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Detection of Mycoplasma pneumoniae by two polymerase chain reactions and role of Mycoplasma pneumoniae in pediatric community–acquired lower respiratory tract infections. Indian J Med Microbiol 2022; 40:250-253. [DOI: 10.1016/j.ijmmb.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/30/2021] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
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Chen J, Yin Y, Zhao L, Zhang L, Zhang J, Yuan S. Mycoplasma pneumoniae infection prediction model for hospitalized community-acquired pneumonia children. Pediatr Pulmonol 2021; 56:4020-4028. [PMID: 34547836 DOI: 10.1002/ppul.25665] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/20/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We sought to develop a nomogram to predict Mycoplasma pneumoniae (Mp) infection among hospitalized children with community-acquired pneumonia (CAP) and compare it with another model developed from age and duration of fever. METHODS Data on 5904 CAP children who were enrolled at Shanghai Children's Medical Center were retrospectively collected and divided into a training set (n = 4133) and a validation set (n = 1771). The model's performance was determined by concordance index (C-index), calibration curves, Brier scores, and decision curve analyses (DCAs). Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used for model comparisons. RESULTS Incorporating five factors (age, duration of fever, erythrocyte sedimentation rate, leukocyte count, and neutrophil proportion), the nomogram achieved good C-index values of 0.74 (95% confidence interval [CI]: 0.72-0.76) and 0.75 (95% CI: 0.73-0.78) and good Brier scores of 0.14 (95% CI: 0.13-0.15) and 0.17 (95% CI: 0.15-0.18) in predicting Mp infection in the training and validation cohorts, respectively, and had moderate fitted calibration plots. The DCAs showed good clinical usefulness of the nomogram. Patients were effectively divided into low, medium, and high risk groups by two cut-off score points of the nomogram, 210 and 300. With the lower AIC (3673.5) and BIC (3774.7) value, the model of five predictors is the better model. CONCLUSIONS By using five predictor variables, a simple nomogram of good predictive accuracy for Mp infection and moderate agreements between the actual outcome and the predicted probability was constructed. It could serve as a tool to aid physicians in clinical decision-making processes.
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Affiliation(s)
- Jiande Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Pediatric AI Clinical Application and Research Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liebin Zhao
- Shanghai Engineering Research Center of Intelligence Pediatrics (SERCIP), Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Aguilera-Alonso D, López Ruiz R, Centeno Rubiano J, Morell García M, Valero García I, Ocete Mochón MD, Montesinos Sanchis E. Epidemiological and clinical analysis of community-acquired Mycoplasma pneumonia in children from a Spanish population, 2010-2015. An Pediatr (Barc) 2020; 91:21-29. [PMID: 32289046 PMCID: PMC7146767 DOI: 10.1016/j.anpede.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction and objectives Mycoplasma pneumoniae (MP) is one of the most common etiological agents of community-acquired pneumonia (CAP) in children. We aimed to describe the clinical and epidemiological characteristics, treatment and outcome of children diagnosed with community-acquired MP pneumonia (CAMP) in a tertiary hospital in Valencia, Spain. Material and methods Medical records of children <14 years with CAMP were retrospectively reviewed from January 2010 to December 2015. Patients with radiological evidence of pneumonia and microbiological confirmation of MP (PCR from nasopharyngeal swab and/or serum specific IgM) were considered CAMP. Results One hundred and sixty two children were diagnosed with CAMP; median age 6 years (IQR: 4-9). The positive MP test rate among children with CAP progressively increased with age as did the empirical use of macrolides. There were two peaks of cases in 2011 and in 2015, being July, August, November and December the seasons with the higher number of cases. The most frequent radiological pattern was segmental infiltrate (62.3%) and 22 (13.6%) children had pleural effusion. It was noteworthy the mild symptomatology and low levels of inflammatory parameters that children with CAMP had. A macrolide was empirically initiated in 68.5% of cases. Hospital admission rate was inversely proportional to patient's age. Conclusions According to this study, older, less symptomatic patients and with lower inflammatory parameters had the greatest rate of MP infection among children with CAP and thus they could benefit of empiric macrolide therapy. Therefore, knowing the epidemiology of a geographical area may be important for the management of CAP in children.
