{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:47:45Z","timestamp":1782283665460,"version":"3.54.5"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Viral co-infections are common in pediatric\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      pneumonia (MPP), yet their age-specific clinical impact on children under six is not fully understood. We aimed to describe the frequency, pathogen-specific inflammatory signatures, and age-dependent clinical impact of viral co-detection in this population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we collected data from the medical records of 504 children hospitalized with MPP between July 2021 and December 2024. The information extracted included clinical manifestations, laboratory findings, treatment modalities, and the presence of viral co-infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Viral co-detection occurred in 193 (38.3%) children, peaking in the 2\u20134 years age group (47.1%). Among children under 2 years, co-detection was associated with a higher severe disease rate (29.7% vs. 9.5%;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.046). Compared to rhinovirus (HRV) co-detection, human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) co-detections were linked to more pronounced inflammatory responses. HMPV co-detection was characterized by leukopenia [median: 2.25 (IQR 1.73\u20133.05) vs. 2.70 (1.72\u20137.31)\u2009\u00d7\u200910\u2079\/L,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.013] and elevated IL-10 [8.76 (5.58\u201318.66) vs. 5.00 (2.97\u20135.95) pg\/mL,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.037] and IFN-\n                      <jats:italic>\u03b3<\/jats:italic>\n                      [4.34 (2.68\u20135.96) vs. 2.24 (1.12\u20132.77) pg\/mL,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028]. RSV co-detection featured a neutrophilic response, with higher neutrophil counts [5.76 (4.11\u20137.36) vs. 3.93 (2.69\u20134.06)\u2009\u00d7\u200910\u2079\/L,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.033], neutrophil-to-lymphocyte ratio [2.87 (1.57\u20134.30) vs. 1.17 (0.62\u20132.13),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003], and IL-10 levels [10.97 (7.74\u201320.23) vs. 5.00 (2.97\u20135.95) pg\/mL,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.024]. Multivariable analysis identified wheezing (aOR=1.909; 95% CI: 1.131\u20133.222), severe pneumonia (aOR=1.797; 95% CI:1.019\u20133.169), and higher serum IL-10 (aOR=1.038 per unit; 95% CI: 1.015\u20131.062) as independent risk factors associated with viral co-detection. In contrast, children aged 4\u20136 years had a significantly lower risk of co-detection compared to those under 2 years (aOR=0.528; 95% CI: 0.308\u20130.903) (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Viral co-detection in preschool children with MPP is associated with more severe clinical outcomes, particularly in those under two years of age. Our findings identify pathogen-specific immune response patterns (driven by HMPV and RSV) and elevated serum IL-10 as key risk markers. These findings are hypothesis-generating; the observed associations do not establish causality, and require validation in prospective studies before informing clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1744105","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:55:40Z","timestamp":1782280540000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mycoplasma pneumoniae pneumonia with and without viral pathogens in preschool-aged children: a comparative study of clinical outcomes"],"prefix":"10.3389","volume":"14","author":[{"given":"Qiuyue","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Pediatric Respiratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengxin","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuliang","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.3201\/eid3007.240315","article-title":"Large-scale outbreak of Mycoplasma pneumoniae infection, Marseille, France, 2023\u20132024","volume":"30","author":"Edouard","year":"2024","journal-title":"Emerg Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.24953\/turkjped.2022.545","article-title":"Clinical and radiologic manifestations of Mycoplasma pneumoniae infection in children","volume":"64","author":"Ocak","year":"2022","journal-title":"Turk J Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2553","DOI":"10.3390\/microorganisms9122553","article-title":"Pulmonary and extrapulmonary manifestations in