Early diagnostic value of the antimycoplasma antibody (IgM) in Mycoplasma pneumoniae pneumonia: A singlecenter study in 2015

Hyo Jung Koh; Min Sub Kim; Kwang Yeon Lee; Dong Hee Kang; Seong Gyu Lee; Yeon Hwa Ahn

doi:10.4168/aard.2019.7.3.129

Journal List > Allergy Asthma Respir Dis > v.7(3) > 1130417

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Koh, Kim, Lee, Kang, Lee, and Ahn: Early diagnostic value of the antimycoplasma antibody (IgM) in Mycoplasma pneumoniae pneumonia: A singlecenter study in 2015

Original Article

Allergy Asthma Respir Dis 2019;7(3):129-136.

Published online: 12 July 2019

DOI: https://doi.org/10.4168/aard.2019.7.3.129

Early diagnostic value of the antimycoplasma antibody (IgM) in Mycoplasma pneumoniae pneumonia: A singlecenter study in 2015

Hyo Jung Koh¹, Min Sub Kim¹, Kwang Yeon Lee¹, Dong Hee Kang¹, Seong Gyu Lee², Yeon Hwa Ahn¹

^¹Departments of Laboratory Medicine, Bundang Jesaeng Hospital, Seongnam, Korea

^²Departments of Pediatrics, Laboratory Medicine, Bundang Jesaeng Hospital, Seongnam, Korea

Correspondence to: Yeon Hwa Ahn https://orcid.org/0000-0003-3504-7346 Department of Pediatrics, Bundang Jesaeng Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea Tel: +82-31-779-0273, Fax: +82-31-779-0894, E-mail: sy1130@dmc.or.kr

Received 10 October 2018 Revised 31 December 2018 Accepted 9 January 2019

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

Recently, the incidence of refractory Mycoplasma pneumoniae (MP) pneumonia has increased in Korea. Given that its early diagnosis is helpful in selection of the treatment, this study aimed at investigating the value of the antimycoplasma antibody (IgM) for early diagnosis of MP pneumonia.

Methods

A total of 315 children admitted with MP pneumonia from September 2015 to May 2016 were investigated with the IgM and polymerase chain reaction (PCR) for the diagnosis of MP pneumonia. Specifically, patients were grouped into nonrefractory respiratory MP and refractory MP groups according to their response to macrolide therapy.

Results

In the 44 PCR-negative seroconversed children, seroconversed IgM was more frequent in the refractory MP group compared with the nonrefractory respiratory MP group with statistical significance (P<0.001). In the 264 IgM-positive children, the time of antibody reaction was more delayed in the refractory MP group compared to the nonrefractory respiratory MP group with statistical significance (P<0.001).

Conclusion

This study showed that there was a higher incidence of seroconversed IgM and delayed antibody reaction in the refractory MP group. In children with suspect MP pneumonia, follow-up studies of antibody are necessary, even through initial antibody and PCR showed negative findings. In addition, this result may suggest that the diagnosis of refractory MP pneunomia will be helpful in establishing the strategy of the treatment.

Keywords: Mycoplasma pneumoniae, IgM, Polymerase chain reaction, Pneumonia, Child

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Fig. 1.

Patient flow chart. PCR, polymerase chain reaction; NRMP, nonrefractory Mycoplasma pneumoniae; RMP, refractory Mycoplasma pneumonia. *PCR(X): do not perform PCR test.

Fig. 2.

Age distribution. NRMP, nonrefractory Mycoplasma pneumoniae; RMP, refractory Mycoplasma pneumonia. ^†All patients included in this study.

Table 1.

Demographic features of the subjects (n=315)

Characteristic	Value
Sex, male:female	151:164 (47.9:52.1)
Age (yr)
Mean±SD	6.08±3.84
Range	0.58–18
<2	41 (13)
2–5	131 (41.6)
6–10	112 (35.6)
>10	31 (9.8)
IgM/PCR result
+/+	100 (31.7)
+/-	164 (52.1)
–/+	51 (16.2)
Seroconversed IgM (IgM/PCR initial result → next result)	44
–/+ → +/+*	15 (34.1)
−/− → +/-^†	29 (65.9)

Values are presented as number of cases (%) unless otherwise indicated. SD, standard deviation; PCR, polymerase chain reaction.

^* In the case of PCR positive among seroconversed IgM group, the initial IgM was negative and the next IgM was positive.

^† In the case of PCR negative among seroconversed IgM group, the initial IgM was negative and the next IgM was positive.

Table 2.

