The Clinical Presentation of Pediatric Mycoplasma pneumoniae Infections—A Single Center Cohort

Abstract

Background: Mycoplasma pneumoniae (MP) is a major cause of community-acquired upper and lower respiratory infections in school-age children; however, there is increasing recognition that younger children are also affected. Clinical manifestations vary from asymptomatic, to severe complicated pneumonia sometimes with extrapulmonary manifestations. Methods: We reviewed the medical records of all MP positive pediatric patients admitted to the Hadassah-Hebrew University Medical Center. MP positive case was defined if MP polymerase chain reaction was positive from an oropharyngeal swab sent from 2007 to 2017. Results: During the study period, we identified 353 MP positive pediatric cases, of which 51.3% (181 of 353) were younger than 6 years old. Full clinical data were available for 332 of 353 (94%). The median age was 5.7 years (range, 3 weeks to 18 years). Disease presentation differed between younger and older children. Children older than 6 years were more likely to have chest radiograph confirmed pneumonia (66% vs. 52%; P = 0.009), while younger children were more likely to have other respiratory manifestations (37% vs. 25%; P = 0.017). The duration of hospitalization and pediatric intensive care unit admission rate, however, did not differ between age groups. The rate of extrapulmonary manifestations were also similar. Conclusions: MP-associated infection is a significant cause of hospitalization in the pediatric population including younger children (<6 years old). However, the clinical presentation in younger age is less typical than is thought. These findings should prompt clinicians to consider MP infections also in children younger than 6 admitted with fever even without pneumonia.

Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children

“…was even true for PCT and CRP of Mp-positive CAP in comparison to viral CAP (RSV) as a subgroup of Mp-negative CAP. Similar trends have been observed in previous CAP studies for CRP, WBC count, and ANC [23,[39][40][41][42][43], and recently for PCT with median levels from 0.05 to 0.19 μg/L in CAP considered to be caused by Mp [39][40][41]44]. A study with conflicting results suggesting higher PCT levels associated with Mp may be hampered by diagnostics [45].…”

“…Third, the study enrolled children from 3 to 18 years of age to reduce the probability of viral infection [9]. However, younger children with Mp infection may have, more likely, other RTIs than CAP [43].…”

The incidence of Mycoplasma pneumoniae in community acquired pneumonia among children: one centre study

“…However, dyspnea, upper respiratory tract involvement, diarrhea and vomiting were reported as more common manifestations in patients <2 years old children. Gordon et al [28] reported that the clinical presentation of pediatric M. pneumoniae infections accompanied by fever in 33.4% of patients, and duration of symptoms was between 3 and 9 days. Fever, cough, and sore throat were the three most common symptoms of children with M. pneumoniae positive [26].…”

Clonal spread of macrolide-resistant Mycoplasma pneumoniae sequence type-3 and type-17 with recombination on non-P1 adhesin among children in Taiwan

“…Clonal spread of macrolide-resistant ST3 and ST17 strains possibly resulted from (a) a type shift phenomenon involving interactions between antigenicity of M. pneumoniae and immunological status of the human population; or (b) increased prescription of macrolide antibiotics in children for respiratory tract infection in Taiwan [31,35]. Differences in clinical presentation were related to age in children with M. pneumoniae infection [36], older patients were more commonly infected by the ST14 strain than the ST3 or ST17 strains, which could indicate that this population had pre-existing immunity against the latter two strains. MR should subside with judicious use of these agents and clonal change.…”