Infect Chemother.  2014 Dec;46(4):239-247. 10.3947/ic.2014.46.4.239.

Early Additional Immune-Modulators for Mycoplasma pneumoniae Pneumonia in Children: An Observation Study

• Youn YS
• Lee SC
• Rhim JW
• Shin MS
• Kang JH
• Lee KY

• KMID: 2170492
• DOI: http://doi.org/10.3947/ic.2014.46.4.239

Abstract

BACKGROUND
Mycoplasma pneumoniae (MP) pneumonia is a self-limiting disease, but some patients complain of progressive pneumonia, despite of appropriate antibiotic treatment. We aimed to introduce the role of immune-modulators (corticosteroid and/or intravenous immunoglobulin, IVIG) treatment for childhood MP pneumonia based on previous our experiences.
MATERIALS AND METHODS
A retrospective case series analysis for 183 children with MP pneumonia was performed. MP pneumonia patients were diagnosed by two Immunoglobulin M (IgM) tests: the micro-particle agglutination method (> or =1:40) and the cold agglutination test (> or =1:4), and were examined twice at the initial admission and at discharge. Among 183 MP pneumonia patients, 90 patients with persistent fever for over 48 hours after admission or those with severe respiratory symptoms and signs received additional prednisolone (82 patients, 1 mg/kg/day) or intravenous methylprednisolone (8 patients, 5-10 mg/kg/day) with antibiotics. Four patients with aggravated clinical symptoms and chest radiographic findings after corticosteroid treatment received IVIG (1 g/kg/day, 1-2 doses).
RESULTS
Mean age of 183 patients was 5.5 +/- 3.2 years (6 months-15 years), and the male: female ratio was 1.1:1 (96:87). Fifty-seven patients (31%) were seroconverters and 126 seropositive patients showed increased diagnostic IgM antibody titres during admission (over 4 folds). The majority of the patients who received corticosteroids (86/90 cases) showed rapid defervescence within 48 hours with improved clinical symptoms, regardless of the used antibiotics. Also, 4 patients who received additional IVIG improved both clinically and radiographically within 2 days without adverse reaction.
CONCLUSIONS
In the era of macrolide-resistant MP strains, early additional immune-modulator therapy with antibiotics might prevent from the disease progression and reduce the disease morbidity without adverse reaction.

Keyword

Pneumonia; Mycoplasma; Corticosteroid; Immunoglobulin; Intravenous; Children

MeSH Terms

Adrenal Cortex Hormones
Agglutination
Agglutination Tests
Anti-Bacterial Agents
Child*
Disease Progression
Female
Fever
Humans
Immunoglobulin M
Immunoglobulins
Immunoglobulins, Intravenous
Male
Methylprednisolone
Mycoplasma
Mycoplasma pneumoniae*
Pneumonia*
Pneumonia, Mycoplasma*
Prednisolone
Radiography, Thoracic
Retrospective Studies
Adrenal Cortex Hormones
Anti-Bacterial Agents
Immunoglobulin M
Immunoglobulins
Immunoglobulins, Intravenous
Methylprednisolone
Prednisolone

Figure

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  Figure 1 Age distribution of Mycoplasma pneumoniae pneumonia patients.

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  Figure 2 Monthly cases of Mycoplasma pneumoniae pneumonia patients.

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  Figure 3 The chest radiographs of the case 2 that had progressive pneumonia during hospitalization; on admission (A), 1 day after prednisolone treatment (1 mg/kg/day, 4th HD) (B), before IVIG treatment (6th HD) (C), and 5 days after IVIG treatment (1 g/kg/day for 2 days, 12th HD) (D). HD, hospital day; IVIG, intravenous immunoglobulin.

• 

  Figure 4 The chest radiographs of the case 4 that also showed progressive pneumonia during hospitalization; on admission (A), 3 days after additional ciprofloxacin treatment (6th HD) (B), and 1 day after methylprednisolone (10 mg/kg) and IVIG (1g/kg, one dose, 7th HD) (C), and 5 days after both treatment (12th HD) (D). HD, hospital day; IVIG, intravenous immunoglobulin.

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