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Allergy Asthma Respir Dis. 2019 Jan;7(1):22-27. Korean.
Published online Jan 30, 2019.
© 2019 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology
Clinical usefulness of serum procalcitonin to distinguish between viral pneumonia and Mycoplasma pneumonia in children: A multicenter, cross-sectional study
Sungmin Kim,1 Gye Hur,1 Myong Soon Sung,1 Hey-Sung Baek,2 Jung Won Yoon,3 Sun Hee Choi,4 Youn Ho Sheen,5 and Man Yong Han6
1Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea.
2Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea.
3Department of Pediatrics, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.
4Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea.
5Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
6Department of Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

Correspondence to: Myong Soon Sung. Department of Pediatrics, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 48108, Korea. Tel: +82-51-797-2000, Fax: +82-51-797-0298, Email:
Received Jul 23, 2018; Revised Oct 26, 2018; Accepted Oct 27, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (



The aim of this study was to compare the clinical usefulness of serum procalcitonin (PCT) levels in Mycoplasma pneumoniae pneumonia (M. pneumonia) and viral pneumonia in children.


We retrospectively analyzed the medical records of 348 patients admitted between June 2015 and December of 2015. There were 162 patients with M. pneumonia without virus coinfection (group 1) and 186 patients with viral pneumonia (group 2). All subjects had radiographic evidence of pneumonia with available specimens for both M. pneumonia and viral testing, and levels of serum PCT, white blood cell counts (WBC), neutrophil portion, and C-reactive protein (CRP). Fifty-eight children who performed follow-up sampling at the time of no fever for more than 48 hours were subdivided into group 3 (M. pneumonia with follow-up sampling, n=41) and group 4 (viral pneumonia with follow-up sampling, n=17).


No difference was noted in the levels of serum PCT (P=0.168), CRP (P=0.296), WBC (P=0.732), and neutrophil proportion (P=0.069) between groups 1 and 2, after adjusting for age. Serial changes in serum PCT levels between the first and second samples were significant in group 3 (P=0.046). Serial changes in serum CRP levels between the first and second samples were significant in group 4 (P=0.008).


Serum PCT and CRP levels may change differently after infection according to the etiology of pneumonia.

Keywords: Mycoplasma pneumonia; Viral pneumonia; Procalcitonin; Community acquired pneumonia; Child


Table 1
Clinical characteristics of the study subjects
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Table 2
Comparison of laboratory findings at admission between mycoplasma pneumonia and viral pneumonia
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Table 3
Comparison of laboratory findings at the time of admission and follow-up in groups 3 and 4
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1. Pfuntner A, Wier LM, Stocks C. Most frequent conditions in U.S. hospitals, 2011: statistical brief #162. 2013 Sep. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006.
2. Lee GE, Lorch SA, Sheffler-Collins S, Kronman MP, Shah SS. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics 2010;126:204–213.
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. Eun BW, Kim NH, Choi EH, Lee HJ. Mycoplasma pneumoniae in Korean children: the epidemiology of pneumonia over an 18-year period. J Infect 2008;56:326–331.
5. Ahn HS, Shin HY, editors. Hong Chang Eui pediatrics. 11th ed. Seoul: MiraeN; 2016. pp. 697.
6. Nohynek H, Valkeila E, Leinonen M, Eskola J. Erythrocyte sedimentation rate, white blood cell count and serum C-reactive protein in assessing etiologic diagnosis of acute lower respiratory infections in children. Pediatr Infect Dis J 1995;14:484–490.
7. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977–983.
8. Stockmann C, Ampofo K, Killpack J, Williams DJ, Edwards KM, Grijalva CG, et al. Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia. J Pediatric Infect Dis Soc 2018;7:46–53.
9. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 2010;375:463–474.
10. Sensini A, Zuccherini F, Cerboni1 G, Galullo M, Meli L, Maso GD, et al. Serological diagnosis of Mycoplasma pneumoniae infection: a complicated puzzle. Microbiol Med 2012;27:171–176.
11. Becker KL, Nylén ES, White JC, Müller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512–1525.
12. Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396–402.
13. Baer G, Baumann P, Buettcher M, Heininger U, Berthet G, Schäfer J, et al. Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED): a randomized controlled trial. PLoS One 2013;8:e68419
14. Esposito S, Tagliabue C, Picciolli I, Semino M, Sabatini C, Consolo S, et al. Procalcitonin measurements for guiding antibiotic treatment in pediatric pneumonia. Respir Med 2011;105:1939–1945.
15. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez JL, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001;84:332–336.
16. Toikka P, Irjala K, Juvén T, Virkki R, Mertsola J, Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000;19:598–602.
17. Menéndez R, Sahuquillo-Arce JM, Reyes S, Martínez R, Polverino E, Cillóniz C, et al. Cytokine activation patterns and biomarkers are influenced by microorganisms in community-acquired pneumonia. Chest 2012;141:1537–1545.
18. Nascimento-Carvalho CM, Cardoso MR, Barral A, Araújo-Neto CA, Guerin S, Saukkoriipi A, et al. Procalcitonin is useful in identifying bacteraemia among children with pneumonia. Scand J Infect Dis 2010;42:644–649.
19. Resch B, Gusenleitner W, Müller W. Procalcitonin, interleukin-6, C-reactive protein and leukocyte counts in infants with bronchiolitis. Pediatr Infect Dis J 2003;22:475–476.
20. Christ-Crain M, Müller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007;30:556–573.
21. Jaye DL, Waites KB. Clinical applications of C-reactive protein in pediatrics. Pediatr Infect Dis J 1997;16:735–746.
22. Squire EN Jr, Reich HM, Merenstein GB, Favara BE, Todd JK. Criteria for the discontinuation of antibiotic therapy during presumptive treatment of suspected neonatal infection. Pediatr Infect Dis 1982;1:85–90.
23. Emmerson AJ. C-reactive protein and the newborn infant. Arch Dis Child Educ Pract Ed 2011;96:e1
24. Peltola H, Jaakkola M. C-reactive protein in early detection of bacteremic versus viral infections in immunocompetent and compromised children. J Pediatr 1988;113:641–646.
25. Bahagon Y, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis 2007;26:349–352.
26. Aminzadeh Z, Parsa E. Relationship between age and peripheral white blood cell count in patients with sepsis. Int J Prev Med 2011;2:238–242.