Journal List > Allergy Asthma Respir Dis > v.6(Suppl 1) > 1108838

Allergy Asthma Respir Dis. 2018 Nov;6(6):295-302. Korean.
Published online Nov 30, 2018.  https://doi.org/10.4168/aard.2018.6.6.295
© 2018 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Mycoplasma pneumoniae pneumonia in children: Clinical characteristics and risk factors of refractory pneumonia by age
Hyung Young Kim,1,2 and Hee Ju Park1
1Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.
2Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Correspondence to: Hee Ju Park. Department of Pediatrics, Pusan National University Children's Hospital, 20 Geumo-ro, Meulgeum-eup, Yangsan 50612, Korea. Tel: +82-55-360-2180, Fax: +82-55-360-2181, Email: phj7294@hanmail.net
Received Jul 19, 2018; Revised Oct 01, 2018; Accepted Oct 01, 2018.

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

It is thought that Mycoplasma pneumoniae infection is more prevalent and causes more severe pneumonia in school-age children and young adults than in preschool children; however, recent studies suggest that the infection may be underdiagnosed and more severe in preschool children. This study investigated the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) and the risk factors of refractory MPP (RMPP) by age.

Methods

We retrospectively reviewed the medical records of 353 children admitted due to MPP from January 2015 to December 2016. Demographics, clinical information, laboratory data and radiological findings were collected from all patients in this study. The patients were divided into 2 groups by the age of 6 years. Also, both preschool (<6 years old) and school-age (≥6 years old) children were divided into RMPP and non-RMPP patients.

Results

Total febrile days, febrile days before admission and the duration of macrolide antibiotic therapy were significantly longer in school-age children than in preschool children. School-age children had significantly greater risk of lobar consolidation (P=0.036), pleural effusion (P=0.001) and extrapulmonary complications (P=0.019). Necrotizing pneumonia and bronchiolitis obliterans tended to occur more frequently in preschool children than in school-age children. In both preschool and school-age children, lactate dehydrogenase (LDH) levels were significantly higher in RMPP patients than in non-RMPP patients. In preschool children, LDH >722 IU/L (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.44–6.50) and ferritin >177 ng/mL (OR, 5.38; 95% CI, 1.61–19.49) were significant risk factors for RMPP, while LDH >645 IU/L (OR, 4.12; 95% CI, 1.64–10.97) and ferritin >166 ng/mL (OR, 5.51; 95% CI, 1.59–22.32) were so in school-age children.

Conclusion

Clinical features of MPP were significantly different between preschool and school-age children. LDH and ferritin may be significant factors of RMPP in preschool and school-age children.

Keywords: Mycoplasma pneumoniae; Child; Lactate dehydrogenase; Ferritin

SUPPLEMENTARY MATERIALS
Supplementary Table 1

Assay procedure protocol

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Supplementary Table 2

Clinical characteristics according to cytokine evaluation

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Figures


Fig. 1
Receiver operator characteristic curves for differentiating RMPP from non-RMPP according to age. (A) Patients <6 years old. (B) Patients ≥6 years old. RMPP, refractory Mycoplasma pneumoniae pneumonia; LDH, lactate dehydrogenase; IL, interleukin.
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Fig. 2
Odds ratio for RMPP according to age. RMPP, refractory Mycoplasma pneumoniae pneumonia; LDH, lactate dehydrogenase. Adjusted for febrile days before admission, sex, year, and season. *P<0.05. **P<0.01.
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Tables


Table 1
Subject characteristics (n=353)
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Table 2
Clinical characteristics according to age
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Table 3
Laboratory values between non-RMPP and RMPP according to age
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Table 4
Receiver operating characteristic curve analysis for predicting RMPP according to age
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Notes

This work was supported by Research Institute for Convergence of Biomedical Science and Technology Grant (30-2015-020), Pusan National University Yangsan Hospital.

