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Lee, Kim, Yang, Kim, Chun, Yoon, Kim, Kim, and Lee: Diagnostic value of serum IgM enzyme-linked immunosorbent assays in polymerase chain reaction-positive Mycoplasma pneumonia in children
Original Article

Allergy Asthma Respir Dis 2018;6(5):248-254.

Published online: 5 September 2018

DOI: https://doi.org/10.4168/aard.2018.6.5.248

Diagnostic value of serum IgM enzyme-linked immunosorbent assays in polymerase chain reaction-positive Mycoplasma pneumonia in children

Yoon Tae Lee, Kyung Hoon Kim, Eun Ae Yang, Hwan Soo Kim, Yoon Hong Chun, Jong-Seo Yoon, Hyun Hee Kim, Jin Tack Kim, Hye Jin Lee

Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Jong-Seo Yoon https://orcid.org/0000-0002-5782-6175 Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: +82-2-2258-7612, Fax: +82-2-537-4544, E-mail: pedjsyoon@catholic.ac.kr

Received 14 March 201828 August 2018       Accepted 12 September 2018

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 pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children. MP serum IgM and polymerase chain reaction (PCR) are the methods that enable early diagnosis in patients with MP pneumonia. The objective of this study was to investigate the clinical value of serum MP-specific IgM antibodies in PCR-positive MP pneumonia for the early diagnosis of MP pneumonia in children with CAP.

Methods

Out of 129 patients with lower respiratory tract infection aged over 3 years, 90 CAP children were enrolled in the study. Throat swab MP realtime PCR and serum enzyme-linked immunosorbent assays (ELISA) IgM antibodies were performed. A positive rate of MP PCR and serum IgM, the level of IgM index, clinical features, and laboratory findings were analyzed.

Results

MP PCR was positive in 57 cases. Longer fever duration before admission (P<0.001), higher rates of lobar or segmental pneumonia (P=0.048), unilateral infiltration (P=0.038), and extrapulmonary symptoms (P=0.049) were associated with MP PCR-positive pneumonia. Serum IgM index was significantly higher in MP PCR-positive pneumonia them in MP PCR-negative pneumonia (3.9±3.0 vs. 0.8±1.3, P<0.001). Using MP PCR as a gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of serum IgM were 85.5%, 82.1%, 91.4%, and 71.9%, respectively. The area under the curves for serum IgM index was 0.892, and the ROC analysis indicated that an optimal cutoff value of 1.05 for serum IgM provided the highest sensitivity and specificity interestingly (83.9% vs. 85.7%, P<0.001).

Conclusion

Serum IgM ELISA has useful diagnostic value in PCR-positive MP pneumonia. Applying an IgM index cutoff of 1.05 improves diagnostic accuracy.

Keywords: Mycoplasma pneumoniae, Diagnosis, Polymerase chain reaction, Immunoglobulin M, Pediatrics

