Allergy Asthma Respir Dis.  2018 Sep;6(5):248-254. 10.4168/aard.2018.6.5.248.

Diagnostic value of serum IgM enzyme-linked immunosorbent assays in polymerase chain reaction-positive Mycoplasma pneumonia in children

• Lee HJ
• Lee YT
• Kim KH
• Yang EA
• Kim HS
• Chun YH
• Yoon JS
• Kim HH
• Kim JT

• KMID: 2421215
• DOI: http://doi.org/10.4168/aard.2018.6.5.248

Abstract

PURPOSE
Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children. MP serum IgM and polymerase chain reaction (PCR) are the methods that enable early diagnosis in patients with MP pneumonia. The objective of this study was to investigate the clinical value of serum MP-specific IgM antibodies in PCR-positive MP pneumonia for the early diagnosis of MP pneumonia in children with CAP.
METHODS
Out of 129 patients with lower respiratory tract infection aged over 3 years, 90 CAP children were enrolled in the study. Throat swab MP real-time PCR and serum enzyme-linked immunosorbent assays (ELISA) IgM antibodies were performed. A positive rate of MP PCR and serum IgM, the level of IgM index, clinical features, and laboratory findings were analyzed.
RESULTS
PCR was positive in 57 cases. Longer fever duration before admission (P < 0.001), higher rates of lobar or segmental pneumonia (P=0.048), unilateral infiltration (P=0.038), and extrapulmonary symptoms (P=0.049) were associated with MP PCR-positive pneumonia. Serum IgM index was significantly higher in MP PCR-positive pneumonia them in MP PCR-negative pneumonia (3.9±3.0 vs. 0.8±1.3, P < 0.001). Using MP PCR as a gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of serum IgM were 85.5%, 82.1%, 91.4%, and 71.9%, respectively. The area under the curves for serum IgM index was 0.892, and the ROC analysis indicated that an optimal cutoff value of 1.05 for serum IgM provided the highest sensitivity and specificity interestingly (83.9% vs. 85.7%, P < 0.001).
CONCLUSION
Serum IgM ELISA has useful diagnostic value in PCR-positive MP pneumonia. Applying an IgM index cutoff of 1.05 improves diagnostic accuracy.

Keyword

Mycoplasma pneumoniae; Diagnosis; Polymerase chain reaction; Immunoglobulin M; Pediatrics

MeSH Terms

Antibodies
Child*
Diagnosis
Early Diagnosis
Enzyme-Linked Immunosorbent Assay*
Fever
Humans
Immunoglobulin M*
Mycoplasma pneumoniae
Mycoplasma*
Pediatrics
Pharynx
Pneumonia
Pneumonia, Mycoplasma*
Polymerase Chain Reaction
Real-Time Polymerase Chain Reaction
Respiratory Tract Infections
ROC Curve
Sensitivity and Specificity
Antibodies
Immunoglobulin M

Figure

• 

  Fig. 1. Correlation of the fever duration before admission with serum Mycoplasma pneumoniae IgM index in all patients (Pearson correlation coefficient r=0.438, P<0.001).

• 

  Fig. 2. Receiver operating characteristic curve for serum M. pneumoniae (MP) IgM index in the diagnosis of MP pneumonia. The optimal cutoff values for serum MP IgM index were 1.05 (area under the curve, 0.892; sensitivity 83.9%, specificity 85.7%; P<0.001).

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