Neutrophils Are Involved in the Development and Outcomes of Plastic Bronchitis Associated with Mycoplasma Pneumoniae Pneumonia

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2025 Mar 8

PMID 40057734

Authors

Xia Huang

Houbing Qin

Rui Zhang

Xinyi Jia

Deyu Zhao

Feng Liu

Affiliations

Soon will be listed here.

Abstract

Background: Previous research has demonstrated a notable increase in neutrophil counts among pediatric patients with plastic bronchitis (PB) associated with Mycoplasma pneumoniae pneumonia (MPP). However, the role of neutrophils in MPP-associated PB remains largely elusive.

Methods: This is a nested case-control study that enrolled patients diagnosed with MPP who underwent bronchoscopy in our department during the MPP pandemic from September 2023 to January 2024. We conducted an analysis of clinical characteristics, blood samples, bronchoalveolar lavage fluid (BALF), and cast specimens, correlating these factors with the development and outcomes of PB.

Results: Among the 557 patients with MPP included in the study, 21 (3.8%) developed PB. The peripheral neutrophil count was identified as an independent risk factor for PB (OR = 3.113 [95%CI 1.050-9.224], P = 0.04) and exhibited strong predictive value for the condition (AUC = 0.885 [95%CI 0.796-0.975], P < 0.001). Notably, there was a marked presence of neutrophil infiltration and neutrophil extracellular traps (NETs) formation in the blood, BALF, and cast samples from patients with PB. Furthermore, the levels of neutrophils and NETs correlated significantly with clinical outcomes.

Conclusion: A high level of neutrophils poses a risk for PB and demonstrates strong predictive value for its diagnosis. Neutrophils and NETs are closely linked to the clinical outcomes of PB in patients with MPP.

References

Soehnlein O, Steffens S, Hidalgo A, Weber C . Neutrophils as protagonists and targets in chronic inflammation. Nat Rev Immunol. 2017; 17(4):248-261. DOI: 10.1038/nri.2017.10. View

Huang X, Luo Y, Wang J, Zhang X, Chen L, Wu R . Integrative study of pulmonary microbiome, transcriptome and clinical outcomes in Mycoplasma pneumoniae pneumonia. Respir Res. 2024; 25(1):35. PMC: 10795342. DOI: 10.1186/s12931-024-02687-4. View

Meyer Sauteur P, Beeton M . Pneumonia outbreaks due to re-emergence of Mycoplasma pneumoniae. Lancet Microbe. 2024; 5(6):e514. DOI: 10.1016/S2666-5247(23)00406-8. View

Papayannopoulos V . Neutrophil extracellular traps in immunity and disease. Nat Rev Immunol. 2017; 18(2):134-147. DOI: 10.1038/nri.2017.105. View

Zhang H, Zhou Y, Qu M, Yu Y, Chen Z, Zhu S . Tissue Factor-Enriched Neutrophil Extracellular Traps Promote Immunothrombosis and Disease Progression in Sepsis-Induced Lung Injury. Front Cell Infect Microbiol. 2021; 11:677902. PMC: 8317465. DOI: 10.3389/fcimb.2021.677902. View

Lefrancais E, Mallavia B, Zhuo H, Calfee C, Looney M . Maladaptive role of neutrophil extracellular traps in pathogen-induced lung injury. JCI Insight. 2018; 3(3). PMC: 5821185. DOI: 10.1172/jci.insight.98178. View

Zhang H, Liu J, Zhou Y, Qu M, Wang Y, Guo K . Neutrophil extracellular traps mediate mA modification and regulates sepsis-associated acute lung injury by activating ferroptosis in alveolar epithelial cells. Int J Biol Sci. 2022; 18(8):3337-3357. PMC: 9134924. DOI: 10.7150/ijbs.69141. View

Waites K, Xiao L, Liu Y, Balish M, Atkinson T . Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev. 2017; 30(3):747-809. PMC: 5475226. DOI: 10.1128/CMR.00114-16. View

Thiam H, Wong S, Wagner D, Waterman C . Cellular Mechanisms of NETosis. Annu Rev Cell Dev Biol. 2020; 36:191-218. PMC: 8499668. DOI: 10.1146/annurev-cellbio-020520-111016. View

10.

Guo L, Liu F, Lu M, Zheng Q, Chen Z . Increased T cell activation in BALF from children with Mycoplasma pneumoniae pneumonia. Pediatr Pulmonol. 2014; 50(8):814-9. DOI: 10.1002/ppul.23095. View

11.

Hu Q, Wu J, Wang C, Liang W, Wang Y, Zheng Y . Outcomes and Risk Factor Analysis of Plastic Bronchitis Among 321 Children with Influenza Pneumonia After Bronchoscopy Examination. Infect Drug Resist. 2023; 16:4001-4011. PMC: 10290863. DOI: 10.2147/IDR.S405444. View

12.

Gong C, Huang F, Suo L, Guan X, Kang L, Xie H . Increase of respiratory illnesses among children in Beijing, China, during the autumn and winter of 2023. Euro Surveill. 2024; 29(2). PMC: 10785205. DOI: 10.2807/1560-7917.ES.2024.29.2.2300704. View

13.

Meyer Sauteur P, Beeton M . Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions. Lancet Microbe. 2023; 5(2):e100-e101. DOI: 10.1016/S2666-5247(23)00344-0. View

14.

Zhang H, Wu D, Wang Y, Guo K, Spencer C, Ortoga L . METTL3-mediated N6-methyladenosine exacerbates ferroptosis via m6A-IGF2BP2-dependent mitochondrial metabolic reprogramming in sepsis-induced acute lung injury. Clin Transl Med. 2023; 13(9):e1389. PMC: 10504453. DOI: 10.1002/ctm2.1389. View

15.

Choi Y, Jeon J, Oh J . Critical combination of initial markers for predicting refractory Mycoplasma pneumoniae pneumonia in children: a case control study. Respir Res. 2019; 20(1):193. PMC: 6706904. DOI: 10.1186/s12931-019-1152-5. View

16.

Huang X, Li D, Liu F, Zhao D, Zhu Y, Tang H . Clinical significance of D-dimer levels in refractory Mycoplasma pneumoniae pneumonia. BMC Infect Dis. 2021; 21(1):14. PMC: 7787414. DOI: 10.1186/s12879-020-05700-5. View

17.

Rubin B . Plastic Bronchitis. Clin Chest Med. 2016; 37(3):405-8. DOI: 10.1016/j.ccm.2016.04.003. View

18.

Zhao L, Zhang T, Cui X, Zhao L, Zheng J, Ning J . Development and validation of a nomogram to predict plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia. BMC Pulm Med. 2022; 22(1):253. PMC: 9235233. DOI: 10.1186/s12890-022-02047-2. View

19.

Yang L, Zhang Y, Shen C, Lu Z, Hou T, Niu F . Clinical features and risk factors of plastic bronchitis caused by Mycoplasma pneumoniae pneumonia in children. BMC Pulm Med. 2023; 23(1):468. PMC: 10668422. DOI: 10.1186/s12890-023-02766-0. View

20.

Zhu Y, Luo Y, Li L, Jiang X, Du Y, Wang J . Immune response plays a role in pneumonia. Front Immunol. 2023; 14:1189647. PMC: 10250694. DOI: 10.3389/fimmu.2023.1189647. View