was significantly lower than that of MP mixed RSV group, and the incidence of MP mixed ADV group in winter was significantly higher than that of the latter. (Table 1 ) Table 1 Comparison of clinical features between single MP infection group and mixed virus infection group clinical features Single MP infection group n = 638 MP mixed virus infection group n = 146 X 2 /t/U P MP mixed with ADV infection group n = 74 MP mixed with RSV infection group n = 67 X 2 /t P Age (month) 77.64 ± 31.31 69.34 ± 34.26 2.835 0.005 71.64 ± 33.32 61.12 ± 35.47 1.802 0.074 Male, n(%) 348(54.55%) 77(52.74%) 0.156 0.693 32(43.24%) 35(52.24%) 1.141 0.314 Age 13.174 0.001 5.054 0.08 5 years 26(4.08%) 171(26.80%) 441(69.12%) 14(9.59%) 51(34.93%) 81(55.48%) 4(5.41%) 28(37.84%) 42(56.76%) 10(14.93%) 29(43.28%) 28(41.79%) Season 89.336 <0.001 20.512 <0.001 Spring 32(5.02%) 17(11.64%) 0 9(13.43%) Summer 87(13.64%) 59(40.41%) 38(51.35%) 31(46.27%) Autumn 327(51.25%) 22(15.07%) 9(12.16%) 17(25.37%) Winter 192(30.10%) 48(32.88%) 27(36.49%) 10(14.93%) Course of illness before admission(day) 7(6,10) 8(6,10) 44139 0.320 7(6,10) 8(6,9) 2269 0.460 Hospital stays (day) 7(6,8) 7(6,9) 40311 0.021 8(6,10) 7(6,9) 2360 0.717 3.2 Clinical symptoms and pulmonary auscultation Among the 784 patients, fever (699 cases, 89.16%) and cough (741 cases, 94.52%) were the main clinical symptoms. The distribution of shortness of breath and wheezing was divided into 30 cases (3.83%) and 45 cases (5.74%), low breath sound (484 cases, 61.73%) and blister sound (612 cases). 78.06%) was a common pulmonary auscultation in children. There was significant difference in the duration of fever between the single MP infection group and the MP mixed virus infection group (P < 0.05). The duration of fever in the MP mixed virus infection group was significantly longer than that in the single MP infection group. There were no significant differences in fever, cough, shortness of breath, wheezing, low breath sound and blister sound between MP mixed ADV group and MP mixed RSV group (P > 0.05).(Table 2 ) Table 2 Clinical symptoms and lung auscultation in single MP infection group and mixed virus infection group signs and symptoms Single MP infection group n = 638 Single MP infection group n = 146 X 2 /t P Single MP infection group N = 74 Single MP infection group N = 67 X 2 P Fever n(%) 566(88.71%) 133(91.10%) 0.697 0.404 69(93.24%) 63(94.03%) - 1.0 Febrile duration(day) 6.25 ± 3.52 7.17 ± 4.33 -2.740 0.006 7.41 ± 4.64 7.64 ± 3.4 -0.339 0.735 Cough n(%) 605(94.83%) 136(93.15%) 0.644 0.422 68(91.89%) 65(97.01%) - 0.280 Polypnea n(%) 23(3.61%) 7(4.79%) 0.708 0.400 5(6.76%) 6(8.96%) 0.236 0.627 Wheeze n(%) 37(5.80%) 8(5.48%) 0.022 0.881 5(6.76%) 3(4.48%) - 0.721 Low breath sound n(%) 396(62.07%) 88(60.27%) 0.162 0.687 44(59.46%) 45(67.16%) 0.897 0.344 Bubbling sound n(%) 505(79.15%) 107(73.29%) 0.387 0.122 55(74.32%) 52(77.61%) 0.208 0.649 3.3 Laboratory examination There were no significant differences in leukocytes, platelets, C-reactive protein, procalcitonin, erythrocyte deposition rate, D-dimer, alanine aminotransferase, ASpartate aminotransferase and lactate dehydrogenase between single MP infection group and MP mixed virus infection group (P > 0.05). Compared with MP mixed ADV, LDH level in MP mixed RSV group was higher than that in MP mixed ADV group, the difference was statistically significant (U = 1757, P = 0.044), but there was no significant difference in other indicators (P > 0.05).(Table 3 ) Table 3 Laboratory indexes of single MP infection group and mixed virus infection group Laboratory index Single MP infection group n = 638 Single MP infection group n = 146 X 2 /t/U P Single MP infection group N = 74 Single MP infection group N = 67 X 2 /t/U P WBC (×10^9/L) 8.14(6.29,10.39) 7.96(6.39,10.32) 45628.5 0.702 8.31(6.66,10.10) 8.17(6.57,11.36) 2448.5 0.901 PLT (×10^9/L) 319(260,396) 323.5(262,419.3) 44545 0.411 360(264.75,446.5) 331(271,414) 2359 0.622 CRP (mg/L) 9.59(3.2,20.1) 8.30(2.49,20.84) 44039.5 0.408 11.43(3.45,24.56) 8.39(2.43,21.65) 2324 0.524 PCT (ng/ml) 0.13(0.076,0.25) 0.11(0.069,0.21) 27040 0.235 0.12(0.069,0.28) 0.12(0.07,0.25) 1589 0.971 ESR (mm/H) 22(14,34) 25(12,38) 24880 0.247 29(11,42) 26(15,36) 15870.5 0.611 D-dimer (mg/L) 0.44(0.25,0.92) 0.46(0.25,0.98) 43221 0.586 0.44(0.25,1.11) 0.58(0.25,1.04) 2401.5 0.751 ALT (U/L) 12.85(10.30,19.22) 12.2(9.02,18.95) 25677 0.106 12.2(9.1,18.4) 12.2(10.4,20.58) 1643 0.618 AST (U/L) 24(20,32) 25(21,31) 27045 0.546 23(20,30) 26.5(22,33) 1455 0.169 LDH (U/L) 313.3(264,383.2) 323(268,399) 36527.5 0.424 305.5(261,394) 345(293,425) 1757 0.044 3.4 Chest imaging findings Among the chest imaging findings of the 784 patients, 244 (31.12%) had double lung involvement, 713 (90.94%) had lung consolidation, 27 (3.44%) had atelectasis, 11 (1.40%) had emphysema, 30 (3.83%) had air bronchogram, and 104 (13.27%) had pleural effusion. There were statistically significant differences in lung consolidation and emphysema between the single MP infection group and the MP mixed virus infection group (P 0.05). The incidence of lung consolidation in the MP mixed virus infection group was lower than that in the single MP infection group. The incidence of emphysema is higher than the latter. There was no significant difference in chest imaging findings between MP mixed ADV group and MP mixed RSV group (P > 0.05).(Table 4 ) Table 4 Chest imaging findings of single MP infection group and mixed virus infection group Chest imaging findings Single MP infection group n = 638 Single MP infection group n = 146 X 2 P Single MP infection group N = 74 Single MP infection group N = 67 X 2 P Double lung disease n(%) 190(29.78%) 54(36.99%) 2.878 0.090 24(32.43%) 26(38.81%) 0.997 0.318 Lung consolidation n(%) 590(92.48%) 123(84.25%) 9.771 0.002 63(85.14%) 55(82.09%) 0.239 0.625 Pulmonary atelectasis n(%) 23(3.61%) 4(2.74%) 0.268 0.605 3(4.05%) 2(2.99%) 0.117 0.732 Emphysema n(%) 5(0.78%) 6(4.11%) 9.500 0.002 3(4.05%) 2(2.99%) 0.117 0.732 Air bronchial sign n(%) 25(3.92%) 5(3.42%) 0.079 0.779 1(1.35%) 4(5.97%) 2.193 0.139 Pleural effusion n(%) 80(12.54%) 24(16.44%) 1.570 0.210 14(18.92%) 12(17.91%) 0.024 0.877 3.5 Bronchoscopic findings Among the 784 patients, there were 646 cases (82.40%) of moderate sputum congestion, 71 cases (9.06%) of endobronchial erosion and bad death, 688 cases (87.76%) of floc discharge, 14 cases (1.79%) of viscous purulent discharge, and 82 cases (10.46%) of plastic discharge. There was no significant difference between the single MP infection group and the MP mixed virus infection group and the MP mixed ADV group and the MP mixed RSV group under fiberoptic bronchoscopy (P > 0.05).