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Tang, Ryu, Jung, Park, and Kim: Related factors for and changes in clinical manifestations in mycoplasma pneumonia nonresponsive to macrolide treatment
Original Article

Allergy Asthma Respir Dis 2018;6(2):116-121.

Published online: 5 March 2018

DOI: https://doi.org/10.4168/aard.2018.6.2.116

Related factors for and changes in clinical manifestations in mycoplasma pneumonia nonresponsive to macrolide treatment

Chih-Lung Tang1, In Kyung Ryu1, Ji-Hyun Jung1, Jin-Sung Park2, Hyo-Bin Kim1

1Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea

2Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea

Correspondence to: Hyo-Bin Kim https://orcid.org/0000-0002-1928-722X Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1663, Fax: +82-2-950-1662, E-mail: hbkim@paik.ac.kr

• This work was supported by Inje University research grant.

Received 16 July 20171 September 2017       Accepted 4 September 2017

Copyright © 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma

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

Mycoplasma pneumonia is known to be a major cause of community-acquired pneumonia in children. Macrolide has been the first-line treatment for mycoplasma pneumonia, but recently there has been an increasing tendency of macrolide-resistant Mycoplasma pneumoniae (MRMP). Therefore, this study aimed to investigate the clinical tendency and the therapeutic responsibility of mycoplasma pneumonia in terms of the fever duration after treatment and its associated factors.

Methods

A total of 346 children admitted with mycoplasma pneumonia during 3 recent periods (2008–2009, 2011–2012, and 2015–2016) were investigated with clinical manifestations, laboratory test results and chest x-ray findings. Patients were grouped according to fever duration and analyzed for differences in clinical features.

Results

There was no statistically significant difference in age or sex between the 3 periods (P=0.284 and P=0.559, respectively). Total fever duration during mycoplasma pneumonia was increased with time (P for trend <0.001). The patients with a longer fever duration (≥3 days) after macrolide treatment presented with a higher CRP (P<0.001) and with lobar-type pneumonia (P=0.020) compared to those with a shorter fever duration. Fever duration after steroid treatment became longer in the longer fever group in 2011 (P=0.015) and 2015 (P<0.001), but not in 2008 (P=0.536).

Conclusion

This study showed that the therapeutic effect of macrolide or steroid for mycoplasma pneumonia is recently attenuat-ing and that high CRP, lobar-type pneumonia and presence of pleural effusion were the associated factors. Therefore, efforts to decrease MRMP and to develop better treatment guidelines for mycoplasma pneumonia are needed in the future.

Keywords: Mycoplasma pneumonia, Macrolide, Fever, Steroid

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Table 1.
Comparison of characteristics of mycoplasma pneumonia patients among 3 periods
Variable 2008–2009 (n=129) 2011–2012 (n=108) 2015–2016 (n=109) P-value
No. of patients 129 108 109  
Age (yr) 5.4±3.2 4.9±3.2 5.5±3.0 0.284
 0–1 11 (8.5) 12 (11.1) 10 (9.2) 0.559
 2–5 64 (49.6) 60 (55.6) 48 (44.0)  
 6–9 44 (34.1) 27 (25.0) 41 (37.6)  
 ≥10 10 (7.8) 9 (8.3) 10 (9.2)  
Sex        
 Male 54 (41.9) 55 (50.9) 56 (51.4) 0.246
 Female 75 (58.1) 53 (49.1) 53 (48.6)  
Total fever days 3.9±4.0 6.2±4.1 7.3±2.9 <0.001
Fever ≥3 days after macrolide 36 (27.9) 37 (34.2) 42 (38.5) 0.227
Steroid use 14 (10.9) 28 (25.9) 37 (33.9) <0.001
Fever duration after steroid use (hr) 0.2±2.1 1.8±6.9 3.2±7.1 <0.001
White blood cell (/mm3) 9,830.2±4,449.8 8,463.2±3,665.8 8,178.8±4,654.0 0.006
 Neutrophil (%) 55.3±29.6 55.1±15.6 59.3±13.5 0.248
 Lymphocyte (%) 34.7±18.3 33.8±14.3 29.7±12.0 0.033
 Eosinophil (%) 3.8±6.3 2.4±2.4 2.4±2.9 0.020
C-reactive protein (mg/L) 2.1±2.6 3.2±4.6 3.1±3.7 0.042
Radiologic findings        
 Pneumonia type        
  Lobar 25 (19.3) 39 (36.1) 44 (40.3) 0.158
  Bronchial 62 (48.1) 65 (60.2) 61 (55.9)  
 Pleural effusion 2 (0.6) 9 (8.4) 8 (2.3) 0.024

