{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:24:11Z","timestamp":1780410251754,"version":"3.54.1"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"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:p>Mycoplasma pneumoniae pneumonia (MPP) is a common cause of community-acquired pneumonia (CAP) in school-aged children, among whom 1%\u201320% may develop pleural effusion. Most effusions are small in volume and self-resolving. We report two pediatric cases of severe MPP complicated by massive pleural effusion that were unresponsive to initial anti-mycoplasma therapy. Targeted next-generation sequencing (tNGS) of pleural fluid identified macrolide-resistant Mycoplasma pneumoniae and Torque teno virus (TTV) in both cases. Both patients recovered after closed thoracic drainage, adjustment of anti-mycoplasma therapy according to resistance findings, and adjunctive immunomodulatory treatment. These cases indicate that, in severe MPP with massive pleural effusion, pleural-fluid tNGS may provide useful diagnostic information beyond conventional testing, including the identification of macrolide resistance and additional viral findings such as TTV. However, given the high background prevalence of TTV in humans and the absence of control samples in this report, the clinical significance of TTV detection in pleural fluid remains uncertain. At present, TTV is more appropriately interpreted as a possible biomarker of immune perturbation or disease severity rather than a confirmed pathogenic driver. Broader pathogen testing in selected specimens such as pleural fluid may complement diagnostic evaluation in complex infections, but larger controlled studies are needed to clarify the significance of TTV in this setting.<\/jats:p>","DOI":"10.3389\/fped.2026.1801533","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T13:42:14Z","timestamp":1780407734000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Torque teno virus identified in pleural effusion of pediatric severe Mycoplasma pneumoniae pneumonia: diagnostic and therapeutic implications"],"prefix":"10.3389","volume":"14","author":[{"given":"Jiaxin","family":"Liang","sequence":"first","affiliation":[{"name":"The Second Hospital & Clinical Medical School, Lanzhou University","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanwei","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Lanzhou University Second Hospital","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanxiao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Lanzhou University Second Hospital","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingxing","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology, Lanzhou University Second Hospital","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingchuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Outpatient and Emergency, Lanzhou University Second Hospital","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","first-page":"110","article-title":"Clinical features of Mycoplasma pneumoniae pneumonia with pleural effusion in children","volume":"20","author":"Wang","year":"2022","journal-title":"Chin Med Guide"},{"key":"B2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.19871\/j.cnki.xfcrbzz.2024.01.015","article-title":"Guidelines for the diagnosis and treatment of Mycoplasma pneumoniae pneumonia in children (2023 edition)","volume":"9","author":"Zhao","year":"2024","journal-title":"J Emerg Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e143","DOI":"10.1002\/imt2.143","article-title":"Multiprime: a reliable and efficient tool for targeted next-generation sequencing","volume":"2","author":"Xia","year":"2023","journal-title":"iMeta"},{"key":"B4","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1006\/bbrc.1997.7765","article-title":"A novel DNA virus (TTV) associated with elevated transaminase levels in posttransfusion hepatitis of unknown etiology","volume":"241","author":"Nishizawa","year":"1997","journal-title":"Biochem Biophys Res Commun"},{"key":"B5","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1128\/CMR.14.1.98-113.2001","article-title":"Molecular properties, biology, and clinical implications of TT virus, a recently identified widespread infectious agent of humans","volume":"14","author":"Bendinelli","year":"2001","journal-title":"Clin Microbiol Rev"},{"key":"B6","doi-asserted-by":"publisher","first-page":"329","DOI":"10.2147\/IDR.S494558","article-title":"Utilizing targeted next-generation sequencing for rapid, accurate, and cost-effective pathogen detection in lower respiratory tract infections","volume":"18","author":"Qin","year":"2025","journal-title":"Infect Drug Resist"},{"key":"B7","doi-asserted-by":"publisher","first-page":"102936","DOI":"10.1016\/j.jiph.2025.102936","article-title":"Targeted next-generation sequencing (tNGS): an upcoming application for pathogen identification in clinical diagnosis","volume":"18","author":"Liang","year":"2025","journal-title":"J Infect Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1321515","DOI":"10.3389\/fmed.2023.1321515","article-title":"Targeted next-generation sequencing for pulmonary infection diagnosis in patients unsuitable for bronchoalveolar lavage","volume":"10","author":"Deng","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e00584","DOI":"10.1128\/JCM.00584-20","article-title":"Genseizer: a multiplex PCR-based targeted gene sequencing platform for rapid and accurate identification of major Mycobacterium Species","volume":"59","author":"Li","year":"2021","journal-title":"J Clin Microbiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1303456","DOI":"10.3389\/fcimb.2023.1303456","article-title":"Epidemiological investigation of lower respiratory tract infections during influenza A (H1N1) pdm09 virus pandemic based on targeted next-generation sequencing","volume":"13","author":"Li","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e178003","DOI":"10.1172\/JCI178003","article-title":"Status check: next-generation sequencing for infectious-disease diagnostics","volume":"134","author":"Rodino","year":"2024","journal-title":"J Clin Invest"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1615965","DOI":"10.3389\/fmicb.2025.1615965","article-title":"Evaluation of targeted next-generation sequencing for microbiological diagnosis of acute lower respiratory infection","volume":"16","author":"Yang","year":"2025","journal-title":"Front Microbiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"230","DOI":"10.19871\/j.cnki.xfcrbzz.2024.01.015","article-title":"Bronchoalveolar lavage fluid assessment facilitates precision medicine for lung cancer","volume":"21","author":"Zhang","year":"2023","journal-title":"Cancer Biol Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.2174\/0929867324666171005112921","article-title":"Virome and inflammasomes, a finely tuned balance with important consequences for the host health","volume":"26","author":"Freer","year":"2019","journal-title":"Curr Med Chem"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1447980","DOI":"10.3389\/fimmu.2024.1447980","article-title":"Torque teno viruses exhaust and imprint the human immune system via the HLA-E\/NKG2A axis","volume":"15","author":"Vietzen","year":"2024","journal-title":"Front Immunol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1097\/INF.0000000000003796","article-title":"Torque teno virus in nasopharyngeal aspirate of children with viral respiratory infections","volume":"42","author":"Del Rosal","year":"2023","journal-title":"Pediatr Infect Dis J"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1801533\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T13:42:17Z","timestamp":1780407737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1801533\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":16,"alternative-id":["10.3389\/fped.2026.1801533"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1801533","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"article-number":"1801533"}}