Allergy Asthma Respir Dis.  2018 Nov;6(6):295-302. 10.4168/aard.2018.6.6.295.

Mycoplasma pneumoniae pneumonia in children: Clinical characteristics and risk factors of refractory pneumonia by age

• Kim HY
• Park HJ

• KMID: 2427488
• DOI: http://doi.org/10.4168/aard.2018.6.6.295

Abstract

PURPOSE
It is thought that Mycoplasma pneumoniae infection is more prevalent and causes more severe pneumonia in school-age children and young adults than in preschool children; however, recent studies suggest that the infection may be underdiagnosed and more severe in preschool children. This study investigated the clinical characteristics of Mycoplasma pneumoniae pneumonia (MPP) and the risk factors of refractory MPP (RMPP) by age.
METHODS
We retrospectively reviewed the medical records of 353 children admitted due to MPP from January 2015 to December 2016. Demographics, clinical information, laboratory data and radiological findings were collected from all patients in this study. The patients were divided into 2 groups by the age of 6 years. Also, both preschool ( < 6 years old) and school-age (≥6 years old) children were divided into RMPP and non-RMPP patients.
RESULTS
Total febrile days, febrile days before admission and the duration of macrolide antibiotic therapy were significantly longer in school-age children than in preschool children. School-age children had significantly greater risk of lobar consolidation (P=0.036), pleural effusion (P=0.001) and extrapulmonary complications (P=0.019). Necrotizing pneumonia and bronchiolitis obliterans tended to occur more frequently in preschool children than in school-age children. In both preschool and school-age children, lactate dehydrogenase (LDH) levels were significantly higher in RMPP patients than in non-RMPP patients. In preschool children, LDH >722 IU/L (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.44-6.50) and ferritin >177 ng/mL (OR, 5.38; 95% CI, 1.61-19.49) were significant risk factors for RMPP, while LDH >645 IU/L (OR, 4.12; 95% CI, 1.64-10.97) and ferritin >166 ng/mL (OR, 5.51; 95% CI, 1.59-22.32) were so in school-age children.
CONCLUSION
Clinical features of MPP were significantly different between preschool and school-age children. LDH and ferritin may be significant factors of RMPP in preschool and school-age children.

Keyword

Mycoplasma pneumoniae; Child; Lactate dehydrogenase; Ferritin

MeSH Terms

Bronchiolitis Obliterans
Child*
Child, Preschool
Demography
Ferritins
Humans
L-Lactate Dehydrogenase
Medical Records
Mycoplasma pneumoniae*
Mycoplasma*
Pleural Effusion
Pneumonia*
Pneumonia, Mycoplasma*
Retrospective Studies
Risk Factors*
Young Adult
Ferritins
L-Lactate Dehydrogenase

Figure

• 

  Fig. 1. Receiver operator characteristic curves for differentiating RMPP from non-RMPP according to age. (A) Patients <6 years old. (B) Patients ≥6 years old. RMPP, refractory Mycoplasma pneumoniae pneumonia; LDH, lactate dehydrogenase; IL, interleukin.

• 

  Fig. 2. Odds ratio for RMPP according to age. RMPP, refractory Mycoplasma pneumoniae pneumonia; LDH, lactate dehydrogenase. Adjusted for febrile days before admission, sex, year, and season. ∗ P<0.05. ∗∗ P<0.01.

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