Infection with and Carriage of Mycoplasma pneumoniae in Children

Abstract

“Atypical” pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4–39%. Although the infection is generally mild and self-limiting, patients of every age can develop severe or extrapulmonary disease. Recent studies indicate that high rates of healthy children carry M. pneumoniae in the upper respiratory tract and that current diagnostic PCR or serology cannot discriminate between M. pneumoniae infection and carriage. Further, symptoms and radiologic features are not specific for M. pneumoniae infection. Thus, patients may be unnecessarily treated with antimicrobials against M. pneumoniae. Macrolides are the first-line antibiotics for this entity in children younger than 8 years of age. Overall macrolides are extensively used worldwide, and this has led to the emergence of macrolide-resistant M. pneumoniae, which may be associated with severe clinical features and more extrapulmonary complications. This review focuses on the characteristics of M. pneumoniae infections in children, and exemplifies that simple clinical decision rules may help identifying children at high risk for CAP due to M. pneumoniae. This may aid physicians in prescribing appropriate first-line antibiotics, since current diagnostic tests for M. pneumoniae infection are not reliably predictive.

Clinical features according to chest radiologic patterns ofMycoplasmapneumonia in children

“…In this study, four of five cases with a severe pleural effusion were school-aged children, and the lobar pneumonia pattern group also showed a higher CRP in school-aged children. Meyer et al suggested that an age-dependent amplification of inflammatory response may be a major factor of the M. pneumoniae-associated disease [19]. Narita et al reported that the severity of MP in children was associated with an increased serum level of interleukin (IL)-8 and IL-18 [20].…”

Cambiando los paradigmas de la infección por M. pneumoniae en pediatría

“…Se estima que alrededor del 3-10% de los niños con infección por M. pneumoniae desarrollarán neumonía, y de estos, menos del 5% necesitarán hospitalización. 39 De los pacientes hospitalizados, hasta un 10% ingresa a unidad de cuidados intensivos (UCI).…”

“…y Canadá se encuentran en 13% y 12%, respectivamente. 39,40 Esto constituye un problema en el tratamiento de infecciones en pacientes pediátricos debido a que las alternativas terapéuticas como tetraciclinas, no son recomendadas para niños. 75 El mecanismo molecular de la resistencia se basa en mutaciones puntuales en el dominio V de la subunidad 23S del rRNA (posiciones 2058, 2059, 2062, 2611), lo que reduce la afinidad del antibiótico al ribosoma 69 y ocasionalmente también involucra mutaciones en las proteínas ribosomales L4 y L22.…”

Commentary: Mycoplasma pneumoniae-associated mild encephalitis/encephalopathy with a reversible splenial lesion: Report of two pediatric cases and a comprehensive literature review

“…Childhood M.pneumoniae infection is complicated by different host-dependent characteristics; variable persistence of antibodies, missing IgM response after re-infection and infrequent production of IgA antibodies 5 . M. pneumoniae infection is less prevalent in infants in whom symptoms are milder 6 , while it predominantly occurs in children (5-15 years) 7 .…”