“…Potential explanations for such a synergistic effect include immunosuppression or alteration in respiratory tract flora due to the presence of M. pneumoniae (78,255,269,358). Children with functional asplenia and immune system impairment due to sickle cell disease, other conditions such as Down syndrome, and various immunosuppressive states are at risk of developing more fulminant pneumonia due to M. pneumoniae (38,137,151,192,273,378,403).…”