Improved Diagnostics Help to Identify Clinical Features and Biomarkers That Predict Mycoplasma pneumoniae Community-acquired Pneumonia in Children
type: Article
item type: journalArticle
is part of: Clin Infect Dis
authors: Person
  surname: Meyer Sauteur
  given name: P. M.
authors: Person
  surname: Krautter
  given name: S.
authors: Person
  surname: Ambroggio
  given name: L.
authors: Person
  surname: Seiler
  given name: M.
authors: Person
  surname: Paioni
  given name: P.
authors: Person
  surname: Relly
  given name: C.
authors: Person
  surname: Capaul
  given name: R.
authors: Person
  surname: Kellenberger
  given name: C.
authors: Person
  surname: Haas
  given name: T.
authors: Person
  surname: Gysin
  given name: C.
authors: Person
  surname: Bachmann
  given name: L. M.
authors: Person
  surname: van Rossum
  given name: A. M. C.
authors: Person
  surname: Berger
  given name: C.
subject: *Community-Acquired Infections/diagnosis
subject: *Pneumonia, Mycoplasma/diagnosis
subject: Aged
subject: Biomarkers
subject: C-reactive protein
subject: Child
subject: Child, Preschool
subject: Diagnostic Tests, Routine
subject: Humans
subject: Mycoplasma pneumoniae
subject: Prospective Studies
subject: antibiotics
subject: diagnosis
subject: procalcitonin
subject: treatment
abstract: BACKGROUND: There are no reliable signs or symptoms that differentiate Mycoplasma pneumoniae (Mp) infection in community-acquired pneumonia (CAP) from other etiologies. Additionally, current diagnostic tests do not reliably distinguish between Mp infection and carriage. We previously determined that the measurement of Mp-specific immunoglobulin M antibody-secreting cells (ASCs) by enzyme-linked immunospot assay allowed for differentiation between infection and carriage. Using this new diagnostic test, we aimed to identify clinical and laboratory features associated with Mp infection. METHODS: This is a prospective cohort study of children, 3-18 years of age, with CAP from 2016 to 2017. Clinical features and biomarkers were compared between Mp-positive and -negative groups by Mann-Whitney U test or Fisher exact test, as appropriate. Area under the receiver operating characteristic curve (AUC) differences and optimal thresholds were determined by using the DeLong test and Youden J statistic, respectively. RESULTS: Of 63 CAP patients, 29 were Mp-positive (46%). Mp positivity was statistically associated with older age (median, 8.6 vs 4.7 years), no underlying disease, family with respiratory symptoms, prior antibiotic treatment, prolonged prodromal respiratory symptoms and fever, and extrapulmonary (skin) manifestations. Lower levels of C-reactive protein, white blood cell count, absolute neutrophil count, and procalcitonin (PCT), specifically PCT <0.25 mug/L, were statistically associated with Mp infection. A combination of age >5 years (AUC = 0.77), prodromal fever and respiratory symptoms >6 days (AUC = 0.79), and PCT <0.25 mug/L (AUC = 0.81) improved diagnostic performance (AUC = 0.90) (P = .05). CONCLUSIONS: A combination of clinical features and biomarkers may aid physicians in identifying patients at high risk for Mp CAP.
date: 2019-10-31
pages: 1645-1654
coverage: 31665253

Clin Infect Dis
type: Journal
volume: 71
number: 7
identifier: DOI 10.1093/cid/ciz1059
identifier: ISSN 1537-6591 (Electronic) 1058-4838 (Print) 1058-4838 (Linking)