Clinical, Laboratory, and Radiographic Features Can Help Predict Mycoplasma pneumoniae Lower Respiratory Tract Infection in Children

Abstract

Mycoplasma pneumoniae (Mp) is a common cause of lower respiratory tract infection (LRTI) in children that is difficult to distinguish from LRTI of other etiologies. We aimed to determine if a combination of clinical, laboratory, and chest radiographic features can help identify patients at higher risk of Mp LRTI. We reviewed medical charts of children referred to our tertiary hospital with suspected acute mycoplasmal LRTI. Pharyngeal swabs obtained from patients were tested by Mp PCR. We compared epidemiological and clinical data of children with positive and negative Mp PCR results. In addition, a multivariable logistic regression analysis was performed to predict Mp LRTI based on the patient’s age, duration of symptoms, presence of extrapulmonary manifestations, laboratory findings, and chest radiographic findings. We included 65 children with Mp PCR-negative and 49 with Mp PCR-positive LRTI and no viral co-detection. Children with Mp LRTI were older (median age 5.8 vs. 2.2 years, p < 0.001), had a longer duration of symptoms on referral (median 7 vs. 4 days, p < 0.001), and lower median WBC (9.9 vs. 12.7 × 109/L, p < 0.001). On chest radiograph, unilateral infiltrates were more frequently observed in the Mp PCR-positive group (57.5% vs. 24.1%, p = 0.001). Age, duration of symptoms, and chest radiographic findings had the highest predictive value for Mp LRTI in a multivariable logistic regression model. Our analysis suggests that a combination of clinical, laboratory, and chest radiographic features can be used to assess the likelihood of Mp LRTI and assist in decision-making for which children need further tests or macrolide antibiotic treatment.

Respiratory pathogenic microbial infections: a narrative review

“…Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 data 43 , the pathogenic bacterium S. pneumoniae was the leading cause of fatal lower respiratory infections with 653 000 deaths and associated with the most deaths among children younger than 5 years. Chlamydophila pneumoniae 44 and M. pneumoniae (MP) 45 are common pathogens responsible for community-acquired pneumonia in children. The families and genera of respiratory pathogenic bacteria and atypical microorganisms are summarised in Table 1 .…”