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Affiliation(s)
- David Aguilera-Alonso
- Servicio de Pediatría, Hospital General Universitario, Valencia, Spain
- Corresponding author.
| | - Rocío López Ruiz
- Servicio de Pediatría, Hospital General Universitario, Valencia, Spain
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Kumar S, Kashyap B, Kumar S, Kapoor S. Diagnostic utility of serology and polymerase chain reaction for detection of Mycoplasma pneumoniae and Chlamydophila pneumoniae in paediatric community-acquired lower respiratory tract infections. Indian J Med Microbiol 2020; 38:152-156. [PMID: 32883927 DOI: 10.4103/ijmm.ijmm_20_145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose Mycoplasma pneumoniae (M. pneumoniae) and Chlamydophila pneumoniae (C. pneumoniae) play a significant role in children of all ages with lower respiratory tract infections (LRTIs). This study was conducted to detect M. pneumoniae and C. pneumoniae in children with community-acquired LRTIs employing serology, polymerase chain reaction (PCR) and nested PCR analysis. Material and Methods This study included 75 children with acute LRTIs for detection of M. pneumoniae and C. pneumoniae. Blood was obtained for M. pneumoniae and C. pneumoniae antibodies and nasopharyngeal aspirates for M. pneumoniae PCR and C. pneumoniae nested PCR. Results M. pneumoniae infection was positive in 9 (64.21%) children aged 2-6 months and in 5 (35.79%) aged 7 months-12 years, and this difference was statistically significant (P = 0.002). C. pneumoniae infection was comparable within the age group and statistically insignificant (P = 0.43). Clinical and radiological profiles of M. pneumoniae- and C. pneumoniae-positive and negative patients were numerically comparable. Serology and PCR together detected M. pneumoniae infection in 14 (18.6%) children. The sensitivity, specificity and positive and negative predictive values of serology were 77.78%, 92.42%, 58.33% and 96.83%, respectively. C. pneumoniae infection was positive in 11 (14.6%) children by serology and nested PCR with 50% sensitivity, 87.67% specificity, 10% positive predictive value and 98.46% negative predictive value. Conclusions Our study confirms that M. pneumoniae and C. pneumoniae play a significant role in community-acquired LRTIs and a combination of serology and nested PCR is useful for its diagnosis.
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Affiliation(s)
- Sanchit Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Bineeta Kashyap
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Seema Kapoor
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
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Kumar S, Chakravarti A, Kumar S, Kapoor S. Detection of respiratory syncytial virus & Mycoplasma pneumoniae in paediatric lower respiratory tract infections. Indian J Med Res 2019; 150:306-309. [PMID: 31719302 PMCID: PMC6886145 DOI: 10.4103/ijmr.ijmr_983_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Respiratory syncytial virus (RSV) and Mycoplasma pneumoniae are considered common cause of lower respiratory tract infections (LRTIs) in children. The present study was conducted to detect M. pneumoniae and RSV in paediatric LRTIs employing serology, polymerase chain reaction (PCR) and reverse transcriptase PCR (RT-PCR) analysis. Methods Seventy five children aged one month to five years with acute LRTIs were investigated for M. pneumoniae antibodies and RSV antigen using immunochromatographic test, RT-PCR for RSV and M. pneumoniae by PCR on nasopharyngeal aspirates. Results RSV infection was observed in 33 (44%) and M. pneumoniae was positive in 26 (35%) children. No significant difference in infection was noted between male and female children. Clinical and radiological features among RSV and M. pneumoniae positive and negative cases were similar. Considering RT-PCR for RSV as gold standard, RSV antigen immunochromatography was 90.90 per cent sensitive and 100 per cent specific. Interpretation & conclusions Our study showed the presence of RSV and M. pneumoniae infection in 44 and 35 per cent children, respectively with community-acquired LRTIs and aged less than five years.