hospitalized children with Mycoplasma pneumoniae infection","volume":"9","author":"Biagi","year":"2021","journal-title":"Microorganisms"},{"key":"B4","first-page":"6","article-title":"Guidelines for the diagnosis and treatment of community-acquired pneumonia in children","volume":"12","year":"2019","journal-title":"Chinese Journal of Clinical Infectious Diseases"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0158922","DOI":"10.1128\/spectrum.01589-22","article-title":"Mycoplasma pneumoniae among hospitalized patients with acute respiratory tract infections in an Indian tertiary Care Hospital: an underreported health problem","volume":"10","author":"Sreenath","year":"2022","journal-title":"Microbiol Spectr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1186\/s12887-025-05804-4","article-title":"Comparative analysis of the clinical characteristics of severe Mycoplasma pneumoniae pneumonia and severe bacterial pneumonia in children","volume":"25","author":"Liu","year":"2025","journal-title":"BMC Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"19892","DOI":"10.1038\/s41598-024-71010-4","article-title":"Epidemiological characteristics and early predict model of children Mycoplasma pneumoniae pneumonia outbreaks after the COVID-19 in Shandong","volume":"14","author":"Zeng","year":"2024","journal-title":"Sci Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1097\/INF.0000000000001628","article-title":"Mycoplasma pneumoniae: a cross-sectional population-based comparison of disease severity in preschool and school-age children","volume":"36","author":"Inchley","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12519-023-00783-x","article-title":"Current status of Mycoplasma pneumoniae infection in China","volume":"20","author":"Yan","year":"2024","journal-title":"World J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12931-025-03262-1","article-title":"Development and validation of an early diagnosis model for severe mycoplasma pneumonia in children based on interpretable machine learning","volume":"26","author":"Xie","year":"2025","journal-title":"Respir Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1186\/s12890-024-03380-4","article-title":"Significance of respiratory virus coinfection in children with Mycoplasma pneumoniae pneumonia","volume":"24","author":"Yu","year":"2024","journal-title":"BMC Pulm Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines12020173","article-title":"Effectiveness of influenza vaccination and early antiviral treatment in reducing pneumonia risk in severe influenza cases","volume":"12","author":"Godoy","year":"2024","journal-title":"Vaccines"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1542\/peds.2013-3729","article-title":"Treatment of mycoplasma pneumonia: a systematic review","volume":"133","author":"Biondi","year":"2014","journal-title":"Pediatrics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/s12879-025-10712-0","article-title":"Antibiotic resistance and viral co-infection in children diagnosed with pneumonia caused by Mycoplasma pneumoniae admitted to Russian hospitals during October 2023-February 2024","volume":"25","author":"Korneenko","year":"2025","journal-title":"BMC Infect Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"394","DOI":"10.15585\/mmwr.mm7423a1","article-title":"Mycoplasma pneumoniae infections in hospitalized children - United States, 2018\u20132024","volume":"74","author":"Diaz","year":"2025","journal-title":"MMWR Morbidity and Mortality Weekly Report"},{"key":"B16","doi-asserted-by":"publisher","first-page":"CD009576","DOI":"10.1002\/14651858.CD009576.pub3","article-title":"Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze","volume":"1","author":"Lassi","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e29616","DOI":"10.1002\/jmv.29616","article-title":"Changing respiratory pathogens infection patterns after COVID-19 pandemic in Shanghai, China","volume":"96","author":"Wei","year":"2024","journal-title":"J Med Virol"},{"key":"B18","year":"2023"},{"key":"B19","doi-asserted-by":"publisher","first-page":"920","DOI":"10.3760\/cma.j.cn112140-20240728-00523","article-title":"Management guidelines for community-acquired pneumonia in children (2024 revision)","volume":"62","year":"2024","journal-title":"Chinese Journal of Pediatrics"},{"key":"B20","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.jmii.2021.09.010","article-title":"The epidemiology, clinical characteristics, and macrolide susceptibility of Mycoplasma pneumoniae pneumonia in children in Southern