Journal List > Allergy Asthma Respir Dis > v.5(1) > 1059300

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

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.

Figures and Tables

Fig. 1

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

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Fig. 2

Percentage of patients with steroid treatment in each epidemic.

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Table 1

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

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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

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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

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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

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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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