Clinical usefulness of serum procalcitonin to distinguish between viral pneumonia and Mycoplasma pneumonia in children: A multicenter, cross-sectional study

Sungmin Kim; Gye Hur; Myong Soon Sung; Hey-Sung Baek; Jung Won Yoon; Sun Hee Choi; Youn Ho Sheen; Man Yong Han

doi:10.4168/aard.2019.7.1.22

Journal List > Allergy Asthma Respir Dis > v.7(1) > 1125514

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Kim, Hur, Sung, Baek, Yoon, Choi, Sheen, and Han: Clinical usefulness of serum procalcitonin to distinguish between viral pneumonia and Mycoplasma pneumonia in children: A multicenter, cross-sectional study

Original Article

Allergy Asthma Respir Dis 2019;7(1):22-27.

Published online: 12 January 2019

DOI: https://doi.org/10.4168/aard.2019.7.1.22

Clinical usefulness of serum procalcitonin to distinguish between viral pneumonia and Mycoplasma pneumonia in children: A multicenter, cross-sectional study

Sungmin Kim^1,, Gye Hur^1,, Myong Soon Sung^1,, Hey-Sung Baek^2,, Jung Won Yoon^3,, Sun Hee Choi^4,, Youn Ho Sheen^5,, Man Yong Han^6,

^¹Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan

^²Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul Korea

^³Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine, Goyang

^⁴Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul Korea

^⁵Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul Korea

^⁶Department of Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Correspondence to: Myong Soon Sung https://orcid.org/0000-0002-6329-286X Department of Pediatrics, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea Tel: +82-51-797-2000, Fax: +82-51-797-0298, E-mail: myong47@hanmail.net

Received 23 July 2018 Revised 26 October 2018 Accepted 27 October 2018

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/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to compare the clinical usefulness of serum procalcitonin (PCT) levels in Mycoplasma pneumoniae pneumonia (M. pneumonia) and viral pneumonia in children.

Methods

We retrospectively analyzed the medical records of 348 patients admitted between June 2015 and December of 2015. There were 162 patients with M. pneumonia without virus coinfection (group 1) and 186 patients with viral pneumonia (group 2). All subjects had radiographic evidence of pneumonia with available specimens for both M. pneumonia and viral testing, and levels of serum PCT, white blood cell counts (WBC), neutrophil portion, and C-reactive protein (CRP). Fifty-eight children who performed follow-up sampling at the time of no fever for more than 48 hours were subdivided into group 3 (M. pneumonia with follow-up sampling, n=41) and group 4 (viral pneumonia with follow-up sampling, n=17).

Results

No difference was noted in the levels of serum PCT (P=0.168), CRP (P=0.296), WBC (P=0.732), and neutrophil proportion (P=0.069) between groups 1 and 2, after adjusting for age. Serial changes in serum PCT levels between the first and second samples were significant in group 3 (P=0.046). Serial changes in serum CRP levels between the first and second samples were significant in group 4 (P=0.008).

Conclusion

Serum PCT and CRP levels may change differently after infection according to the etiology of pneumonia.

Keywords: Mycoplasma pneumonia, Viral pneumonia, Procalcitonin, Community acquired pneumonia, Child

References

1. Pfuntner A, Wier LM, Stocks C. Most frequent conditions in U.S. hospitals, 2011: statistical brief #162. 2013 Sep. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US);2006.

2. Lee GE, Lorch SA, Sheffler-Collins S, Kronman MP, Shah SS. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics. 2010; 126:204–13.

3. Ferwerda A, Moll HA, de Groot R. Respiratory tract infections by Mycoplasma pneumoniae in children: a review of diagnostic and therapeutic measures. Eur J Pediatr. 2001; 160:483–91.

4. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect. 2008; 56:326–31.

