Clinical and radiological features can help predict Mycoplasma pneumoniae lower respiratory tract infection in children

Abstract

<b>Introduction:</b><i>Mycoplasma pneumoniae</i> (<i>Mp</i>) is a common cause of lower respiratory tract infection (LRTI) in children that is difficult to distinguish from LRTI of other etiologies. <b>Aims and objectives:</b> We aimed to determine if a combination of clinical, laboratory and X-ray features can help identify patients at higher risk of <i>Mp</i> LRTI. <b>Methods:</b> We reviewed medical charts of children referred to our tertiary hospital with clinical signs of acute mycoplasmal LRTI. Pharyngeal swabs obtained from patients were tested by <i>Mp</i> PCR. We compared epidemiological and clinical data of children with positive and negative <i>Mp</i> PCR result. In addition, a bivariate logistic regression analysis was performed to predict <i>Mp</i> LRTI based on patient’s age, duration of symptoms, presence of extrapulmonary manifestations, laboratory findings and presence of X-ray confirmed pleural effusion. <b>Results:</b> We included 104 children with positive and 105 children with negative <i>Mp</i> PCR. Children with <i>Mp</i> LRTI were older (median age 6.1 vs 2.9 years, p&lt;.005), had longer duration of symptoms (median 7 vs 4 days, p&lt;.005), a lower WBC (mean 9.9 vs 12.8x10⁹/L, p&lt;.005) and more often had a rash (13% vs 3% of patients, p=.005) and pleural effusion (28% vs 14% of patients, p=.026). Presence of skin manifestation and pleural effusion on X-ray were found to have the highest predictive value of <i>Mp</i> LRTI (OR 6.8, 95% CI 1.4-32.3, p=.015 and OR 4.4, 95% CI 1.6-11.9, p=.003, respectively). <b>Conclusions:</b> Our analysis suggests that a combination of clinical, laboratory and X-ray features can be used to assess the likelihood of <i>Mp</i> LRTI and assist in decision making which children need further tests or antibiotic treatment.