(Table 5 ) Table 5 Fiberoptic bronchoscopic findings of single MP infection group and mixed virus infection group Bronchoscopic changes Single MP infection group n = 638 Single MP infection group n = 146 X 2 P Single MP infection group N = 74 Single MP infection group N = 67 X 2 P Sputum choked up 519(81.35%) 127(87.00%) 2.604 0.107 64(86.49%) 56(83.58%) 0.234 0.629 Endobronchial membrane Erosion, necrosis 58(9.09%) 13(8.90%) 0.005 0.943 9(12.16%) 6(8.96%) 0.380 0.537 Flocculent discharge 563(88.24%) 127(87.00%) 0.178 0.673 66(89.19%) 54(80.60%) 2.048 0.152 Thick purulent discharge 11(1.72%) 3(2.05%) 0.074 0.786 1(1.35%) 2(3.00%) 0.451 0.502 Shape 64(10.03%) 18(12.33%) 0.670 0.413 7(9.46%) 11(16.42%) 1.529 0.216 4 Discussion Children with SMPP have long fever time, high proportion of extrapulmonary complications, lung imaging and bronchoscopic weight changes, which have attracted extensive attention of pediatricians. MP can cause damage to the airway ciliary columnar epithelium, resulting in the failure of the clearance function of the mucociliary system, resulting in the persistence of lung infection, such as other virus invasion, and more likely to cause mixed infection [6], which is also an important reason for the poor effect of the simple application of macrolide antibacterial drugs. A total of 784 children with SMPP treated with alveolar lavage were included in this study, with a high incidence of SMPP over 5 years old, which was consistent with previous studies [1]. SMPP co-infection rate was 18.62%, and the highest co-infection rate was ADV (50.68%) and RSV (45.89%), which was similar to previous studies [7]. Severe ADV pneumonia is a common pathogen of acute lower respiratory tract infection in children, often complicated with acute respiratory distress syndrome and attasis [8-11], accounting for 8.98% of severe pneumonia in children. The main symptoms of RSV pneumonia include cough, wheezing, etc. In severe cases, circulatory system and digestive system complications may also occur [12-14]. In this study, the MP mixed virus infection group had a younger age of onset and a longer hospital stay, which may be related to the low immune function of young children, the damage of airway mucosa after MP infection, the increased likelihood of co-infection with virus, the prolonged pathogen clearance time after virus infection, and the aggravation of host inflammation and immune response, resulting in prolonged treatment time [15]. In this study, fever and cough were the main clinical manifestations of SMPP children. The duration of fever in the MP mixed virus infection group was significantly longer than that in the single MP infection group, which was related to the accumulation of a large number of inflammatory factors in the body and serious lung infection, suggesting that long-term persistent fever should be more alert to the possibility of SMPP co-infection [1]. In addition, LDH was significantly increased in the mixed RSV infection group, which was consistent with previous studies [16]. As a glycolytic enzyme, the enhanced activity of LDH was closely related to hypoxia and inflammatory response. Among the chest imaging findings of SMPP children, about 1/3 showed double lung involvement, with lung compacted as high as 90.94%, accompanied by complications such as atatasis, emphysema and pleural effusion, which was similar to previous studies [17-19]. The incidence of emphysema in MP mixed viral infection group is higher, which may be caused by viral infection causing the loss of airway cilia and airway epithelial cells, and the accumulation of the lost airway epithelial cells, neutrophils and lymphocytes in the airway leading to airway obstruction. Meanwhile, excessive secretion of mucus and airway edema aggravate airway obstruction [20]. The bronchoscopic incidence of sputum congestion in children with SMPP was as high as 82.40%, which was similar to previous studies [21-22]. MP infection can increase mucus secretion in the airway, and delayed clearance can lead to pulmonary sequelae such as atelectasis, bronchiectasis, and obliterated bronchitis. Therefore, alveolar lavage is an effective treatment for SMPP. In summary, children with SMPP have a long fever time and more extrapulmonary complications, which seriously endangers their health. ADV and RSV were the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar without specificity. Young age, long fever time, long hospital stay, combined with emphysema should be more alert to SMPP combined with virus infection; Patients with significantly elevated lactate dehydrogenase should be alert to RSV infection. This study is a single-center retrospective study, limited by sample size and region, the conclusions have certain limitations, and further validation is needed with multi-center and large-sample clinical study data. 5 Conclusion Adenovirus and respiratory syncytial virus are the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar. The age of MP patients with virus infection was younger, the hospitalization time was longer, the fever time was longer, and the patients with emphysema were more. The level of lactate dehydrogenase in children with RSV infection was higher than that in patients with ADV infection. Limitations This study had two limitations. First, the sample size was small. Second, this retrospective study enrolled hospitalized children from a single center. Multicenter studies with larger sample sizes are needed. Conclusions Adenovirus and respiratory syncytial virus are the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar. The age of MP patients with virus infection was younger, the hospitalization time was longer, the fever time was longer, and the patients with emphysema were more. The level of lactate dehydrogenase in children with RSV infection was higher than that in patients with ADV infection. Declarations Acknowledgements We would like to thank all the pediatric staff of the Affiliated Hospital of Jining Medical University for their support and help. Authors contribution NL, GFQ and GZY designed and wrote paper; RHL and LLM collected data; JN and CQS reviewed data and made statistical analysis of data.All authors have read and approved the final manuscript. Souce of Funding This work was supported by the Affiliated Hospital of Jining Medical University (grant number JYFY363231). Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. 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Pediatric Respiratory Working Committee of Respiratory Physicians Branch of Chinese Medical Doctor Association, etc. Expert consensus on the diagnosis, treatment and prevention of respiratory syncytial virus infection in children. Chin J Practical Pediatr, 20, 35(04):241–50. Huang X, Gu H, Wu R, Chen L, et al. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes. Respir Med. 2024;221:10748. 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. 