Taiwan, 2019\u20132020","volume":"55","author":"Kuo","year":"2022","journal-title":"Journal of Microbiology, Immunology and Infection"},{"key":"B21","volume-title":"Zhu Futang Practice of Pediatrics","author":"Wang","year":"2022"},{"key":"B22","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s12887-025-05435-9","article-title":"Comparison of the epidemiological characteristics of Mycoplasma pneumoniae infections among children during two epidemics in Wuhan from 2018 to 2024","volume":"25","author":"Mao","year":"2025","journal-title":"BMC Pediatr"},{"key":"B23","doi-asserted-by":"publisher","first-page":"9414","DOI":"10.1038\/s41598-025-94292-8","article-title":"Analysis of the characteristics of mixed infections with Mycoplasma pneumoniae in children","volume":"15","author":"Yuan","year":"2025","journal-title":"Sci Rep"},{"key":"B24","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1186\/s12879-020-05356-1","article-title":"Impact of viral coinfection and macrolide-resistant mycoplasma infection in children with refractory Mycoplasma pneumoniae pneumonia","volume":"20","author":"Zhou","year":"2020","journal-title":"BMC Infect Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1186\/s12879-024-10257-8","article-title":"Etiological analysis of acute respiratory infections in hospitalized children after the relaxation of COVID-19 non-pharmacological interventions in Quzhou, China","volume":"24","author":"Fu","year":"2024","journal-title":"BMC Infect Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09603123.2025.2488482","article-title":"Epidemiological characteristics of respiratory pathogens in Changchun, Jilin Province, China, following the pandemic","volume":"35","author":"Wang","year":"2025","journal-title":"Int J Environ Health Res"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e28692","DOI":"10.1002\/jmv.28692","article-title":"Comparison of common human respiratory pathogens among hospitalized children aged \u2264 6 years in Hainan Island, China, during spring and early summer in 2019\u20132021","volume":"95","author":"Mai","year":"2023","journal-title":"J Med Virol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/s00705-024-06147-8","article-title":"Epidemiology of human metapneumovirus in Taiwan from 2013 to 2023","volume":"169","author":"Yang","year":"2024","journal-title":"Arch Virol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.jmii.2025.05.002","article-title":"Clinical features and genomic characteristics of post-pandemic human metapneumovirus infections in hospitalized Taiwanese children","volume":"58","author":"Lee","year":"2025","journal-title":"Journal of Microbiology, Immunology and Infection"},{"key":"B30","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12985-024-02376-0","article-title":"Clinical and epidemiological characteristics of 96 pediatric human metapneumovirus infections in Henan, China after COVID-19 pandemic: a retrospective analysis","volume":"21","author":"Ji","year":"2024","journal-title":"Virol J"},{"key":"B31","doi-asserted-by":"publisher","first-page":"100405","DOI":"10.1016\/j.lana.2022.100405","article-title":"Severe COVID-19 outcomes in pediatrics: an observational cohort analysis comparing Alpha, Delta, and Omicron variants","volume":"18","author":"Bahl","year":"2023","journal-title":"The Lancet Regional Health \u2013 Americas"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e27467","DOI":"10.1002\/ppul.27467","article-title":"The impact of viral co-infection in children treated with respiratory support due to lower respiratory tract infections. An observational study","volume":"60","author":"Vahlkvist","year":"2025","journal-title":"Pediatr Pulmonol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"25518","DOI":"10.1038\/s41598-024-77005-5","article-title":"Epidemiological characteristics and meteorological factors of acute respiratory infections (ARIs) in hospitalized children in eastern Guangdong, China","volume":"14","author":"Yang","year":"2024","journal-title":"Sci Rep"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1016\/j.jfma.2020.07.014","article-title":"Characteristics and etiology of hospitalized pediatric community-acquired pneumonia in Taiwan","volume":"119","author":"Chi","year":"2020","journal-title":"J Formos Med Assoc"},{"key":"B35","doi-asserted-by":"publisher","first-page":"957","DOI":"10.1001\/jamapediatrics.2025.2044","article-title":"Inflammatory pathways in residual asthma exacerbations among mepolizumab-treated urban children: a secondary analysis of