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Affiliation(s)
| | - Anita Chakravarti
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Seema Kapoor
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
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Kumar S, Garg IB, Sethi GR. Serological and molecular detection of Mycoplasma pneumoniae in children with community-acquired lower respiratory tract infections. Diagn Microbiol Infect Dis 2019; 95:5-9. [PMID: 31097260 DOI: 10.1016/j.diagmicrobio.2019.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
This study was designed to evaluate the incidence of Mycoplasma pneumoniae infection in children with community-acquired lower respiratory tract infections (LRTIs). A total of 245 patients 6 months to 12 years of age were investigated for M. pneumoniae employing serological tests, polymerase chain reaction (PCR), nested PCR, and reverse transcription PCR (RT-PCR) on throat swab samples. Forty five (59.2%) children <5 years and 31 (40.7%) children ≥5 years age group were positive for M. pneumoniae infection, and this difference was statistically significant (P ≤ 0.01).Clinical and radiological findings across M.pneumoniae-positive and -negative cases were comparable. Serology, PCR, nested PCR, and RT-PCR together detected M. pneumoniae infection in 76 (31%) patients. Sensitivity, specificity, and positive and negative predictive values of PCR were 16.18%, 95.48%, 57.89%, and 74.78%, respectively, and those of serology were 57.89%, 74.78%, 16.18%, and 95.48%, respectively. Serological and molecular detection in combination is useful for rapid and reliable diagnosis of M. pneumoniae infections in children with LRTIs.
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Affiliation(s)
- Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - Indu Bala Garg
- Department of Microbiology, Maulana Azad Medical College, New Delhi 110002, India.
| | - G R Sethi
- Department of Pediatrics, Maulana Azad Medical College, New Delhi 110002, India.
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Aguilera-Alonso D, López Ruiz R, Centeno Rubiano J, Morell García M, Valero García I, Ocete Mochón MD, Montesinos Sanchis E. [Epidemiological and clinical analysis of community-acquired Mycoplasma pneumonia in children from a Spanish population, 2010-2015]. An Pediatr (Barc) 2019; 91:21-29. [PMID: 30679135 PMCID: PMC7185449 DOI: 10.1016/j.anpedi.2018.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/27/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022] Open
Abstract
Introducción y objetivos Mycoplasma pneumoniae (MP) es uno de los agentes etiológicos más comunes de las neumonías adquiridas en la comunidad (NAC) en niños. Objetivo: describir las características clínicas y epidemiológicas, tratamiento y evolución de los pacientes con NAC por MP (NACM) en un hospital terciario de Valencia, España. Material y métodos Se revisaron retrospectivamente las historias clínicas de los niños < 14 años con NACM entre enero de 2010 y diciembre de 2015. Los pacientes con evidencia radiológica de neumonía y confirmación microbiológica de MP (PCR de exudado nasofaríngeo y/o anticuerpos IgM específicos frente a MP) se consideraron NACM. Resultados Un total de 162 pacientes se diagnosticaron de NACM; mediana de edad de 6 años (rango intercuartílico: 4-9 años). La proporción de pruebas positivas para MP en pacientes con NAC, así como el uso empírico de macrólidos, aumentó progresivamente con la edad. Hubo un pico de casos en 2011 y en 2015, con un máximo de casos en julio, agosto, noviembre y diciembre. El patrón radiológico más frecuente fue el infiltrado segmentario (62,3%), mientras que 22 (13,6%) presentaron derrame pleural. Los niños con NACM desarrollaron una clínica leve, con poca elevación de parámetros inflamatorios. Se inició tratamiento empírico con un macrólido en el 68,5% de los casos. La necesidad de ingreso hospitalario fue inversamente proporcional a la edad del paciente. Conclusiones Según este estudio, los niños con NAC de mayor edad tuvieron la mayor proporción de infección por MP, siendo poco sintomáticos y con escasa elevación de parámetros inflamatorios, pudiéndose beneficiar del tratamiento empírico con macrólidos. Por consiguiente, conocer la epidemiología de un área geográfica podría ser importante para el abordaje de las NAC en niños.