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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-4397743","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308938639,"identity":"4c553e45-3e73-4cc3-a5f6-dc4767a5f1ce","order_by":0,"name":"Na Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACPhDB+E+ino29sfHhB2K0sEFImwR+nsPNxhIkaElLkJyR3ibAQ5QW6R7jlz94DucZ3HzYxiDBYCen20BIi8wZMwsJicPFBrcT2x4UMCQbmx0gpEUix8zAwOAw44bbie0GEgwHErcRpSUhAajl5sE2CR4itRg/OHAgLXHmDEaitaSVMTY22Bjz8yQCA9mACL/wSyRv/vizQUKOjf34w4cfKuzkCGphYOAwQ4pAA4LKQYD9MVHJZBSMglEwCkYwAAAiZkE+PWC3LAAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":true,"prefix":"","firstName":"Na","middleName":"","lastName":"Li","suffix":""},{"id":308938640,"identity":"b014ee26-a509-4598-a939-9456adbefa59","order_by":1,"name":"Guang feng Qiang","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guang","middleName":"feng","lastName":"Qiang","suffix":""},{"id":308938641,"identity":"cd6bda37-4a44-4830-a33e-bcd714e3896a","order_by":2,"name":"Rui han Liu","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rui","middleName":"han","lastName":"Liu","suffix":""},{"id":308938642,"identity":"2ef359f6-3ddd-494c-a89f-c98a35b91a1a","order_by":3,"name":"Lan lan Meng","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lan","middleName":"lan","lastName":"Meng","suffix":""},{"id":308938643,"identity":"7cce3250-2080-4396-96c3-828ff603259a","order_by":4,"name":"Jun Ning","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Ning","suffix":""},{"id":308938644,"identity":"cb343034-4971-4560-9ba5-f2f7ad1c53ba","order_by":5,"name":"Chang qing Shen","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chang","middleName":"qing","lastName":"Shen","suffix":""},{"id":308938645,"identity":"2930c407-af77-4b81-8eec-a039b4f731e3","order_by":6,"name":"Guang zhi Yu","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guang","middleName":"zhi","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2024-05-10 02:40:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4397743/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4397743/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60409717,"identity":"f3538dcf-33c9-4b66-be2a-a489ddbb9053","added_by":"auto","created_at":"2024-07-16 12:45:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":754957,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4397743/v1/aec67967-44cf-45f2-8aa8-6bc52c5ad2a0.pdf"}],"financialInterests":"","formattedTitle":"Analysis of clinical characteristics of severe mycoplasma pneumoniae pneumonia complicated with virus infection in children","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSevere mycoplasma pneumoniae pneumonia (SMPP) is characterized by rapid disease progression and complex clinical manifestations, which can easily lead to severe pulmonary diseases such as necrotizing pneumonia, attasis, bronchiolitis obliterans and extrapulmonary complications, posing a serious threat to the health of children [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Viruses, bacteria or some atypical pathogens are the main pathogens of SMPP mixed infection, with an incidence as high as 30%-60%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. A major challenge for pediatricians remains the ability to identify and manage severe infections early enough to improve prognosis and reduce mortality. In recent years, with the increasing maturity of fiberoptic bronchoscopy technology, the adoption of alveolar lavage fluid for etiological detection has a higher etiological detection rate than the original oral (or nasal) retention of induced sputum, which can more effectively guide clinical rational diagnosis and treatment[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, this study retrospectively analyzed the clinical data of SMPP children treated by fiberbronchoscopic alveolar lavage, aiming to explore the clinical characteristics and related risk factors of SMPP with viral infection, and provide theoretical basis for early diagnosis, targeted prevention and treatment of severe pneumonia in children.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Study subjects and group\u003c/h2\u003e\n \u003cp\u003eStudy subjects were hospitalized children diagnosed with severe mycoplasma pneumoniae pneumonia from July 2021 to June 2022. Diagnostic criteria: The patients were \u0026lt;\u0026thinsp;14 years old and met the MPP criteria for severe diagnosis [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]. Exclusion criteria: (1) The patient\u0026apos;s condition had entered the recovery stage at the time of admission (temperature was stable for \u0026gt;\u0026thinsp;1 week, chest imaging examination showed improvement); (2) previous malignant tumors, immune deficiency diseases, chronic underlying diseases; (3) Patients with a history of thrombosis; (4) Patients with contraindications of bronchoscopy and incomplete clinical data. General clinical data of the subjects were collected, including demographic data, clinical manifestations and results of auxiliary examinations (within 24 hours of admission). They were divided into single MP infection group and MP mixed infection group according to whether the virus was mixed. Informed consent was signed by close relatives of the child. This study was approved by the Hospital Medical Ethics Committee (2021C234).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Etiological diagnosis\u003c/h2\u003e\n \u003cp\u003eAll the children with etiological diagnosis had bronchoscopy indications and no contraindications of bronchoscopy. About 3ml of BALF was collected from each patient and the samples were stored at -80s℃for 2 hours. SureX 13 multiple detection kit for respiratory pathogens from Ningbo Health Gene Technology Co., Ltd. was used to detect common viruses and atypical bacteria in 200\u0026micro;L BALF. mRT-PCR products were analyzed on an Applied Biosystems 3500Dx genetic analyzer with internal label LIZ500, and then GeneMapper 4.1 software was used (Thermo Fisher Scientific, Waltham, MA, USA) for analysis. Influenza A virus (FluA, FLUA) was detected in BALF. H1N1, H3N2), influenza B virus (FluB), Parainfluenza virus (PIV), adenovirus (ADV), respiratory syncytial virus (RSV), human rhinovirus (HRV), human metapneumovirus (hMPV), human Boca virus (HBoV), coronavirus (CoV), mycoplasma pneumoniae and Chlamydia pneumoniae at least 1 positive, Virus or atypical pathogen infection is considered to be present. Etiological diagnosis of MP infection: one of them can be confirmed: (1) MP-igm antibody positive; (2) Single MP antibody titer\u0026thinsp;\u0026ge;\u0026thinsp;1:160 (particle agglutination method); (3) Pulmonary alveolar lavage fluid (mRT-PCR) tested positive for MP-DNA [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Statistical analysis\u003c/h2\u003e\n \u003cp\u003eSPSS 26.0 software was used for statistical analysis of data. Continuous variables conforming to normal distribution were represented by x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, and T-test was applied between the two groups. The counting data were expressed as percentage (%), and the comparison of the significant difference of rates was conducted by 2 test. Continuous variables that do not conform to the normal distribution are represented by the median (IQR) using the Mann-Whitney U test in non-parametric statistical methods. Bilateral P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was used as the test level to determine the statistical significance.