Clinical characteristics of respiratory viral coinfection in pediatric Mycoplasma pneumoniae pneumonia

Jong Hyun Kim; Eunji Kim; Jung Hyun Kwon; Won Hee Seo; Young Yoo; Ji Tae Choung; Dae Jin Song

doi:10.4168/aard.2017.5.1.15

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Kim, Kim, Kwon, Seo, Yoo, Choung, and Song: Clinical characteristics of respiratory viral coinfection in pediatric Mycoplasma pneumoniae pneumonia

Original Article

Allergy, Asthma & Respiratory Disease 2017; 5(1): 15-20.

Published online: 31 January 2017

DOI: https://doi.org/10.4168/aard.2017.5.1.15

Clinical characteristics of respiratory viral coinfection in pediatric Mycoplasma pneumoniae pneumonia

Jong Hyun Kim¹, Eunji Kim¹, Jung Hyun Kwon¹, Won Hee Seo¹, Young Yoo^1,², Ji Tae Choung^1,², Dae Jin Song^1,²

¹Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.

²Environmental Health Center, Korea University Anam Hospital, Seoul, Korea.

Correspondence to: Dae Jin Song. Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea. Tel: +82-2-2626-3158, Fax: +82-2-2626-1249, djsong506@korea.ac.kr

Received 23 August 2016 Revised 14 September 2016 Accepted 19 September 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

Bacterial/viral coinfection is not uncommon in children with community acquired pneumonia. However, the data about viral coinfection in Mycoplasma pneumoniae pneumonia is limited. The aim of this study was to investigate the frequency and clinical characteristics of respiratory viral coinfection in pediatric M. pneumoniae pneumonia.

Methods

A retrospective cross sectional study was performed in 432 children hospitalized with M. pneumoniae pneumonia in a tertiary teaching hospital between June 2015 and May 2016.

Results

One hundred forty patients (32.4%) were coinfected with M. pneumoniae and respiratory viruses. Among coinfected viruses, rhinovirus (44.4%) was most commonly detected. Viral coinfection was more likely to occur under the age of 5 years in winter and spring. As compared with patients infected with M. pneumoniae monoinfection, patients coinfected with respiratory viruses showed a lower mean age and shorter total febrile days. Although total leukocyte count was higher, relative proportion of neutrophils and C-reactive protein level were significantly lower in these patients.

Conclusion

Viral coinfection was common in pediatric M. pneumoniae pneumonia, especially in patients under the age of 5 years, and this was associated with shorter total febrile days and lower level of acute phase response as compared with M. pneumoniae monoinfection.

Keywords: Mycoplasma pneumoniae, Viruses, Coinfection, Pneumonia, Child

Figures and Tables

Fig. 1

Monthly distribution of patients with Mycoplasma pneumoniae pneumonia.

Fig. 2

Respiratory viruses coinfected in patients with Mycoplasma pneumoniae pneumonia.

Fig. 3

Age distribution of patients coinfected with Mycoplasma pneumoniae pneumonia and respiratory virus. RSV, respiratory syncytial virus.

Table 1

clinical characteristics of virus coinfection group versus Mycoplasma pneumoniae monoinfection group in children with M. pneumoniae pneumonia

Characteristic	Virus coinfection (n = 140)	M.pneumoniae monoinfection (n = 292)	P-value
Sex, male:female	63:77	150:142	NS
Age (yr)	4.5 ± 2.9	6.2 ± 3.0	< 0.001
≤2	55	39
3–5	52	105	< 0.001^*
≥6	33	148
Season			< 0.001^*
Spring	27	22
Summer	20	64
Autumn	48	141
Winter	45	65
Clinical finding
Total febrile days (day)	7.8 ± 3.7	8.6 ± 3.4	0.017
Hospitalization (day)	6.0 ± 3.3	6.1 ± 3.0	NS
Febrile days before admission (day)	4.3 ± 2.8	5.1 ± 2.4	0.004
Extrapulmonary complication	17 (12.1)	30 (10.3)	NS
Febrile days after initiation of macrolides (day)	3.8 ± 3.0	4.2 ± 3.1	NS
Steroid treatment
Steroid use	21 (15.0)	50 (17.1)	NS
Febrile days after initiation of steroid (day)	2.4 ± 2.2	3.2 ± 3.2	NS
Oxygen use	7 (5.0)	14 (4.8)	NS
ICU care	1 (0.7)	0 (0)	NS
Radiographic findings
Lobar consolidation	10 (7.1)	23 (7.9)	NS
Pleural effusion	1 (0.7)	7 (2.4)	NS
Laboratory findings^†
White blood cell (/µL)	9,818 ± 326	8,306 ± 225	< 0.001
Neutrophil (%)	60.0 ± 1.2	63.2 ± 0.8	0.025
Lympocyte (%)	29.9 ± 1.0	26.5 ± 0.7	0.007
Platelet count (× 10³/µL)	295.1 ± 7.2	266.3 ± 5.0	0.001
Lactate dehydrogenase (IU/L)	601.6 ± 14.2	590.5 ± 10.0	NS
Erythrocyte sedimentation rate (mm/hr)	38.1 ± 1.4	38.7 ± 0.9	NS
C-reactive protein (mg/L)	25.0 ± 2.4	33.0 ± 1.7	0.008

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

NS, not significant; ICU, intensive care unit.