a randomized clinical trial","volume":"179","author":"Altman","year":"2025","journal-title":"JAMA Pediatr"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e68864","DOI":"10.7554\/eLife.68864","article-title":"Dynamically linking influenza virus infection kinetics, lung injury, inflammation, and disease severity","volume":"10","author":"Myers","year":"2021","journal-title":"eLife"},{"key":"B37","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1038\/s41590-024-02064-9","article-title":"Temporal profiling of human lymphoid tissues reveals coordinated defense against viral challenge","volume":"26","author":"Coates","year":"2025","journal-title":"Nat Immunol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1161067","DOI":"10.3389\/fimmu.2023.1161067","article-title":"The multifaceted nature of IL-10: regulation, role in immunological homeostasis and its relevance to cancer, COVID-19 and post-COVID conditions","volume":"14","author":"Carlini","year":"2023","journal-title":"Front Immunol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2190650","DOI":"10.1080\/21505594.2023.2190650","article-title":"An important call: suggestion of using IL-10 as therapeutic agent for COVID-19 with ARDS and other complications","volume":"14","author":"Shih","year":"2023","journal-title":"Virulence"},{"key":"B40","doi-asserted-by":"publisher","first-page":"8032","DOI":"10.1111\/febs.16207","article-title":"Cryo-EM structure of the IL-10 receptor complex provides a blueprint for ligand engineering","volume":"289","author":"Saxton","year":"2022","journal-title":"FEBS J"},{"key":"B41","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1111\/imm.13457","article-title":"The relationship between peripheral immune response and disease severity in SARS-CoV-2-infected subjects: a cross-sectional study","volume":"165","author":"Walter","year":"2022","journal-title":"Immunology"},{"key":"B42","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s40001-025-02487-6","article-title":"Glucocorticoids can reduce mortality in patients with severe community-acquired pneumonia: a systematic review and meta-analysis of randomized controlled trials","volume":"30","author":"Gu","year":"2025","journal-title":"Eur J Med Res"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1931","DOI":"10.1056\/NEJMoa2215145","article-title":"Hydrocortisone in severe community-acquired pneumonia","volume":"388","author":"Dequin","year":"2023","journal-title":"N Engl J Med"},{"key":"B44","doi-asserted-by":"publisher","first-page":"e0410722","DOI":"10.1128\/spectrum.04107-22","article-title":"Metatranscriptome reveals specific immune and microbial signatures of respiratory syncytial virus infection in children","volume":"11","author":"Feng","year":"2023","journal-title":"Microbiol Spectr"},{"key":"B45","doi-asserted-by":"publisher","first-page":"111503","DOI":"10.1016\/j.isci.2024.111503","article-title":"Risk factors and prescription patterns analysis for macrolide-resistant Mycoplasma pneumoniae pneumonia in children","volume":"27","author":"Lu","year":"2024","journal-title":"iScience"},{"key":"B46","doi-asserted-by":"publisher","first-page":"5844","DOI":"10.26355\/eurrev_202208_29524","article-title":"Regional and annual patterns in respiratory virus co-infection etiologies and antibiotic prescriptions for pediatric Mycoplasma pneumoniae pneumonia","volume":"26","author":"Sung","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2475","DOI":"10.1007\/s10096-025-05215-4","article-title":"Clinical features and risk factors for severe macrolide-resistant mycoplasma pneumoniae pneumonia induced by 23S rRNA A2063G mutation: a retrospective observational study","volume":"44","author":"Ding","year":"2025","journal-title":"European Journal of Clinical Microbiology and Infectious Diseases"},{"key":"B48","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1093\/cid\/ciae588","article-title":"Predictors of persistent fever among patients with suspected infective endocarditis: think outside the box","volume":"80","author":"Stavropoulou","year":"2025","journal-title":"Clin Infect Dis"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1744105\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:55:42Z","timestamp":1782280542000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1744105\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":48,"alternative-id":["10.3389\/fped.2026.1744105"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1744105","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1744105"}}