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 General data\u003c/h2\u003e\n \u003cp\u003eA total of 784 children with SMPP who were hospitalized in the pediatrics Department of the Affiliated Hospital of Jining Medical College from July 2021 to June 2022 for bronchoscopic alveolar lavage were included, including 425 males (54.21%) and 359 females (45.79%), with a male to female ratio of 1.18:1. The youngest was 7 months, the oldest was 163 months (13 years July), and the average age was 76.10 years (about 6.3 years). 40 cases (5.1%) were \u0026lt;\u0026thinsp;2 years old, 222 cases (28.32%) were 2 to 5 years old, 522 cases (66.58%) were \u0026gt;\u0026thinsp;5 years old, and the high incidence of SMPP was \u0026gt;\u0026thinsp;5 years old. There were 49 cases (6.25%) in spring, 146 cases (18.62%) in summer, 349 cases (44.52%) in autumn, 240 cases (30.61%) in winter, and most cases (75.13%) in autumn and winter. All 784 samples were diagnosed with SMPP, of which 638 (81.38%) were infected with single MP and 146 (18.62%) were infected with co-virus. The detection rate of virus infection from high to low was 74 cases (50.68%) of adenovirus, 67 cases (45.89%) of syncytial virus, 12 cases (8.21%) of rhinovirus, 9 cases (6.16%) of parainfluenza virus, 8 cases (5.48%) of influenza B virus, 5 cases (3.42%) of metapneumovirus and 1 case (0.68%) of Boca virus. There were significant differences in age, season and length of hospital stay between the single MP infection group and the MP mixed virus infection group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The age of onset was younger and the length of hospital stay was longer in the MP mixed virus infection group. The incidence of single MP infection group was the highest in autumn, and the incidence of MP mixed virus infection group was the highest in summer. Compared with MP mixed ADV group and MP mixed RSV group, statistical analysis showed that there was a significant difference in the incidence season between the two groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), that is, the incidence of MP mixed ADV group in spring was significantly lower than that of MP mixed RSV group, and the incidence of MP mixed ADV group in winter was significantly higher than that of the latter. (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of clinical features between single MP infection group and mixed virus infection group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eclinical features\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;638\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMP mixed virus infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;146\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/t/U\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMP mixed with ADV infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMP mixed with RSV infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/t\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (month)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.64\u0026thinsp;\u0026plusmn;\u0026thinsp;31.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.34\u0026thinsp;\u0026plusmn;\u0026thinsp;34.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.64\u0026thinsp;\u0026plusmn;\u0026thinsp;33.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.12\u0026thinsp;\u0026plusmn;\u0026thinsp;35.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e348(54.55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77(52.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32(43.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35(52.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;2 years\u003c/p\u003e\n \u003cp\u003e2\u0026ndash;5 years\u003c/p\u003e\n \u003cp\u003e\u0026gt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(4.08%)\u003c/p\u003e\n \u003cp\u003e171(26.80%)\u003c/p\u003e\n \u003cp\u003e441(69.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(9.59%)\u003c/p\u003e\n \u003cp\u003e51(34.93%)\u003c/p\u003e\n \u003cp\u003e81(55.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(5.41%)\u003c/p\u003e\n \u003cp\u003e28(37.84%)\u003c/p\u003e\n \u003cp\u003e42(56.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(14.93%)\u003c/p\u003e\n \u003cp\u003e29(43.28%)\u003c/p\u003e\n \u003cp\u003e28(41.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeason\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32(5.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(11.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(13.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSummer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87(13.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59(40.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(51.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31(46.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAutumn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e327(51.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(15.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(12.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(25.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWinter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e192(30.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(32.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(36.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(14.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCourse of illness before admission(day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6,10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(6,10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6,10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital stays\u003c/p\u003e\n \u003cp\u003e(day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(6,10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(6,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Clinical symptoms and pulmonary auscultation\u003c/h2\u003e\n \u003cp\u003eAmong the 784 patients, fever (699 cases, 89.16%) and cough (741 cases, 94.52%) were the main clinical symptoms. The distribution of shortness of breath and wheezing was divided into 30 cases (3.83%) and 45 cases (5.74%), low breath sound (484 cases, 61.73%) and blister sound (612 cases). 78.06%) was a common pulmonary auscultation in children. There was significant difference in the duration of fever between the single MP infection group and the MP mixed virus infection group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The duration of fever in the MP mixed virus infection group was significantly longer than that in the single MP infection group. There were no significant differences in fever, cough, shortness of breath, wheezing, low breath sound and blister sound between MP mixed ADV group and MP mixed RSV group (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).(Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical symptoms and lung auscultation in single MP infection group and mixed virus infection group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003esigns and symptoms\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;638\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;146\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/t\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFever n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e566(88.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e133(91.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69(93.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63(94.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFebrile duration(day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-2.740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.41\u0026thinsp;\u0026plusmn;\u0026thinsp;4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.735\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCough n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e605(94.83%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e136(93.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68(91.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65(97.01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolypnea n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23(3.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(4.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(6.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(8.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWheeze n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37(5.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8(5.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5(6.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3(4.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow breath sound n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e396(62.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88(60.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44(59.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45(67.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBubbling sound n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e505(79.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e107(73.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55(74.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52(77.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Laboratory examination\u003c/h2\u003e\n \u003cp\u003eThere were no significant differences in leukocytes, platelets, C-reactive protein, procalcitonin, erythrocyte deposition rate, D-dimer, alanine aminotransferase, ASpartate aminotransferase and lactate dehydrogenase between single MP infection group and MP mixed virus infection group (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Compared with MP mixed ADV, LDH level in MP mixed RSV group was higher than that in MP mixed ADV group, the difference was statistically significant (U\u0026thinsp;=\u0026thinsp;1757, P\u0026thinsp;=\u0026thinsp;0.044), but there was no significant difference in other indicators (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).(Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLaboratory indexes of single MP infection group and mixed virus infection group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLaboratory index\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;638\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;146\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/t/U\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003cem\u003e/t/U\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBC\u003c/p\u003e\n \u003cp\u003e(\u0026times;10^9/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.14(6.29,10.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.96(6.39,10.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45628.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.31(6.66,10.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.17(6.57,11.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2448.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003cp\u003e(\u0026times;10^9/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e319(260,396)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e323.5(262,419.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e360(264.75,446.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e331(271,414)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCRP\u003c/p\u003e\n \u003cp\u003e(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.59(3.2,20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.30(2.49,20.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44039.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.43(3.45,24.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.39(2.43,21.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2324\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT\u003c/p\u003e\n \u003cp\u003e(ng/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13(0.076,0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11(0.069,0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12(0.069,0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12(0.07,0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1589\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESR\u003c/p\u003e\n \u003cp\u003e(mm/H)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(14,34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(12,38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29(11,42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(15,36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15870.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eD-dimer\u003c/p\u003e\n \u003cp\u003e(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44(0.25,0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46(0.25,0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44(0.25,1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58(0.25,1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2401.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.751\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003cp\u003e(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.85(10.30,19.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2(9.02,18.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2(9.1,18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.2(10.4,20.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1643\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003cp\u003e(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(20,32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(21,31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(20,30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.5(22,33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDH\u003c/p\u003e\n \u003cp\u003e(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e313.3(264,383.