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

Table 2.
Comparison of clinical findings among 3 periods depending on the fever duration (3 days) after treatment
Variable 2008–2009 2011–2012 2015–2016 Total
Fever duration (day) P-value Fever duration (day) P-value Fever duration (day) P-value Fever duration (day) P-value
<3 ≥3 <3 ≥3 <3 ≥3 <3 ≥3
No. of patients 93 36   71 37   67 42   231 115  
Age (yr) 5.1±3.2 5.9±3.1 0.193 4.6±3.1 5.3±3.3 0.291 5.0±2.8 6.3±3.0 0.036 5.0±3.1 5.9±3.1 0.011
 0–1 9 (9.7) 2 (5.6) 0.818 7 (9.9) 5 (13.5) 0.098 9 (13.4) 1 (2.4) 0.141 25 (10.8) 8 (7.0) 0.054
 2–5s 47 (50.5) 17 (47.2)   45 (63.4) 15 (40.5)   31 (46.3) 17 (40.5)   123 (53.2) 49 (42.6)  
 6–9 30 (32.3) 14 (38.9)   113 (18.3) 14 (37.8)   21 (31.3) 20 (47.6)   64 (27.7) 48 (41.7)  
 ≥10 7 (7.5) 3 (8.3)   6 (8.5) 3 (8.1)   6 (9.0) 4 (9.5)   19 (8.2) 10 (8.7)  
Sex                        
 Male 38 (40.9) 16 (44.4) 0.711 35 (49.3) 20 (54.1) 0.639 35 (52.2) 21 (50.0) 0.820 108 (46.8) 57 (49.6) 0.622
 Female 55 (59.1) 20 (55.6)   36 (50.7) 17 (45.9)   32 (47.8) 21 (50.0)   123 (53.2) 58 (50.4)  
Total fever days 2.4±2.8 7.7±4.0 <0.001 4.5±2.8 9.4±4.3 <0.001 6.6±3.2 8.5±2.0 <0.001 4.3±3.4 8.5±3.6 <0.001
Steroid use 1 (2.8) 13 (14.0) 0.056 8 (11.3) 20 (54.1) <0.001 12 (17.9) 25 (59.5) <0.001 33 (14.3) 46 (40.0) <0.001
Fever duration after steid use (hr) (hr) 0.3±2.5 0.0±0.0 0.536 0.2±1.4 4.8±11.0 0.015 0.9±3.3 6.9±9.7 <0.001 0.4±2.5 4.1±9.0 <0.001

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

Table 3.
Comparison of laboratory and radiologic findings among three periods depending on the fever duration (3 days) after treatment
Variable 2008–2009   2011–2012 2015–2016 Total
Fever duration (day) P-value Fever duration (day) P-value Fever duration (day)   Fever duration (day) P-value
<3 ≥3 <3 ≥3 <3 ≥3 P-value <3 ≥3
Laboratory findings                        
 White blood cell (/mm3 3) 9,779.5±4,254.2 9,960.8±4,981.6 0.837 8,855.9±4,052.2 7,709.4±2,669.0 0.081 9,029.5±5,252.9 6,821.5±3,092.9 0.230 9,278.1±4,508.8 8,089.9±3,879.9 0.016
 Neutrophil (%) 54.2±32.0 58.0±22.5 0.512 52.3±15.9 60.5±13.6 0.009 57.6±13.6 62.0±13.0 0.097 54.6±23.3 3 60.3±16.7 0.020
 Lymphocyte (%) 36.4±17.6 30.3±19.6 0.090 36.1±14.8 29.4±12.2 0.014 30.8±12.0 28.0±11.9 0.230 34.7±15.4 4 29.2±14.7 0.002
 Eosinophil (%) 4.2±6.9 2.6±4.26 0.190 2.2±2.2 2.7±2.8 0.385 2.6±3.1 2.0±2.4 0.285 3.2±4.9 2.4±3.2 0.143
 C-reactive protein (mg/ /L) 1.6±2.3 3.3±3.08 0.004 1.9±2.4 5.5±6.5 0.002 2.6±3.7 3.8±3.6 0.094 2.0±2.8 4.2±4.7 <0.001
Radiologic findings                        
 Pneumonia type                        
  Lobar 20 (30.8) 6 (24.0) 0.610 18 (26.5) 21 (58.3) 0.003 21 (32.8) 23 (56.1) 0.026 59 (29.9) 50 (49.0) 0.020
  Bronchial 45 (69.1) 19 (76.0)   50 (73.5) 15 (41.7)   43 (67.2) 18 (43.9)   138 (70.1) 52 (51.0)  
 Pleural effusion 1 (1.1) 1 (2.8) 0.482 3 (3.4) 6 (14.3) 0.058 3 (3.7) 5 (10.6) 0.139 7 (3.6) 12 (11.8) 0.010

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

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