References
1. Lee KY. Pediatric respiratory infections by Mycoplasma pneumoniae. Expert Rev Anti Infect Ther 2008;6:509–521.
2. Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev 2008;32:956–973.
3. 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.
4. Almasri M, Diza E, Papa A, Eboriadou M, Souliou E. Mycoplasma pneumoniae respiratory tract infections among Greek children. Hippokratia 2011;15:147–152.
5. Chalker V, Stocki T, Litt D, Bermingham A, Watson J, Fleming D, et al. Increased detection of Mycoplasma pneumoniae infection in children in England and Wales, October 2011 to January 2012. Euro Surveill 2012;17
6. 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.
7. Wy HH, Min DH, Kim DS, Park MS, Shim JW, Jung HL, et al. Clinical characteristics of Mycoplasma pneumoniae pneumonia in Korean children during the recent 3 epidemics. Allergy Asthma Respir Dis 2017;5:8–14.
8. Sørensen CM, Schønning K, Rosenfeldt V. Clinical characteristics of children with Mycoplasma pneumoniae infection hospitalized during the Danish 2010-2012 epidemic. Dan Med J 2013;60:A4632.
9. Inchley CS, Berg AS, Vahdani Benam A, Kvissel AK, Leegaard TM, Nakstad B. Mycoplasma pneumoniae: a cross-sectional population-based comparison of disease severity in preschool and school-age children. Pediatr Infect Dis J 2017;36:930–936.
10. Tamura A, Matsubara K, Tanaka T, Nigami H, Yura K, Fukaya T. Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children. J Infect 2008;57:223–228.
11. Lu A, Wang L, Zhang X, Zhang M. Combined treatment for child refractory Mycoplasma pneumoniae pneumonia with ciprofloxacin and glucocorticoid. Pediatr Pulmonol 2011;46:1093–1097.
12. Inamura N, Miyashita N, Hasegawa S, Kato A, Fukuda Y, Saitoh A, et al. Management of refractory Mycoplasma pneumoniae pneumonia: utility of measuring serum lactate dehydrogenase level. J Infect Chemother 2014;20:270–273.
13. Zhang Y, Zhou Y, Li S, Yang D, Wu X, Chen Z. The clinical characteristics and predictors of refractory Mycoplasma pneumoniae pneumonia in children. PLoS One 2016;11:e0156465
14. Lu A, Wang C, Zhang X, Wang L, Qian L. Lactate dehydrogenase as a biomarker for prediction of refractory Mycoplasma pneumoniae pneumonia in children. Respir Care 2015;60:1469–1475.
15. Kawamata R, Yokoyama K, Sato M, Goto M, Nozaki Y, Takagi T, et al. Utility of serum ferritin and lactate dehydrogenase as surrogate markers for steroid therapy for Mycoplasma pneumoniae pneumonia. J Infect Chemother 2015;21:783–789.
16. Zhang Y, Mei S, Zhou Y, Huang M, Dong G, Chen Z. Cytokines as the good predictors of refractory Mycoplasma pneumoniae pneumonia in school-aged children. Sci Rep 2016;6:37037.
17. Waris ME, Toikka P, Saarinen T, Nikkari S, Meurman O, Vainionpää R, et al. Diagnosis of Mycoplasma pneumoniae pneumonia in children. J Clin Microbiol 1998;36:3155–3159.
18. Yang J, Hooper WC, Phillips DJ, Talkington DF. Cytokines in Mycoplasma pneumoniae infections. Cytokine Growth Factor Rev 2004;15:157–168.
19. Shin JE, Cheon BR, Shim JW, Kim DS, Jung HL, Park MS, et al. Increased risk of refractory Mycoplasma pneumoniae pneumonia in children with atopic sensitization and asthma. Korean J Pediatr 2014;57:271–277.
20. Skakni L, Sardet A, Just J, Landman-Parker J, Costil J, Moniot-Ville N, et al. Detection of Mycoplasma pneumoniae in clinical samples from pediatric patients by polymerase chain reaction. J Clin Microbiol 1992;30:2638–2643.
21. Loens K, Goossens H, Ieven M. Acute respiratory infection due to Mycoplasma pneumoniae: current status of diagnostic methods. Eur J Clin Microbiol Infect Dis 2010;29:1055–1069.
22. Wang M, Wang Y, Yan Y, Zhu C, Huang L, Shao X, et al. Clinical and laboratory profiles of refractory Mycoplasma pneumoniae pneumonia in children. Int J Infect Dis 2014;29:18–23.
23. Zhou Y, Zhang Y, Sheng Y, Zhang L, Shen Z, Chen Z. More complications occur in macrolide-resistant than in macrolide-sensitive Mycoplasma pneumoniae pneumonia. Antimicrob Agents Chemother 2014;58:1034–1038.
24. Yamazaki T, Kenri T. Epidemiology of Mycoplasma pneumoniae infections in Japan and therapeutic strategies for macrolide-resistant M. pneumoniae. Front Microbiol 2016;7:693.
25. Hong KB, Choi EH, Lee HJ, Lee SY, Cho EY, Choi JH, et al. Macrolide resistance of Mycoplasma pneumoniae, South Korea, 2000–2011. Emerg Infect Dis 2013;19:1281–1284.
26. Guo H, He Z, Li M, Wang T, Zhang L. Imbalance of peripheral blood Th17 and Treg responses in children with refractory Mycoplasma pneumoniae pneumonia. J Infect Chemother 2016;22:162–166.