Importance of acute Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with wheezing

Abstract

In order to evaluate the role of Mycoplasma pneumoniae and Chlamydia pneumoniae in reactive airway disease, 71 children aged 2±14 yrs with an acute episode of wheezing and 80 age-matched healthy children were studied.Sera for the determination of specific antibody levels and nasopharyngeal aspirates for the detection of M. pneumoniae and C. pneumoniae deoxyribonucleic acid were obtained on admission and after 4±6 weeks. All children with wheezing received a standard therapy with inhaled corticosteroids and bronchodilators for 5±7 days; when antibiotic was added on the basis of the judgement of the paediatrician in charge, clarithromycin 15 mg . kg body weight -1 . day -1 for 10 days was used.Acute M. pneumoniae and C. pneumoniae infections were detected significantly more often in children with wheezing than in controls. In patients infected with one of the two pathogens, a history of recurrent wheezing was significantly more frequent than in those without either infection. During a 3-month follow-up period, among nonantibiotic-treated children, those with acute M. pneumoniae and/or C. pneumoniae infection showed a significantly higher recurrence of wheezing than those without acute M. pneumoniae and/or C. pneumoniae infection (p=0.03).These results highlight the apparently significant relationship of Mycoplasma pneumoniae and Chlamydia pneumoniae with wheezing in children, particularly in subjects with a history of recurrent episodes, and the possible improvement in the course of reactive airway disease within paediatric patients with acute Mycoplasma pneumoniae and/or Chlamydia pneumoniae infection.

Nasopharyngeal bacterial colonization during the first wheezing episode is associated with longer duration of hospitalization and higher risk of relapse in young children

“…indication of symptomatic or asymptomatic infection), however, had more often prednisolone treatment. Although we could not show link between age and bacterial seroconversion, M pne or C pne seroconversion associated wheezing may increase by age (4).…”

“…In wheezing children, Nagayama et al (2007) reported the prevalence of 17% for S pne, H infl and M cat cultured from sputum samples (6). Serologic evidence for M pne infection has ranged from 4% to 23% and for C pne from 3% to 17% in children with acute wheezing (4,19,22). Serologic evidence of H infl and M cat has been <5% in wheezing children (19).…”

“…Evidence of bacteria in the upper airways of children has been found using culture or serology in up to 40% of wheezing children (4)(5)(6). These have included Streptococcus pneumoniae (S Pne),…”

A randomised, double-blind, placebo-controlled study to evaluate the efficacy of oral azithromycin as a supplement to standard care for adult patients with acute exacerbations of asthma (the AZALEA trial)

“…[6][7][8] However, non-viral respiratory pathogens such as Mycoplasma pneumoniae and Chlamydophila pneumoniae have also been associated with wheezing episodes and asthma exacerbations in both adults and children. [9][10][11][12][13] Interestingly, in two of these studies virus detection rates were ≈80%, 9,11 whereas serological positivity for atypical bacterial infection/reactivation can be as high as 40-60%, 9,13 indicating that viral and atypical bacterial infections probably interact in increasing the risk of asthma exacerbations.…”

Inhibition of message for FcεRI α chain blocks mast cell IL-4 production induced by co-culture with Mycoplasma pneumoniae

“…Some studies have detected the presence of M. pneumoniae at significantly higher rates in asthmatic patients than in nonasthmatic control patients [8][9][10][11][12]. Treatment of asthmatics with macrolides frequently has a beneficial effect on airway reactivity, and, in the study by Kraft et al, the beneficial effect was only evident in the subset of asthmatics with evidence of M. pneumoniae infection [13][14][15].…”