MYCOPLASMA PNEUMONIAE INFECTION IN CHILDREN: WHAT WE NEED TO KNOW?
DOI:
https://doi.org/10.46793/PP250126008MKeywords:
Mycoplasma pneumoniae, children, diagnosiss, diagnostics and therapyAbstract
An increase in the number of subjects suffering from infections caused by Mycoplasma pneumoniae was recorded worldwide in the 2023-2024 season, after a three-year decline during the Covid-19 pandemic. This review article investigates studies from previous outbreaks to emphasize the multifaceted nature of M.pneumoniae infections, epidemiology, diagnostic innovations, antibiotic resistance, and therapeutic challenges.
After inhalation of respiratory aerosols, the bacteria attaches itself to host epithelial cells in the respiratory tract. In addition to causing severe lower respiratory tract disease and milder upper respiratory tract symptoms, M.pneumoniae can cause extrapulmonary complications, which occur in the skin, kidneys, gastrointestinal tract, cardiovascular system, and central nervous system (CNS).
Imaging techniques (chest X-rays, CT scans, chest ultrasound), clinical assessment, and laboratory investigations (culture, serological methods, direct antigen detection and molecular-based PCR tests) are used in the diagnosis of M. pneumoniae infections. In the future, artificial intelligence (AI) could be an important tool to assist in the diagnosis of M. pneumoniae.
Macrolides are the first-line antibiotic treatment for infection and in pneumonia caused by macrolide-resistant M. pneumoniae (MRMP), tetracyclines and fluoroquinolones are recommended as second-line treatment. For severe MRMP pneumonia, systemic glucocorticoid therapy should be considered. Intravenous immunoglobulins (IVIG) therapy may be considered in case of severe extrapulmonary complications such as central nervous system damage, skin and mucous membrane lesions, hematological manifestations, myocarditis and heart failure.
References
Kant R, Kumar N, Malik YS, Everett D, Saluja D, Launey T, et al. Critical insights from recent outbreaks of Mycoplasma pneumoniae: decoding the challenges and effective interventions strategies. Int J Infect Dis. 2024;147:107200. doi: 10.1016/j.ijid.2024.107200. PMID: 39117175.
Goycochea-Valdivia WA, Ares Alvarez J, Conejo Fernández AJ, Jiménez Jiménez AB, Maté Cano I, de Jesús Reinoso Lozano T, et al. Position statement of the Spanish Society of Paediatric Infectious diseases on the diagnosis and treatment of Mycoplasma pneumoniae infection. An Pediatr (Engl Ed). 2024;101(1):46-57. doi: 10.1016/j.anpede.2024.05.014. PMID: 38987075.
National Center for Immunization and Respiratory Diseases (CDC) Mycoplasma Pneumoniae Infections Have Been Increasing. Available from: https://www.cdc.gov/ncird/whats-new/mycoplasma-pneumoniae-infections-have-been-increasing.html (accessed January, 2025)
European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 26 November - 2 December 2023, week 48. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-26-november-2-december-2023-week-48 (accessed January, 2024)
Meyer Sauteur PM, Beeton ML et al. Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions. Lancet Microbe. 2024;5(2):e100-e101. doi: 10.1016/S2666-5247(23)00344-0. PMID: 38008103.
Yan C, Xue GH, Zhao HQ, Feng YL, Cui JH, Yuan J. Current status of Mycoplasma pneumoniae infection in China. World J Pediatr. 2024;20(1):1-4. doi: 10.1007/s12519-023-00783-x. PMID: 38185707.
Graham M, Tran T, Zhang C, Sam M, Daley A, Jackson K, et al. A rise in Mycoplasma pneumoniae respiratory infections in Victoria in late 2023 and early 2024 detected at two major testing laboratories. Med J Aust. 2024;221(8):436-437. doi: 10.5694/mja2.52433. PMID: 39239796.
Abdulhadi B, Kiel J. Mycoplasma Pneumonia. 2023 Jan 16. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 28613531.
Hu J, Ye Y, Chen X, Xiong L, Xie W, Liu P. Insight into the Pathogenic Mechanism of Mycoplasma pneumoniae. Curr Microbiol. 2022;80(1):14. doi: 10.1007/s00284-022-03103-0. PMID: 36459213.
Waites KB, Xiao L, Liu Y, Balish MF, Atkinson TP. Mycoplasma pneumoniae from the Respiratory Tract and Beyond. Clin Microbiol Rev. 2017 Jul;30(3):747-809. doi: 10.1128/CMR.00114-16. PMID: 28539503.
