M pneumoniae infection hits preschoolers hard

A study of Mycoplasma pneumoniae disease during an epidemic in Norway found that preschool children infected with this bacterium had a significantly higher risk of severe disease, particularly severe pneumonia, than school-aged children.

Investigators retrospectively assessed the records of hospital-referred children who tested positive for M pneumoniae for respiratory disease and chest radiograph results. Of 92 cases, 37 were preschool children (aged 0 to 5 years) and 55 were of school age (aged 6 to 17 years). Of the preschool children, 22 (60%) had severe disease; 20 children (54%) had severe pneumonia. By comparison, 23 (42%) of school-aged children had severe disease; 19 (35%) had severe pneumonia. In addition, preschool-aged children were at greater risk of dyspnea, wheeze, and of receiving inhaled ß2 agonists. These younger children were less likely than those who were older to experience extrapulmonary manifestations, however.

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Of the 22 preschool children with severe disease, 15 (68%) received supplemental oxygen compared with 9 of 23 (39%) of school-aged children with severe disease (Inchley CS, et al. Pediatr Infect Dis J. 2017;36[10]:930-936).

Thoughts from Dr Burke

The researchers found that severe Mycoplasma disease in their community was more common in preschool versus school-aged children, and that may be so for this epidemic. However, it also may be that in this outbreak more preschoolers were infected but went unseen due to mild disease, and that older children with infection had more severe disease. The more important point may not be which group had more respiratory disease from Mycoplasma, but rather that young children did get lower respiratory tract infection from the organism. With elimination of other pathogens through vaccination and earlier exposure in daycare, pneumonia in preschool children may include more Mycoplasma disease than we thought. Keep this in mind when a young child with respiratory disease doesn’t respond as expected to treatment.