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Affiliation(s)
| | - Rocío López Ruiz
- Servicio de Pediatría, Hospital General Universitario, Valencia, España
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Kumar S, Roy RD, Sethi GR, Saigal SR. Mycoplasma pneumoniae infection and asthma in children. Trop Doct 2018; 49:117-119. [PMID: 30537911 DOI: 10.1177/0049475518816591] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A clinical association between exacerbation of asthma symptoms and Mycoplasma pneumoniae ( M. pneumoniae) infection has long been suspected. We studied 80 children aged 5-15 years; 50 with asthma (Group 1) and 30 without an acute exacerbation of asthma (Group 2) for detection of M. pneumoniae by serology and polymerase chain reaction (PCR) on nasopharyngeal aspirates. Our study confirms that lower respiratory tract infections with M. pneumoniae are frequently associated with exacerbations of asthma in children.
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Affiliation(s)
- Surinder Kumar
- 1 Director Professor, Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Ruma Dev Roy
- 2 Resident, Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - G R Sethi
- 3 Professor, Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Sanjeev R Saigal
- 4 Research Associate, Department of Microbiology, Maulana Azad Medical College, New Delhi, India
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Kumar S. Mycoplasma pneumoniae: A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections. Indian J Med Res 2018; 147:23-31. [PMID: 29749357 PMCID: PMC5967212 DOI: 10.4103/ijmr.ijmr_1582_16] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Lower respiratory tract infections are considered a common cause responsible for morbidity and mortality among children, and Mycoplasma pneumoniae is identified to be responsible for up to 40 per cent of community-acquired pneumonia in children greater than five years of age. Extrapulmonary manifestations have been reported either due to spread of infection or autoimmune mechanisms. Infection by M. pneumoniae has high incidence and clinical importance but is still an underrated disease. Most widely used serologic methods are enzyme immunoassays for detection of immunoglobulin M (IgM), IgG and IgA antibodies to M. pneumoniae, though other methods such as particle agglutination assays and immunofluorescence methods are also used. Detection of M. pneumoniae by nucleic acid amplification techniques provides fast, sensitive and specific results. Utilization of polymerase chain reaction (PCR) has improved the diagnosis of M. pneumoniae infections. Besides PCR, other alternative amplification techniques include (i) nucleic acid sequence-based amplification, (ii) Qβ replicase amplification, (iii) strand displacement amplification, (iv) transcription-mediated amplification, and (v) ligase chain reaction. Macrolides are used as the first-line treatment in childhood for M. pneumoniae infections; however, emergence of macrolide-resistant M. pneumoniae is a cause of concern. Development of a safe vaccine is important that gives protective immunity and would be a major step in reducing M. pneumoniae infections.
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Affiliation(s)
- Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
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Mycoplasma pneumoniae in Community-Acquired Lower Respiratory Tract Infections. Indian J Pediatr 2018; 85:415-419. [PMID: 29318527 DOI: 10.1007/s12098-017-2580-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the role of Mycoplasma pneumoniae (M. pneumoniae) in pediatric lower respiratory tract infections (LRTIs) employing serological tests and polymerase chain reaction (PCR) analysis. METHODS In this prospective study, 200 children aged 6 mo to 12 y hospitalized with acute LRTIs were investigated for M. pneumoniae. Serum samples were collected for serological analysis of M. pneumoniae. Throat swab samples were obtained on admission to amplify 277-base pair region of 16S rDNA gene of M. pneumoniae by PCR. RESULTS In the present study, 40(26.1%) children <5 y and 28(59.5%) children ≥5 y age group were positive for M. pneumoniae infection and this difference was statistically significant (P < 0.001). M. pneumoniae was positive in 32(41%) female and 36(29.5%) male children though this difference was statistically insignificant (P = 0.12). The clinical profile across M. pneumoniae positive and negative cases were comparable except for presence of chest pain which was statistically significant (P = 0.023). None of the radiological findings was statistically associated with incidence of M. pneumoniae infection. Serological evidence of acute M. pneumoniae infection was observed in 64(32%) patients with sensitivity 66.6% and specificity 70.1% while PCR positivity in 12(6%) patients with sensitivity 12.5% and specificity 97%. Together, serology and PCR detected M.pneumoniae infection in 68(34%) patients. CONCLUSIONS The present study underlines the role of M. pneumoniae in children with community- acquired LRTIs and more particularly in ≥5 y of age.