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e323(268,399)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36527.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e305.5(261,394)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e345(293,425)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.4 Chest imaging findings\u003c/h2\u003e\n \u003cp\u003eAmong the chest imaging findings of the 784 patients, 244 (31.12%) had double lung involvement, 713 (90.94%) had lung consolidation, 27 (3.44%) had atelectasis, 11 (1.40%) had emphysema, 30 (3.83%) had air bronchogram, and 104 (13.27%) had pleural effusion. There were statistically significant differences in lung consolidation and emphysema between the single MP infection group and the MP mixed virus infection group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but no significant differences in double lung involvement, atelectasis, emphysema, air bronchogram and pleural effusion (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The incidence of lung consolidation in the MP mixed virus infection group was lower than that in the single MP infection group. The incidence of emphysema is higher than the latter. There was no significant difference in chest imaging findings between MP mixed ADV group and MP mixed RSV group (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).(Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eChest imaging findings of single MP infection group and mixed virus infection group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"10\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChest imaging findings\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;638\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;146\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDouble lung disease\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190(29.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54(36.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(32.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(38.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eLung consolidation\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e590(92.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123(84.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63(85.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55(82.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.625\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePulmonary atelectasis\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(3.61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(2.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(4.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(2.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEmphysema\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(0.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(4.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(4.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(2.99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAir bronchial sign\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(3.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(3.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(1.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(5.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePleural effusion\u003c/p\u003e\n \u003cp\u003en(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e80(12.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(16.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(18.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(17.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.5 Bronchoscopic findings\u003c/h2\u003e\n \u003cp\u003eAmong the 784 patients, there were 646 cases (82.40%) of moderate sputum congestion, 71 cases (9.06%) of endobronchial erosion and bad death, 688 cases (87.76%) of floc discharge, 14 cases (1.79%) of viscous purulent discharge, and 82 cases (10.46%) of plastic discharge. There was no significant difference between the single MP infection group and the MP mixed virus infection group and the MP mixed ADV group and the MP mixed RSV group under fiberoptic bronchoscopy (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).(Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFiberoptic bronchoscopic findings of single MP infection group and mixed virus infection group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBronchoscopic changes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;638\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;146\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;74\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSingle MP infection group\u003c/p\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;67\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSputum choked up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e519(81.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127(87.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64(86.49%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56(83.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndobronchial membrane\u003c/p\u003e\n \u003cp\u003eErosion, necrosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(9.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(8.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(12.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(8.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlocculent discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e563(88.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127(87.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(89.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54(80.60%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThick purulent discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(1.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(2.05%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(1.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(3.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64(10.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(12.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(9.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(16.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eChildren with SMPP have long fever time, high proportion of extrapulmonary complications, lung imaging and bronchoscopic weight changes, which have attracted extensive attention of pediatricians. MP can cause damage to the airway ciliary columnar epithelium, resulting in the failure of the clearance function of the mucociliary system, resulting in the persistence of lung infection, such as other virus invasion, and more likely to cause mixed infection [6], which is also an important reason for the poor effect of the simple application of macrolide antibacterial drugs.