Incidence of community‐acquired pneumonia in children caused by <i>Mycoplasma pneumoniae</i>: Serological results of a prospective, population‐based study in primary health care

Korppi, Matti; Heiskanen‐Kosma, Tarja; Kleemola, Marjaana

doi:10.1111/j.1440-1843.2003.00522.x

Cited by 126 publications

(94 citation statements)

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“…Furthermore, coinfection with a pathogen in addition to M. pneumoniae is common but rarely identified via clinical testing, making it difficult to draw specific conclusions about therapeutic effects. 9,38 Finally, no study included in our analysis took into account the duration of illness before the start of antibiotic therapy. It is possible that the timing of intervention relative to the start of symptoms is related to the outcome.…”

Section: Figurementioning

confidence: 99%

“…3 M. pneumoniae is a common cause of CAP and other community-acquired lower respiratory tract infections (CA-LRTIs), particularly in school-age children and adolescents, but there are large gaps in our understanding of this disease. 3,4 Prevalence estimates vary from 10% to 40% in pediatric CA-LRTI, [5][6][7][8][9] and few studies address treatment recommendations. 4,10 Additionally, the IDSA guidelines target the use of macrolides in CA-LRTI as an area needing additional research.…”

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confidence: 99%

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Treatment of Mycoplasma Pneumonia: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVE: Children with community-acquired lower respiratory tract infection (CA-LRTI) commonly receive antibiotics for Mycoplasma pneumoniae. The objective was to evaluate the effect of treating M. pneumoniae in children with CA-LRTI.METHODS: PubMed, Cochrane Central Register of Controlled Trials, and bibliography review. A search was conducted by using Medical Subject Headings terms related to CA-LRTI and M. pneumoniae and was not restricted by language. Eligible studies included randomized controlled trials (RCTs) and observational studies of children #17 years old with confirmed M. pneumoniae and a diagnosis of CA-LRTI; each must have also compared treatment regimens with and without spectrum of activity against M. pneumoniae. Data extraction and quality assessment were completed independently by multiple reviewers before arriving at a consensus. Data were pooled using a random effects model. RESULTS:Sixteen articles detailing 17 studies were included. The most commonly selected primary outcome was symptomatic improvement. Nine studies examined M. pneumoniae treatment in CA-LRTI secondary to M. pneumoniae, and 5 RCTs met criteria for meta-analysis. The suggested pooled risk difference of 0.12 (95% confidence interval, 20.04 to 0.20) favoring treatment was not significantly different and demonstrated significant heterogeneity. Limitations included substantial bias and subjective outcomes within the individual studies, difficulty interpreting testing modalities, and the inability to correct for mixed infections or timing of intervention. CONCLUSIONS:We identified insufficient evidence to support or refute treatment of M. pneumoniae in CA-LRTI. These data highlight the need for well-designed, prospective RCTs assessing the effect of treating M. pneumoniae in CA-LRTI.

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confidence: 99%

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Treatment of Mycoplasma Pneumonia: A Systematic Review

et al. 2014

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“…Even when the diagnosis is made, there is evidence that MP infections are often mixed; Korppi et al 4 reported .50% of MP CAP to be mixed infections, with Streptococcus pneumoniae identified in two-thirds of cases. MP may precede and intensify subsequent infections with various respiratory viruses and bacteria.…”

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Treatment of Mycoplasma pneumoniae in Pediatric Lower Respiratory Infection