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Kumar S, Garg IB, Sethi GR, Kumar S, Saigal SR. Detection of immunoglobulin M and immunoglobulin G antibodies to Mycoplasma pneumoniae in children with community-acquired lower respiratory tract infections. INDIAN J PATHOL MICR 2018; 61:214-218. [PMID: 29676360 DOI: 10.4103/ijpm.ijpm_21_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Mycoplasma pneumoniae (M. pneumoniae) causes up to 40% of community-acquired pneumonia in children. It is impossible to identify M. pneumoniae infection on the basis of clinical signs, symptoms, and radiological features. Therefore, correct etiological diagnosis strongly depends on laboratory diagnosis. Aims This study aims to investigate the role of M. pneumonia e in pediatric lower respiratory tract infections (LRTIs) employing enzyme-linked immunosorbent assays (ELISA) and particle agglutination (PA) test. Settings and Design Two hundred and eighty children, age 6 months to 12 years with community-acquired LRTIs were investigated for M. pneumoniae etiology. Materials and Methods We investigated 280 children hospitalized for community-acquired LRTIs, using ELISA and PA test for detecting M. pneumoniae immunoglobulin M (IgM) and immunoglobulin G antibodies. Statistical Analysis Used The difference of proportion between the qualitative variables was tested using the Chi-square test and Fischer exact test. P ≤ 0.05 was considered as statistically significant. Kappa value was used to assess agreement between ELISA and PA test. Results M. pneumoniae was positive in 51 (23.2%) <5 years and 33 (54.0%) children in ≥5 years of age group, and this difference was statistically significant (P < 0.001). Clinical and radiological findings in M. pneumoniae positive and negative groups were comparable. ELISA detected M. pneumoniae in 78 (27.8%) and PA test 39 (13.9%) patients; 33 (84.6%) ELISA positive and 6 (15.4%) ELISA negative. ELISA/PA test together detected M. pneumoniae infection in 84 (30%) children. Conclusions Our data underline that M. pneumoniae plays an important role in children with community-acquired LRTIs and more particularly in children >5 years of age.
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Affiliation(s)
- Surinder Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Indu Bala Garg
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Gulshan Rai Sethi
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India
| | - Sanchit Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Sanjeev R Saigal
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
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Kumar S, Kapoor S, Saigal SR. Hemorrhagic encephalitis caused by Mycoplasma pneumoniae in an 11-year-old boy: A rare case report. Indian J Med Microbiol 2015; 33:463-4. [PMID: 26068367 DOI: 10.4103/0255-0857.158610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S Kumar
- Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002, India
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Chiappini E, Venturini E, Galli L, Novelli V, de Martino M. Diagnostic features of community-acquired pneumonia in children: what's new? Acta Paediatr 2013; 102:17-24. [PMID: 24330269 DOI: 10.1111/apa.12502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM To critically summarise the available data on diagnosis of CAP in children, focusing on the newest findings and on the need for new studies. METHODS Eighty studies on the diagnosis of paediatric community-acquired pneumonia were scrutinised. RESULTS We found no significant associations between the signs or symptoms and aetiology of pneumonia and concluded that chest radiographs remain controversial and real-time polymerase chain reaction appears more sensitive than blood cultures. CONCLUSION Antibiotic overuse could make it difficult to differentiate viral and bacterial causes. Molecular methods provide promising tools for diagnosing infection by atypical bacteria, but are expensive and should be used selectively.