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Fig. 1.
Correlation of the fever duration before admission with serum Mycoplasma pneumoniae IgM index in all patients (Pearson correlation coefficient r=0.438, P<0.001).
aard-6-248f1.tif
Fig. 2.
Receiver operating characteristic curve for serum M. pneumoniae (MP) IgM index in the diagnosis of MP pneumonia. The optimal cutoff values for serum MP IgM index were 1.05 (area under the curve, 0.892; sensitivity 83.9%, specificity 85.7%; P<0.001).
aard-6-248f2.tif
Table 1.
Demographic and clinical features and laboratory findings of study subjects
Variable A All patients (n=90) M. pneumoniae PCR
 P-value M. pneumoniae IgM
 P-value
Positive (n=62) Negative (n=28) Positive (n=58) Negative (n=32)
Age (yr) 5.7±3.7 6.4±3.6 4.2±3.5 0.080 6.0±3.5 5.1±4.0 0.261
Male sex 37 (41.1) 25 (67.6) 12 (32.4) 0.172 22 (37.9) 15 (46.9) 0.503
Hospital days 5.5±4.0 6.0±4.7 4.5±1.3 0.137 6.2±4.9 4.2±1.0 0.003
Symptoms              
 Fever before admission (day) 4.9±2.3 5.6±2.1 3.4±2.1 <0.001 5.5±2.2 3.8±2.1 0.001
 Fever after admission (day) 1.9±2.7 2.2±3.1 1.4±1.3 0.068 2.3±3.2 1.3±1.1 0.082
 Total fever duration (day) 6.9±3.7 7.7±3.7 4.7±2.5 <0.001 7.8±3.8 5.1±2.6 0.001
 Cough before admission (day) 5.4±3.0 5.9±2.7 4.3±3.3 0.001 5.9±2.8 4.6±3.2 0.046
 Peak temperature (° C) 38.6±0.8 38.7±0.7 38.5±1.0 0.413 38.5±1.5 38.6±0.9 0.413
Lobar/segmental pneumonia 46 (51.1) 36 (58.1) 10 (35.7) 0.048 33 (56.9) 13 (40.6) 0.139
Unilateral infiltration 47 (52.2) 37 (59.7) 10 (35.7) 0.038 33 (56.9) 14 (43.8) 0.232
Extrapulmonary symptoms 13 (14.4) 12 (19.4) 1 (3.6) 0.049 2 (6.3) 11 (19) 0.100
Pleural effusion 11 (12.2) 9 (14.5) 2 (7.1) 0.492 9 (15.5) 2 (6.3) 0.199
Steroid use 61 (67.8) 47 (75.8) 14 (50.0) 0.015 46 (79.3) 15 (46.9) 0.002
O2 need 12 (13.3) 5 (8.1) 7 (25.0) 0.029 6 (10.3) 6 (18.8) 0.262
Positive RV PCR 36 (40.0) 19 (30.6) 17 (60.7) 0.013 21 (36.2) 15 (46.9) 0.248
Laboratory findings              
 WBC (10/μL) 9.5±4.9 9.8±5.3 9.0±4.0 0.788 10.1±5.3 8.6±4.1 0.179
 Neutrophils (%) 64.1±14.4 66.6±12.5 58.5±17.0 0.056 66.3±12.8 60.0±16.5 0.047
 Lymphocyte (%) 25.4±12.1 23.0±9.6 30.8±15.1 0.027 23.4±10.2 29.0±14.4 0.058
 Monocyte (%) 8.4±3.2 7.9±3.0 9.6±3.4 0.052 8.0±2.9 9.3±3.6 0.068
 Eosinophil (%) 2.0±3.7 2.4±4.2 0.9±1.5 0.003 2.6±4.4 0.7±1.1 0.002
 ESR (mm/hr) 37.9±19.2 39.1±20.3 35.3±16.5 0.599 39.4±20.7 35.3±16.3 0.333
 CRP (mg/dL) 4.5±4.9 4.8±5.2 3.9±4.1 0.705 4.7±5.2 4.2±4.2 0.664
 AST (IU/L) 36.2±17.7 35.8±19.4 37.1±13.6 0.621 36.8±19.7 35.0±13.5 0.644
 ALT (IU/L) 26.9±34.7 25.0±25.7 31.1±49.5 0.960 26.3±26.6 28.0±46.5 0.826
Serum MP IgM (index) 2.9±3.0 3.9±3.0 0.8±1.3 <0.001 4.3±2.8 0.4±0.2 <0.001

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

MP, Mycoplasma pneumoniae; PCR, polymerase chain reaction; RV, respiratory virus; WBC, white blood cells; ESR, erthyrocyte sedimentation rate; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

Table 2.
Relationship between serum Mycoplasma pneumoniae (MP) PCR and IgM antibodies of all study subjects (n=90, P<0.01)
MP IgM antibodies MP PCR Total
Positive Negative
Positive 53 (58.9) 5 (5.6) 58 (64.4)
Negative 9 (10.0) 23 (25.6) 32 (35.6)
Total (n=90) 62 (68.9) 28 (31.1) 90 (100)

Values are presented as number (%).

PCR, polymerase chain reaction.

Table 3.
Diagnostic values of serum Mycoplasma pneumoniae (MP) IgM ant bodies with a MP PCR as the gold standard
Sensitivity (%) Specificity (%) PPV (%) NPV (%) PLR
MP IgM antibodies 85.5 82.1 91.4 71.9 4.79

PCR, polymerase chain reaction; PPV, positive predictive value; NPV, negative predic tive value; PLR, positive likely hood ratio.

Table 4.
Propensity score matching and multivariable Analysis of clinical features and laboratory findings of Mycoplasma pneumoniae PCR positive pneumonia
Characteristic Adjusted odds rattio 95% CI P-value
Crude analysis      
 IgM positivity 27.09 8.80–99.34 <0.001
Matched analysis∗      
 IgM positivity 13.50 3.69–60.68 <0.001
Multivariable analysis†      
 Fever duration before admission 1.60 1.11–2.31 0.013
 Unilateral infiltration 3.50 0.90–13.57 0.070
 Extrapulmonary symptoms 11.40 1.07–121.10 0.044
 O2 need 0.12 0.01–1.12 0.062
 Eosinophil (%) 1.25 0.93–1.67 0.140
 IgM titer (index) 2.61 1.44–4.73 0.002

PCR, polymerase chain reaction; CI, confidence interval.

∗ Matched on age, fever before admission, cough before admission, lobar/segmental pneumonia, unilateral infiltration, O2 need, extrapulmonary symptoms, Lymphocyte, eosinophil.

† Adjusted for fever before admission, cough before admission, lo-barsegmental pneumonia, unilateral infiltration, O2 need, extrapulmonary symptoms, Lymphocyte, eosinophil.

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