Indirect Particle Agglutination Antibody Testing for Early Diagnosis of Mycoplasma pneumoniae pneumonia in Children

Jin Soo Kim; Jeong Hee Ko; Sung Hee Oh

doi:10.14776/kjpid.2013.20.2.71

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Kim, Ko, and Oh: Indirect Particle Agglutination Antibody Testing for Early Diagnosis of Mycoplasma pneumoniae pneumonia in Children

Original Article

Korean Journal of Pediatric Infectious Diseases 2013; 20(2): 71-80.

Published online: 20 August 2013

DOI: https://doi.org/10.14776/kjpid.2013.20.2.71

Indirect Particle Agglutination Antibody Testing for Early Diagnosis of Mycoplasma pneumoniae pneumonia in Children

Jin Soo Kim, M.D., Jeong Hee Ko, M.D., Sung Hee Oh, M.D.

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

Correspondence: Sung Hee Oh, M.D. Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea. Tel: +82-2-2290-8388, Fax: +82-2-2297-2380, sungheeo@hanyang.ac.kr

Received 11 January 2013 Revised 21 March 2013 Accepted 24 March 2013

Abstract

Objectives

Outbreaks of pneumonia caused by Mycoplasma pneumoniae (MP) occur every 3-4 years in Korea, most recently in 2011. The aim of our study was to determine the optimal time to perform indirect particle agglutination antibody assays to improve early diagnosis of MP pneumonia in children.

Methods

A database of 206 pediatric patients treated for pneumonia at the Hanyang University Hospital from June to October 2011 was analyzed retrospectively for demographic characteristics and laboratory test results.

Results

Among the 206 patients treated for pneumonia during the study period, there were 160 children (mean age, 5.44 years) diagnosed with MP pneumonia, who were studied further. The mean age of these MP pneumonia patients was 5.44 years. Antibody titers increased with increasing time between symptom onset and the collection of serum collection: MP titers were <1:640 for sera collected after 5.44 days and titers ≥1:640 for those collected after 8.58 days; P<0.001). Antibody titers were considered positive when they reached ≥1:640. In 42 MP pneumonia patients in whom there was a four-fold or greater increase in titer between successive serum samples, the optimal cut-off time-point for distinguishing between the initial and second titer groups was 7.5 days after the onset of symptoms (sensitivity, 90.5%; specificity, 92.9%).

Conclusions

Negative MP antibody titers earlier than 8 days after the onset of symptoms in children with pneumonia may require repeating to confirm the diagnosis. This finding could optimize diagnosis and result in better therapeutic outcomes of MP pneumonia in children.

Keywords: Mycoplasma pneumoniae, Pneumonia, Diagnosis, Serology, Children

Figures and Tables

Fig. 1

Age distribution among children diagnosed with Mycoplasma pneumoniae pneumonia in the 2011 outbreak.

Fig. 2

Distribution of positive/negative Mycoplasma pneumoniae antibody titers according to time from symptom onset to serum collection.

Fig. 3

Mycoplasma pneumoniae (MP) antibody titers in paired sera from children with MP pneumonia.

Fig. 4

Receiver operating characteristics (ROC) curve to estimate the diagnostic sensitivity and specificity of Mycoplasma pneumoniae (MP) antibody testing of paired sera in children with MP pneumonia based on time from onset of symptoms. Arrow points to the optimum cut-off value: 7.5 days after symptom onset (sensitivity, 90.5%; specificity, 92.9%).

Fig. 5

Distribution of positive/negative Mycoplasma pneumoniae PCR results according to time from symptom onset to NP specimen collection.

Table 1

Selected Characteristics of the Patients with Mycoplasma Pneumoniae Pneumonia

^*Mycoplasma pneumoniae

^†Mean±SD

^‡Rhinovirus (46 cases), RSV (5 cases), parainfluenza (5 cases), adenovirus (3 cases), metapneumovirus (1 case); 6 patients with rhinovirus had co-infections, 4 with RSV, 1 with adenovirus, and 1 with parainfluenza.

Table 2

Relationship between PCR Assay Results and Maximum Antibody Titers in Children with Mycoplasma Pneumoniae Pneumonia

^*Mycoplasma pneumoniae

Table 3

Correlation between Positive Results by PCR and by Antibody Testing in Children with Mycoplasma Pneumoniae Pneumonia

^*Mycoplasma pneumoniae

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