Association of Mycoplasma Pneumoniae Infections with Status Asthmaticus

Abstract

Background & Objective: Viral respiratory infections (VRI) have been commonly associated with exacerbation of wheezing in asthmatic children. Mycoplasma pneumoniae (MP) causes many respiratory syndromes that clinically mimic VRI. Due to the nature of the organism, cultures are of no practical value and the diagnosis is usually made by serology. Only a few studies have associated mycoplasma infections with acute exacerbations of wheezing in the asthmatic patient. This study was an attempt to assess the incidence of recent mycoplasma infections in patients with status asthmaticus and to review their laboratory, clinical and radiological findings.Methods: Retrospective review of all patients admitted to PICU over 12 month period with status asthmaticus. Recent mycoplasma infection was determined utilizing the Immunocard Mycoplasma Enzyme Immunoassay (EIA) for detection of MP IgM antibodies (Meredian Diagnostics, Inc., Cincinnati, OH)Results: The records of 44 patients were reviewed. 9 were excluded because MP tests were never obtained during hospitalization. 15/35 (42%) were MP Positive. There were no statistically significant differences (P>0.05) in length of hospitalization (LOH), ICU days, duration of continuous albuterol aerosol hours (cont. Nebs hrs.), days on O2 (02 days) or WBC between the two groups, however patients who were mycoplasma positive were treated with a macrolide antibiotic in addition to their standard asthma therapy. Patients with evidence of recent MP infection were more likely to have one or more infiltrates on their CXR (13/15 vs 7/20; P= 0.002). Conclusion:Our study suggests that recent MP infections play a significant role in exacerbations of asthma and occurrence of status asthmaticus in children. The presence of infiltrates on CXR in status asthmaticus warrants tests for MP.

Seropositivity for Chlamydia Pneumoniae and Mycoplasma Pneumoniae in Asthmatic Children

“…Along with the factors supportive of the abovementioned hypothesis that MP and CP infections take part in the pathogenesis of asthma [10,12,14,29,30,32,38], the available data indicates both the correlation between this organism and asthma episodes and its role in the development of asthma. Although the role of the viral respiratory tract infections is evident in the occurrence of asthma attacks and wheezing, it is concluded that extensive studies should be conducted regarding the role and efficacy of MP and CP.…”

“…Therefore, determining the previous viral or mycoplasmal respiratory tract infection is essential in describing the etiology of asthma in patients with bronchial asthma. As particularly IgG antibody level remains high following the infection for years, (+) test result also indicates the previous MP and CP infections [30]. In 1986, Korppi et al [33] conducted a study in 127 children with wheezing under the age of 2, and determined the rate of infection agents as 56%.…”

“…The correlation between the bacterial infections and asthma attacks was less remarkable as compared to the viral infections. MP and CP are possible cofactors accused of the development and exacerbation of asthma [10,30]. Although childhood infections have been proven to provide protection against atopy and asthma development [26], it has been shown that the extended presence of certain microorganisms in the bronchi may be associated with the development of asthma.…”

“…Our study has shown that the rate of antibody seropositivity for both MP (59.2%) and CP (55.5%) was higher in children between the ages of 7 and 10. In order to understand the causal relationship between the infectious agents and chronic diseases, either the agent should stimulate the abnormal immunopathological host response sensitive individuals [15][16][17]36], or all of the following three conditions should be provided: 1-the agent should be determined more frequently in patients as compared to normal individuals [13,30,32]; 2-the presence of the agent should be associated with the severity of the disease [12,30], 3-successful treatment for the agent should provide clinical benefit for the disease [37]. Our study has determined a higher rate of previous chlamydial and mycoplasmal seropositivity in asthmatic patients as compared to the healthy controls (χ²=3.26,p=0.056, χ²=11.986, p<0.001, respectively); and has established an association between the chlamydial seropositivity, particularly, and the number of asthma episodes (χ²=13.917, p<0.001).…”

Typical or atypical pneumonia and severe acute respiratory symptoms in PICU

“…The epidemiologic characteristics, including periodic epidemics, and some clinical characteristics of MP are similar to those observed in systemic viral infections . AP caused by MP has been called ‘walking pneumonia’ because it usually affects older children and seldom results in PICU admission . Nevertheless, the pathogen can occasionally cause severe acute respiratory symptoms (sars) .…”