^*Cochran-Armitage trend test. ^†All laboratory data were adjusted by febrile days before admission.

References

1. Juvén T, Mertsola J, Waris M, Leinonen M, Meurman O, Roivainen M, et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 2000; 19:293–298.

2. Wang YJ, Vuori-Holopainen E, Yang Y, Wang Y, Hu Y, Leboulleux D, et al. Relative frequency of Haemophilus influenzae type b pneumonia in Chinese children as evidenced by serology. Pediatr Infect Dis J. 2002; 21:271–277.

3. Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics. 2004; 113:701–707.

4. Honkinen M, Lahti E, Österback R, Ruuskanen O, Waris M. Viruses and bacteria in sputum samples of children with community-acquired pneumonia. Clin Microbiol Infect. 2012; 18:300–307.

5. Ghani AS, Morrow BM, Hardie DR, Argent AC. An investigation into the prevalence and outcome of patients admitted to a pediatric intensive care unit with viral respiratory tract infections in Cape Town, South Africa. Pediatr Crit Care Med. 2012; 13:e275–e281.

6. Kurz H, Göpfrich H, Huber K, Krugluger W, Asbott F, Wabnegger L, et al. Spectrum of pathogens of in-patient children and youths with community acquired pneumonia: a 3 year survey of a community hospital in Vienna, Austria. Wien Klin Wochenschr. 2013; 125:674–679.

7. Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev. 2008; 32:956–973.

8. Lee KY. Pediatric respiratory infections by Mycoplasma pneumoniae. Expert Rev Anti Infect Ther. 2008; 6:509–521.

9. Lee SH, Noh SM, Lee KY, Lee HS, Hong JH, Lee MH, et al. Clinico-epidemiologic Study of Mycoplasma pneumoniae Pneumonia(1993 through 2003). Korean J Pediatr. 2005; 48:154–157.

10. Kim JW, Seo HK, Yoo EG, Park SJ, Yoon SH, Jung HY, et al. Mycoplasma pneumoniae pneumonia in Korean children, from 1979 to 2006-a meta-analysis. Korean J Pediatr. 2009; 52:315–323.

11. 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; 160:483–491.

12. Nilsson AC, Björkman P, Welinder-Olsson C, Widell A, Persson K. Clinical severity of Mycoplasma pneumoniae (MP) infection is associated with bacterial load in oropharyngeal secretions but not with MP genotype. BMC Infect Dis. 2010; 10:39.

13. Tanaka H, Narita M, Teramoto S, Saikai T, Oashi K, Igarashi T, et al. Role of interleukin-18 and T-helper type 1 cytokines in the development of Mycoplasma pneumoniae pneumonia in adults. Chest. 2002; 121:1493–1497.

14. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004; 17:697–728.

15. Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, et al. Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med. 1999; 160:397–405.

16. File TM. Community-acquired pneumonia. Lancet. 2003; 362:1991–2001.

17. Brown JS. Geography and the aetiology of community-acquired pneumonia. Respirology. 2009; 14:1068–1071.

18. File TM Jr. New diagnostic tests for pneumonia: what is their role in clinical practice? Clin Chest Med. 2011; 32:417–430.

19. Pavia AT. What is the role of respiratory viruses in community-acquired pneumonia?: What is the best therapy for influenza and other viral causes of community-acquired pneumonia? Infect Dis Clin North Am. 2013; 27:157–175.

20. Chen CJ, Lin PY, Tsai MH, Huang CG, Tsao KC, Wong KS, et al. Etiology of community-acquired pneumonia in hospitalized children in northern Taiwan. Pediatr Infect Dis J. 2012; 31:e196–e201.

21. Chiu CY, Chen CJ, Wong KS, Tsai MH, Chiu CH, Huang YC. Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia. J Microbiol Immunol Infect. 2015; 48:51–56.

22. O'Brien KL, Walters MI, Sellman J, Quinlisk P, Regnery H, Schwartz B, et al. Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection. Clin Infect Dis. 2000; 30:784–789.

23. Martín-Loeches I, Sanchez-Corral A, Diaz E, Granada RM, Zaragoza R, Villavicencio C, et al. Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus. Chest. 2011; 139:555–562.

24. Drews AL, Atmar RL, Glezen WP, Baxter BD, Piedra PA, Greenberg SB. Dual respiratory virus infections. Clin Infect Dis. 1997; 25:1421–1429.

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ORCID iDs: Dae Jin Song
https://orcid.org/http://orcid.org/0000-0003-0647-3186
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