Clinical characteristics of Mycoplasma pneumoniae pneumonia in Korean children during the recent 3 epidemics

Hwa Hyun Wy; Dong Hoon Min; Deok Soo Kim; Moon Soo Park; Jae Won Shim; Hye Lim Jung; Jung Yeon Shim

doi:10.4168/aard.2017.5.1.8

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Wy, Min, Kim, Park, Shim, Jung, and Shim: Clinical characteristics of Mycoplasma pneumoniae pneumonia in Korean children during the recent 3 epidemics

Original Article

Allergy, Asthma & Respiratory Disease 2017; 5(1): 8-14.

Published online: 31 January 2017

DOI: https://doi.org/10.4168/aard.2017.5.1.8

Clinical characteristics of Mycoplasma pneumoniae pneumonia in Korean children during the recent 3 epidemics

Hwa Hyun Wy, Dong Hoon Min, Deok Soo Kim, Moon Soo Park, Jae Won Shim, Hye Lim Jung, Jung Yeon Shim

Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Jung Yeon Shim. Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea. Tel: +82-2001-2484, Fax: +82-2001-1413, jy7.shim@samsung.com

Received 19 August 2016 Revised 25 October 2016 Accepted 28 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. Since 2000, emerging macrolide-resistant MP has been reported. Three epidemics of MP pneumonia have occurred in Korea during the past 10 years: 2006–2007, 2011, and 2015. We investigated the differences in MP pneumonia of each epidemic in terms of clinical, laboratory, and radiologic perspectives.

Methods

We retrospectively analyzed 529 medical records of children (1–18 years of age) who were admitted and diagnosed with MP pneumonia at Kangbuk Samsung Hospital during the past 3 epidemic periods. We compared the clinical, laboratory, and radiologic characteristics of MP pneumonia among individual epidemics and between children younger and older than 6 years of age.

Results

The mean age of the patients was 5.7 years old, which had increased by each epidemic and showed the highest (6.3 years old) in 2015 compared to previous epidemics. Among 3 epidemics, there were no sex differences. The duration of fever after admission and hospitalization, and the percentage of lobar pneumonia and use of systemic steroids increased significantly in 2015 epidemic. Since 2006, the mean levels of erythrocyte sedimentation rate and lactate dehydrogenase had increased and in 2015 it marked the highest. Children older than 6 years showed a higher proportion of lobar pneumonia and pleural effusion as well as longer duration of fever (before and after admission) and hospitalization days than those younger than 6 years.

Conclusion

This study suggests an increasing incidence of refractory MP pneumonia which required a more frequent use of systemic steroids over the past 10 years, and children older than 6 years were found to have more severe pneumonia than those younger than 6 years.

Keywords: Mycoplasma pneumoniae, Pneumonia, Epidemics, Child, Korea

Figures and Tables

Fig. 1

Age distribution of total Mycoplasma pneumoniae pneumonia patients (n=529).

Fig. 2

Percentage of patients with steroid treatment in each epidemic.

Table 1

Comparison of demographic data, duration of fever and hospitalization among 3 recent epidemics

Variable	2007 (n = 84)	2011 (n = 268)	2015 (n = 177)	P for trend
Age (yr)	5.2 ± 3.0	5.4 ± 3.1	6.3 ± 3.2^*,†	< 0.01
Male sex	34 (40.5)	138 (51.5)	85 (48.0)	0.68
Fever duration before admission^‡ (day)	5.7 ± 3.6	5.6 ± 3.3	4.8 ± 2.7^*	0.02
Fever duration after admission^‡ (day)	1.8 ± 2.3	2.3 ± 2.3	2.9 ± 2.5^*	< 0.01
Fever duration^‡ (day)	7.5 ± 4.3	7.9 ± 3.9	7.7 ± 3.3	0.89
Duration of hospitalization^‡ (day)	7.7 ± 3.5	5.6 ± 2.5*	6.8 ± 2.3^*,†	0.44

Values are presented as mean±standard deviation or number (%).

^*P<0.05, compared to 2007. ^†P<0.05, compared to 2011. ^‡Multiple linear regression analysis adjusted for age.

Table 2

Comparison of the type of pneumonia and complications among 3 recent epidemics

Pneumonia and complication	2007 (n = 84)	2011 (n = 268)	2015 (n = 177)	P-value
Type of pneumonia
Bronchopneumonia	32 (38.1)	111 (41.4)	47 (26.6)	0.01
Lobar pneumonia	52 (61.9)	157 (58.6)	130 (73.4)^†
Effusion	23 (27.4)	24 (9.0)^*	8 (4.5)^*,†	< 0.01
Chest tube	7 (8.3)	5 (1.9)^*	2 (1.1)^*,†	0.01
Oxygen use	6 (7.1)	10 (3.7)	13 (7.4)	0.19

Values are presented as number (%).

^*P<0.05, compared to 2007. ^†P<0.05, compared to 2011.

Table 3

Multiple linear regression analysis of laboratory findings among 3 recent epidemics

Variable	2007 (n = 84)	2011 (n = 268)	2015 (n = 177)	P for trend
Lymphocyte (/mm³)	2,750 ± 1,626	2,638 ± 1,459	2,235 ± 1,240	0.08
White blood cell count (/mm³)	10,300 ± 5,797	9,047 ± 4,366^*	8,810 ± 3,554^*	0.15
LogTEC (/mm³)	5.15 ± 1.26	4.79 ± 1.18^*	4.48 ± 1.30^*	< 0.01
LogCRP (mg/dL)	0.46 ± 1.31	0.53 ± 0.91	0.68 ± 0.89	0.53
Erythrocyte sedimentation rate (mm/hr)	18.8 ± 9.7	36.1 ± 16.4^*	42.0 ± 24.4^*	< 0.01
Platelet count (× 10³/mm³)	365 ± 136	334 ± 123^*	283 ± 93^*	< 0.01
Hemoglobin (g/dL)	12.5 ± 1.0	12.4 ± 0.9	12.3 ± 0.9	0.08
Lactate dehydrogenase (IU/L)	256 ± 75	207 ± 63^*	314 ± 70^*	< 0.01

Values are presented as mean±standard deviation. Adjusted for age and the duration of fever before admission.

LogTEC, logarithmic transformation of blood total eosinophil count; LogCRP, logarithmic transformation of C-reactive protein.

^*P<0.05, compared to 2007.

Table 4

Comparison of clinical characteristics by the age of 6 years

Variable	< 6 Years (n = 276)	≥ 6 Years (n = 253)	P-value
Age (yr)	3.2 ± 1.3	8.3 ± 2.3	< 0.01
Male sex	138 (50.0)	119 (47.0)	0.49
Type of pneumonia
Broncho pneumonia	129 (46.7)	61 (24.1)	< 0.01
Lobar pneumonia	147 (53.3)	192 (75.9)
Effusion	19 (6.9)	36 (14.2)	0.01
Oxygen use	13 (4.7)	16 (6.3)	0.42
Fever duration before admission (day)	5.1 ± 3.4	5.8 ± 2.8	0.01
Fever duration after admission (day)	2.0 ± 2.1	2.9 ± 2.6	< 0.01
Fever duration (day)	7.1 ± 3.9	8.6 ± 3.3	< 0.01
Duration of hospitalization (day)	6.1 ± 2.4	6.6 ± 3.0	0.01

Values are presented as mean±standard deviation or number (%).

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ORCID iDs: Jung Yeon Shim
https://orcid.org/http://orcid.org/0000-0001-9367-2233
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