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Vol. 24 - Num. 95

Original Papers

Mycoplasma pneumoniae: differential clinical features and diagnostic challenges in atypical pneumonias in children

Mercedes Cemeli Canoa, Mónica López Camposb, Pilar Oliván Otalc, Eva M.ª Navarro Serranod, M.ª Isabel Lostal Graciab, César García Verae

aPediatra. CS Valdespartera-Montecanal. Zaragoza. España.
bPediatra. CS Actur Norte. Zaragoza. España.
cCS Canal Imperial. Zaragoza. España.
dPediatra. CS Alfajarín. Zaragoza. España.
ePediatra. CS José Ramon Muñoz Fernández. Zaragoza. España.

Correspondence: M Cemeli. E-mail: mcemeli@salud.aragon.es

Reference of this article: Cemeli Cano M, López Campos M, Oliván Otal P, Navarro Serrano EM, Lostal Gracia MI, García Vera C. Mycoplasma pneumoniae: differential clinical features and diagnostic challenges in atypical pneumonias in children . Rev Pediatr Aten Primaria. 2022;24:273-84.

Published in Internet: 11-10-2022 - Visits: 884

Abstract

Introduction: pneumonia caused by Mycoplasma pneumoniae continues to be underdiagnosed in paediatric primary care, especially in younger children.

Material and methods: prospective study conducted in 9 primary care paediatric caseloads, including children aged 1 month to 14 years with pneumonia diagnosed based on compatible radiographic findings and clinical features. The aetiological diagnosis was made by acute-phase serological testing. We analysed the association of different variables with atypical and typical aetiologies.

Results: of the 92 patients in the sample, 30.4% had atypical pneumonias which, while not rare in children under 2 years (26%) predominated in children over 5 years (80.9%). The mean age in months was significantly higher in cases with an atypical (74.2±42.2) versus typical (35.9±33.8) aetiology (p<0.0001). Nasal congestion (42.8%; OR 1.8; p<0.01) and tachypnoea (64.2%; OR 2.4; p<0.014) were significantly more frequent in typical pneumonia. The alveolar pattern was observed in 53.6% of atypical pneumonias, with no differences compared to typical pneumonias. Only 25% of atypical pneumonia cases were treated correctly with first-line macrolide monotherapy, with no differences in outcomes based on the choice of antibiotherapy. Patients with typical pneumonia required intravenous antibiotic therapy more frequently (15.6%), but the difference was not statistically significant.

Conclusion: atypical germs were more frequent at younger ages than previously described, in some cases with concomitant detection of viruses. Improving the diagnosis and treatment of atypical pneumonia remains a challenge.

Keywords

Mycoplasma pneumoniae Pneumonia Primary care

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