5. Ahn HS, Shin HY, editors. Hong Chang Eui pediatrics. 11th ed.Seoul: MiraeN;2016. p. 697.

6. Nohynek H, Valkeila E, Leinonen M, Eskola J. Erythrocyte sedimentation rate, white blood cell count and serum C-reactive protein in assessing etiologic diagnosis of acute lower respiratory infections in children. Pediatr Infect Dis J. 1995; 14:484–90.

7. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zim-merli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000; 28:977–83.

8. Stockmann C, Ampofo K, Killpack J, Williams DJ, Edwards KM, Grijalva CG, et al. Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia. J Pediatric Infect Dis Soc. 2018; 7:46–53.

9. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010; 375:463–74.

10. Sensini A, Zuccherini F, Cerboni1 G, Galullo M, Meli L, Maso GD, et al. Serological diagnosis of Mycoplasma pneumoniae infection: a complicated puzzle. Microbiol Med. 2012; 27:171–6.

11. Becker KL, Nylén ES, White JC, Müller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004; 89:1512–25.

12. Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001; 164:396–402.

13. Baer G, Baumann P, Buettcher M, Heininger U, Berthet G, Schäfer J, et al. Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial. PLoS One. 2013; 8:e68419.

14. Esposito S, Tagliabue C, Picciolli I, Semino M, Sabatini C, Consolo S, et al. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia. Respir Med. 2011; 105:1939–45.

15. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez JL, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child. 2001; 84:332–6.

16. Toikka P, Irjala K, Juvén T, Virkki R, Mertsola J, Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J. 2000; 19:598–602.

17. Menéndez R, Sahuquillo-Arce JM, Reyes S, Martínez R, Polverino E, Cillóniz C, et al. Cytokine activation patterns and biomarkers are influenced by microorganisms in community-acquired pneumonia. Chest. 2012; 141:1537–45.

18. Nascimento-Carvalho CM, Cardoso MR, Barral A, Araújo-Neto CA, Guerin S, Saukkoriipi A, et al. Procalcitonin is useful in identifying bacteraemia among children with pneumonia. Scand J Infect Dis. 2010; 42:644–9.

19. Resch B, Gusenleitner W, Müller W. Procalcitonin, interleukin-6, C-reactive protein and leukocyte counts in infants with bronchiolitis. Pediatr Infect Dis J. 2003; 22:475–6.

20. Christ-Crain M, Müller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J. 2007; 30:556–73.

21. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J. 1997; 16:735–46.

22. Squire EN Jr, Reich HM, Merenstein GB, Favara BE, Todd JK. Criteria for the discontinuation of antibiotic therapy during presumptive treatment of suspected neonatal infection. Pediatr Infect Dis. 1982; 1:85–90.

23. Emmerson AJ. C-reactive protein and the newborn infant. Arch Dis Child Educ Pract Ed. 2011; 96:e1.

24. Peltola H, Jaakkola M. C-reactive protein in early detection of bacteremic versus viral infections in immunocompetent and compromised children. J Pediatr. 1988; 113:641–6.

25. Bahagon Y, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis. 2007; 26:349–52.

26. Aminzadeh Z, Parsa E. Relationship between age and peripheral white blood cell count in patients with sepsis. Int J Prev Med. 2011; 2:238–42.

Table 1.

Clinical characteristics of the study subjects

Characteristic	Group 1 (n=162)	Group 2 (n=186)	P-value	Group 3 (n=41)	Group 4 (n=17)	P-value	P-value*	P-value^†
Age (yr)	5.03±3.12	3.78±3.13	<0.001	5.92±2.68	4.29±2.49	0.041	0.096	0.223
Boys	70 (43.2)	97 (52.2)	0.119	24 (58.5)	7 (41.18)	0.359	<0.001	0.540
Body mass index (kg/m²)	16.05±2.09	16.06±1.68	0.997	16.36±2.29	16.42±2.02	0.267	0.418	0.489
Chief complain
Fever (>38°C)	120 (75.0)	137 (73.6)	0.930	31 (75.6)	17 (100)	0.063	0.448	0.004
Respiratory symptoms	42 (25.9)	49 (26.3)	0.929	13 (31.7)	17 (100)	<0.001	0.584	<0.001
Missing data	0 (0)	5 (2.7)	–	0 (0)	0 (0)	–	–	–
Duration of admission (day)	4.28±2.78	3.96±1.93	0.227	8.80±4.52	7.29±3.19	0.230	<0.001	<0.001
Mechanical ventilation care	0 (0)	0 (0)	–	0 (0)	0 (0)	–	–	–

