Journal List > Pediatr Allergy Respir Dis > v.21(2) > 1033158

Park and Lee: A Clinical Comparative Study of Mycoplasma Pneumoniae Pneumonia in Children under Three Years Old

Abstract

Purpose

Mycoplasma pneumoniae pneumonia is rarely found in children under 3 years old. Nevertheless, infants have been recently and frequently diagnosed with M. pneumoniae pneumonia. Therefore, the clinical characteristics of such children were investigated in this study.

Methods

Subjects were 232 infants (group A: 0 to 11 months, group B: 12 to 23 months, group C: 24 to 35 months) who were diagnosed between January 2004 and December 2009 with M. pneumoniae pneumonia infection at Myongji Hospital. We reviewed their medical records, the early and monthly incidence of infection, clinical manifestations, and laboratory findings.

Results

Group A consisted of 28 patients (12.1%), group B 78 (33.6%), and group C 126 (54.3 %). The younger patient group in the peak season, 2006, demonstrated a high incidence rate. Wheezing was more often auscultated in group A than in the other groups. Negative findings on chest X-rays were more often observed in group A. Serologically, high titers of mycoplasma-specific antibody (>1:1,280) were observed in lobar pneumonia and correlated with the severity of clinical manifestations.

Conclusion

The age at which M. pneumoniae infection has been diagnosed has recently decreased and has been found with a particularly high frequency in infants. Despite shorter fever duration before hospitalization and uncertain radiological findings, including M. pneumoniae in the differential diagnosis of pneumonia is recommended for children under 1 year.

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Fig. 1.
Annual incidence of Mycoplasma pneumoniae pneumonia in three groups.
pard-21-91f1.tif
Fig. 2.
Seasonal distribution of Mycoplasma pneumoniae pneumonia in three groups.
pard-21-91f2.tif
Table 1.
Pulmonary Symptoms of Patients with Mycoplasma pneumoniae Pneumoniae
Symptoms No. of patients (%)
Group A Group B Group C
Cough 27 (96.4) 69 (88.5) 117 (92.9)
Dyspnea 4 (14.3) 1 (1.3) 2 (1.6)
Fever 20 (71.4) 58 (74.4) 105 (83.3)
Sputum 20 (71.4) 51 (65.4) 74 (58.7)
Rhinorrhea 4 (14.3) 16 (20.5) 33 (26.2)
Barking cough 1 (3.6) 2 (2.6) 1 (0.8)
Hoarseness 0 (0.0) 2 (2.6) 0 (0.0)
Tachypnea 4 (14.3) 1 (1.3) 3 (2.4)
Table 2.
Extrapulmonary Symptoms of Patients with Mycoplasma pneumoniae Pneumonia
  No. of patients (%)
Group A Group B Group C
Febrile seizure 0 (0.0) 1 (1.3) 0 (0.0)
Oral intake poor 0 (0.0) 2 (2.6) 3 (2.4)
Vomiting 2 (7.1) 6 (7.7) 14 (11.1)
Abdominal pain 0 (0.0) 1 (1.3) 9 (7.1)
Diarrhea 3 (10.7) 8 (10.3) 8 (6.3)
Irritability 1 (3.6) 2 (2.6) 0 (0.0)
Rash 1 (3.6) 3 (3.8) 3 (2.4)
Dysuria 0 (0.0) 0 (0.0) 1 (0.8)
Otalgia 0 (0.0) 0 (0.0) 2 (1.6)
Conjuntiva injection 0 (0.0) 0 (0.0) 1 (0.8)
Table 3.
Physical Findings of Patients with Mycoplasma pneumoniae Pneumoniae
Physical findings No. of patients (%)
Group A Group B Group C
Auscultation finding
  Rale 20 (71.4) 57 (73.1) 91 (72.2)
  Decreased breathing sound 2 (7.1) 19 (24.4) 17 (13.5)
  Wheezing 10 (35.7) 2 (2.6) 2 (1.6)
Others
  Pharyngeal injection 6 (21.4) 32 (41.0) 70 (55.6)
  Rash 1 (3.6) 3 (3.8) 3 (2.4)
  Otitis media 2 (7.1) 4 (5.1) 11 (8.7)
  Conjuntiva injection 1 (3.6) 0 (0.0) 0 (0.0)

P<0.05 was considered to be significant.

Table 4.
Radiologic Findings of Patients with Mycoplasma pneumoniae Pneumoniae
Radiologic findings No. of patients (%)
Group A Group B Group C
Pneumonic infiltration 10 (35.7) 40 (51.3) 83 (65.9)
Lobar pneumonia      
 Single lung      
  Multilobar 1 (3.57) 0 (0.0) 0 (0.0)
  Right lower lobe 0 (0.0) 6 (7.7) 9 (7.1)
  Right middle lobe 0 (0.0) 6 (7.7) 4 (3.2)
  Left lower lobe 1 (3.57) 5 (6.4) 2 (1.6)
  Left upper lobe 0 (0.00) 1 (1.3) 1 (0.8)
  Right upper lobe 3 (10.71) 6 (7.7) 4 (3.2)
 Both lungs 1 (3.57) 0 (0.0) 0 (0.0)
Pleural effusions 1 (3.6) 1 (1.3) 2 (1.6)
Atelectasis 0 (0.0) 1 (1.3) 1 (0.8)
Negative finding 12 (42.86) 14 (17.9) 23 (18.3)

P<0.05 was considered to be significant.

Table 5.
Laboratory Findings of Patients with Mycoplasma pneumoniae Pneumoniae
Laboratory findings No. of patients (%)
Group A Group B Group C
WBC counts (/mm3)
  <5,000 1 (3.6) 4 (5.1) 8 (6.3)
  5,000–10,000 6 (21.4) 34 (43.6) 53 (42.1)
  10,000–15,000 11 (39.3) 31 (39.7) 41 (32.5)
  >15,000 10 (35.7) 9 (11.5) 24 (19.0)
ESR
  >20 mm/hr 4 (14.3) 16 (20.5) 67 (53.2)
CRP
  >0.8 mg/dL 12 (42.9) 29 (37.2) 76 (60.3)
AST/ALT
  AST>45 U/L 23 (82.1) 43 (55.1) 74 (58.7)
  ALT>55 U/L 5 (17.9) 11 (14.1) 7 (5.6)

P<0.05 was considered to be significant.

WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; AST, aspartate transaminase; ALT, alanine transaminase.

Table 6.
Comparison of the Mycoplasma Antibody (Ab) Titer in the Three Groups
  No. of patients (%)
Group A Group B Group C
Mycoplasma Ab titer      
1:320 12 (42.9) 32 (41.0) 52 (41.3)
1:640 7 (25.0) 16 (20.5) 19 (15.1)
>1:1,280 9 (32.1) 30 (38.5) 55 (43.7)
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