Kumar S. Mycoplasma pneumoniae: A significant but underrated pathogen in paediatric community-acquired lower respiratory tract infections. Indian J Med Res. 2018;147(1):23-31. doi: 10.4103/ijmr.IJMR_1582_16. PMID: 29749357.
Søndergaard MJ, Friis MB, Hansen DS, Jørgensen IM. Clinical manifestations in infants and children with Mycoplasma pneumoniae infection. PLoS One. 2018;13(4):e0195288. doi: 10.1371/journal.pone.0195288. PMID: 29698412
Narita M. Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Front Microbiol. 2016;7:23. doi: 10.3389/fmicb.2016.00023. PMID: 26858701
Dungu KHS, Holm M, Hartling U, Jensen LH, Nielsen AB, Schmidt LS, et al. Mycoplasma pneumoniae incidence, phenotype, and severity in children and adolescents in Denmark before, during, and after the COVID-19 pandemic: a nationwide multicentre population-based cohort study. Lancet Reg Health Eur. 2024;47:101103. doi: 10.1016/j.lanepe.2024.101103. PMID: 39469091.
Edouard S, Boughammoura H, Colson P, La Scola B, Fournier PE, Fenollar F. Large-Scale Outbreak of Mycoplasma pneumoniae Infection, Marseille, France, 2023-2024. Emerg Infect Dis. 2024 Jul;30(7):1481-1484. doi: 10.3201/eid3007.240315. PMID: 38816344.
Upadhyay P, Singh V. Mycoplasma pneumoniae Outbreak in 2023: Post-pandemic Resurgence of an Atypical Bacterial Pathogen. Cureus. 2024;16(4):e58757. doi: 10.7759/cureus.58757. PMID: 38779270.
Tong L, Huang S, Zheng C, Zhang Y, Chen Z. Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med. 2022;11(10):2824. doi: 10.3390/jcm11102824. PMID: 35628949.
Cho YJ, Han MS, Kim WS, Choi EH, Choi YH, Yun KW et al. Correlation between chest radiographic findings and clinical features in hospitalized children with Mycoplasma pneumoniae pneumonia. PLoS One. 2019;14(8):e0219463. doi: 10.1371/journal.pone.0219463. PMID: 31461462
Saraya T. Mycoplasma pneumoniae infection: Basics. J Gen Fam Med. 2017;18(3):118-125. doi: 10.1002/jgf2.15. PMID: 29264006.
Tang M, Wang D, Tong X, Wu Y, Zhang J, Zhang L, et al. Comparison of different detection methods for Mycoplasma pneumoniae infection in children with community-acquired pneumonia. BMC Pediatr. 2021;21(1):90. doi: 10.1186/s12887-021-02523-4. PMID: 33607971.
Gao L, Sun Y. Laboratory diagnosis and treatment of Mycoplasma pneumoniae infection in children: a review. Ann Med. 2024;56(1):2386636. doi: 10.1080/07853890.2024.2386636. PMID: 39097794.
Li W, Liu Y, Zhao Y, Tao R, Li Y, Shang S. Rapid diagnosis of Mycoplasma pneumoniae in children with pneumonia by an immuno-chromatographic antigen assay. Sci Rep. 2015;5:15539. doi: 10.1038/srep15539. PMID: 26486047.
Miyashita N, Kawai Y, Tanaka T, Akaike H, Teranishi H, Wakabayashi T, et al. Diagnostic sensitivity of a rapid antigen test for the detection of Mycoplasma pneumoniae: Comparison with real-time PCR. J Infect Chemother. 2015;21(6):473-5. doi: 10.1016/j.jiac.2015.02.007. PMID: 25818195.
Zhang Y, Su C, Zhang Y, Ding S, Yan X, Zhang J, et al. Epidemiological and clinical characteristics of hospitalized pediatric patients with Mycoplasma pneumoniae pneumonia before and after the COVID-19 pandemic in China: a retrospective multicenter study. BMC Infect Dis. 2025;25(1):18. doi: 10.1186/s12879-024-10370-8. PMID: 39754040.
Wang YS, Zhou YL, Bai GN, Li SX, Xu D, Chen LN, et al. Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. World J Pediatr. 2024;20(9):901-914. doi: 10.1007/s12519-024-00831-0. PMID: 39143259.
Wang L, Xie Q, Xu S, Li H, Zhang L, Ai J, et al. The role of flexible bronchoscopy in children with Mycoplasma pneumoniae pneumonia. Pediatr Res. 2023;93(1):198-206. doi: 10.1038/s41390-021-01874-z. PMID: 35459766.
