Written by Kimiko Dunbar
Spoon Feed
Children with mycoplasma pneumonia were older and experienced longer duration of symptoms, but there were no differences in CRP, WBC, or presence of consolidation on CXR.
What’s the typical course for an atypical bug?
This multicenter prospective cohort study examined clinical features and outcomes of Mycoplasma pneumoniae (Mp) community-acquired pneumonia (CAP) in children. Among 415 pneumonia cases, 7.4% had Mp, with older age (median 8.8 vs. 4.6 years), longer symptom duration (7.5 vs. 5 days), and higher macrolide use (68.4% vs. 22.2%). Compared to patients with non-mycoplasma CAP, there were no differences in WBC, CRP or presence of consolidation on CXR. Patients with Mp CAP had statistically lower procalcitonin levels. Mp CAP was not associated with worse clinical outcomes, including ICU admission. While this study comments on macrolide use, authors did not investigate whether this was associated with improved clinical outcomes. Limitations include single-region data and observational design. Further, this study was conducted from 2015 -2018 and may not be representative of the current clinical population. Findings suggest polymerase chain reaction testing is necessary for Mp CAP diagnosis.
How will this change my practice?
Given the significant increase in the prevalence of Mycoplasma pneumonia, I’m constantly debating if I should test for mycoplasma. It’s helpful to know that presence or absence of consolidation on CXR is not helpful in these cases, which aligns with my recent clinical experiences. I’ve seen patients with distinct localized consolidations and even large associated effusion in the setting of mycoplasma. Overall, I’ll be slightly more inclined to test in older patients with a prolonged course. Unfortunately, this study does not answer the question of whether or not treatment is effective, arguing that there may be no reason to test at all if it wouldn’t change management.
Source
Clinical Features and Management Strategies in Children With Mycoplasma Pneumoniae. Pediatr Emerg Care. 2025 Feb 17. doi: 10.1097/PEC.0000000000003338. Epub ahead of print. PMID: 39960098