et al. 2014

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In this issue of Pediatrics, Biondi et al 1 present a rigorous systematic review and meta-analysis of the literature on the use of antibiotics to treat community-acquired (CA) lower respiratory infections (LRIs) secondary to Mycoplasma pneumoniae (MP). Consistent with previous studies, but on a larger scale, the evidence is deemed insufficient to support or refute such treatments for MP.The following comments, although largely addressed in the article, are intended to highlight the caution that is required on the part of the reader when attempting to implement these conclusions to everyday practice. In particular, we must point out that lack of evidence of efficacy is not evidence of inefficacy when addressing current treatment paradigms. The problems of this and previous studies lie in the lack of uniformity of diagnostic methods, complicated by the fact that mixed infections with other microorganisms often go undiagnosed and contaminate any analysis of treatment efficacy. The small number of studies and their heterogeneity add to our inability to conclude either way, and therefore statements about results of MP-oriented antibiotic treatment are difficult to substantiate, particularly when applied to individual cases.MP is a common cause of CA LRI, particularly in school-aged children and adolescents. It is responsible for at least 40% of cases of CA pneumonia (CAP) and as many as 18% of cases requiring hospitalization in children. 2The diagnosis of MP infection is difficult and nonuniform, and serology and nucleic acid amplification (polymerase chain reaction) are mostly used. Few commercial serologic assays have been shown to have appropriate sensitivity and specificity.3 Conversely, polymerase chain reaction may overestimate the incidence of MP and cost considerations limit its use. These factors frequently limit or delay diagnosis and introduce arbitrariness to therapeutic decisions.Even when the diagnosis is made, there is evidence that MP infections are often mixed; Korppi et al 4 reported .50% of MP CAP to be mixed infections, with Streptococcus pneumoniae identified in two-thirds of cases. MP may precede and intensify subsequent infections with various respiratory viruses and bacteria.5 Such data raise the question of how statements on efficacy of therapies for MP can be made when there is not even the knowledge of which organisms are being targeted.Patients with MP infections mostly recover spontaneously, and it is difficult to assess how intervention and the timing thereof within the course of the infection can be factored in when studying the results of therapies. In human studies, antibiotics have been shown to shorten the clinical course of MP infection, 6 but at the same time carriage of organisms in the upper respiratory tract may not be eliminated.7 It is therefore difficult to assess the effect of medication when organism eradication is not achieved, and thus the response of MP, unlike bacterial infections, is inherently more subtle and variable. Biondi

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“…Age is an important predictor of etiologic agent in pneumonia. 11,12 13 found hospitalization rates of 67% for children younger than 4 years old, 5% for children 5 to 9 years old, and 9% for children 10 to 14 years old. The present study assessed only hospitalized children, which explains its large share of subjects younger than 5 years old.…”

Section: Discussionmentioning

confidence: 99%

Características clínico-radiológicas e hematológicas das pneumonias causadas pelo Mycoplasma pneumoniae

Vervloet¹,

Camargos²,

Soares³

et al. 2010

J. Pediatr. (Rio J.)

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Objective: To describe the clinical, hematological and radiographic characteristics of children hospitalized for Mycoplasma pneumoniae pneumonia. Method:The study population consisted of 190 children between 3 months and 16 years old, hospitalized for radiographically confirmed pneumonia. Patients were divided into two groups, to wit: 95 children with Mycoplasma pneumoniae pneumonia, as diagnosed using the enzyme-linked immunosorbent assay (ELISA) method; and 95 children with pneumonia caused by other etiologic agents. Using a validated scoring system, the clinical, hematological and radiographic findings of both groups were compared to differentiate Mycoplasma pneumoniae pneumonia (group 1) from pneumonia caused by other etiologic agents (group 2), itself divided into two groups, bacterial (n = 75) and viral (n = 20).Results: Mycoplasma pneumoniae pneumonia was found most often in girls (p < 0.01), older children (p < 0.01), and patients with dry cough (p < 0.01) and extrapulmonary manifestations (p < 0.01). The clinical, hematological and radiographic variables of Mycoplasma pneumoniae pneumonia (mean score = 6.95) scored between those found in bacterial (mean score = 8.27) and viral pneumonia (mean score = 0.90). Conclusion:Results suggest that the scoring system can contribute to the presumptive diagnosis of Mycoplasma pneumoniae pneumonia and help differentiate pneumonic status caused by other etiologic agents.J Pediatr (Rio J). 2010;86(6):480-487: Mycoplasma, Mycoplasma pneumoniae, pneumonia, radiography, children. No conflicts of interest declared concerning the publication of this article. Organization (WHO). 9 MP pneumonia was defined by the Mycoplasma pneumoniae pneumonia -Vervloet LA et al. Original article

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Incidence of community‐acquired pneumonia in children caused by Mycoplasma pneumoniae: Serological results of a prospective, population‐based study in primary health care

Cited by 126 publications

References 34 publications

Treatment of Mycoplasma Pneumonia: A Systematic Review

Treatment of Mycoplasma Pneumonia: A Systematic Review

Treatment of Mycoplasma pneumoniae in Pediatric Lower Respiratory Infection

Características clínico-radiológicas e hematológicas das pneumonias causadas pelo Mycoplasma pneumoniae

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