\u003c/p\u003e\n\u003cp\u003eA total of 784 children with SMPP treated with alveolar lavage were included in this study, with a high incidence of SMPP over 5 years old, which was consistent with previous studies [1]. SMPP co-infection rate was 18.62%, and the highest co-infection rate was ADV (50.68%) and RSV (45.89%), which was similar to previous studies [7]. Severe ADV pneumonia is a common pathogen of acute lower respiratory tract infection in children, often complicated with acute respiratory distress syndrome and attasis [8-11], accounting for 8.98% of severe pneumonia in children. The main symptoms of RSV pneumonia include cough, wheezing, etc. In severe cases, circulatory system and digestive system complications may also occur [12-14]. In this study, the MP mixed virus infection group had a younger age of onset and a longer hospital stay, which may be related to the low immune function of young children, the damage of airway mucosa after MP infection, the increased likelihood of co-infection with virus, the prolonged pathogen clearance time after virus infection, and the aggravation of host inflammation and immune response, resulting in prolonged treatment time [15].\u003c/p\u003e\n\u003cp\u003eIn this study, fever and cough were the main clinical manifestations of SMPP children. The duration of fever in the MP mixed virus infection group was significantly longer than that in the single MP infection group, which was related to the accumulation of a large number of inflammatory factors in the body and serious lung infection, suggesting that long-term persistent fever should be more alert to the possibility of SMPP co-infection [1]. In addition, LDH was significantly increased in the mixed RSV infection group, which was consistent with previous studies [16]. As a glycolytic enzyme, the enhanced activity of LDH was closely related to hypoxia and inflammatory response.\u003c/p\u003e\n\u003cp\u003eAmong the chest imaging findings of SMPP children, about 1/3 showed double lung involvement, with lung compacted as high as 90.94%, accompanied by complications such as atatasis, emphysema and pleural effusion, which was similar to previous studies [17-19]. The incidence of emphysema in MP mixed viral infection group is higher, which may be caused by viral infection causing the loss of airway cilia and airway epithelial cells, and the accumulation of the lost airway epithelial cells, neutrophils and lymphocytes in the airway leading to airway obstruction. Meanwhile, excessive secretion of mucus and airway edema aggravate airway obstruction [20]. The bronchoscopic incidence of sputum congestion in children with SMPP was as high as 82.40%, which was similar to previous studies [21-22]. MP infection can increase mucus secretion in the airway, and delayed clearance can lead to pulmonary sequelae such as atelectasis, bronchiectasis, and obliterated bronchitis. Therefore, alveolar lavage is an effective treatment for SMPP.\u003c/p\u003e\n\u003cp\u003eIn summary, children with SMPP have a long fever time and more extrapulmonary complications, which seriously endangers their health. ADV and RSV were the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar without specificity. Young age, long fever time, long hospital stay, combined with emphysema should be more alert to SMPP combined with virus infection; Patients with significantly elevated lactate dehydrogenase should be alert to RSV infection. This study is a single-center retrospective study, limited by sample size and region, the conclusions have certain limitations, and further validation is needed with multi-center and large-sample clinical study data.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eAdenovirus and respiratory syncytial virus are the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar. The age of MP patients with virus infection was younger, the hospitalization time was longer, the fever time was longer, and the patients with emphysema were more. The level of lactate dehydrogenase in children with RSV infection was higher than that in patients with ADV infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study had two limitations. First, the sample size was small. Second, this retrospective study enrolled hospitalized children from a single center. Multicenter studies with larger sample sizes are needed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdenovirus and respiratory syncytial virus are the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar. The age of MP patients with virus infection was younger, the hospitalization time was longer, the fever time was longer, and the patients with emphysema were more. The level of lactate dehydrogenase in children with RSV infection was higher than that in patients with ADV infection.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all the pediatric staff of the Affiliated Hospital of Jining Medical University for their support and help.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNL, GFQ and GZY\u0026nbsp;designed\u0026nbsp;and wrote\u0026nbsp;paper;\u0026nbsp;RHL and LLM\u0026nbsp;collected\u0026nbsp;data;\u0026nbsp;JN and CQS\u0026nbsp;reviewed\u0026nbsp;data\u0026nbsp;and\u0026nbsp;made\u0026nbsp;statistical analysis of data.All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSouce of Funding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Affiliated Hospital of Jining Medical University (grant number JYFY363231).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Affiliated Hospital of Jining Medical University Medical Ethics Committee (2021C234).The written Informed consent was obtained from all parents or guardians of all the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKuan-Lin LC-M, et al. Severe Mycoplasma pneumoniae pneumonia requiring intensive care in children, 2010\u0026ndash;2019. J Formos Med Assoc. 2020;120:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi L, Run G, Yingxue Z, et al. Construction and Validation of a Nomogram Model to Predict the Severity of Mycoplasma pneumoniae Pneumonia in Children. J Inflamm Res. 2024;17:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYi LP, Xue J, Ren SL, et al. [Clinical characteristics of Mycoplasma pneumoniae infection and factors associated with co-infections in children]. Zhonghua Liu Xing Bing Xue Za Zhi. 2022;43:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLijun W, Qiuling X, Shanshan, Xu, et al. The role of flexible bronchoscopy in children with. Mycoplasma pneumoniae pneumonia Pediatr Res. 2022;93:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Health Commission of the People's Republic of China. Guidelines for Diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023 edition). Int J Epidemiol Infect Dis. 2023;50(02):79\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoyoun S, Sunhoe K, Yong-Jin Y et al. Characteristics of the Mycoplasma pneumoniae Epidemic from 2019 to 2020 in Korea: Macrolide Resistance and Co-Infection Trends.Antibiotics (Basel), 2023, 12: 0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhai TQ, Hung TD, Van P, Hung, et al. Study on the co-infection of children with severe community-acquired pneumonia. Pediatr Int. 2021;64:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQihong C, Lihua L, Ning, Zhang, et al. Adenovirus and Mycoplasma pneumoniae co-infection as a risk factor for severe community-acquired pneumonia in children[. J] Front Pediatr. 