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

Group 1, mycoplasma pneumonia; group 2, viral pneumonia; group 3, mycoplasma pneumonia with follow-up sampling; group 4, viral pneumonia with follow-up sampling, respiratory symptoms were defined as having coughing, sputum, or respiratory difficulty.

Scale variables were analyzed using analysis of chi-square test or Fisher exact test and continue variables were analyzed using analysis of Student t-test or Mann-Whitney U-test.*Group 1 compared with group 3.

^† Group 2 compared with group 4.

Table 2.

Comparison of laboratory findings at admission between mycoplasma pneumonia and viral pneumonia

Characteristic	Group 1 (n=162)	Group 2 (n=186)	P-value
WBC (×10³/μL)	8.94±4.80	9.45±4.47	0.732*
Neutrophil proportion (%)	61.90±14.19	55.98±17.05	0.069*
CRP (mg/dL)	3.14±3.43	3.29±3.81	0.296*
PCT (ng/mL)	0.49±2.25	0.92±3.29	0.168*
PCT status (ng/mL)
<0.25	143 (88.3)	142 (76.3)	0.006
0.25–1	8 (4.9)	42 (22.6)	<0.001
>1	11 (6.8)	28 (15.1)	0.023

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

Group 1, mycoplasma pneumonia; group 2, viral pneumonia; WBC, white blood cell; CRP, C-reactive protein; PCT, procalcitonin.

Scale variables were analyzed using analysis of chi-square test or Fisher exact test.

* P-values are from analysis of covariance after adjusting for age.

Table 3.

Comparison of laboratory findings at the time of admission and follow-up in groups 3 and 4

Characteristic	First		P-value	Follow-up		P-value	P-value*	P-value^†
Characteristic	Group 3	Group 4	P-value	Group 3	Group 4	P-value	P-value*	P-value^†
WBC (×10³/μL)	7.99±3.62	8.77±3.97	0.494	8.27±2.69	8.04±2.46	0.765	0.531	0.598
Neutrophil proportion (%)	65.14±11.31	57.75±17.38	0.216	64.73±14.35	51.65±17.41	0.012	0.832	0.269
CRP (mg/dL)	4.39±5.51	4.31±2.90	0.286	4.81±7.07	1.86±1.39	0.252	0.682	0.008
PCT (ng/mL)	1.72±4.30	1.77±4.89	0.844	0.43±0.80	0.44±0.79	0.850	0.046	0.236
PCT status (ng/mL)							0.587	0.315
<0.25	23 (56.1)	9 (52.9)	1.000	26 (63.4)	12 (70.6)	0.826
0.25–1	9 (22.0)	3 (17.6)	0.507	7 (17.1)	2 (11.8)	0.912
>1	9 (22.0)	5 (29.4)	0.386	8 (19.5)	3 (17.6)	0.869

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

Group 3, mycoplasma pneumonia with follow-up sampling; group 4, viral pneumonia with follow-up sampling; WBC, white blood cell; CRP, C-reactive protein; PCT, procalcitonin. Scale variables were analyzed using analysis of chi-square test or Fisher exact test and continue variables were analyzed using analysis of Student t-test or Mann-Whitney U-test.

*First sampling compared with follow-up sampling in group 3 from Wilcoxon signed rank test.

^† First sampling compared with follow-up sampling in group 4 from Wilcoxon signed rank test.

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