The Efficacy of Glucocorticoid on Macrolide Resistant Mycoplasma Pneumonia in Children

© Copyright The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease http://e-aair.org Mycoplasma pneumoniae (MP) is a common etiology of pediatric and adult community-acquired pneumonia that represents 10%-40% of cases; however, the immunopathogenesis of MP in humans is poorly understood. The role of cell-mediated immunity in MP infections is controversial. Both human infection tissue and animal model lung tissue are consistent in demonstrating mononuclear perilumenal infiltrates. Animal model studies have found hyperaccentuated reactions after repeated infection that is also mimicked by repeated exposure to non-viable microbe. Macrolides are first-line antimicrobials against MP pneumonia. Treatment of MP pneumonia with appropriate antibiotics (such as macrolides) is found to significantly improve the course of the disease. Observations have demonstrated that MP in a clinical sample obtained from patients successfully treated with macrolides was detectable by culture. However, in some cases, the suppression of microorganisms by a macrolide may be inadequate for the treatment of MP pneumonia. The worldwide prevalence of macrolide-resistant MP has increased to 10%-30% since macrolide resistance (such as erythromycin resistance) was first reported in Japan in 1970. Macrolide-resistant strains are known to cause severe refractory MP. The M144V mutation of the L4 protein and mutation at position 2064 of domain V in the 23S rRNA gene of M. pneumoniae was reported in Korea in 2010; consequently, the appearance of macrolide-resistant strains has increased. The immune status is T-helper 2 dominant after infection by MP. This is confirmed by an MP infection that exacerbates inflammation in asthma patients associated with the activation of nuclear factor kB. Serum levels of VEGF and IL-5 increased more in atopic children with MP pneumonia. These cytokines may act through their respective pro-inflammatory pathways to aggravate the allergic status and induce airway hypersensitivity during MP pneumonia in atopic children. These observations suggest that MP pneumonia is a combination of infection and The Efficacy of Glucocorticoid on Macrolide Resistant Mycoplasma Pneumonia in Children