Demographic features of the subjects with positive result (n=315)

Variable	PCR (+)^*	IgM (+)^†	PCR (+) & IgM (+)
No. of subjects	151 (47.9)	264 (83.8)	100 (31.7)
Sex, male:female	75:76 (49.7:50.3)	123:141 (46.6:53.4)	47:53 (47:53)
Age (yr)	6.77±3.96	5.88±3.77	6.62±5.82
Duration of fever (day)
Before admission	4.74±2.28	4.44±2.41	4.99±6.62
After admission	2.55±2.05	2.56±2.25	2.64±2.19
Total duration	7.30±3.10	7.00±3.29	7.65±3.42
Positive rate
NRMP	114 (47.5)	201 (83.8)	75 (31.3)
RMP	37 (49.3)	63 (84)	25 (33.3)

Values are presented as number of cases (%) or mean±standard deviation. PCR, polymerase chain reaction; NRMP, nonrefractory Mycoplasma pneumoniae; RMP, refractory Mycoplasma pneumonia.

^* PCR (+)=PCR positive result.

^† IgM (+)=IgM positive result.

Table 3.

Demographic features of the subjects in NRMP and RMP groups (n=315)

Variable	NRMP	RMP
No. of subjects	240 (76.2)	75 (23.8)
Sex, male:female	118:122 (49.2:50.8)	33:42 (44:56)
Age (yr)	5.98±3.97	6.39±3.41
Duration of fever (day)
Before admission	4.38±2.29	4.49±2.49
After admission	1.85±1.44	4.71±2.68
Total duration	6.23±2.75	9.20±3.26

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

NRMP, nonrefractory Mycoplasma pneumoniae; RMP, refractory Mycoplasma pneumonia.

Table 4.

IgM and PCR positive rate in NRMP and RMP groups

Variable	NRMP	RMP	P-value
IgM/PCR result	40	75
+/+	75 (31.3)	25 (33.3)	0.735
+/-	126 (52.5)	38 (50.7)	0.781
–/+	39 (16.3)	12 (16)	0.959
Seroconversed IgM^*	20	24
–/+ → +/+^†	9 (45)	6 (25)	0.131
−/− → +/−^‡	11 (55)	18 (75)	0.000

Values are presented as number or number of cases (%). PCR, polymerase chain reaction; NRMP, nonrefractory Mycoplasma pneumoniae RMP, refractory Mycoplasma pneumonia.

^* Seroconversed IgM=Conversion initial IgM negative to next IgM positive.

^† In th case of PCR positive among seroconversed IgM group, the initial IgM was negativ and the next IgM was positive.

^‡ In the case of PCR negative among seroconverse IgM group, the initial IgM was negative and the next IgM was positive.

Table 5.

Evaluation time of antibody in IgM positive group (including serocon-ersed IgM group)

Variable	NRMP (n=201)	RMP (n=63)	P-value
Admission (day)^*
<5	199 (99)	50 (79.4)	0.985
≥5, <10	2 (1)	12 (19)	0.923
≥10	0 (0)	1 (1.6)
Mean±SD	1.28±0.90	2.56±2.34	0.000
Range	0–14	1–14
Fever (day)^†
<5	96 (47.8)	13 (20.6)	0.000
≥5, <10	98 (48.8)	41 (65.1)	0.024
≥10	7 (3.5)	9 (14.3)	0.002
Mean±SD	4.76±2.59	6.54±2.78	0.000
Range	0–14	1–14

Values are presented as number of cases (%) unless otherwise indicated.

NRMP, nonrefractory Mycoplasma pneumoniae; RMP, refractory Mycoplasma pneumonia; SD, standard deviation.

^* Days after admission.

^† Days after fever onset.

Table 6.

Switching time of antibody in seroconversed IgM group

Variable (days)	NRMP (n=20)	RMP^† (n=24)	P-value
Admission (day)^*
<5	18 (90)	11 (45.8)	0.002
≥5, <10	2 (10)	12 (50)	0.005
≥10	0 (0)	1 (4.2)	0.356
Mean±SD	3.80±1.06	5.08±2.00	0.010
Range	2–7	2–11
Fever (day)^†
<5	0 (0)	0 (0)
≥5, <10	17 (85)	17 (70.8)	0.264
≥10	3 (15)	7 (29.2)	0.264
Mean±SD	8.0±1.52	8.38±1.52	0.512
Range	5–11	5–13

Values are presented as number of cases (%) unless otherwise indicated. NRMP, nonrefractory Mycoplasma pneumoniae; RMP, refractory Mycoplasma pneumonia; SD, standard deviation.

^* Days after admission.

^† Days after fever onset.

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