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Affiliation(s)
- Elena Chiappini
- Department of Health Sciences; University of Florence; Anna Meyer Children's University Hospital; Florence Italy
| | - Elisabetta Venturini
- Department of Health Sciences; University of Florence; Anna Meyer Children's University Hospital; Florence Italy
| | - Luisa Galli
- Department of Health Sciences; University of Florence; Anna Meyer Children's University Hospital; Florence Italy
| | - Vas Novelli
- Department of Infectious Diseases; Great Ormond Street Hospital for Children NHS Trust; London UK
| | - Maurizio de Martino
- Department of Health Sciences; University of Florence; Anna Meyer Children's University Hospital; Florence Italy
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Wang K, Gill P, Perera R, Thomson A, Mant D, Harnden A. Clinical symptoms and signs for the diagnosis of Mycoplasma pneumoniae in children and adolescents with community-acquired pneumonia. Cochrane Database Syst Rev 2012; 10:CD009175. [PMID: 23076954 PMCID: PMC7117561 DOI: 10.1002/14651858.cd009175.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is a significant cause of community-acquired pneumonia in children and adolescents. Treatment with macrolide antibiotics is recommended. However, M. pneumoniae is difficult to diagnose based on clinical symptoms and signs. Diagnostic uncertainty can lead to inappropriate antibiotic prescribing, which may worsen clinical prognosis and increase antibiotic resistance. OBJECTIVES The objectives of this review are (i) to assess the diagnostic accuracy of symptoms and signs in the clinical recognition of M. pneumoniae in children and adolescents with community-acquired pneumonia; and (ii) to assess the influence of potential sources of heterogeneity on the diagnostic accuracy of symptoms and signs in the clinical recognition of M. pneumoniae. SEARCH METHODS We searched MEDLINE (January 1950 to 26 June 2012) and EMBASE (January 1980 to 26 June 2012). We identified additional references by handsearching the reference lists of included articles and snowballing. We searched the reference lists of relevant systematic reviews identified by searching the Medion database, Database of Reviews of Effects 2012, Issue 6 (25 June 2012) and the Cochrane Register of Diagnostic Test Accuracy studies (2 July 2012). Experts in the field reviewed our list of included studies for any obvious omissions. SELECTION CRITERIA We included peer-reviewed published studies which prospectively and consecutively recruited children with community-acquired pneumonia from any healthcare setting, confirmed the presence of M. pneumoniae using serology with or without other laboratory methods and reported data on clinical symptoms and signs in sufficient detail to construct 2 x 2 tables. DATA COLLECTION AND ANALYSIS One review author scanned titles to exclude obviously irrelevant articles. Two review authors independently scanned the remaining titles and abstracts, reviewed full-text versions of potentially relevant articles, assessed the quality of included articles and extracted data on study characteristics and the following clinical features: cough, wheeze, coryza, crepitations, fever, rhonchi, shortness of breath, chest pain, diarrhea, myalgia and headache.We calculated study-specific values for sensitivity, specificity and positive and negative likelihood ratios with 95% confidence intervals (CIs). We estimated the post-test probability of M. pneumoniae based on the absence or presence of symptoms and signs.We calculated pooled sensitivities, specificities, positive and negative likelihood ratios with 95% CIs for symptoms and signs where data were reported by at least four included studies by fitting a bivariate normal model for the logit transforms of sensitivity and specificity. We explored potential sources of heterogeneity by fitting bivariate models with covariates using multi-level mixed-effects logistic regression. We performed sensitivity analyses excluding data from studies for which we were concerned about the representativeness of the study population and/or the acceptability of the reference standard. MAIN RESULTS Our search identified 8299 articles (excluding duplicates). We examined the titles and abstracts of 1125 articles and the full-text versions of 97 articles. We included seven studies in our review, which reported data from 1491 children; all were conducted in hospital settings. Overall, study quality was moderate. In two studies the presence of chest pain more than doubled the probability of M. pneumoniae. Wheeze was 12% more likely to be absent in children with M. pneumoniae (pooled positive likelihood ratio (LR+) 0.76, 95% CI 0.60 to 0.97; pooled negative likelihood ratio (LR-) 1.12, 95% CI 1.02 to 1.23). Our sensitivity analysis showed that the presence of crepitations was associated with M. pneumoniae, but this finding was of borderline statistical significance (pooled LR+ 1.10, 95% CI 0.99 to 1.23; pooled LR- 0.66, 95% CI 0.46 to 0.96). AUTHORS' CONCLUSIONS M. pneumoniae cannot be reliably diagnosed in children and adolescents with community-acquired pneumonia based on clinical symptoms and signs. Although the absence of wheeze is a statistically significant diagnostic indicator, it does not have sufficient diagnostic value to guide empirical macrolide treatment. Data from two studies suggest that the presence of chest pain more than doubles the probability of M. pneumoniae. However, further research is needed to substantiate this finding. More high quality large-scale studies in primary care settings are needed to help develop prediction rules based on epidemiological data as well as clinical and baseline patient characteristics.
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Affiliation(s)
- Kay Wang
- Department of Primary Care Health Sciences,University of Oxford, Oxford, UK.
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