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October 13, 2025

Clinical Characteristics and Risk Factors for Bronchitis Obliterans in Pediatric Mycoplasma pneumoniae Pneumonia Complicated by Plastic Bronchitis: A 116-Case Study

Key Points

Bronchitis obliterans was detected in 32.5% of cases, notably linked to airway narrowing and delayed treatment.
Children with distal airway narrowing had a higher risk of developing bronchitis obliterans, indicated by an adjusted odds ratio of 5.5.
Laboratory data highlighted that 88.1% had decreased serum prealbumin, suggesting its role as a predictive biomarker for complications.
Analysis covered clinical manifestations and outcomes in 116 pediatric patients with Mycoplasma pneumoniae pneumonia over two years.

Abstract

Mycoplasma pneumoniae pneumonia (MPP) complicated by plastic bronchitis (PB) may progress to severe sequelae such as bronchitis obliterans (BO). We conducted a retrospective cohort study of 116 children with MPP complicated by PB (and subsequent BO in 25 cases) at Chengdu Women and Children's Central Hospital (December 2022–2024). Data encompassed clinical manifestations, laboratory results, imaging features, bronchoscopy data, and treatment regimens. A total of 116 children were enrolled. 33/116 (28.4%) children had concurrent allergic diseases; 96/109 (88.1%) serum prealbumin levels were decreased (median 101.4 mg/L); 31/37 (83.8%) had resistance gene positivity at the mutation site 2603A>G; bronchoalveolar lavage fluid targeted next-generation sequencing identified microbial nucleic acids in 51.2% (20/39) of cases, with 16 cases of bacterial coinfection; 63/116 (54.3%) had distal airway narrowing and/or occlusion on CT scans. BO developed in 32.5% of cases (25/77), with significantly higher incidence in patients exhibiting: radiographic distal airway narrowing/occlusion (adjusted OR = 5.5, 95% CI: 1.518-19.925, p = 0.009); delayed glucocorticoid initiation (adjusted OR = 1.178, 95% CI: 1.027-1.352, p = 0.019). Conclusions. Decreased serum prealbumin levels could serve as a valuable predictive biomarker for the development of PB. PB pathogenesis may involve allergic predisposition and bacterial coinfection. Early radiographic identification of distal airway narrowing/occlusion could serve as an independent predictor for subsequent BO development, whereas initiation of glucocorticoid therapy beyond 8 days after symptom onset may be associated with a significantly elevated risk of BO.

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