2024;12:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFei L, Yuhan Z, Peng S, et al. Mycoplasma pneumoniae and Adenovirus Coinfection Cause Pediatric Severe Community-Acquired Pneumonia. Microbiol Spectr. 2022;10:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi P, Li-Li Z, Zhen H, et al. Clinical features of Mycoplasma pneumoniae pneumonia with adenovirus infection in children. Zhongguo Dang Dai Er Ke Za Zhi. 2021;23:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu Y, Huang RW, Wang M, et al. [Epidemiological characteristics of adenovirus infection in hospitalized children with acute respiratory tract infection in Kunming during 2019. Zhonghua Er Ke Za Zhi. 2021;59:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGwo-Hwa et al. Wan,Chung-Guei, Huang,Fen-Fang, Chung. Detection of Common Respiratory Viruses and Mycoplasma pneumoniae in Patient-Occupied Rooms in Pediatric Wards.Medicine (Baltimore), 2016, 95: 0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEun LC-H, Ju KY. Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea. BMC Infect Dis. 2020;20:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYing L, Yi Y, Jiaming H, et al. Respiratory Viruses and Mycoplasma Pneumoniae Surveillance Among Hospitalized Children with Acute Respiratory Infections - Wuhan City, Hubei Province, China, September-November 2023. China CDC Wkly. 2024;6:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin X, Jian L, Jie LC, Wang et al. Clinical features of severe Mycoplasma pneumoniae pneumonia with pulmonary complications in childhood: A retrospective study.Pediatr Pulmonol, 2023, 58: 0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEun L. Insu, Choi,Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children. Indian J Pediatr. 2022;89:0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiaoshuai W, Xiaofei. Lin,Analysis of Clinical Related Factors of Severe Mycoplasma pneumoniae Pneumonia in Children Based on Imaging Diagnosis.[J].Comput Math Methods Med, 2022, 2022: 0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXia HH et al. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes.Respir Med, 2023, 221: 0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShuo,Yang et al. Sukun. A comparative study of general and severe mycoplasma pneumoniae pneumonia in children.BMC Infect Dis, 2024, 24: 0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Clinical Medical Research Center for Respiratory Diseases, Respiratory Group of Pediatrics Branch of Chinese Medical Association. Pediatric Respiratory Working Committee of Respiratory Physicians Branch of Chinese Medical Doctor Association, etc. Expert consensus on the diagnosis, treatment and prevention of respiratory syncytial virus infection in children. Chin J Practical Pediatr, 20, 35(04):241\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang X, Gu H, Wu R, Chen L, et al. Chest imaging classification in Mycoplasma pneumoniae pneumonia is associated with its clinical features and outcomes. Respir Med. 2024;221:10748.\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":"Severe mycoplasma pneumoniae pneumonia, Viral infection, Clinical features, Children","lastPublishedDoi":"10.21203/rs.3.rs-4397743/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4397743/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo summarize the pathogenesis and etiological characteristics of Severe Mycoplasma Pneumoniae Pneumonia (SMPP) with viral infection.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSMPP patients admitted to Affiliated Hospital of Jining Medical Universityfrom July 2021 to June 2022 requiring bronchoscopic alveolar lavage were retrospectively collected. Multiple reverse transcription polymerase chain reaction (mRT-PCR) was used to detect respiratory pathogens combined with serum mycoplasma antibody titer. The children were divided into Mycoplasma Pneumoniae (MP) infection group and MP mixed virus infection group according to whether they were infected with mixed virus or not. The differences of clinical manifestations, physical examination, laboratory examination, imaging data and bronchoscopy manifestations were analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 784 children with SMPP, 425 were males (54.21%) and 359 were females (45.79%). The ratio of males to females was 1.18:1. Children over 5 years old were the high incidence group of SMPP. There were 638 cases of single MP infection (81.38%), 146 cases of co-infection (18.62%), and the top two cases of co-infection were adenovirus (ADV) in 74 cases (50.68%) and respiratory syncytial virus (RSV) in 67 cases (45.89%). Compared with the MP mixed virus infection group, there were statistically significant differences in age, season, hospital stay, fever time, lung consolidation and emphysema (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but no significant differences in other clinical manifestations, laboratory indicators and bronchoscopy (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Compared with MP mixed ADV group, there were significant differences in the level of lactate dehydrogenase and season (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAdenovirus and respiratory syncytial virus are the most common co-infected viruses of SMPP. In terms of laboratory indexes and fiberoptic bronchoscopy, the disease characteristics of single MP infection group, mixed virus infection group, MP mixed ADV group and MP mixed RSV group were similar. The age of MP patients with virus infection was younger, the hospitalization time was longer, the fever time was longer, and the patients with emphysema were more. The level of lactate dehydrogenase in children with RSV infection was higher than that in patients with ADV infection.\u003c/p\u003e","manuscriptTitle":"Analysis of clinical characteristics of severe mycoplasma pneumoniae pneumonia complicated with virus infection in children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 18:16:41","doi":"10.21203/rs.3.rs-4397743/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":"f3c50e54-bda5-4e62-916a-3fe06189c38e","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-16T12:37:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-13 18:16:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4397743","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4397743","identity":"rs-4397743","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}